Provide your proposed DNP practice change project (Fall prevention in health care settings) purpose statement in one concise sentence. The statement should clearly identify the following:

1. Gap in practice
2. Population impacted
3. Goal of the project

ANSWER

Case Study

History of Present Illness: A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated for it. This treatment did not improve her respiratory symptoms, and she has gradually worsened over six months. She reports a 20-pound (9 kg) intentional weight loss over the past year.

A brief review of systems is negative for chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, or muscular changes. She admits a cough, shortness of breath, and shortness of breath on exertion.

Social History: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six months ago. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-week vacation one year ago.

General: She is well in appearance, but anxious, a pleasant female lying flat on a hospital stretcher. She is conversing freely, with respiratory distress causing her to stop mid-sentence 

Physical Exam:

Vitals: Temperature, 97.8 F; heart rate 88; respiratory rate, 22; blood pressure 130/86; body mass index, 28

Respiratory: She has diffuse rales and mild wheezing; tachypneic.

Cardiovascular: She has a regular rate and rhythm with no murmurs, rubs, or gallops.

Gastrointestinal: Bowel sounds X4. No bruits or pulsatile mass. Last BM 4 days ago.

Questions regarding the case study: 

1. Based on this initial assessment, I am concerned about the following issues because:
2. Two nursing priorities for this patient are:

Because:

1. My first intervention/s to help this patient are:
2. After completing this case study, I learned:
3. I need more clarity on: (Look for answers on your own – use your resources and use your critical thinking skills)

ANSWER

Based on this initial assessment, I am concerned about the following issues because

1. Chronic Respiratory Symptoms: The patient’s chronic shortness of breath on exertion and unintentional weight loss over the past year are concerning, especially considering her history of heavy smoking. These symptoms may be indicative of a serious underlying respiratory condition, possibly lung cancer.

2. Smoking History: While the patient quit smoking recently, her significant smoking history of 33 pack-years puts her at a higher risk for respiratory diseases, including malignancies. Smoking cessation may have been prompted by the development of her symptoms.

Two nursing priorities for this patient are

1. Respiratory Assessment and Management: Given the patient’s respiratory distress and chronic symptoms, a comprehensive respiratory assessment, including diagnostic tests like chest X-rays and pulmonary function tests, is essential. Oxygen therapy and bronchodilators may be required to alleviate her symptoms and improve oxygenation.

2. Cancer Screening and Education: Due to the patient’s history of significant smoking and concerning symptoms, it is crucial to prioritize cancer screening. Initiating discussions about the possibility of malignancy, the importance of early detection, and potential treatment options are essential to ensure she is well-informed and can actively participate in her care decisions.

My first interventions to help this patient are

1.Immediate Oxygen Support: Given the patient’s respiratory distress, initiating oxygen therapy through nasal cannula or mask at an appropriate flow rate to maintain oxygen saturation within normal limits.

2. Consultation with Pulmonologist:Requesting a consultation with a pulmonologist to evaluate and manage the patient’s respiratory condition further. This should include ordering appropriate diagnostic tests to rule out lung cancer or other chronic respiratory conditions.

3. Patient Education:Initiating a conversation with the patient about her smoking history, the potential risks associated with it, and the importance of continued smoking cessation. Providing information about the diagnostic tests and procedures she may undergo and addressing her concerns and questions.

After completing this case study, I learned:

The importance of considering a comprehensive differential diagnosis for patients presenting with chronic respiratory symptoms, especially those with significant risk factors such as a history of heavy smoking. It’s crucial not to dismiss symptoms as acute and to investigate further if they persist or worsen.

I need more clarity on:

The results of diagnostic tests and imaging, such as chest X-rays and pulmonary function tests, to confirm or rule out specific respiratory conditions. Additionally, it would be helpful to know the patient’s response to initial interventions and the subsequent treatment plan based on the assessment findings. This would aid in understanding the progression of the case and the patient’s ultimate diagnosis and outcomes.