The patient is a 68-year-old man who has had shortness of breath (SOB) for the past 2 to 3 days. His past medical history includes a 40–pack-year smoking history, COPD, and heart failure. He reports that he became concerned when he woke from sleep because he could not breathe. Your physical assessment reveals crackles in the lower lobes bilaterally. His oxygen saturation (Spo2) is 84% without supplemental oxygen. What are some areas of focus to assess as part of this patient's current history? Whom should you contact and why? What are some factors that may affect gas exchange for this patient? What additional referrals might be appropriate for this patient? Compose two (2) complete nursing diagnostic statement specific to this case study

1. Some areas of focus to assess as part of this patient's current history are manifestations´ onset, exacerbating or alleviting actions, dyspnea, orthopnea, the distance he can walk without getting shortness of breath (SOB), daily activities´affectation by SOB, medication, oxygen use and if he is a smoker or if there are smokers at home.

2. You should contact his PCP, and therapists, and cessation counceling if the patient is a smoker and is willing to quit.

3. Decreased alveolar surface may affect gas exchange for this patient.

4. The appropriate referrals for this patient is respiratory therapy, pulmonary re-hab and home oxygen.

5. Nursing diagnostic statement specific to this case study.

Explanation:

1. The questions we need to ask this patient are on some areas of focusing: - Ask this patient how these symptoms began and if he has done something to make them better or worse.

- Ask him if he has gotten paroxysmal nocturnal dyspnea (PND), orthopnea, and if so, how many pillows does he need to be able to sleep.

- Ask about how far he is able to walk without getting shortness of breath, and he is able to do his daily routine with his SOB.

- Ask him about the medication he is currently taking, including over-the-counter, herbal and supplements.

- Ask if he uses oxygen at home.

- Ask if he is working and what he does to determine if he is exposed to toxins.

-Ask him if he has been coughing and about his smoking history.

2. First contact this patient's primary health care provider to update him on the patient's oxygen saturation; reach respiratory therapy for an appropriate oxygen delivery method and additional treatments as cessation counceling and quit smoking (only if patient agrees).

3. Some factors that may affect gas exchange for this patient are decreased alveolar surface area, which could be age related, also crackles may represent interstitial edema with gas exchange reduction. The patient's decreased endurance will decrease gas exchange, along with COPD and his existing heart failure.

4. The appropriate additional referrals that might benefit this patient would be a respiratory therapy to instruct him on breathing exercises and pulmonary re-hab and asses him for the possibility of getting home oxygen therapy.

5. This 68-year-old patient is related to decreased skeletal muscle strength causing a poor gas exchange, that is, less air moving in and out of the lungs at the alveolar-capillary membrane, but do not directly affect pulmonary circulation though.

When auscultating the client's breath sounds, consider that the vesicular sounds, at the peripheral lung fields where air flows through smaller bronchioles and alveoli, is a normal finding that does not require any action other than documentation.