Clinical Priority Problems Analysis

Clinical Priority Problems Analysis Patient Overview The patient is a 77-year-old female admitted on 2/14/26 with worsening shortness of breath and productive cough. She has a history of chronic hypoxic respiratory failure secondary to COPD and requires continuous oxygen therapy at 4L nasal cannula at baseline. Her past medical history includes hypertension, hyperlipidemia, Type 2 diabetes mellitus, renal artery stenosis, chronic anemia, IBS-C, anxiety, depression, and prior stroke. During hospitalization, she has demonstrated wheezing, increased sputum production, elevated blood glucose (284), elevated BUN (49), chronic anemia (Hgb 10.2), and low diastolic blood pressure (116/46). She is being treated for acute COPD exacerbation likely triggered by respiratory infection. Priority Problem #1: Impaired Gas Exchange Problem Statement The patient is experiencing impaired gas exchange related to COPD exacerbation and airway inflammation, placing her at risk for acute-on-chronic respiratory failure. Supporting Evidence Subjective: Reports shortness of breath Reports chest discomfort when coughing Objective: Productive cough Wheezing on auscultation O2 dependent (4L nasal cannula baseline) Admitted for acute COPD exacerbation Advanced age (77) History of hypoxic respiratory failure Underlying Pathophysiology COPD causes chronic airway inflammation, mucus hypersecretion, and alveolar destruction, leading to ventilation-perfusion mismatch. Infection increases bronchial inflammation and mucus production, worsening airflow obstruction and impairing oxygen exchange. In elderly patients with reduced pulmonary reserve, this may rapidly progress to acute-on-chronic respiratory failure. Nursing Interventions & Rationales Assess respiratory rate, lung sounds, work of breathing, and oxygen saturation every 24 hours. Rationale: Early detection of respiratory deterioration prevents progression to respiratory failure. Maintain oxygen therapy at prescribed rate and titrate to maintain SpO2 8892% (COPD goal). Rationale: Controlled oxygen prevents hypoxemia while reducing risk of CO2 retention. Administer bronchodilators (albuterol) and corticosteroids as ordered. Rationale: Bronchodilators relieve bronchospasm; steroids reduce airway inflammation. Position patient in high Fowlers. Rationale: Maximizes lung expansion and decreases work of breathing. Encourage use of incentive spirometer every hour while awake. Rationale: Promotes alveolar expansion and prevents atelectasis. Collaborate with respiratory therapy for nebulizer treatments. Rationale: Enhances secretion mobilization and airway patency. Expected Outcomes SpO2 maintained between 8892% within 24 hours Decreased wheezing within 48 hours Reports decreased shortness of breath No progression to respiratory failure during hospitalization Priority Problem #2: Ineffective Airway Clearance Problem Statement The patient demonstrates ineffective airway clearance related to increased mucus production and bronchial inflammation. Supporting Evidence Subjective: Reports productive cough Reports chest discomfort with coughing Objective: Audible wheezing Productive sputum COPD exacerbation diagnosis Underlying Pathophysiology COPD exacerbation increases mucus secretion and airway narrowing. Thickened secretions obstruct airflow, impair gas exchange, and increase infection risk. Nursing Interventions & Rationales Encourage coughing and deep breathing exercises every 2 hours. Administer guaifenesin as ordered. Encourage oral fluids if not contraindicated. Provide chest physiotherapy if ordered. Monitor sputum color, amount, and consistency. Suction airway if patient unable to clear secretions independently. Rationale: These interventions promote mucus mobilization and prevent airway obstruction. Expected Outcomes Improved sputum clearance within 48 hours Breath sounds improved Decreased coughing discomfort Priority Problem #3: Hyperglycemia Problem Statement The patient is experiencing hyperglycemia related to stress response and corticosteroid therapy in the setting of Type 2 diabetes mellitus. Supporting Evidence Subjective: History of Type 2 diabetes Objective: Glucose 284 Receiving prednisone Acute