What email address or phone number would you like to use to sign in to Docs.com?
If you already have an account that you use with Office or other Microsoft services, enter it here.
Or sign in with:
Signing in allows you to download and like content, and it provides the authors analytical data about your interactions with their content.
Embed code for: 試題一 鄭依姍
Select a size
試題 1 ：■醫院□居家□機構□日照
Mr. Lee is a 65 year-old moderately obese male who lives with his wife. He had a myocardial infarction and four-vessel coronary artery bypass surgery 3 years ago and had been asymptomatic following surgery. Mr. Lee is a former smoker, having smoked a pack a day until 2015. Over the last 3 months, he has developed shortness of breath during average daily activities. He was admitted two days ago due to his worsening cough, and shortness of breath (dyspnea), and swelling ankles was also noted.
李先生是一位 65 歲的中度肥胖的男性並與他的妻子住。他 3 年前有心肌梗塞四條血管有做過冠狀動脈繞道手術，而在手術後已無再次發作過。李先生以前曾有煙癮，在 2015 年以前他每天都抽一包。在過去的 3 個月，他常常在活動時都會感到呼吸短促。由於，前兩天他咳嗽的情形加重、呼吸急促（呼吸困難），外加上他的腳踝有腫脹的情形，因此入院治療。
Today, Mr. Lee complained of dyspnea. His blood pressure was 108/58 mmHg with an irregular pulse of 140 beats/min, respiration rate 30 breaths/min, 4+ pitting edema, and minimally cyanotic nail beds. Echocardiography defined congestive heart failure (CHF). An immediate treatment plan was ordered by the doctor, including O2 by cannula at 2 L/min prn, medication for CHF, fluid restriction to 1.5L per day, and low salt diet to prevent further heart failure complications.
今天，李先生抱怨呼吸困難的情形。他的血壓為 108/58 毫米汞柱，他的脈搏十分不規則為 140 次 / 分，呼吸頻率 30 次 / min ，水腫為 4+ ，以及指甲床有些微發紺的情形。心臟超音波顯示他有充血性心臟衰竭（ CHF ）。他的主治醫師給予他的即時醫囑為使用鼻套管 2 L/min ( 需要時給予 ) ，服用心衰竭的藥物，並且他被限制液體攝取每天只能攝取 1.5L 和低鹽飲食，以預防有心衰竭的併發症。
Your tasks: 621435
Educate Mr. Lee regarding heart failure. 給予李先生心衰竭之衛教。
Assess Mr. Lee’s symptoms of heart failure. 評估李先生心衰竭的症狀。
Educate Mr. Lee regarding his medication. 教育李先生他的心衰竭用藥。
Educate Mr. Lee regarding diet control for heart failure. 衛教李先生適合的飲食
Advise Mr. Lee what kind of activities and exercise he should engage in daily.
Check Oxygen Saturation by pulse oximeter.
N: Hello, Mr. Lee. I’m nurse YI-SHAN, CHENG. I’ve heard that you didn’t feel well today, right?
N: How do you feel right now?
N: I see. Mr. Lee now I’ve to check your oxygen in your body by the pulse oximeter. Can you please give me your hand?
N: Mr. Lee the oxygen level in your body is XX ％ , it’s a little bit low, do you feel any uncomfortable right now? I can see you have short of breath, So I suggest you should your cannula to breath, also I’ll let your body to sit up for a little bit higher that can help you to breath much easier.
N: Mr. Lee if you feel some symptoms like dizziness, nausea and headache and it became more serious that mean you don’t have enough oxygen in your body, please tell me, and I’ll be stand by you.
N: Mr. Lee according to your Echocardiography defined that you have congestive heart failure, and also the symptoms you have these days especially today it’s not stable, so now I am going to do some assessment to see if there are any symptoms of heart failure.
N: I knew you have developed shortness of breath during average daily activities for over the last 3 months. Does it get better when you take a breath or sit up for a little bit higher like we do just now? Do you have some others symptoms? Like dizziness, nausea or want to throw up (vomit)? Do you feel tired all the time?
N: Also I knew you have cough these two days and it have become more serious, do you cough up with sputum? What’s the color? Do you have palpitation which means you can feel your heart is beating too hard or too fast? Do you have difficulty voiding ？ May I look for your nail bed to and your leg to know do you have edema or cyanosis?
N: Mr. Lee all the symptoms you have has to do with heart failure. Can you tell me how much do you know about heart failure?
