v-sim Vincent Brody 5,6단계
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"v-sim Vincent Brody 5,6단계"에 대한 내용입니다.목차
1) Document your focused respiratory assessment for Vincent Brody.2) Identify and document key nursing priorities for Vincent Brody.
3) Document pain management interventions and Vincent Brody’s response to therapy.
4) Document key assessments you would undertake for a chest tube
5) Referring to your feedback log, document the nursing care you provided.
6) How did the scenario make you feel?
7) When a patient develops a rapid onset of shortness of breath, what are the nurse’s immediate priorities?
8) What assessment findings would indicate that the patient’s condition is worsening?
9) Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these results relate to his clinical presentation and chronic disease process.
10) Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these results relate to his clinical presentation and chronic disease process.
11) What are safety considerations when caring for a patient with a chest drain?
12) What key elements would you include in the handover report for this patient? Consider the ISBAR format.
13) What patient teaching priorities would be important in the patient experiencing an acute exacerbation of COPD?
14) For a patient with COPD who is stable, what resources would you recommend?
15) What would you do differently if you were to repeat this scenario? How would your patient care change?
본문내용
<5,6단계>1)Document your focused respiratory assessment for Vincent Brody.
-대상자는 12:30pm 호흡수 21회/분, 약간의 wheezes 있으며, 호흡 시 양 쪽 가슴은 대칭적으로 올라온다. 폐 청진 결과는 천명음이 들렸다.
12:40pm 대상자는 “가슴이 아파요, 숨쉬기가 점점 힘들어져요”라고 호소하여 호흡 사정결과 호흡수 27회/분, 약간의 wheezes, 호흡 시 가슴의 움직임이 줄어들었다. 청진 시 오른쪽 폐 호흡음은 정상이며, 왼쪽 폐 호흡음이 감소로 기흉이 의심된다.
2)Identify and document key nursing priorities for Vincent Brody.
-계속되는 기침과 관련된 비효율적 호흡 양상
: 호흡과 관련 되어 가장 우선순위로 정했으며 COPD로 섬모운동 억제, 기관지 수축, 신체방어기능 약화로 나타나는 증상을 기침으로 환자는 기침과 기침으로 호흡이 힘들어서 가장 힘들어하기 때문이다.
기관지 분비물 증가와 관련된 비효율적 기도 청결
기관지 분비물과 관련된 감염 위험성
만성질환과 관련된 불안