online solution: Identifying Immediate Nursing Priorities As a nurse, you beg

Identifying Immediate Nursing Priorities As a nurse, you begin the… Identifying Immediate Nursing PrioritiesAs a nurse, you begin the nursing process with assessment. Assessment contains gathering subjective and objective data and clustering cues of information.  Once the data is collected, the nurse must begin to formulate priorities (helps guide towards nursing diagnoses).  You get full credit for completing the assignment.  If anything is incorrect, I will provide feedback, as this is a formative learning experience.  1.  Read through the following case study.  Make a list of pertinent subjective and objective data you find.  Shortness of Breath Case Study Scenario Mrs. Brown, a 62-year-old African American woman, comes to your clinic seeking medical attention for increasing shortness of breath on exertion for the past 18 months, and especially today, as well as a cough that has been present for approximately nine weeks.  She used to walk 18 holes of golf with her husband every Saturday, but over the last six months has had to use a golf cart due to fatigue and shortness of breath.  She initially attributed this change to getting older, but is worried something more may be going on.  Based on the electronic health record, during the past year, she had three trips to the emergency department and was diagnosed with acute bronchitis.  Her primary care provider felt she had developed a case of mild asthma and provided an inhaler for her to use as needed.  She smoked 1.5 packs per day for about 17 years but stopped 18 years ago. Her husband smokes cigars in the home two or three times per week.  No other significant medical history is reported or noted in her chart. Family history is significant per Mrs. Brown:  Her biological father died of emphysema at age 78 after smoking for 52 years, and mother is currently living, age 82, with end-stage renal failure and a 40-year history of hypertension.  Her maternal grandmother and grandfather both smoked and both died of myocardial infarction.  Her paternal grandparent history is unknown. On exam, Mrs. Brown reports feeling short of breath while sitting on the exam table, and she has a capillary refill of four seconds. Some of her finger tips and toenail beds have a slight blue hue, and her face appears pale.  She is sitting, leaning forward with her hands on the knees, which she reports is the most comfortable position for her to be in at this time.  She also mentions feeling very fatigued.  She states her chest hurts when taking a deep breath, rates the pain medium to high. She is intermittently coughing throughout the interview, and the cough is sometimes productive, producing thick white sputum at times.  Auscultation shows wheezes bilaterally, especially in the right middle lob and left lower lobe.  Vital signs are Temp 98.9, heart rate 98, blood pressure 127/88, respiratory rate 26 (a bit high), oxygen 92% (low), and no pain.   You know from reading her chart that she has a history of mild asthma and was prescribed an inhaler, when asked when she last used it, she states “I don’t use the inhaler because it makes me anxious.”  Subjective DataObjective Data               2. Re-read the exam part of the case study (in italics below) and highlight areas in the text that correspond with first, second, and third level priorities, as instructed below.  First level priority:   emergent, life-threatening, need immediate attention (thinks ABCs) (Highlight text in red) Second level priority:  next in line of urgency/requires prompt intervention to avoid further deterioration (think mental status change, acute pain, abnormal labs, risks, safety concerns).(Highlight text in yellow) Third level priority:  important to the patient’s health but can be attended to after first and second level priorities are managed (think teaching, collaboration with others on healthcare team).(Highlight text in green) On exam, Mrs. Brown reports feeling short of breath while sitting on the exam table, and she has a capillary refill of four seconds.  Some of her finger tips and toenail beds have a slight blue hue, and her face appears pale.  She is sitting, leaning forward with her hands on the knees, which she reports is the most comfortable position for her to be in at this time.  She also mentions feeling very fatigued.  She states her chest hurts when taking a deep breath, rates the pain medium to high.  She is intermittently coughing throughout the interview, and the cough is sometimes productive, producing thick white sputum at times.  Auscultation shows wheezes bilaterally, especially in the right middle lob and left lower lobe.  Vital signs are Temp 98.9, heart rate 98, blood pressure 127/88, respiratory rate 26 (a bit high), oxygen 92% (low), and no pain.   You know from reading her chart that she has a history of mild asthma and was prescribed an inhaler, when asked when she last used it, she states “I don’t use the inhaler because it makes me anxious.”  3.  Based on what you know about the three levels of priority.  Rearrange the following list: showing the order in which you would provide care for Mrs. Brown.               a. Get an order for a bronchodilator for wheezing and pain medication               b. Apply oxygen 4 liters by nasal cannula and continue to monitor vital signs closely.               c. Provide teaching about the disease process and medication teaching                d. Reposition the exam table for comfort (pillows behind the back) to support her                preferred position.   Health Science Science NursingNURSG 125