Mr. Gordon Needaire is a 69 year old widower

Gordon Needaire

Mr. Gordon Needaire is a 69 year old widower who has been admitted with extreme fatigue. During the second day of his hospital stay he complains that his chest hurts and he is unable to stop coughing. He develops a fever and starts getting shaking chills. His cough is productive with a consistency of yellowish thick sputum. He is unable to lie down to sleep/rest. The physician asks you to perform a head-to-toe routine assessment and to call with your findings.

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1. Identify the four most critical elements in your physical assessment of Mr. Needaire. Your assessment findings include these vital signs: BP 155/82, pulse 106, temp. 39.4C, oxygen saturation is 84% on room air. Upon chest auscultation, you discover decreased breath sounds in the LLL, anterior and posterior aspect of his chest. You can also hear coarse crackles in the LUL. His nail beds are dusky on fingers and toes. Mr. Needaire has never smoked in his life, has not been sexually active in over 15 years, and was monogamous with his wife. He denies allergic reaction to any medications.

He has type 2 diabetes and is on Metformin. 2. Which of the findings above concern you most and why?

3. The physician write an order to maintain oxygen saturation levels >90%. What is the rationale for ordering his level of oxygen level?

4. What nursing plan would be most appropriate based on the above case study so far? ??ª??ª??ª

5. The physician orders a specimen to be drawn for blood culture. Why would this be performed in a patient who spikes a fever?

6. Mr. Needaire recovers from his pneumonia and is preparing for discharge from the hospital. As his nurse, what four prevention strategies in relation to the increased risk for pneumonia will you be discussing with him.

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The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

Imagine you are a staff psychotherapist at an intensive outpatient clinic that treats psychotic disorders, and you are meeting with a new patient for the first time.

You greet the new patient, Andrew, in the waiting room and take him into your office to begin your first session. As you take your seat and encourage Andrew to do the same, he asks, “Could you please bring in three more chairs for my friends?” Confused, you ask him to elaborate. Andrew says, “Well, I don’t want my three Martian friends that are with me to have to stand the whole time.” What would you do? Would you refuse the request, which could potentially disrupt the therapeutic relationship? Or would you grant the request, which might reinforce his psychotic symptoms? How might you proceed?