1

Date: 11/21/2020

Type of activity: Assessment Technologies Institute (ATI) Real Life Registered Nurse Medical

Surgical 3.0

Module: Chronic Obstructive Pulmonary Disease (COPD)

Score: Satisfactory

I started the scenario in ATI Real Life. The case focused on Mr. G., a 68-year-old Latino

man, who was admitted with pneumonia and exacerbation of his COPD. When the patient

arrived at the medical-surgical unit, I identified that respiratory insufficiency and failure are life-

threatening complications of COPD. Since the patient can readily go into respiratory arrest, I

used the ABC priority framework to determine the best course of action. Thus, I recognized the

need for establishing a patient’s baseline oxygenation and gas exchange, by evaluating his

arterial blood gases, and when the patient received the last dose of bronchodilator medication.

Besides, I maintained the patient’s oxygen status without depressing the respiratory drive by

decreasing the rate of oxygen flow. When the patient developed a pleural effusion, I assessed

all tube connections between the chest and drainage system for any air leak, demonstrating

good application of evidence based practice. My weakness in managing the care for this patient

was following the correct steps for administering the intermittent IV bolus medication. Doing a

review of the rationales helped me to reinforce my knowledge on the six rights of medication

administration and have a more complete understanding of the procedure. Following the

principle of the right dose, I used good clinical reasoning to determine the amount of

ceftriaxone to administer. In addition to this, I practiced good clinical decision when I

monitored the patient for signs of increasing edema and respiratory distress caused by an
 2

allergic response to medication. Also, I encouraged Mr. G. and his daughter to express their

emotions. Lastly, I identified some factors that placed the patient at risk for skin breakdown

(alcohol intake, history of corticosteroid use, limited mobility, and presence of chronic illness)

and the patient’s need for beginning a pulmonary rehabilitation program.