Reference no: EM133953456
Problem
Serendipity Robinson, a 77-year-old female client (DOB: 9/22/1947), was admitted to the ICU with acute respiratory failure. When she presented to the Emergency Department, she complained of shortness of breath, was not able to speak in complete sentences, and had substernal and supraclavicular retractions. Her sister states she ran out of her medications a month ago because her insurance changed. Her initial pulse ox is 80% on room air with wheezes auscultated bilaterally. She was afebrile. She was intubated in the ED and administered a continuous albuterol nebulizer through the mechanical ventilator. She developed a fever and leukocytosis on the third day of her ICU admission while still intubated. Rhonchi can be heard on auscultation and a portable chest X-ray shows bilateral infiltrates. The provider diagnoses the client with ventilator-associated pneumonia (VAP) and considers the most appropriate antibiotic.
Past Medical History: COPD, MRSA
Allergies: None
Medications: olodaterol 2.5 mcg/tiotropium 2.5 mcg (Stiolto Respimat) Respimat two puffs via inhalation once daily, budesonide (Pulmicort Flexhaler) 180 mcg/inhalation DPI two puffs via inhalation once daily
Social History: She quit smoking 5 years ago and does not drink alcohol.
Physical Exam:
1) Height: 5 feet 5 inches
2) Weight: 141 lbs (64 kg)
3) Body Mass Index (BMI): 23.5
4) Blood Pressure (BP): 104/71
5) Heart Rate (HR): 114
6) Respiratory Rate (RR): 18
7) Oxygen Saturation (O2 Sat): 91% on 40% FiO2 via mechanical ventilator
8) Temperature (TEMP): 101.9 rectal
Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
1) Describe your assigned client's situation. What medications are they currently taking? Why are they presenting to the clinic?
2) Discuss your professional assessment of the client's situation based on the information provided. What pharmacological treatment is necessary and why? Get the instant assignment help.
3) Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?