N: Mr. Lee, we are going discuss about what the heart failure is. If you have any question you can ask me, and I’ll do my best to help you.
N: Heart failure is a chronic, progressive condition which means your heart muscle is unable to pump well.
N: The normal heart has strong muscular wall which contract to pump blood out, but when you have heart failure your muscle in the heart wall be slowly weaken and lose its ability to pump blood.
N: So your heart must use more energy to pump the blood out, and your body will be focus on your heart and lose sight of the other area blood volume, then your body need to keep your blood , and the retained water will get increase and cause you have edema right now.
N: Most often there’s swelling in your legs and ankles, but it can also happen in other parts of the body. When the fluid collects in the lungs and interferes with breathing, causing you have short of breath these days.
If you watch carefully, you'll find out it happen especially when you’re lying down, but when you sit up for a little bit higher you will feel much better.
N: There is many reason make heart failure happen. As I know, you have surgery 3 years ago because of myocardial infarction, but do you know it is one of the reason that makes heart failure happen.
N: That’s because when an artery that supplies blood to the heart muscle gets blocked, then your heart won’t be able to get the oxygen and nutrients, and the damaged heart will be weaken and lost its ability to pump blood.
N: Your physician has prescribed some medicine to control your disease, but do you know? Take medicine is not the only way to control, you can also control it by your diet, exercise, and life style, and I’ll introduce for you one by one. If there is anything you don’t understand you can ask me, and I’ll do my best to help you.
N: So let’s talk about your medication. As I know, you use *** to control you disease. Do you know what is it for?
N: Do you still have any question about your medication? Okay, so let talk about your diet. The treatment by physician says the fluid restriction is to 1.5L per day, and also you have to have low salt diet. Do know why?
N: That because there is too much water in your body that cause you have edema, so you have to drink less and eat the salt less that can help you to let the water in your body get less, too!
N: Can you tell me what kinds of food do you eat the most? Okay, I see. So we’ll going to talk about is it suitable for you or not. People can eat for 6 gram of salt a day, but for you have eat less 6 gram. You can eat many kinds of food to get the nutrient you need for a day like protein, vegetables, and fruit.
N: Do you like to bread or rice? For the bread and grains you can eat 6 or more serving for a day, such as low-sodium bread/cereals/bagels or you can eat 1/2 (one-half) cup of rice.
N: Are you a vegetarian or you can eat meat? What kind of meat do you eat the most? For protein you can eat 2-3 serving a day, like 1/2 cup of dried beans or low-sodium fish such as salmon or you maybe you can eat an egg or you can eat 2-3 ounces of beef/chicken/lamb/pork.
N: For vegetables and fruits you can eat 5 or more serving a day. You can eat 1/2 cup of fresh or frozen vegetables without added sauces or low-sodium tomato sauce or fresh or frozen, canned or dried fruits.
N: For dairy you can eat 2 or more serving a day and I suggest you can eat naturally low-sodium cheese or a cup of milk/soy milk. The most important one is fat and oils you can chose low-sodium butter or vegetable oils.
N: Do you have any question about your diet? If you afraid that you will forget the detail, I’ll give you the information sheet next time.
N: Let’s talk about your exercise. Doing exercise can help you to strengthen the skeletal muscles. Mr. Lee do you do exercise in your daily life? What kinds of exercise do you do the most? As I know you will feel uncomfortable during daily activity, also you feel uncomfortable when you lying on the bed like today.
N: So I’ll suggest you can do some exercise on the bed, but remember to sit up for a little bit higher. For example, you can do strengthening exercise such as strength your arm and ankle or knee. You can do exercise for about 20 to 30 minutes for once, and at least 5 times a week, but if you feel any uncomfortable please take a rest. Is that okay for you?
N: Now we are going to discuss about your life style. As I know you have already quit smoke for one year that’s good for you, please keep it.
N: (if he ask why: That’s because smoking will affects the oxygen carrying ability of the blood. Therefore, the heart has to work harder to supply the body with adequate oxygen.)
N: Do you have any question about control your life style?
N: How do you feel right now, do you feel better?
N: Do you have any problems you need to ask me?
N: Can you tell me two tips that you remember about ….
N: If you need any help you can ring the bell then call me, and I’ll do my best to help you. Bye~
N: wash hands.ully, you'll find out it happen especially when you’re lying down, but when you sit up for a little bit higher you will feel much better.
N: (if he ask why: That’