Hyper Secretion of Mucus Results in the Production of Sputum - Essay Example

?Care delivery intervention essay This essay will focus on respiratory care given to a patient during my practice placement on a high dependency ward(HDU). I will reflect on how I conducted a systematic assessment and will discuss the importance of assessing and maintaining a client’s airway. Whilst demonstrating an understanding of nursing care given to a patient upon an accurate interpretation of assessment data. To respect confidentiality, all names have been changed to meet the Nursing and Midwifery (NMC) Code of conduct (2008). John is a seventy two year old gentleman who suffers from depression. He was admitted into High Dependency Unit (HDU) following a PR bleed. John has a history of previously smoking for 28 years and stopped when diagnosed with chronic obstructive pulmonary disease (COPD) and has had asthma since he was a teenager, which is being treated with inhalers. John’s airway, breathing, and circulation were checked on arrival to identify any actual or potential problems. These observations are taken on admission as an initial assessment and management of a patient during their stay on HDU. They provide a baseline for future comparison, to monitor the patient condition during treatment and to monitor the patient’s response to treatment or medication. Whilst on HDU, John started developing respiratory problems like shortness of breath (dyspnea) with a raised respiratory rate 33 along with low oxygen saturations 88% (hypoxemia). Hypoxemia may lead to anxiety, dyspnea, and a reduction in oxygen saturation. The effect of a lowered cardiac output, poor circulation, and potential lung dysfunction may cause a drop in oxygen to tissues affecting other organs, which is why I will administer 2L of oxygen to Jack via nasal cannula. I, then, went on to assess John’s circulation where I found his skin color, capillary refill, and fluid balance to be normal. His blood pressure was slightly raised 180/120. John’s temperature was 37 and I found his skin to be slightly moist. John pulse was 88, strong and bounding, following a sinus rhythm. Disability was assessed next and I found John’s Glasgow Coma Score (GCS) to be 15/15 and he was alert. His blood glucose was normal; however his pain score was 7/10 so I administered some analgesia. On assessing exposure, I found no rashes, wounds or bruising which was noted on the water-low score chart. John did however have a cannula in his left hand which I mentor just inserted. He explained that he had eaten breakfast in the morning before the incident and his bowels were open the previous night. His abdominal assessment was normal, soft, and tender. Lastly, family was assessed and I found that John had no allergies, and his wife did not know he had been admitted, so after the assessment I phoned his wife and informed her about John’s admission. Upon this acknowledgment, his wife started visiting him frequently, but no positive effects of the visits were noticed in John. No side effects of Morphine were detected upon immediate assessment, but later on certain negative symptoms were noticed. Opioids or Narcotic Analgesics are known to cause respiratory depression and further complications in some cases. The symptoms which were seen in John, included agitation, insomnia, and mood changes which were triggered due to his previous history of depression (McNicol, E.,2007, p.2-4). Further accounts of side effects like itching, swelling, and difficulty in swallowing suggested that Morphine was not a suitable analgesic for the patient. After assessing the symptoms, evaluating previous medical history, and calculating any other factors which could have been responsible for these complications in John's health, it was devised that some other suitable analgesic should be used for his treatment (Bassett and Bassett, 2004, p.98-103). Naproxen, which belongs to the NSAIDs or Non-steroidal Anti-Inflammatory Drugs, was used instead to relieve John's pain as chronic pain is a significant problem related to COPD. As opposed to Narcotic Drugs, NSAIDs do not cause major contradictions with the health of patients suffering from severe COPD (Hilbert et al., 1998, p.1349-1353). Thus, the change in analgesia was received without any complications by the patient's body. Out of the symptoms caused by the previous analgesic, Morphine was not detected this time and the restlessness caused by it was overcome. According to drug charts of the prescribed analgesic, 500 mg of Naproxen is equivalent to 3.6 g of ASA and peak plasma levels of Naproxen anion are achieved after 2-4 hours. Moreover, the medication guidelines state that prolonged and excessive use of this drug may cause heart problems, thus it should never be used before or after CABG (Best Buy Drugs, 2011, p. 13-17). Even though the analgesic was changed and the symptoms subsided eventually, the soreness of the throat was