Case study, chapter 23, management of patients with chest and lower

   

3. Howard Long is 50 years of age and is a male patient who is diagnosed with bronchiectasis. The patient has smoked 1 pack per day of cigarettes for 35 years. He has a long history of recurrent bronchial infections. He has a chronic productive cough with copious amounts of purulent sputum. The patient complains that he is short of breath even at rest. The patient has clubbing of his fingers. The chest CT scan reveals bronchial dilation. 

  

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a. How should the nurse explain to the patient and family the pathophysiology of bronchiectasis as it related to the symptoms the patient is experiencing? 

  

b. How should the nurse explain to the patient and family the goals of medical management that may be used to treat the bronchiectasis?

  

c. What does the nursing management for bronchiectasis entail? 

4. Sallie Thorp, a 21-year-old client presents to the physician’s office with an asthma action plan form she acquired from a literature search on the World Wide Web at http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf . She also brought in the wallet card she found at http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf . She states that she would like to develop the plan with the help of the nurse and physician and review it at each appointment to keep it current. She has had moderate persistent asthma for five years, and she has visited the emergency department several times in the past year with severe asthma attacks. She stated that she forgets to take her medications, because the medications are at times that the hospital provided the inhalers (12 noon and midnight), and she gets confused on which inhalers are the long-acting ones and which inhaler is the short-acting rescue inhaler she is supposed to use when she has an exacerbation. The client stated that if she could, she would like to take the inhalers at 8 AM and again at 8 PM. The client stated that she has a flow meter and a respiratory therapist at the hospital taught her how to use it in the past, and he wrote down her personal best peak flow, which is 400 liters/second. The nurse reviews the client’s medical chart and discovers that the client has been prescribed the following from today’s visit: 

a. Explain the medications to the client and practice filling in the asthma action plan. 

  

b. Explain ways to evaluate the client’s mastery of the content?