Case Study 2 (Dyspnea and Shortness
of Breath) - Prioritization, Delegation,
and Assignment
Mr. W is an 83-year-old man who was brought to the hospital from a long-term care facility by
emergency medical services after reporting severe dyspnea and shortness of breath. He has been
experiencing coldlike symptoms for the past 2 days. He has a productive cough with thick yellowish
sputum. When Mr. W awoke in the nursing home, it was found that he was having difficulty breathing
even after using his albuterol metered-dose inhaler (MDI). He appears very anxious and is in respiratory
distress. His history includes chronic obstructive pulmonary disease (COPD) related to smoking 2 packs
of cigarettes per day since he was 15 years old; he quit smoking 2 years ago when he was admitted to
the long-term facility. Mr. W has been incontinent of urine and stool for the past 2 years.
In the emergency department, Mr. W undergoes chest radiography, and admission laboratory tests are
performed, including serum electrolyte lev ANS:
Which *priority* actions will the nurse take when the patient is initially admitted to the emergency
department (ED)? *Select all that apply.*
•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Change the patient's adult pad
•Send the patient for a chest x-ray
•Order the patient a lunch tray ANS: •Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Send the patient for a chest x-ray
, •Baseline data that are essential to decisions for the care of this patient take priority at this time
including vital signs, cardiac rhythm, lab values, and chest x-ray findings. Placement of a saline lock is
essential for administration of fluids and emergency drugs. Changing the patient's incontinence pad is
important to protect his skin but is not urgent. Ordering a lunch tray may be premature because the
interventions for this patient's care are undecided when he is first admitted to the ED.
What is the *priority* nursing concern for this patient?
•Skin care due to incontinence
•Clearance of thick secretions
•Rapid heart rate
•Elevated temperature ANS: •Clearance of thick secretions
•The patient's major problems at this time relate to airway and breathing including thick sputum,
difficulty breathing, and respiratory distress. The patient's skin care, blood pressure, and elevated
temperature will need to be followed up on soon but are not as urgent at this time as his respiratory
status.
The RN assesses Mr. W in the emergency department. Which assessment findings are consistent with a
diagnosis of COPD? *Select all that apply.*
•Enlarged neck muscles
•Forward bent posture
•Respiratory rate 15 to 25 breaths/min
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•Symmetrical lung expansion ANS: •Enlarged neck muscles
•Forward bent posture
•Inspiratory and expiratory wheezes
of Breath) - Prioritization, Delegation,
and Assignment
Mr. W is an 83-year-old man who was brought to the hospital from a long-term care facility by
emergency medical services after reporting severe dyspnea and shortness of breath. He has been
experiencing coldlike symptoms for the past 2 days. He has a productive cough with thick yellowish
sputum. When Mr. W awoke in the nursing home, it was found that he was having difficulty breathing
even after using his albuterol metered-dose inhaler (MDI). He appears very anxious and is in respiratory
distress. His history includes chronic obstructive pulmonary disease (COPD) related to smoking 2 packs
of cigarettes per day since he was 15 years old; he quit smoking 2 years ago when he was admitted to
the long-term facility. Mr. W has been incontinent of urine and stool for the past 2 years.
In the emergency department, Mr. W undergoes chest radiography, and admission laboratory tests are
performed, including serum electrolyte lev ANS:
Which *priority* actions will the nurse take when the patient is initially admitted to the emergency
department (ED)? *Select all that apply.*
•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Change the patient's adult pad
•Send the patient for a chest x-ray
•Order the patient a lunch tray ANS: •Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Send the patient for a chest x-ray
, •Baseline data that are essential to decisions for the care of this patient take priority at this time
including vital signs, cardiac rhythm, lab values, and chest x-ray findings. Placement of a saline lock is
essential for administration of fluids and emergency drugs. Changing the patient's incontinence pad is
important to protect his skin but is not urgent. Ordering a lunch tray may be premature because the
interventions for this patient's care are undecided when he is first admitted to the ED.
What is the *priority* nursing concern for this patient?
•Skin care due to incontinence
•Clearance of thick secretions
•Rapid heart rate
•Elevated temperature ANS: •Clearance of thick secretions
•The patient's major problems at this time relate to airway and breathing including thick sputum,
difficulty breathing, and respiratory distress. The patient's skin care, blood pressure, and elevated
temperature will need to be followed up on soon but are not as urgent at this time as his respiratory
status.
The RN assesses Mr. W in the emergency department. Which assessment findings are consistent with a
diagnosis of COPD? *Select all that apply.*
•Enlarged neck muscles
•Forward bent posture
•Respiratory rate 15 to 25 breaths/min
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•Symmetrical lung expansion ANS: •Enlarged neck muscles
•Forward bent posture
•Inspiratory and expiratory wheezes
