AB is a 72-year-old female who the nurse is admitting to a telemetry hospital bed.  She stated: “I was feeling terrible—I had trouble breathing for a few days, but thought it would go away in awhile. But, I couldn’t sleep at night.   I haven’t eaten much of anything for days, but I gained 10 pounds! We were going to church this morning, but I just couldn’t catch my breath, so my husband brought me to the hospital to get help.”

Physical assessment revealed an elderly woman with average body habitus, but an enlarged waist. She is alert, oriented x 4 and denies chest pain.  Her facial expression is slightly anxious and she is breathing with some difficulty, although she can finish a complete sentence in one breath. The telemetry monitor reveals sinus tachycardia with no ectopic beats.  The client is tachypneic. The nurse inspects the client’s chest, which reveals symmetric chest movement and  intact skin.  Lung sounds on the anterior chest reveal no adventitious sounds on the apices or the 2nd through 4th ICS on either sternal border. Abdomen is soft and slightly distended.  Radial, brachial, post tibial pulses are 2+.  Patient denies chest pain, but endorses feeling short of breath with a persistent nonproductive cough.

Assignment:

1. Organize the information by subjective and objective data.  (10%)
2. List five priority questions the nurse should ask to obtain a more complete history focused on this client’s thorax and lungs, heart and great vessels, peripheral vascular and lymphatic system, and abdomen.   (15%)
3. What additional assessments should the nurse do to complete a focused physical assessment of this client’s thorax and lungs, heart and great vessels, peripheral vascular and lymphatic system, and abdomen? (60%)
4. List three priority health problems the nurse should help this client with. (Use NANDA terminology)  (15%)

This week’s topic  is :  The case of  “I can’t catch my breath”

John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospital’s emergency room. The emergency room physician listened to John’s breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor’s questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker.

After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in John’s right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lung’s own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of thepneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying innon pressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray.

Case Background

Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal.

The pneumothorax decreases the efficiency of the respiratory system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If thepneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the re expansion of the lung.

Utilizing the med terms you learned this week answer the following questions

Why was John instructed to avoid high altitudes and flying in non pressurized aircrafts?

That is, what are the effects of high altitudes and or decreased air pressures on the respiratory system.

Here are the discussion board requirements.

• The initial discussion post must be at least 250 words of content, referencing the reading of the week, and include a scholarly source.
• classmates.
• Plagiarism of any kind will result in a “0”.

Community Assessment and Analysis Presentation

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop interview questions to gather information about the role of the provider in the community and the healthissues faced by the chosen community.

Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest.

Include the following in your presentation:

1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health.
2. Summary of community assessment: (a) funding sources and (b) partnerships.
3. Summary of interview with community health/public health provider.
4. Identification of an issue that is lacking or an opportunity for health promotion.
5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop interview questions to gather information about the role of the provider in the community and the healthissues faced by the chosen community.

Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest.

Include the following in your presentation:

1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health.
2. Summary of community assessment: (a) funding sources and (b) partnerships.
3. Summary of interview with community health/public health provider.
4. Identification of an issue that is lacking or an opportunity for health promotion.
5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

HSA 545 Week 6 Discussion – Implementing Culture Change in Food Service 

Q. Review the Case Study: Implementing Culture Change in Food Service, located on page 479 of your text. Next, examine the main structural and process changes that will be required to design and implement family-style dining at this facility.

Q. Suggest a plan of action to address Ms. Laird’s concerns from the Planning Committee meeting regarding noise, security, and other potential disruptions expected during the construction of the new kitchens and dining areas. Provide a rationale for your response.