The next few visits are uneventful. C.E. has continued to not smoke and is doing better with managing episodes of dyspnea. At your next visit, you greet C.E., immediately note that he sounds congested, and comment that he sounds like he has a cold. He replies, "Oh, our great-grandchildren were over to visit several days ago and they all had snotty noses."
What basic hygiene measures would you include in a teaching plan for C.E. and his wife to prevent his developing an infection? Select all that apply.
a. Practice good hand washing technique, and wash hands often.
b. Avoid people with cold and flu infections, and screen visitors.
c. Avoid enclosed, public a reas at all times.
d. Get pneumonia and flu vaccines every year.
e. Use the dishwasher to wash eating utensils, glasses, and plates.
f. Use antibacterial wipes daily to clean frequently touched surfaces.

At your next visit 2 weeks later, C.E. tells you that he has not smoked since your previous visit. He is upset, though, over an episode a week ago. He says he walked to the kitchen for a snack and became increasingly short of breath. Per your instructions, C.E. removed the nasal cannula (NC), tested the flow against his check, and felt no 0 2 flowing from the catheter. He lacked the force and volume required to yell for help and was too short of breath to return to the living room to check his 0 2 tank. He bent forward with his elbows on the countertop and struggled to breathe. He became more frightened with each passing second, and his breathing became increasingly more difficult. A minute later, C.E.'s wife found him and reconnected his 0 2 tubing. C.E. sat at the table for 20 minutes before he could walk back to the living room.
What referrals could you consider at this time and why?

What information would you want to review with M.D. regarding the signs and symptoms of infection and when to seek treatment?

Postoperative wound infection is a concern for S.P. Describe what you would do to monitor her for a wound infection.

At your next visit $3$ weeks later, C.E. tells you that the previous evening he walked to the kitchen for a snack and became increasingly short of breath. As per your instructions, C.E. removed the nasal cannula, tested the flow against his check, and felt no $\mathrm{O}_2$ flowing from the catheter. He lacked the force and volume required to yell for help and was too short of breath to return to the living room to check his $\mathrm{O}_2 \operatorname{tank}$. He bent forward with his elbows on the countertop and struggled to breathe. He became more frightened with each passing second, and his breathing became increasingly more difficult. A minute later, C.E.'s wife found him and reconnected his $\mathrm{O}_2$ tubing. C.E. sat at the table for $20$ minutes before he could walk back to the living room.

A week later you receive a call from C.E.'s wife. Since the incident, C.E. “doesn't want her out of his sight.” She asks you to come to the house and “talk some sense into him.” What teaching strategies will you use with C.E. and his wife?

At your next visit $3$ weeks later, C.E. tells you that the previous evening he walked to the kitchen for a snack and became increasingly short of breath. As per your instructions, C.E. removed the nasal cannula, tested the flow against his check, and felt no $\mathrm{O}_2$ flowing from the catheter. He lacked the force and volume required to yell for help and was too short of breath to return to the living room to check his $\mathrm{O}_2 \operatorname{tank}$. He bent forward with his elbows on the countertop and struggled to breathe. He became more frightened with each passing second, and his breathing became increasingly more difficult. A minute later, C.E.'s wife found him and reconnected his $\mathrm{O}_2$ tubing. C.E. sat at the table for $20$ minutes before he could walk back to the living room.

Why did C.E. assume the peculiar position at the countertop?

The next time you visit, C.E. complains of sores behind his ears. He explains, "That long oxygen tubing seems to take on a life of its own. It twists around and gets caught under doors, chairs, everything. It darn near rips the ears off my head."
After you have finished, his wife seems upset and tells you that C.E. is still "'smoking a couple of cigarettes" a day. How do you handle this situation?

The next time you visit, C.E. complains of sores behind his ears. He explains, "That long oxygen tubing seems to take on a life of its own. It twists around and gets caught under doors, chairs, everything. It darn near rips the ears off my head."
You auscultate C.E.'s breath sounds and detect the odour of Vicks VapoRub. When you question C.E. about the use of Vicks, he tells you that he started to apply it in and around his nose to prevent his nose from becoming dry and sore. What specific teaching do you need to reinforce with C.E. and his wife?

The next time you visit, C.E. complains of sores behind his ears. He explains, "That long oxygen tubing seems to take on a life of its own. It twists around and gets caught under doors, chairs, everything. It darn near rips the ears off my head."
What can you tell him that could help?

C.E. affirmed he has been a half-pack-per-day smoker for 50 years. The physician counseled C.E. on smoking cessation and C.E. agreed to stop smoking. The physician told C.E. his office would have a home equipment company call him to arrange delivery of the oxygen equipment and educate him on its use. As a registered nurse (RN) working for the company, you are assigned to be C.E's case manager.
What assessment do you need to do at each follow- up visit with C.E.?

C.E. affirmed he has been a half-pack-per-day smoker for 50 years. The physician counseled C.E. on smoking cessation and C.E. agreed to stop smoking. The physician told C.E. his office would have a home equipment company call him to arrange delivery of the oxygen equipment and educate him on its use. As a registered nurse (RN) working for the company, you are assigned to be C.E's case manager.
What would you address with C.E. and his wife at the first visit?

C.E. affirmed he has been a half-pack-per-day smoker for 50 years. The physician counseled C.E. on smoking cessation and C.E. agreed to stop smoking. The physician told C.E. his office would have a home equipment company call him to arrange delivery of the oxygen equipment and educate him on its use. As a registered nurse (RN) working for the company, you are assigned to be C.E's case manager.
How would you prepare for the initial home visit?

The next few visits are uneventful. C.E. has continued to not smoke and is doing better with managing episodes of dyspnea. At your next visit, you greet C.E., immediately note that he sounds congested, and comment that he sounds like he has a cold. He replies, "Oh, our great-grandchildren were over to visit several days ago and they all had snotty noses."
What is your immediate concern and why?

C.E., a 73-year-old married man and retired railroad engineer, visited his internist, complaining, "Whenever I try to do anything, I get so out of breath I can't go on. I think I'm j ust getting older, but my wife told me I had to come see you about it:' His resting Spo2 registered 83%. He was sent to the local hospital for a chest x-ray examination and arterial blood gases (ABGs) after resting 20 minutes on room air. C.E. returned to the office. After evaluating t he results, t he physician told C.E. he had severe emphysema and must start on continuous oxygen (0) t herapy at a 2 L flow rate. The physician completed a prescript ion for the oxygent herapy, including on the prescription C.E.'s pulse oximetry and ABG results.
Based on the most common cause of emphysema, what assessment regarding health behaviors is needed?