Problem: A 72-year-old male arrives at the emergency department complaining of shortness of breath for the past four days. He states; "the shortness of breath is getting worse", "Now it's happening even when lying down and with minimal exertion". He complains of a night time cough. The patient also reports increased swelling in his legs bilaterally. He states, "My feet are so swollen I cannot wear my shoes, so I had to come here in my slippers." He also complains of increased weight, particularly in the abdomen and around the waist. When asked how long the swelling had occurred, he reports he started "to gain weight about three weeks ago after the doctor took me off my Lasix." The patient has a history of hypertension, chronic renal insufficiency, and chronic respiratory infections. He has recently complete a round of Rituximab for follicular CD20-positive non-
Hodgkin's lymphoma.
Assessment findings:
His vital signs are as follows: BP 210/105, HR 118, RR 26, T 98.2. The patient has rales in the lung bases bilaterally and 2+ pitting edema in the lower extremities bilaterally. The patient is in no acute respiratory distress but states he feels better if he sits up. His oxygen saturation is 94% on room air.
Instructions: Using the DECs and the AACN Baccalaureate Essential for Professional Nursing Practice IX to this case, describe how the plan of care for this patient by an associate degree nurse and a baccalaureate-prepared nurse should differ. Which assessment findings would each nurse identify and what interventions would accompany each