Respiratory Distress
Clinical Reasoning Activity
Mark Peterson, 45 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Gas Exchange
Infection
Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Category/SubcategoryCovered in
Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
© 2019 Keith Rischer/ www.KeithRN.comThis study source was downloaded by 100000829683264 from CourseHero.com on 07-29-2021 06:01:46 GMT -05:00
https://www.coursehero.com/file/82826706/respiratory-distress-CSdocx/This study resource was
shared via CourseHero.com Part I: Present Problem:
Mark Peterson is a 45-year-old African American male with a new diagnosis of cardiomyopathy (40% EF), poorly controlled type one diabetes mellitus, hypertension, and stage III chronic kidney disease. He is a one-pack-per-day smoker
who came to the emergency department (ED) with increased redness in his lower extremities, fever, and chills. He was diagnosed with cellulitis and acute renal failure. He received his first dose of ceftriaxone 1 g IVPB in the ED. He has a baseline creatinine of 2.8, and his current creatinine is 3.9. His WBC is 18.5. He was just admitted to the med/surg unit where you will be the primary nurse caring for him. His initial set of VS: T: 99.8 F/37.7 C (o) P: 84 reg R: 22 (reg) BP: 148/88 O2 sat: 93% room air. He has fine bibasilar crackles in both bases posteriorly that do not clear with a cough.
Respirations do not appear to be labored, and he denies shortness of breath.
1. What clinical data do you notice that is RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEV ANT Data: Clinical Significance:
45 yr old African American M, cardiomyopathy, uncontrolled diabetes, HTN, Stage III chronic kidney dz, Smoker (pack a day), erythema in lower extremities, fever on admission, chills, cellulitis, acute renal failure, creatinine high (2.8 on admission, 3.9 now), WBC high (18.5), RR:22 O2 Sat 93% on RA, fine bibasilar crackles bilaterally, unproductive cough-Cardiomyopathy causes the heart to become enlarged and replaced with scar tissue. The heart becomes less able to pump blood through the body and maintain normal electrical rhythm.
-HTN and diabetes not being taken care of can cause increase risk of heart attack, stroke, and decreased kidney function
-Smoking along with HTN can lead to more severe forms of HTN hat can cause accelerated atherosclerosis
-Elevated WBC, fever, and chills are signs infection. Cellulitis is a bacterial skin infection that may present with skin redness, warmth, and skin pain
-Acute renal failure can present with h hematuria, proteinuria, decreased eGFR, and elevated BUN and creatinine. Important to
monitor labs. -Bibasilar crackles with an unproductive cough can signify excessive fluid in the airway that is not being cleared out. Four Hours Later…
It has been four hours since he was admitted. You notice that his O2 sat on room air has decreased from 95 percent to 88 percent, his respiratory rate has increased from 22 to 28 at rest, and he has coarse crackles halfway up bilaterally posteriorly. You have a PRN order to titrate oxygen to keep O2 sat >92%, so you place a nasal cannula at 2 L/min which improves his O2 sat to 94%. Two hours later, his respiratory rate has increased to 24, and his O2 sat is 90 percent. He now
requires 4 L/min per nasal cannula to keep his O2 sat greater than 92%.
His current VS are T: 99.6 F/37.6 C (o) P: 94 R: 28 BP: 156/90 O2 sat: 92% on 6 L/min per n/c. You contact the primary care provider because of his increasing oxygen needs. He is feeling more short of breath. He has had 400 mL of
water but has not been able to void since admission to the floor. His bladder ultrasound (BUS) reveals 90 mL of urine in
his bladder.
1.What clinical data do you notice that is RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEV ANT Data: Clinical Significance:This study source was downloaded by 100000829683264 from CourseHero.com on 07-29-2021 06:01:46 GMT -05:00
https://www.coursehero.com/file/82826706/respiratory-distress-CSdocx/This study resource was
shared via CourseHero.com
Clinical Reasoning Activity
Mark Peterson, 45 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Gas Exchange
Infection
Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Category/SubcategoryCovered in
Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
© 2019 Keith Rischer/ www.KeithRN.comThis study source was downloaded by 100000829683264 from CourseHero.com on 07-29-2021 06:01:46 GMT -05:00
https://www.coursehero.com/file/82826706/respiratory-distress-CSdocx/This study resource was
shared via CourseHero.com Part I: Present Problem:
Mark Peterson is a 45-year-old African American male with a new diagnosis of cardiomyopathy (40% EF), poorly controlled type one diabetes mellitus, hypertension, and stage III chronic kidney disease. He is a one-pack-per-day smoker
who came to the emergency department (ED) with increased redness in his lower extremities, fever, and chills. He was diagnosed with cellulitis and acute renal failure. He received his first dose of ceftriaxone 1 g IVPB in the ED. He has a baseline creatinine of 2.8, and his current creatinine is 3.9. His WBC is 18.5. He was just admitted to the med/surg unit where you will be the primary nurse caring for him. His initial set of VS: T: 99.8 F/37.7 C (o) P: 84 reg R: 22 (reg) BP: 148/88 O2 sat: 93% room air. He has fine bibasilar crackles in both bases posteriorly that do not clear with a cough.
Respirations do not appear to be labored, and he denies shortness of breath.
1. What clinical data do you notice that is RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEV ANT Data: Clinical Significance:
45 yr old African American M, cardiomyopathy, uncontrolled diabetes, HTN, Stage III chronic kidney dz, Smoker (pack a day), erythema in lower extremities, fever on admission, chills, cellulitis, acute renal failure, creatinine high (2.8 on admission, 3.9 now), WBC high (18.5), RR:22 O2 Sat 93% on RA, fine bibasilar crackles bilaterally, unproductive cough-Cardiomyopathy causes the heart to become enlarged and replaced with scar tissue. The heart becomes less able to pump blood through the body and maintain normal electrical rhythm.
-HTN and diabetes not being taken care of can cause increase risk of heart attack, stroke, and decreased kidney function
-Smoking along with HTN can lead to more severe forms of HTN hat can cause accelerated atherosclerosis
-Elevated WBC, fever, and chills are signs infection. Cellulitis is a bacterial skin infection that may present with skin redness, warmth, and skin pain
-Acute renal failure can present with h hematuria, proteinuria, decreased eGFR, and elevated BUN and creatinine. Important to
monitor labs. -Bibasilar crackles with an unproductive cough can signify excessive fluid in the airway that is not being cleared out. Four Hours Later…
It has been four hours since he was admitted. You notice that his O2 sat on room air has decreased from 95 percent to 88 percent, his respiratory rate has increased from 22 to 28 at rest, and he has coarse crackles halfway up bilaterally posteriorly. You have a PRN order to titrate oxygen to keep O2 sat >92%, so you place a nasal cannula at 2 L/min which improves his O2 sat to 94%. Two hours later, his respiratory rate has increased to 24, and his O2 sat is 90 percent. He now
requires 4 L/min per nasal cannula to keep his O2 sat greater than 92%.
His current VS are T: 99.6 F/37.6 C (o) P: 94 R: 28 BP: 156/90 O2 sat: 92% on 6 L/min per n/c. You contact the primary care provider because of his increasing oxygen needs. He is feeling more short of breath. He has had 400 mL of
water but has not been able to void since admission to the floor. His bladder ultrasound (BUS) reveals 90 mL of urine in
his bladder.
1.What clinical data do you notice that is RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEV ANT Data: Clinical Significance:This study source was downloaded by 100000829683264 from CourseHero.com on 07-29-2021 06:01:46 GMT -05:00
https://www.coursehero.com/file/82826706/respiratory-distress-CSdocx/This study resource was
shared via CourseHero.com
