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Nursing intervention - Case Study Example

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Denver (name changed to protect identity) is a 60 year old male who has a history of undergoing surgery for carcinoma of the colon. Despite liver metastases he has been managing well until he was diagnosed to have a pleural effusion. His breathlessness has been increasing over the past few weeks and comes to the clinic because his breathing is progressively getting worse…
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Nursing intervention Case Study
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Download file to see previous pages This essay focuses on the importance of a primary intervention strategy for a patient presenting to the clinic in a critical state of hypoxia. Taking the case example of Denver, we will discuss the presenting signs and symptoms, diagnostic and assessment tools specific to the problem and its severity and the intervention strategies to provide immediate relief and prevent morbidity and mortality. Here we specifically stress on the significance of Continuous Positive Airway Pressure (CPAP) and it's rational in this particular situation along with its description and effectivity in the management of a hypoxic patient suffering from Impaired Gas Exchange.
A patient with IGE has characteristic symptoms of visual disturbances, dyspnea, irritability, somnolence, restlessness and headache on awakening. Clinical manifestations may be in form of abnormal arterial blood gas levels, hypoxia; hypercapnia, tachycardia, cyanosis, abnormal skin color (pale, dusky), hypercarbia, diaphoresis, abnormal arterial pH and nasal flaring.Factors like ventilation-perfusion imbalance or alveolar-capillary membrane changes may also be related to the condition.
The primary goal of the management plan would be to demonstrate improved ventilation and adequate oxygenation as evidenced by blood gas levels within normal parameters for the patient concerned maintain clear lung fields and remain free of signs of respiratory distress and verbalize understanding of oxygen supplementation and other therapeutic interventions. Suggested NIC (Nursing Intervention Classification) plans are Acid-Base Management and Airway Management.
AIRWAY: Auscultate breath sounds every 1 to 2 hours. The presence of crackles and wheezes may alert the nurse to airway obstruction, which may lead to or exacerbate existing hypoxia. In severe exacerbations of chronic obstructive pulmonary disease (COPD), lung sounds may be diminished or distant with air trapping (Zampella, 2003).
BREATHING: The second step would be to monitor respiratory rate, depth, and effort, including use of accessory muscles, nasal flaring, and abnormal breathing patterns. Increased respiratory rate, use of accessory muscles, nasal flaring, abdominal breathing, and a look of panic in the client's eyes may be seen with hypoxia.
CIRCULATION: Monitor oxygen saturation continuously using pulse oximetry and note blood gas results for diagnostic and comparatative reference. An oxygen saturation of less than 90% (normal: 95% to 100%) or a partial pressure of oxygen of less than 80 mm Hg (normal: 80 to 100 mm Hg) indicates significant oxygenation problems (Berry and Pinard, 2002; Grap, 2002).
DISABILITY (CNS DYSFUNCTION): Next, observe and assess the patient's behavior pattern and psychological status for the onset of restlessness, agitation, confusion, and extreme lethargy that may occur in later stages. Changes in behavior and mental status can be early signs of impaired gas exchange (Misasi and Keyes, 1994). In the late stages the client becomes lethargic and somnolent.
EXPOSURE: Observe the skin colour and tone and look for signs of cyanosis, especially note color of the tongue and oral mucous membranes. Central cyanosis of the tongue and oral mucosa is indicative of serious hypoxia and is a medical emergency. Peripheral cyanosis in the extremities may or may not be ...Download file to see next pagesRead More
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