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F.T. is a 70-year-old African American man who comes to the emergency department (ED) complaining of increased shortness of breath. He states that he started using his albuterol inhaler every 4 hours a few days ago, but it does not seem to be helping. He has been having trouble sleeping or doing any activity because of his shortness of breath.

**SUBJECTIVE Data:**

- **PMH:** COPD, hypertension, and benign prostatic hyperplasia. No history of allergies.
- **Medications:** Metoprolol (Lopressor) 50 mg/day PO, furosemide (Lasix) 20 mg PO daily, finasteride (Proscar) 5 mg/day PO, Advair inhaler (fluticasone and salmeterol) 2 puffs bid, and albuterol inhaler 2 puffs q4hr PRN. Does not use O2 at home.
- **Health Perception–Health Management:** F.T. states he usually manages his COPD well with the Advair inhaler and occasional use of the albuterol inhaler PRN. He thinks he caught a cold from his granddaughter last week. Increasing difficulty breathing, even with albuterol. Has a history of 30 pack-years of smoking, quitting 5 years ago.
- **Nutritional-Metabolic Pattern:** Not eating, drinking very little over the past 2 to 3 days.
- **Activity-Exercise:** At present, cannot walk 100 feet without feeling short of breath, nor walk up one flight of stairs without stopping to catch his breath.
- **Sleep-Rest:** Difficulty sleeping at present. Last night he slept upright in his recliner.
- **Cognitive-Perceptual:** Denies any pain associated with shortness of breath. Feels slightly irritable because of lack of sleep.
- **Coping–Stress Tolerance:** Denies any stress or emotional disturbance.

**Discussion Questions:**

1. What type of assessment would be most appropriate for F.T.: comprehensive, focused, or emergency?
2. From the information provided by F.T., what other information would you ask him about his condition (time permitting)?
3. How will you individualize the assessment based on his current physiologic condition?
4. What considerations will you make based on his age and ethnic/cultural background?
5. Of the information provided, which subjective assessment findings are of most concern to you?
6. F.T. cannot use his inhaler appropriately while he is talking with you. Is this an appropriate time to teach him about the proper use of his inhaler?
7. What should be included in the physical assessment? What do you think will be the priorities in your physical assessment?

Answer :

Final answer:

The most appropriate type of assessment for F.T. would be a focused assessment, as his symptoms and medical history indicate a specific area of concern. Based on the information provided, additional information to ask F.T. about would include his vital signs and any recent changes in his cough or sputum production. The assessment for F.T. should be individualized to focus on his respiratory status, and considerations should be made based on his age and ethnic/cultural background.

Explanation:

1. The most appropriate type of assessment for F.T. would be a focused assessment, as his symptoms and medical history indicate a specific area of concern.

2. Based on the information provided, it would be important to ask F.T. about his current vital signs, including heart rate and oxygen saturation levels, as well as any recent changes in his cough or sputum production.

3. To individualize the assessment for F.T.'s current physiologic condition, the focus should be on assessing his respiratory status, including auscultation of lung sounds and monitoring for signs of respiratory distress.

4. Age and ethnic/cultural background are important considerations in the assessment. F.T.'s age and African American background may increase his risk for certain health conditions, such as cardiovascular disease.

5. The subjective assessment findings of most concern are F.T.'s increasing difficulty breathing, even with the use of albuterol, and his decreased intake of food and fluids over the past few days, which may indicate worsening respiratory distress and dehydration.

6. While F.T. cannot use his inhaler appropriately during the assessment, this may be an appropriate time to provide brief education on the proper use of the inhaler, emphasizing the importance of correct technique and adherence to the prescribed medication regimen.

7. The physical assessment should include assessing vital signs, auscultating lung sounds, checking oxygen saturation levels, and assessing F.T.'s skin color and moisture for signs of cyanosis or diaphoresis. Priorities in the physical assessment would include respiratory status, cardiovascular status, and hydration status.

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Explanation:

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