OLA HA Lec

DE JESUS, Mary Betina 27
1NUR-3
Other Learning Activities
CASE SCENARIO 1 (Pneumonia)

“A 76 y/o male, came in with a complaint of dyspnea, fever, and cough.”
Medical Interventions
1. Provide the patient with Antibiotics
• Antibiotics would help in treating the Pneumonia because this helps in treating
the bacteria in pneumonia. Though it takes time in detecting the type of bacteria that is
causing the pneumonia the doctor should pick the best antibiotic to treat it and if the
symptoms does not improve, the doctor should recommend a different antibiotic.
2. Provide the patient with Cough Medicine

• Since the patient is experiencing productive coughs the doctor should prescribe
the patient with a cough medicine that could be used to calm his/her coughs so that
the patient could rest. Coughing can help loosen and move fluid from the lungs but it
isn’t good to completely remove the cough.
Nursing Interventions
1. Administer medications the doctor has indicated
• The medications that were indicated by the attending physician would aid in the
reduction of bronchospasm and it would help in the mobilization of secretions.
Analgesics or cough medicines would help improve cough effort by increasing the
comfort of the patient but the usage of medicine should be monitored because it
depresses respirations.
2. Assess the rate and depth of respirations and chest movement

• The assessment of the lungs and thorax, even if it is just the rate and depth of the
respiratory pattern or the chest movement would have a great effect. The nurse
should assess the patient since he is showing a lot of symptoms of his sickness.
Dyspnea is present in his case as well as asymmetric chest movements because his
left lung is infected maybe out of the discomfort of moving chest wall/ the fluid
accumulated in the lung.
3. Elevate head of bed, change position frequently

• Elevating the head of the patient would lower the diaphragm and promote chest
expansion, aeration of lung segments and mobilization and expectoration of secretion
or fluids in the lungs.
CASE SCENARIO 2 (Breast Cancer- Metastasized to the Lungs)

“A breast cancer patient came in with severe respiratory difficulties. She had undergone surgery
3 years prior.”
Medical Interventions
1. Hormone Therapy
• Hormone therapy works as the first treatment for metastatic breast cancers. Hormone
therapy works by preventing the cancer cells from getting the estrogen they need to
grow. Though this therapy works depending on the menopausal status of the woman
and any past hormone treatment for early breast cancer.
2. Chemotherapy
• Chemotherapy could be another intervention since chemotherapy can shrink tumors
faster than hormone therapy does. In chemotherapy every new drug that is used it is
less likely that the cancer will shrink.
1. Education, Information & Communication
• This is essential because this is where the nurse promotes high quality care and
empower their patients. The need of information and empowerment for the patients
and their families is highly important. This three things would also influence,
encourage and support women to be breast aware.
2. Symptom management and importance of multidisciplinary teamwork

• This is an essential element of the care that the nurse issuing to give because this will
help the patient and her family to cope with the symptoms across the treatments and
time. The main function of the nurse in this intervention is to implement symptoms
management treatment in care of a patients families.
3. Psychological support and coordination of care

• Cancer patients need supportive care to alleviate psychological distress and assist
them adapt to the situation. Informational care that you are to give the patients is
advice in dealing with problems, emotional support contributing to the feeling. Tangible
support is a direct aid such as taking care of a critically ill patient.
CASE SCENARIO 3 (Collapsed Lung/ Pneumothorax)

“A 25 y/o came in with a stab wound on the Left chest near the nipple.”
Medical Interventions:
1. Chest Tube Insertion
• Since the lung collapsed, a needle or chest tube will be inserted to take the excess air
out.The needle is inserted between the ribs into the air-filled space that is pressing on
the collapsed lung. With the needle, a syringe is attached so that the doctor can pull
out the excess air — just like a syringe is used to pull blood from a vein. A chest tube
may be attached to a suction device that continuously removes air from the chest
cavity.
2. Surgery
• Surgery may be necessary to close the leak in the collapsed lung. The doctor may
either create a small incision or may use a substance that will irritate the tissues in the
lung so that they will stick together and seal any leaks.
1. Auscultate breath sounds
• Breathe sounds may be absent in one part of the lung. The collapsed area would have
decreased or absent breath sounds that is why auscultation is important because this
will provide a baseline to evaluate resolution of pneumothorax
2. Assist patient with splinting painful area when coughing or deep breathing
• The nurse should support the chest and abdominal muscles when the person coughs
or breathes deeply. This would make the patient’s coughing and deep breathing more
effective and less traumatic.
3. Maintain position of comfort

