Physicians visiting patients at home

Mr. Charles Lamont is a 45-year-old patient who is visiting his primary care physician for his an annual checkup. His wife is waiting for him in the lobby; she is hoping that Mr. Lamont will tell the physician about his recent bout of coughing and shortness of breath. Mr. Lamont works for a construction company as a heavy machine operator. He smokes 1½ packs of cigarettes per day. His wife has been encouraging Mr. Lamont to stop, but he has not showed any interest in quitting. Laura, the registered nurse, takes Mr. Lamont to an examination room. Laura asks him about his overall health and he tells her about a nagging cough and how he sometimes feels short of breath. He then denies any other health problems. Laura takes Mr. Lamont’s vital signs and gets the following results: blood pressure 156/94 mm Hg, temperature 99.8° F orally, apical pulse 104 beats/min, respirations 25 breaths/min and regular, and pulse oximetry 95%.

1. Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which of the results are abnormal. What are Laura’s findings? What would be normal for any of these that are not normal?

1. The primary care physician examines Mr. Lamont and tells him he should quit smoking. He gives him an antihypertensive medication to help lower his blood pressure. Mr. Lamont asks Laura if she can teach his wife how to take his blood pressure. Laura agrees and brings Mrs. Lamont in to explain the process. Laura decides that she will use demonstration to teach Mrs. Lamont the procedure, but she also wants to explain some important concepts. What should she include? Select all that apply.A. Choose a cuff that is the right size.
   B. Ensure that the patient is sitting or lying.
   C. Support the extremity.
   D. Ensure proper cuff application.
2. Mr. Lamont tells Laura that he doesn’t understand how smoking could influence his blood pressure. How should Laura respond?
3. Mr. Lamont tells his wife that the physician told him his respiratory rate was increased. Mrs. Lamont asks Laura what could cause him to breathe faster. What factors could cause his increased respirations? Select all that apply.A. Smoking
   B. Medications
   C. Increased activity
   D. Pain