Problem
Mr. Park is a 70-year-old retired man who was admitted to Sterling College Hospital last night with a diagnosis of COPDE and pneumonia.
Social History
Mr. Park emigrated from South Korea to Canada in 1980 with his wife. Together they ran a successful realty and property management business from 1982 to 2012. He is now retired and living with his daughter in Burnaby, B.C. He is financially secure. Sadly, his wife died two years ago after 45 years of marriage. Mr. Park used to be very involved with the local Korean business association and was a pillar of the community. He now enjoys playing cards with his friends and watching sports but has been less involved with these activities for the last few months. He is not very physically active. Lately his daughter has noticed that he has a poor appetite.
Medical History
Mr. Park was diagnosed with COPD and HTN in 2011 and was started on antihypertensive medications and bronchodilators. He has used tobacco since he was a young man. Since his diagnosis, he has cut down his smoking significantly. In 2014 he was treated for atrial fibrillation with an ablation procedure; however, this was not successful. He was put on a beta blocker for rate control. In the last few years, he has struggled with insomnia, and usually sleeps in his chair watching TV. He occasionally takes Zopiclone but doesn't like the way it makes him feel in the morning.
Over the last 2 weeks he has been experiencing increased SOBOE, fatigue, and a loss of appetite. Yesterday, his daughter noticed he was struggling to breathe while sitting in his chair and that he seemed disoriented. She brought him to the ER where his vital signs were: BP 145/85 HR 70 Temp 37.5 Sp02 86% RR 26, GCS = 14.
After a CXR he was diagnosed with COPDE and pneumonia. He was admitted to the medical ward.
Night shift report:
Mr. Park remains very SOB, increased upon exertion. Requiring 3-4L 02 via NP. Wheezes throughout lung fields. Coarse crackles to mid-upper fields. Thick yellow sputum. Please encourage coughing. Required 3 x rescue inhaler treatments. BP remains elevated at 154/88. HR: 67 irreg. Temp: 38.0. Sp02: 89% on 3-4L 02 via NP. RR: 28.
Slept very poorly but didn't want to take Zopiclone. Flat affect. Minimal fluid intake overnight. Voiding qs per urinal, but urine is concentrated. CXR scheduled for this morning at 0830. Blood samples were drawn at 0630 for ordered lab tests. Daughter says will visit today after work. She wants him to stop smoking before he comes home.
Task
List 10 of your assessments in order of priority and follow the table.