Case Study, Management of Patients With Chest and Lower Respiratory Tract Disorders

Objective:

Marie Perez, a 53-year-old client is one day post-op after a gastric bypass. The client complains of shortness of breath,
the respiratory rate is 30 breaths/ minute, the pulse rate is 110 beats/ minute, the temperature is 100 degrees F., and the
blood pressure is 90/50. The client complains of feeling anxious and having stabbing chest pain which gets worse with
inspiration. She complains that she feels like she is going to pass out or possibly die.

What could possibly be going on with the client and what measures should the nurse provide immediately?
This patient may have a pulmonary embolism so as a nurse administer oxygen by nasal cannula, give IV fluids to treat
hypotension, if ineffective initiate vasopressor therapy as prescribed, and administer small doses of IV morphine or
sedatives as prescribed to relieve anxiety and discomfort

What risk factors does the client have for a pulmonary embolus?
Postoperative status, immobility, and her age being over 50 years

What measures are appropriate to manage a pulmonary embolism?

1. Perform frequent assessments
2. Anticoagulation therapy as prescribed
3. thrombolytic therapy as prescribed
4. Administer analgesics as prescribed
5. Frequently reposition patient
6. Place patient in semi-fowler’s position for more comfortable breathing
7. Continuous oxygen therapy
8. Perform deep breathing and incentive spirometry frequently
9. Continuously monitor ECG for dysrhythmias and right ventricular failure
10. Indwelling urinary catheter to monitor output when the patient is Hypotensive
11. Inferior vena cava filter

What measures are appropriate to help the client in this case study to prevent the reoccurrence of a pulmonary
embolism? Please apply QSEN concepts to the care of this client
Provide the patient with adequate oxygenation and teaching of how to use nasal canuala/oxygen mask. Have patient
learn the Importance and use of spirometer to use 10 times in an hour to prevent atelectasis. Have patient understand
the importance to adhering to the medications prescribed and importance of tpa treatment to avoid clots and promote
perfusion.