Question

RS 74-year-old male admitted on 3/15/23 for a scheduled coronary artery bypass and endoscopic vein harvest, and esophageal echocardiogram. Teaching done with this patient was the importance of using his heart pillow every time he has to cough or stand up. \#2: LV 49-year-old male who was found down in this house unresponsive with a SpO2 in the 50's. Teaching I did for this patient was teaching him the importance of keeping his oxygen mask on at all times. This patient kept taking it off every time we would leave the room and his O2 would drop to the 70 's. \#3: KJ 60-year-old female admitted on 3/8/23 who came in for a scheduled angiogram and became hypotensive. Teaching I did for this patient was to inform her of the importance of us coming in and doing Q2 turns. Pt has a BKA on the left side and is unable to turn herself. Informed pt that we are reducing the risk of pressure injuries by doing these turns, even though she did not like when we do them. Please write one nursing problem and one goal for one of the above-mentioned potients. Please indicated the selected patient by their assigned number and write the problem in NADA format (Basic Human Need related to pathophysiology in your own words...... aeb ......abnormal assessment findings).

Answer 1

For the 49-year-old patient with low oxygen saturation, the nursing problem is Impaired Gas Exchange, and the goal is to maintain oxygen saturations above 92% over the next 24 hours.

Step-by-step explanation:

For patient #2 (LV, the 49-year-old male who was found unresponsive with a low oxygen saturation), the nursing problem can be formulated in NANDA format as follows: Impaired Gas Exchange related to decreased oxygen-carrying capacity of the blood secondary to hypoventilation as evidenced by repeated desaturations when removing the oxygen mask, with oxygen saturation dropping to the 70s. The goal for this patient is: The patient will maintain oxygen saturations above 92% at all times over the next 24 hours.