exacerbated. John started suffering from an asthma attack which he was previously prone to during periods of severe influenza and extreme coughing. The pulmonary resistance faced due to Morphine was discerned as the cause of the asthma attack (Fulmer, T. et al., 2001, p.221-234). As inhaled corticosteroids used for abating an asthma attack become less effective in the elderly, and many at times worsen the condition due to side by side use of pain relievers and analgesics, it was not advisable to use them in John's condition. To control the asthma attack, aerosolized beta-agonized medications were used by the help of a Nebuliser. A face mask was attached with the Nebuliser to ensure a continuous supply of medication in the form of a mist spray (Pierson, 1996, p.439- 452). This was highly beneficial in the case of John as he had lost the power of movement and a Nebuliser with a face mask allowing John to passively receive the medication properly. As common with patients suffering from Asthma, the suffering person is engulfed by a coughing fit. Due to John's condition and various ailments, mainly COPD, the airflow obstruction caused results in severe coughing periods, in which the blood capillaries lining the pharynx might rupture and bleeding may occur. Pulmonary hyperinflation is another problem caused as a consequence of this ailing health (Schutz,S.,2001, p.1-5). Due to a history of prolonged smoking of nearly 28 years, John's respiratory tract is severely damaged. Moreover, reports have shown a case of irreversible damage to the alveoli and cilia of the patient. Excessive smoking on the patient's part led to this damage of the air and bronchial sacs; this complication has made it even more difficult to breathe properly as diffusion is not taking place effectively (Aronson, J., 2010, p.200-203). This condition is worsened by the asthma John has had since his teenage years. All these respiratory track and bronchial problems have made John more susceptible to coughing diseases. The constriction of bronchial airways caused by the asthmatic attacks and chronic obstructive pulmonary disease is caused and as a result a wheezing sound is produced by the obstructed air pathway. Along with the audible wheezing cough, labored and heavy breathing was noticed with perspiration and cold chills. This wheeze was accompanied by mucus or phlegm secreted by the constricted bronchial tubes and yellow colored sputum. This is released by the tubes as a secondary reaction to soothe the irritation, caused by the harmful irritants and to cease the inflammation and swelling caused in various regions of respiratory tract due to prolonged coughing and wheezing (Maj et al., 2003,p.2134-2140). This constriction of the airways also hinders in the proper diffusion of respiratory gases i.e. oxygen and carbon dioxide. There is a decreased degree for the diffusion of carbon monoxide also, which is due to the complications caused by COPD. Medications were used to ease the irritation caused by the prolonged coughing. To ensure the opening and dilation of the airways to reduce the wheezing, a bronchodilater inhaler Albuterol (Proventil HFA, Ventolin HFA) and Levalbuterol (Xopenex) was given to John by the help of a Nebuliser. Another medication; Zafirlukast (Acle Colate) was sprayed to soothe the inflammation and stop the secretion of uncontrollable phlegm and dry mucus (Morice, A., 2004, p.481-492). For the appropriate triage and treatment of a patient suffering from COPD, it is essential to make a timely assessment consisting of pathophysiologic changes in the respiratory tract and previous medical history. These include physical examinations such as progression and presence of Dyspnea, exposure to noxious substances, and frequency and duration of coughing etc. Thus John's physical assessment was carried out to which showed an increase in mean inspiration flow, dead space ventilation, minute ventilation, oxygen and carbon dioxide ventilation equivalents, and reduction of pulse oximetry. Inspiratory flows were monitored by Spirometry techniques and instruments. The increased values showed that John's breathing patterns are not normal. Assessment showed non-uniform ventilation resulting in alveolar dead space. Furthermore, Changes in ventilation efficiency in John were found to be correlated with decreased respiratory times, lower oxygen uptake and reduced diaphragmatic movement (Gradon and Marijnissen, 2003, p.23-57). As stated by Baillie (2001), a decrease in movement and ventilation causes a reduced stimulation of coughing. So, in order to eliminate any further risks of coughing or wheezing, John was given medications immediately to ease the coughing. High friction activities like heavy breathing, wheezing, coughing, and movements which require high energy or even low energy movements in the case of patients suffering from severe stages of COPD, such as John, obstruct in the way of proper ventilation required for the