Reference no: EM133658346
CASE STUDY
Ms. Martinez is a 66-year-old woman of shortness of breath. The following initial data were collected.
Interview data Ms. Martinez says that she has had breathing problems "for years" but her breathing is getting worse. She tells the nurse that she gets short of breath with activity, adding that she can do things around the house for only a few minutes before she must sit down to catch her breath.
She says that she can sleep for only a couple of hours at a time. She sleeps best using two pillows to prop up, but on some nights, she just sits in a chair. Ms. Martinez does not currently use oxygen, but she thinks oxygen would help. She admits to smoking 1.5 packs of cigarettes a day. She has never quit because she says she "just can't do it."
Examination data
• General survey: Alert and slightly anxious female, sitting slightly forward, with moderately
labored breathing. Skin pale with slight cyanosis around the lips and in nail beds. Slight clubbing
of fingers.
• Chest and lungs: Chest is round shaped and symmetric with increased AP diameter. Small
muscle mass is noticed over chest; ribs protrude. Respiratory rate is 24 breaths/min and
labored. Chest wall expansion with respirations is reduced but symmetric. Wheezes are heard
on expiration throughout lung fields. Lung sounds are diminished in lung bases bilaterally.
Clinical judgment
1. What cues do you recognize that suggest a deviation from expected findings, suggesting a need for further investigation?
2. For which additional information should the nurse ask or assess?
3. Based on the data, which risk factors does Ms. Martinez have for lung cancer?
4. With which health care team member would you collaborate to meet this patient's needs?