advanced nursing

A 6o-year-old white man presents with an accelerated decline in lung function. Last year he was diagnosed with metastatic ling cancer. Today
he is dyspneic,
pale, and seems almost listless. He continues to smoke and his pack-year history is 40 years. He says “I am tired of this fight”.
CC: “I have to sleep in my recliner because I can’t lie in bed, and I have no energy to do anything—I don’t even have energy to eat, I just want
to die.”
Physical exam: Blood pressure, 120/74; pulse rate, 120 beats/min; respiration rate, 36/min
Height, 5΄9΄΄; weight, 130 lbs.
AP to lateral diameter: 1:1
Cough with clear mucoid sputum
Diminished breath sounds
Dullness overright lower and middle lung fields on percussion and use of accessory muscles during respiration
Chest x-ray film: Mass noted RML and RLL, tracheal shift to left, no cardiomegaly
Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26
Questions:
1. What additional subjective data do you think the patient will share?
2. What additional objective data will you be assessing for?
3. What National Guidelines are appropriate to consider?
4. What tests will you order?
5. Will you be looking for a consult? If so with whom?
6. What are the medical and nursing diagnoses?
7. Are there any legal/ethical considerations?
8. What is your plan of care?
medical
nursing
complementary therapies
9. Are there any Healthy People 2020 objectives that you should consider?
10. Using the Circle of Caring, what or who else should be involved to truly hear the patient’s voice, getting him and the family involved in the
care to reach optimal health?
11. What additional patient teaching may be needed?
12. What billing codes would you recommend?

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