University:
Oak Point University
Course:
NUR 3030 | Fundamentals Of Nursing Care
Academic year:

2019
Views:

230

Pages:

1
Author:

Nesbyenvkk

Medical Case 1: Kenneth Bronson Documentation Assignments 1. Document Kenneth Bronson’s new allergy information in his patient record.  Pt had anaphylaxis to Ceftriaxone. 2. Document your initial focused respiratory assessment of Kenneth Bronson.  Chest was moving equally bilateral. Reduced lung sounds at the right lung with 17 bpm. 3. Document the assessment changes that occurred before and after the anaphylactic reaction.  Pt had reduced breath sounds in the right lung base and the airway was obstructed after antibiotic. After giving the prescribed medication, the airway was still obstructed. 4. Identify and document key nursing diagnoses for Kenneth Bronson.  Impaired gas exchange related to bronchospasm as evidenced by changes in O2 saturation. 5. Referring to your feedback log, document the nursing care you provided.  I assessed the patient’s previous medical history and his pain level. I made sure to ask if he has any allergies. I listened to the pts lungs and took the respirations. I made sure to do all vital signs and flushed the IV once I assessed the IV site. I called the provider after giving the pt the antibiotic bc he started to wheeze. Then I administered all the medications the provider assigned to the pt.

Vsim Kenneth Bronson

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