THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM. REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH APPROPRIATE REFERENCE WITHIN 5 YEARS AND 7TH EDITION APA STYLE . MINIMUM OF 350 WORDS WITH AT LEAST 2 PEER REVIEW REFERENCE. Please answerer all four point of the question summary in detail You are a new AGACNP at an urban, tertiary referral center working in the emergency department. You are presented with the following case. Summarize your actions for the following, in detail:
As a new AGACNP (Acute Gerontology Adult Clinical Nurse Practitioner) in an urban, tertiary referral center working in the emergency department, I am presented with a case that requires prompt and appropriate action. The case involves a patient who is experiencing difficulty breathing and has a persistent cough.
Upon initial assessment, I would first ensure the patient’s airway is patent and assess their respiratory rate, oxygen saturation levels, and lung sounds. This is crucial in determining the severity of their respiratory distress and guiding subsequent interventions. If the patient’s oxygen saturation is below 94% or their respiratory rate is elevated, immediate oxygen therapy would be initiated via nasal cannula or non-rebreather mask to maintain adequate oxygenation.
Next, I would conduct a comprehensive physical examination, including a thorough auscultation of the patient’s lungs to assess for abnormal breath sounds such as crackles, wheezes, or decreased breath sounds. The presence of these findings may indicate underlying pathology such as pneumonia, chronic obstructive pulmonary disease (COPD), or congestive heart failure (CHF), which would require further evaluation and targeted treatment.
Simultaneously, I would obtain a detailed history of the patient’s symptoms, including the duration of the cough, any associated fever or night sweats, recent travel history, and exposure to individuals with respiratory infections. This information can help identify potential causes like respiratory infections, pulmonary embolism, or exacerbation of chronic respiratory diseases.
Given the patient’s persistent cough and difficulty breathing, I would order appropriate diagnostic tests such as a chest x-ray, complete blood count (CBC), arterial blood gas (ABG) analysis, and sputum culture to further evaluate the underlying etiology. The chest x-ray would assist in detecting any structural abnormalities or infiltrates, while the CBC would help identify infections or inflammatory processes. The ABG analysis would provide information regarding the patient’s acid-base balance and oxygenation, which is vital for determining the need for respiratory support. The sputum culture would aid in identifying potential pathogens that could guide antibiotic therapy if needed.
Based on the patient’s presentation and initial assessment findings, a provisional diagnosis should be made. It is important to consider conditions such as pneumonia, COPD exacerbation, congestive heart failure exacerbation, or even pulmonary embolism, as these can manifest with similar respiratory symptoms. The provisional diagnosis will guide the initiation of specific treatments and interventions.
In this case, if pneumonia is suspected, appropriate empirical antibiotic therapy should be initiated based on local antibiogram data and the patient’s individual risk factors. Oxygen supplementation should also be continued to maintain oxygen saturation levels above 94%. If the patient shows signs of respiratory distress that are not relieved with oxygen therapy alone, non-invasive positive pressure ventilation (NIPPV) should be considered. NIPPV has been shown to improve oxygenation and decrease the need for invasive mechanical ventilation in patients with acute exacerbations of COPD or cardiogenic pulmonary edema.
Moreover, it is essential to involve other members of the healthcare team, such as respiratory therapists, to assist with additional interventions like nebulization treatments or bronchodilator therapy if appropriate. Collaborating with the primary care physician or pulmonologist may be necessary, especially if the patient has a history of known respiratory conditions such as COPD or asthma.
In conclusion, as an AGACNP in the emergency department, my actions would involve a systematic approach to the assessment and management of a patient presenting with difficulty breathing and a persistent cough. This would include ensuring adequate oxygenation, performing a thorough physical examination, obtaining relevant diagnostic tests, establishing a provisional diagnosis, initiating appropriate treatments, and collaborating with the healthcare team to optimize patient outcomes.