illness Underlying Pathophysiology Steroids increase gluconeogenesis and decrease insulin sensitivity. Stress hormones further elevate blood glucose, increasing infection risk and delaying recovery. Nursing Interventions Monitor blood glucose before meals and at bedtime. Administer insulin lispro per sliding scale. Educate patient on hyperglycemia symptoms. Monitor for hypoglycemia after insulin administration. Coordinate insulin timing with meals. Monitor for signs of infection. Expected Outcomes Blood glucose maintained between 140180 during hospitalization No episodes of severe hypoglycemia Demonstrates understanding of glucose monitoring before discharge Priority Problem #4: Risk for Bleeding Problem Statement The patient is at increased risk for bleeding related to dual antiplatelet therapy and chronic anemia. Supporting Evidence Subjective: Denies active bleeding Objective: On aspirin and clopidogrel Hgb 10.2 Hct 30.8 Age 77 Underlying Pathophysiology Antiplatelet medications inhibit platelet aggregation, increasing bleeding risk. Chronic anemia decreases physiologic reserve if bleeding occurs. Nursing Interventions Monitor Hgb/Hct daily. Assess for bruising, hematuria, melena. Implement bleeding precautions. Avoid IM injections. Monitor vital signs for signs of hemorrhage. Educate patient on bleeding symptoms. Expected Outcomes No evidence of active bleeding Hgb/Hct remain stable Patient verbalizes understanding of bleeding precautions before discharge Clinical Priority Problems Analysis Clinical Priority Problems Analysis Criteria Ratings Points Patient Overview — Brief summary of the patients demographics, admitting diagnosis, and relevant history (PMH and hospital course) is present. 5.1 to 10 pts — Few components of the background information are missing. 0.1 to 5 pts — The patient overview is grossly incomplete or the assignment is submitted late. 0 to 0 pts /10 pts Nursing Priority Problem Statement — 4 Priority nursing problems are identified and rationale for why the problem is a priority is present. 7.6 to 15 pts — 2-3 Priority nursing problems are identified and rationale for why the problem is a priority is present. 0.1 to 7.5 pts — Nursing problems selected are not relevant to the patient, or the assignment is submitted late. 0 to 0 pts /15 pts Supporting Subjective and Objective Evidence — There are at least 3-4 pieces of data that support the prioty problem identified including subjective AND objective data. 10.1 to 20 pts — There are less than 3 pieces of subjective and objective data that support the prioty problem identified. Data is subjective or objective, not both. 0.1 to 10 pts — Supportive data is minimal or not relevant to the priority problem identified, or the assignment is submitted late. 0 to 0 pts /20 pts Underlying Pathophysiology — An evidence based exploration of pathophysiology is present with linkage between the patient’s presentation, assessment findings, and the disease process. 10.1 to 20 pts — An evidence based exploration of pathophysiology is present, however, some links are missing or major factors are omitted. 0.1 to 10 pts — There is limited evidence of understanding of the patient’s pathophysiology causing current issues or the assignment is submitted late. 0 to 0 pts /20 pts Nursing Interventions — Contains at least 5-6 relevant nursing interventions for each patient problem identified with rationales. Interventions including actual actions and not just monitoring and assessing. 10.1 to 20 pts — Contains at least 3-4 relevant nursing interventions for each patient problem identified. Rationales are minimal or incomplete. 0.1 to 10 pts — There are less than 2 nursing interventions per patient problem; or the assignment is submitted late. 0 to 0 pts /20 pts Expected outcomes — Expected evidence based outcomes of previosuly identified nursing interventions are described in detail with an appropriate timeframe for follow up. 7.6 to 15 pts — Expected evidence based outcomes of previosuly identified nursing interventions are briefly described with an appropriate timeframe for follow up. 0.1 to 7.5 pts — Expected outcomes are not appropriately identified, or the assignment is submitted late. 0 to 0 pts /15 pts