Assignment task: James White, a patient with an exacerbation of chronic obstructive pulmonary disease (COPD), is on your medical-surgical unit. You need to obtain his vital signs and give him a bath. His vital signs at 0800 were as follows: temperature, 98.4°F; pulse, 86 beats/min and regular; respirations, 18 breaths/min; blood pressure, 130/68 mm Hg. The physical therapist who is working with this patient on conditioning therapy has just brought him back from his exercises. You notice that his breathing is labored, with audible expiratory wheezes. While you are obtaining his oral temperature and vital signs, you continue to hear audible expiratory wheezing. His vital signs now are as follows: temperature, 96.8°F; pulse, 106 beats/min and irregular; respirations, 26 breaths/min; blood pressure, 140/74 mm Hg.
Prescribed Interventions
Daily physical therapy for conditioning
Oxygen at 2 L via nasal prongs prn for pulse oximetry <90%
Vital signs q4h
Oxygen saturation levels via pulse oximeter every shift and prn
1. Did you take the second set of vital signs at the most appropriate time? Why or why not?
2. How has Mr. White's physical activity affected the accuracy of his vital signs?
3. What would be your course of action in response to his labored breathing?
4. Describe the timing and type of bath you think Mr. White requires and the degree of assistance he will need. Explain your rationale