• This promotes maximal inspiration. This intervention would also enhance lung
expansion and ventilation in unaffected side.
CASE SCENARIO 4 (Coronary Heart Disease)

“A 48 y/o male came in and verbalizes, substernal chest pain “like someone sitting on my
chest”. He has a 10 year smoking history, and is also diabetic. BP @ 140/60, apical pulse @
104/min”
1. Coronary Artery bypass surgery
• The surgeon create a graft to bypass blocked coronary arteries. This procedure will all
the blood to flow around the blocked or narrowed coronary artery.
2. Angioplasty and stent placement

• The doctor will insert a long this catheter into a narrowed part of the artery. A stent is
left in an artery to help keep it open, some stents slowly release medications to help
keep the artery open.
Nursing Interventions:
1. Monitor heart rate and rhythm
• since patients with Coronary Heart Disease or Angina has an increased risk of acute-
life threatening dysrhythmias. These dysrhythmias could occur in response to
ischemic changes or stress.
2. Stay with patient

• Stay with the patient especially if the patient is experiencing pain or feeling anxious.
Anxiety releases a chemical which increases myocardial workload and can escalate
or prolong ischemic pain.
3. Provide light meals

• Provide light meals and let the patient rest for 1 hour after meals. This decreases
myocardial workload associated with work of digestion, reducing risk of anginal attack.
CASE SCENARIO 5 (Acute Appendicitis)

“A 18 y/o patient came in with general abdominal pain at 8/10 accompanied by nausea &
vomiting – . non projectile. . BP 110/70. Temp. 38.3’C, PR 107/min, RR 18/min”
1. Appendectomy
• This laprascopic surgery will allow the patient to recover faster and heal with less pain
and scarring. This procedure is better for patients who are elderly or obese.
2. Draining an Abscess
• An abscess may be drained by using a tube through your skin into the abscess.
Appendectomy can be performed after this procedure.
1. Keep at rest in Semi-Fowler’s position
• This position would lessen the pain of the patient. Gravity localizes inflammatory
exudate into lower abdomen relieving abdominal tension which is accentuated by
supine position.
2.Encourage early ambulation

• This promotes normalization of organ function. Encouraging early ambulation would
also stimulate the peristalsis and passing of flatus, reducing abdominal discomfort.
3. Administer analgesics as indicated

• Administration of analgesics would relieve the patient from pain. When the patient is
relieved from pain, this would then lead to the facility of cooperation with other
therapeutic interventions.
CASE SCENARIO 6 (Hemorrhagic Stroke)

“Mr S a 55 year old accountant was admitted to A&E with sudden onset of left sided weakness.”
1. Endovascular Procedures
• This procedure may be used to treat certain hemorrhagic strokes similar to how it is
used to treat ischemic strokes. This procedure is a less invasive procedure than
surgery is wherein it involves the use of a catheter through a major artery in the leg or
in the arm.
2. Surgical Treatment
• Since this type of stroke is caused by a bleed in the brain or an abnormal tangle of
blood vessels, surgical treatment may be done to stop the bleeding. Another way is by
putting a metal clip at the base of the aneurysm to secure it.
1. Evaluate Pupils
• Evaluate pupils, note their size, shape, equality, and light reactivity. These functions
are regulated by the Occulumotor cranial nerve and this is linked to determining
whether the brainstem is intact.
2. Assess higher functions

• Higher functions, including speech and to see if patient is alert. Changes in cognition
and speech content are indicators of locations and degree of cerebral involvement.
3. Administer supplemental oxygen as indicated

• This act reduces hypoxemia. Hypoxemia can cause cerebral vasodilation and
increases pressure or edema formation.

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DE JESUS, Mary Betina 27

Other Learning Activities

CASE SCENARIO 1 (Pneumonia)

2. Provide the patient with Cough Medicine

2. Assess the rate and depth of respirations and chest movement

3. Elevate head of bed, change position frequently

CASE SCENARIO 2 (Breast Cancer- Metastasized to the Lungs)

2. Symptom management and importance of multidisciplinary teamwork

3. Psychological support and coordination of care

CASE SCENARIO 3 (Collapsed Lung/ Pneumothorax)

3. Maintain position of comfort

CASE SCENARIO 4 (Coronary Heart Disease)

2. Angioplasty and stent placement

2. Stay with patient

3. Provide light meals

CASE SCENARIO 5 (Acute Appendicitis)

2.Encourage early ambulation

3. Administer analgesics as indicated

CASE SCENARIO 6 (Hemorrhagic Stroke)

2. Assess higher functions

3. Administer supplemental oxygen as indicated

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