Patient Profile

Mr. Artuso is a 63-year-old electrician who came to the emergency department complaining of shortness of breath, morning cough, and swelling in his lower extremities.

Subjective Data

Has smoked one pack of cigarettes daily for over 30 years

Has difficulty breathing when he walks

Has been sleeping in a recliner to make it easier to breathe

His shoes are tight at the end of the day

Objective Data

Physical Examination

Blood pressure 125/90, pulse 90, temperature 98.4° F, respirations 32

Increased anterior-posterior diameter

Breath sounds diminished with prolonged expiration

2+ peripheral edema bilateral lower extremities

Thin with muscle wasting

Respirations labored

Diagnostic Studies

Arterial blood gases: pH 7.32, SaO2 86%, PaCO2 55 mm Hg, PaO2 70 mm Hg

Chest x-ray shows hyperinflation of lungs

FEV1 65%

Question 1

What in Mr. Artuso’s history is commonly associated with pulmonary problems?

Question 2

Interpret Mr. Artuso’s arterial blood gases.

Question 3

What is a likely medical diagnosis for Mr. Artuso?

Question 4

What assessment data and diagnostic study results led you to this diagnosis?

Question 5

What complication associated with this diagnosis does Mr. Artuso also have? What clinical manifestation led you to that and what is the cause of it?

Question 6

What are the priority nursing diagnoses for Mr. Artuso at this time?

Question 7

What interventions are indicated for Mr. Artuso and what outcome is expected for each intervention?

Question 8

As part of patient teaching, is it “too late” to encourage Mr. Artuso to stop smoking? Why?

Question 9

What other teaching needs would you review with Mr. Artuso while he is hospitalized?