Medical Case 3: Vincent Brody

Guided Reflection Questions

1. How did the scenario make you feel?

The first time I felt ready for it, and thought I knew what to do. Then the patient started

complaining of chest pain during the nebulizer and I started panicking.

2. When a patient develops a rapid onset of shortness of breath, what are the nurse’s

immediate priorities?

Maintain a patent airway, administering oxygen, position the patient in the position that

best facilitates breathing (i.e. high-flowers position), and administer medications

(bronchodilators, anticholinergics, corticosteroids) as ordered.

3. What assessment findings would indicate that the patient’s condition is worsening?

Patient reporting worsening of pain or dyspnea, decreasing SpO2 or SaO2, increase in

respiratory rate and PaCO2, decreased level of consciousness, diminished or absent lung

sounds on the right side, apnea, cardiac arrythmias

4. Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these

results relate to his clinical presentation and chronic disease process.

His HCT, PCO2, and HCO3 were all high, while his SaO2 and PO2 were low. This indicates

he has been rather obstructed due to the exacerbation, leading to hypoxemia and

compensated respiratory acidosis. The obstruction would explain his cough and dyspnea

during his assessment.

5. What are safety considerations when caring for a patient with a chest tube?

Ensuring that the tube is patent and properly secured.

Keep the drainage system below the chest

Monitoring the drainage every 2 hours; call the doctor if drainage is more than

150mL/hr

Assist the patient with ambulation and exercises in bed to avoid falls and complications

from immobility

Monitor that the chest tube is functioning properly and has no air leaks

Ensure that the suction/water level is at the prescribe amount.

6. What key elements would you include in the handoff report for this patient? Consider the

SBAR (situation, background, assessment, recommendation) format.

Vincet Brody is a 67-year-old, African American male who came in due to COPD

exacerbation with dyspnea and a cough that started yesterday.

He has history of COPD.

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CASE 3

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