Question

Please answer as soon as possible

Q/Please design a nursing care plan based on Johnson’s theory, for this patient.

The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep.
She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.
She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is new onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath.
There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. There are no known foods, drugs, or environmental allergies.
Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, and hysterectomy.
Her current medications include Breo Ellipta 100-25 mcg inhaled daily, hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, Duo-Neb inhaled q4 hr PRN, levothyroxine 175 mcg by mouth daily, metformin 500 mg by mouth twice per day, nebivolol 5 mg by mouth daily, aspirin 81 mg by mouth daily, vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide mononitrate 60 mg by mouth daily, and rosuvastatin 40 mg by mouth daily.
Physical Exam
Initial physical exam reveals temperature 38.2 C, heart rate 74 bpm, respiratory rate 24, BP 104/54, BMI 40.2, and O2 saturation 90% on room air.
Constitutional: Extremely obese, acutely ill-appearing female. Well-developed and well-nourished with BiPAP in place. Lying on a hospital stretcher under 3 blankets.
Head: Normocephalic and atraumatic
Mouth: Moist mucous membranes
Macroglossia
Eyes: Conjunctiva and EOM are normal. Pupils are equal, round, and reactive to light. No scleral icterus. Bilateral periorbital edema present.
Neck: Neck supple. No JVD present. No masses or surgical scarring.
Throat: Patent and moist
Cardiovascular: Normal rate, regular rhythm, and normal heart sound with no murmur. 2+ pitting edema bilateral lower extremities and strong pulses in all four extremities.
Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. Patient barely able to finish a full sentence due to shortness of breath.
Abdominal: Soft. Obese. Bowel sounds are normal. No distension and no tenderness
Skin: Skin is very dry
Neurologic: Alert, awake, able to protect her airway. Moving all extremities. No sensation losses

Please answer as soon as possible

Answer 1

Assessment patient complaints about breathlessness 2.assessment patient complaints about activity intollerance

Diagnosis impared breathing pattern related to disease condition as manifested by decreased spo2 2.diagnosis activity intolerance related to disease condition as manifested by observation

Planing *asess the general condition of patient *provide comfortable position (semi foulus) *perform ABG to know the o2 and co2 levels *adjust the IPAP and EPAP in the Bipap machine *administer medication as adviced by doctor *provide health education *provide psychological suport *provide diversional therapy   2.planning asess the general condition of patient *provide comfortable position (semi foulus) *administer medications as adviced by doctor *provide health education regarding weight loss *provide psychological suport *provide diversional therapy

Implimentation *assessed the general condition *provided semi folous position *monitore the ABG readings *Applied IPAP and EPAP on the Bipap to mainatain O2 levels and CO2 levels *Administered medications *provided health education on balanced diet *provided psychological support *provided diversional therapy 2.implimentation *assessed the general condition *provided semi folous position *Administered medications *provided health education on weight loss *provided psychological support *provided diversional therapy

Evaluation patient got releived from breathlessness 2.evaluation waiting for the long term outcome and patient feels relaxed