Reference no: EM133268573

Question - Patient-Centered Care; Evidence-Based Practice

The client is a 51-year-old woman who is a grade school principal. She is brought to the emergency department on Sunday morning by her wife of 15 years. The client appears anxious and tells the nurse that she thinks she has the "flu" because she has been nauseated since she left school on Friday afternoon (but has not vomited), has a cough, is sweaty, and is very tired. For 2 days she has felt chest heaviness and now has sharp chest pain that seems to be getting worse and feels breathless. She is 5' 7" tall (1.7 meters) and weighs about 196 lb (89 kg). She quit smoking 20 years ago. Her current medications include olmesartan 20 mg daily for hypertension and meloxicam 7.5 mg for chronic low back pain. Her mother and sister have type 2 diabetes mellitus. She drinks a glass of wine at dinner daily. She began menopause about 6 months ago. Her only hospitalization was 10 years ago for gall bladder surgery. Her admitting vital signs and laboratory work are:

Temperature = 100.6 degrees F (38.1 degrees C)

HR = 116, regular

RR = 34 shallow

BP = 122/60

Oxygen saturation = 89%

White blood cell count = 12,000/mm3

Red blood cell count = 4.0 million/μL (4.0 x 1012 cells/L)

Hemoglobin = 10 g/dL (100 g/L)

Hematocrit = 42% (0.42 volume fraction)

Platelets = 180,000/mm3 (180 × 109/L)

D-dimer = 1.4 mcg/mL

Blood glucose level (fasting) = 216 mg/dL

1. What assessment information in this client situation is the most important and immediate concern for the nurse? (Hint: Identify the relevant information first to determine what is most important.)

2. What client conditions are consistent with the most relevant information? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)

3. Which possibilities or explanations are most likely to be present in this client situation? Which possibilities or explanations are the most serious? (Hint: Consider all possibilities and determine their urgency and risk for this client.)

4. What activities would most likely achieve the desired outcomes for this client? Which actions should be avoided or are potentially harmful? (Hint: Determine the desired outcomes first to decide which interventions are appropriate and those that should be avoided.)

5. Which actions are the most appropriate and how should they be implemented? In what priority order should they be implemented? (Hint: Consider health teaching, documentation, requested health care provider orders or prescriptions, nursing skills, collaboration with or referral to health team members, etc.)

6. What client assessment would indicate the nurse's actions were effective? (Hint: Think about signs that would indicate an improvement, decline, or unchanged patient condition.)