Diagnostics/Labs: Medications: Nursing Interventions:

Albuterol- 2.5 mg in 3mL normal

Arterial blood gases saline nebulized every 20 min
-Obtain order for pain medication and placement of chest tube from provider.
-pH:7.27 PRN (3 dose max). (1230)
-Educate patient on chest tube insertion procedure, and obtain consent.
-PCO2: 53 Potassium chloride in 5%
-PO2: 61 Patient Story; Medical Diagnosis & Past
Evidence of
impaired gas
dextrose and normal saline IV at 1*Administer prescribed morphine for relief of pain, monitor for effect.
-SaO2: 90 100 mL/hr. (1200) -Number one priority for the patient because he in severe pain and distress. We need to
-Base excess: -3.1
Medical History:
exchange and
respiratory 2mL/min O2- per nasal canula. administer the medication for (a) comfort measures, and (b) to insert the chest tube
Patient is a 69 year
Blood analysis old male who was admitted to the medical Morphine-2mg IV push (1240)
acidosis.
without pain and distress.
-HCT: 49 oncology unit on 06/09/20 for complex medical problems related to
advanced laryngeal squamous cell carcinoma extending into the 2*Assist with chest tube insertion, maintain suction, and ensure placement and patency.
Inhaler on regular basis
ORDER FOResophagus
X-RAY BEFORE AND AFTER
requiring tracheostomy and PEG tube placement. Provide chest tube care according to facility protocol.
CHEST TUBE PLACEMENT:
Currently managed with chemo/radiation. Patient shows progressing Goals/Outcomes: -The chest tube is the second priority, for the patient is suffering from a medical
-Chest x-ray: large left-sided
weakness, acutesimple
on chronic hyponatremia, progressive leukopenia emergency and the tube in needed in order to restore negative pressure in lung and save
pneumothoraxand present.
anemia. Patient is mostly nonverbal, with moderate language Patient will verbalize relief from pain his life.
-Chest tube inserted
barrier, primary language being Korean. Patient communicates -Monitor chest tube for proper drainage and auscultate lungs every 5 minutes to assess
-X-ray taken after tube inserted revealed within 30 minutes of morphine
chest tube through
placement handwritten
was correct.messages. Stable through hypersensitive vitals improvement.
administration.
Originally admitted with no health insurance - Medicaid application -Administer prescribed bronchodilator (Albuterol), monitor for effects.
pending -Administer prescribed oxygen to maintain SpO2 >90%.
Objective (Signs) Vital changes at 1240 with spontaneous
Patient will have restored negative
Barrel chest development of pneumothorax: intrathoracic pressure in the left Assess vitals every 5 minutes and attach continuous ECG and SpO2 monitors.
Classic COPD signs
Clubbed fingers Auscultate lungs for evidence of adventitious breath sounds.
Cough HR: 120 bpm (tachycardia) lung after insertion of chest tube.
SpO2: 93% Elevate the head of the bed to ease the work of breathing.
HR: 104 BP: 139/82 mmHg (hypertension)
---(all were completed during the V-SIM)
Radial pulse:105 bpm and regular Patient will maintain O2 saturation
21 breaths per min, chest moving equally bilaterally SpO2: 88% (ineffective gas exchange) Educate patient on smoking-cessation measures.
BP: 126/76 mmHg levels above 90% with supplemental
Auscultation of lungs: Diminished breath Prior to discharge, educate patient on importance of resting between activities in order to
Temp: 99
sounds on Left side. Right side normal. oxygen.
Normal skin turgor and color, no diaphoresis prevent over exhaustion and exasperation of COPD.
Auscultation of lungs: audible wheezing in the chest
-corresponds to the findings on the x-ray of
Capillary Refill- less than 2 seconds
large pneumothorax in left lung. Patient will restore effective
Respiratory rate:30 breaths/min (tachypnea) breathing pattern.
Subjective (symptoms) Conscious and oriented

Difficulty breathing
-due to the inflammation
and narrow airways of lungs.

Sudden acute pain in

chest at 1240. “Its 2 Nursing Diagnoses/Prioritize:
ASSESSMENT:
getting harder to
breath.” Acute pain related to sudden left-sided
pneumothorax development.

Ineffective breathing pattern related to

respiratory distress.

Pathophysiology:
Chronic Obstructive Pulmonary Disease (COPD) is a slowly
progressive respiratory disease characterized by chronic
inflammation and narrowing of the airways. Inflammation
causes release of proteolytic enzymes from the cells of the
lungs, which leads to irreversible enlargement of distal alveoli.
Destruction of the alveolar walls of airways occurs, resulting in
destruction of lung elasticity, which further limits airflow.
Mucus begins to accumulate in the narrow airways, creating
resistance and severe ventilation-perfusion imbalance. Gas
exchange is impaired. A potential complication of COPD is
pneumothorax. This occurs when severe changes develop large
bullae that may rupture spontaneously or with coughing. The
rupture causes air to fill the lungs, creating pressure and
preventing lung expansion. This is a life threatening event, Evaluation:
especially in COPD patients. (Lippincott Advisor, 2020). The patient maintains pulse oximetry of 90% or above and maintains normal arterial blood gas values.
The patient maintains regular rate, rhythm, and adequate depth of breathing within baseline values.
"Chronic Obstructive Pulmonary Disease (COPD)” (2020). In Lippincott advisor. Retrieved from The patient remains free of pain and verbalizes increased ease with respirations.
https://advisor-edu.lww.com/lna/document.do?bid=4&did=791316
. The patient maintains negative intrathoracic pressure in the left lung, and breath sounds remain equally and bilaterally present in both lungs.

Something I will take away from this patient experience is to always be prepared and aware that a spontaneous medical emergency can occur at any time,
especially in chronically ill patients.