Anthony , a 68-year-old man, has experienced recurring bronchitis for the past 30 years and was 8 years ago given the diagnosis of COPD. He measures 172 cm tall and weighs 170 lbs. He smokes, and he typically consumes one pack of cigarettes every day.
He weighed a typical adult weight of 175 pounds about two years ago. Due to his lack of appetite and early satiety, he has lost 9 pounds in the past month. He laments that "meal has lost its taste" and that his tongue is dry. He is currently using a number of drugs, including an antibiotic, an inhaler, and a bronchodilator. He takes oxygen when he needs it.
He was just admitted to the hospital for pneumonia, and the nutritionist advised him to consume at least 2000 calories daily. The dietician advised him to consume at least 2000 calories while he was recently treated for pneumonia, but he lacks the stamina to make or consume that much food.
Vital signs:
BP: 120/70 mmHg,P: 90 bpm,RR: 22 /min,T: 38.5°C,SpO2: 90% in room air
Physical assessment:- Restlessness,Chest tightness,Crackles heard over bilateral lower lobes of lung,Swelling of feet
The doctor has prescribed the following management after the assessment:
- Salbutamol inhaler 2 puff QID
- Salmeterol 1 puff BD
- Bromhexine 8 mg PO TDS
- Cefuroxime 500 mg PO BID
- Oxygen 2L/min via nasal cannula- Sputum study for culture and sensitivity
- Paracetamol 500mg QID prn
- CXR
Q1. Identify and prioritize the top 3 health problems and write the respective nursing diagnosis in PES format.
Q2. Give rationales for the prioritization.