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Chapter 18 Case: Respiratory 

Ms. Winston is a 66-year-old woman complaining of shortness of breath. 
Ms. Winston says that she has had breathing problems “for years” but her breathing is getting worse. She tells the nurse that she gets short of breath with activity, adding that she can do things around the house for only a few minutes before she has to sit down to catch her breath. 
She says that she can sleep for only a couple of hours at a time. She sleeps best using two pillows to prop up, but on some nights she just sits in a chair.
Ms. Winston does not currently use oxygen, but she thinks oxygen would help. She admits to smoking 1.5 packs of cigarettes a day. She has never quit because she says she “just can’t do it.”
General survey: Alert and slightly anxious female, sitting slightly forward, with moderately labored breathing. Skin pale with slight cyanosis around the lips and in nail beds. Appears extremely thin.
Chest and lungs: Chest is round shaped and symmetric with increased AP diameter and costal angle greater than 90 degrees. Small muscle mass is noted over chest; ribs protrude. Respiratory rate is 24 breaths/min and labored. Chest wall expansion with respirations is reduced but symmetric. Sibilant wheezes are heard on expiration throughout lung fields. Lung sounds are diminished in lung bases bilaterally. Vocal sounds are muffled bilaterally.

QUESTIONS

Which data deviate from expected findings, suggesting a need for further investigation?
Which additional information should the nurse ask or assess?
Based on the data, what risk factors does Ms. Winston have for lung cancer?
 Which health care team member would you collaborate to meet this patient’s needs
SCIENCE
HEALTH SCIENCE
NURSING

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