Name: NURHASSEM AKANG

Date of Submission: May 13, 2020(8am-5pm only)

Consider the scenarios and answer the questions.

Scenario A: Mr. Kecklin is scheduled for bronchoscopy for the diagnostic purpose of locating a suspected
pathologic process.

1. Because a bronchoscopy was prescribed, the nurse is aware that the suspected lesion may be located where?
Answer: The suspected lesion may be located into the respiratory tract, bronchoscope is a thin flexible
instrument with a lighted viewing tube that is used to visualize air passages to the lungs.

2. The nurse is preparing the patient for a bronchoscopy. What interventions by the nurse are required prior to the
procedure? (Give rationale to your answers)
Answer:
 Secure informed consent: A signed consent form is obtained from the patient.
 Obtain medical history: It will help determine the past health history, allergies and other problem of the
client.
 Check for the NPO status: Withhold food and fluid for 6 to 12 hours,. To decrease te risk of aspiration.
 Monitor VS: Obtain baseline data inform physician of any abnormal findings.
 Prepare emergency resuscitation equipment at the bedside: Laryngospasm and respiratory distress may
occur following the procedure.

3. What complications should the nurse be aware may occur during bronchoscopy?
Answer: Bronchospasm or bronchial perforation, indicated by facial or or neck crepitus, dysrhythmias,
hemorrhage, hypoxemia, and pneumothorax.

4. After the bronchoscopy, what should the nurse assess Mr. Kecklin for? Why?
Answer: Returning of gag reflex, it will determine if the client is okay to eat and drink.

5. What nursing actions are appropriate in the care of Mr. Kecklin after his bronchoscopy? (Give rationale to your
answers)
Answer:
 Monitor vital signs- to evaluate the baseline data.
 Have an emesis basin readily available for the client to expectorate sputum.
 Notify the physician if fever, difficulty in breathing, or other signs of complications occur following the
procedure.

Scenario B: Mrs. Lomar is admitted to the clinical area for a thoracentesis. The physician wants to remove
excess air from the pleural cavity.

1. What interventions by the nurse are required prior to the thoracentesis? (Give rationale to your answers)
Answer:
 Obtain informed consent
 Obtain vital signs
 Note the client is positioned sitting upright, with the arms and shoulders supported to a table at the
bedside during the procedure.
  If the client cannot sit up, the client is placed lying in bed toward the unaffected side with the hed of the
bed elevated.
 Instruct the client not to cough, breathe deeply, or move during the procedure.
2. Into which position should the nurse assist the patient prior to thoracentesis? Why?
Answer: Sitting upright and should not lean forward, because this causes pleural fluid to move costophrenic
space and increases the risk of puncture of the liver or spleen.

3. What anatomic site does the nurse anticipate the physician will use for the thoracentesis?
Answer: Pleural space of the lungs

4. What should the nurse assess for after the patient has a thoracentesis? Why?
Answer: Respiratory status, the patient is risk for respiratory-related complcations such as pneumothorax, air
embolism and pulmonary edema.

Scenario C: Isabel, a 14 yr old girl, has just undergone a tonsillectomy and adenoidectomy. The staff nurse
assists her with transport from the recovery area to her room.

1. The nurse observes Isabel swallowing frequently. What may this assessment finding indicate to the nurse?
Answer: swallowing frequently to a patient who undergone tonsillectomy indicates bleeding

2. The nurse assesses Isabel and her vital signs. What specific postoperative complication should the nurse monitor
for? Why do you think so?
Answer: signs of the bleeding should frequently monitored because in this procedure, bleeding is the most
common complication.

3. What recommended postoperative position should the nurse ensure that Isabel maintains? Why?
Answer: Prone or side-lying, this position facilitates the drainage.

4. Isabel is to be discharged the same day of her tonsillectomy. What education should the nurse provide to Isabel
and her family? ( answer as much as you can) (Give rationale to your answers)
Answer:
 Avoid milk products such as milk, ice crem and pudding initially because they coat the throat causing the
child to cough to clear the throat.
 Provide clear, cool, non-citrus and noncarbonated fluid (crushed ice, ice pops)
 Do not give child any straws, forks or sharp objects that can be put into the mouth.
 Mouth odor, slight ear pain, and low-grade fever may occur for a few days postoperatively but the
patient should notify the physician if bleeding earache, or fever occurs.
 Instruct the parents to keep the child away from crowds until healing has occurred; usually the child is
able to resume normal activities after 1 to 2 weeks postoperatively

Scenario D: Jerome, a 52 yr old widower, is scheduled for a laryngectomy due to malignant tumor.

