Directions:

1. Highlight ALL of the pertinent information in the above scenario/situation.
2. State how the highlighted information is important to the patient’s care.

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Scenario/Situation:

Mr. Noair is 55 years old and on disability from his previous work as a bricklayer. He is married with two children, one who is grown and the second who is a teenager living at home. Mr. Noair loves his family, sports, and "hanging out" with his buddies at the local bar.

Diagnosed 5 years ago with chronic obstructive pulmonary disease due to emphysema. Has multiple hospitalizations during the past year for lung-related issues.

Medical History:
- Ex-smoker for 5 years
- Hypertension (HTN)
- Appendectomy
- Anxiety
- Angina

Vital Signs:
- Blood pressure: 180/92 mm Hg
- Temperature: 100.2º F
- Pulse: 116 beats per minute (bpm)
- Respirations: 28 breaths per minute
- Lung sounds: Wheezing with loud crackles throughout
- Oxygen saturation: 84%, receiving oxygen via a Venturi (Venti) mask
- Cyanosis of toes, fingers, and oral mucous membranes

ABG (Arterial Blood Gas) Results:
- Abnormal, showing respiratory acidosis

CXR:
- No evidence of infiltrates; hyperinflated lungs

Labs:
- WBC: 13
- BUN/Creatinine: 1, 0.9

Medications:
- Albuterol
- Advair
- Aspirin
- Prednisone
- Metoprolol

Current Situation:
"I can’t breathe," Mr. Noair gasped for breath. "Help me," Mr. Noair looked up at you, his nurse, with eyes filled with fear. He raised the head of the bed further with the control and continued to gasp for breath. You could feel your own anxiety increasing; it felt like Mr. Noair’s anxiety was contagious. You pushed the overbed table so that Mr. Noair could lean forward on it; you sat on his bed and worked with him to breathe using the pursed-lip technique and to slow his breathing. You have given him all the medications he can have and then called the provider.

Mr. Noair, a 55-year-old ex-bricklayer with chronic obstructive pulmonary disease (COPD) due to emphysema, is currently facing a critical health situation. His vital signs show high blood pressure, rapid pulse, elevated temperature, and increased respirations. He exhibits wheezing, crackling lung sounds, and low oxygen saturation, despite using a Venturi mask. With a history of hypertension, anxiety, and angina, Mr. Noair's medical condition is complicated. His current distress emphasizes the urgency of nursing intervention.

Mr. Noair's profile outlines key details crucial for his care plan. The primary diagnosis of COPD due to emphysema is pivotal, especially considering his smoking history. This explains his severe respiratory issues. The abnormal vital signs, notably the elevated blood pressure, pulse, and temperature, signify his critical state and necessitate prompt action.

The lung sounds—wheezing and loud crackles—indicate compromised airways and impaired lung function. The low oxygen saturation and cyanosis underscore his inadequate gas exchange and the urgency of oxygen support. The respiratory acidosis revealed in ABG results reinforces the severity of his respiratory distress.

His medical history of hypertension, anxiety, and angina adds complexity. The prescribed medications target his COPD, hypertension, and anxiety, all of which are intertwined in his current situation.

The scene of Mr. Noair struggling to breathe highlights the emotional and physical distress he's experiencing. Utilizing techniques like the pursed-lip breathing method offers immediate relief and comfort. Contacting the healthcare provider reflects the need for timely medical assessment and adjustments to his treatment regimen.

In summary, Mr. Noair's intricate medical history and current presentation stress the crucial need for a comprehensive and swift nursing response, addressing both his physical and emotional well-being.

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