C. E., a 73-year old married man, visits his internist complaining…

Question Answered step-by-step C. E., a 73-year old married man, visits his internist complaining… C. E., a 73-year old married man, visits his internist complaining that he becomes “so winded” with activity. C. E.’s pulse oximetry (SaO2) registers 83% at rest. He is sent to the local hospital for a CXR and ABG’s to be drawn after resting 20 minutes on room air. The next day, his physician calls C. E. and informs him that he has severe emphysema and must start on continuous oxygen therapy. The physician tells C. E. that his office will have a home health equipment company call him to make arrangements to deliver the equipment and educate him in its use. As a nurse working for the company, you are assigned to make a home visit.  1)  How would you prepare for the home visit? 2)    What would address with C. E. and his wife?    The next time you visit, C. E. complains about sores behind his ears. He explains “That long oxygen tubing seems to take on a life of its own. It twists around and gets caught under doors, chairs, everything. It darn near rips the ears off my head.” He asks for your help. 3)How would you respond?     You auscultate C. E.’s breath sounds and detect the odor of Vicks Vapo Rub. When you question C. E. about the use of Vicks, he tells you that he started to apply it in and around his nose to prevent his nose from becoming dry and sore. 4)How would you counsel C. E. and his wife? C. E. elected to use liquid oxygen because it offers more freedom and portability. It is also lighter in weight.     Over the next 3 ½ weeks, C. E. seemed to adjust well to his liquid oxygen system. However, one evening he walked to the kitchen for a snack and became increasingly short of breath. 5) Identify 4 possible causes. Per your instructions, C. E. removed the nasal cannula, tested the flow against his cheek, and felt no oxygen flowing from the catheter. He lacked the force and volume required to yell for help and was too short of breath to return to the living room to check his oxygen tank. He bent forward with his elbows on the counter top, and struggled to breathe. He became more frightened with each passing second, and his breathing seemed to become increasingly more difficult. A minute later, C. E.’s wife found him and reconnected his oxygen tubing. C. E. sat at the table for 20 minutes before he could walk back to the living room.  6)   Why did C. E. assume the peculiar position at the counter top?     A week later you receive a call from C. E.’s wife. She relates the incident from the previous week and tells you that C. E. “doesn’t want her out of his sight.” She asks you to come to the house and “…talk some sense into him.” 7)What teaching strategies will you use with C. E. and his wife?     C. E.’s wife asks you what her husband can do to help her around the house. She says, “The doctor told him to go home and take it easy. He sits in a chair all day. He won’t even get up to get himself a glass of water. I’ve got a bad hip and this has been very hard on me.” 8)How would you address her issue? The OT instructs the couple about energy saving ways to complete their housework. They both seem satisfied with their new division of labor. In addition, their church women’s group has volunteered to help once a week with laundry, vacuuming, and other stressful tasks.     C. E. states, “You seem to know what you are talking about so let me ask you something. I wake up with a headache almost every morning. My wife says it’s because I snore so loud and don’t  breathe right when I sleep. Do you know anything about that?” After asking several questions you inform C. E. that it sounds like he has obstructive sleep apnea.8) Explain the connection between obstructive sleep apnea and morning headaches.     C. E. seemed impressed by your explanation. He asks if there is anything that can be done for his problem. You inform him that there is a treatment called continuous positive airway pressure (CPAP).9) What is CPAP and how does it work? You comment that C. E. sounds like he has a cold. He replies, “Oh, our great grandchildren were over to visit several days ago and they all had snotty noses. I suspect that I’ll get it pretty soon. The problem is, every time I get a cold it goes straight to my lungs.”   10)  What information would you want to review with C. E. and his wife about the signs and symptoms of infection and when to seek treatment?  11)   Why is it important for people with lung disease to seek early intervention for infection? C. E. learned to manage his emphysema fairly well. His wife had her hip replaced, made speedy recovery, and was discharged to home. She suddenly died 4 weeks later from pulmonary embolus. C. C. was panic stricken at her loss. A psychiatric nurse practitioner was requested to work with him Health Science Science Nursing Share QuestionEmailCopy link Comments (0)