1. Before developing the plan of care, the nurse needs to know whether Jerome’s voice will be preserved. What
surgical procedure does the nurse understand will not cause damage to the voice box?
Answer: Laryngectomy, removing the larynx and vocal cords, it will change the way he speak, the voice will
sound different because it is no longer coming from vocal cors.

2. Jerome is scheduled for a total laryngectomy. What education should the nurse provide to the patient in the
preoperative phase of surgery? (Give rationale to your answers)
Answer:
 Checking the incision site frequently to assess if there is a bleeding.
 Develop a plan for learning to speak again.
  Plan a diet that helps avoid choking. You may get tube feedings and progress to soft foods and liquids as
the swallowing reflex return.

3. The nurse is educating Jerome about the presence of a nasogastric catheter after surgery. The nurse should
inform him that he will begin receiving oral feedings about how long after the surgery?
Answer: 7-10 days

4. Jerome ask the nurse when the laryngectomy tube will be removed. What should the nurse tell him? Why?
Answer: laryngectomy tube keeps the stoma at a reasonable size and it may removed in several days after
surgery.

Scenario E: Anne, 71 years old and single, is admitted to the unit with a diagnosis of ARDS. She was receiving
treatment at home for viral pneumonia and had appeared to be improving until yesterday.

1. The nurse is assessing Anne for clinical manifestations associated with ARDS. What symptoms does the nurse
know positively correlate with ARDS? Explain why.
Answer: ARDS occurs as a complication of some other condition and in the case of the patient, viral pneumonia
complicates the condition.

2. The nurse is performing a neurologic assessment for Anne. What symptoms observed by the nurse indicate that
Anne is developing cerebral hypoxia? Relate your answer to the case of the patient.
Answer: cerebral hypoxia is when the brain isn’t getting enough oxygen, symptoms observed:
 Feeling of light-headed
 Loss of consciousness
 Seizure.
 Changes in mood

Scenarion F: Sandy, a 37 yr old woman recovering from multiple fractures sustained in a car accident, was
admitted to the ICU for treatment of a pulmonary embolism. Before admission, she was short of breath
after walking up a flight of stairs.

1. Sandy asks the nurse what could have caused this, since she was getting better from the accident and getting
plenty of rest. What is the best response by the nurse?
Answer: The lungs of the patient is not yet recovered.

2. What symptom does Sandy exhibit that most frequently occurs in the presence of pulmonary embolism?
Answer: Restlessness, cough, difficulty of breathing, feeling of impending doom, shallow respiration and chest
pain.

3. With a diagnosis of pulmonary embolism, what decrease in function should the nurse assess for? Why do you
think so?
Answer; Lung, embolus blocks blood flow and prevents functioning part of the lung. Preventing the exchange of
oxygen and carbon dioxide and decreases blood supply to the lung tissue itself.

Scenario G: Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of
bronchitis.

1. The nurse observes that Lois has a “barrel chest”. What is the cause of the alteration in the chest shape & size?
Support your answer.
Answer: Barrel chest occurs because lungs are chronically overinflated with air, so the rib cages stays partially
expanded all the time.
 2. The nurse recognized the need to be alert for what major presenting symptom of emphysema?
Answer: Respiratory Failure.

3. The nurse is assessing the results of Loi’s arterial blood gas. Which blood gas analysis will correlate with the
diagnosis of emphysema?
Answer: in patient with emphysema the ABG level indicated hypoxemia and respiratory acidosis.

4. Lois is being medicated with a bronchodilator to reduce airway obstruction. What side effects of bronchodilator
should the nurse observe considering the patient’s condition?
Answer:
 Palpitation and tachycardia
 Restlessness
 Mouth dryness and throat irritation with inhalers.
 Headaches and dizziness

5. The nurse is educating Lois on diaphragmatic breathing. How will this type of breathing help Lois? Explain why

Answer: Diaphragmatic breathing is intended to help use the diaphragm, decreasing the work of breathing by slowing
breathing rate and decreases oxygen demand.

REFERENCES:
NursesLabs
Phipps Medical Surgical Book 7th Edition

Read next paper.

B. Include what references/sources you will utilize in answering the following case study questions. Place your
references/sources at the last part of your paper whenever you are done.

C. Submission of assignments is until 5pm only of May 13( Wednesday), 2020.

D. Provide rationale / further explanation for each of your answer to get higher score as much as possible.

E. Rest if you are tired of answering. You have 1 week to go.

F. You may bullet your answers to organize your work.

G. Do not remove this note even if you finish answering the questions.

H. Use Calibri (Body) as the font style of your answer size 11-12

I. Bolding /italicizing to emphasize any part of your answers are allowed

J. Give rationales which are not too short or too long. Make it brief but concise and direct to the point as much as possible

K. Copying or similarity from the answers of your other classmates will be observed therefore research and read by your own.