healthy functioning of a body. A pulse oximeter was used to monitor the oxygenation of John's blood, this examination showed that the oxygen saturation level of his blood was low. As mentioned above, John's airways are already constricted due to his asthmatic condition and sufferance of COPD which is exacerbated by a previous history of excessive chain smoking (Kelly et al.,1996, p.489-493). Under normal circumstances, air travels through the naval cavities at a speed of 8 km/h but due to the constriction of airways caused by audible wheezing and coughing, proper ventilation does not take place. Due to coughing, air rushes out of the respiratory track at the speed of 120-160 km/h. This exhalation is more than the amount of air inhaled, thus a sudden loss of carbon dioxide is produced in the body due to inappropriate and poor ventilation. This causes alveolar hypocapnia and bronchospasm, as well as increased mechanical friction in the airways. These complications can result in serious problems in someone with John's medical condition and history as prolonged poor ventilation can be fatal for him. Constriction of airways can result in inefficient diffusion resulting in less amount of oxygen being transferred in the body which might cause hypoxia (Sin et al., 2006, p.44-50). Thus, it was of utmost importance to restrict the body movement of John as they exhaust him causing serious ventilation related problems. If timely action is not taken and medication and treatment is not provided properly, then there is a crucial need of intubation and mechanical ventilation to supply the required quantity of respiratory gases needed by the body. It was ensured that there were no exhaustive movements performed by him so this does not stress his respiration process. But this, ultimately leads to a buildup of secretions in the bronchi and bronchioles, which can become infected causing a chest infection (Barnes et al., 2008, p.569-581). According to Alfageme (2006) Flu vaccines are highly beneficial in this case as they are known to lessen the exacerbations of COPD. The build-up of secretions and mucus, along with the chest infections can be cured by these vaccines. Thus, these problems caused by the primary treatment can be eliminated. Especially vaccines against the bacterial organism pneumococcus are known to cure this condition effectively. John's oxygen saturation level was measured when he was suffering from a wheezing fit. Due to the constriction of bronchioles at that time, the oxygen level dropped as low as 87%. People suffering from COPD are known to have Tachycardial problems as well and they frequently suffer from high blood pressure and high pulse rate. John’s pulse rate was measured at that time and it was 132/minute. His blood pressure was also raised significantly. After proper medication and uninterrupted ventilation all these factors turned back to normal after a while, indicating that he is not in a danger of Tachycardia or Hypertension unless it is triggered by heavy breathing, coughing, or wheezing (Pierson, D., 2000, p.39-42). This states that John is not in real danger except if or until, he is involved in exhaustive movements. These coughing fits cannot be eliminated completely due to his poor health but they can be controlled to a certain level so that his condition is not exacerbated. In case of Hypoxemia, a patient is provided with oxygen through mechanical ways. The most commons methods include providing oxygen via a nasal cannula and face mask etc. When the oxygen saturation level in John's hemoglobin dropped acutely low, due to the obstruction in ventilation, which ultimately resulted in poor diffusion of oxygen, he was given oxygen via a nasal cannula. This method is more efficient and effective than any other technique of providing a patient with oxygen. Supplemental oxygen was previously thought to be detrimental for patients suffering from COPD but recent studies show that supplemental oxygen reduces oxidant molecule levels and inflammatory cytokines by supporting normal metabolism and by implementing the prevention of stress-induced oxidant molecules from being produced. Thus, supplemental oxygen is another technique through which the medical condition of John could be improved (Hanania and Sharafkhaneh, 2010, p.12-45). Hyper secretion of mucus results in the production of sputum which is usually infected in the case of COPD patients (Bouros , D. and Pneumatikos , I., 2007, p.13-14). A sample specimen of John's sputum was collected to be examined so it could be established whether it is infected or not. John was instructed to inhale deeply for 2-4 times, cough up deeply and spit in a sputum container. It was made sure that the sample sputum was thick, purulent and in sufficient quantity (about 2-3 ml). It was yellow and slightly light brown in color. The specimen were examined through various methods of sputum microscopy and the sputum culture was found to be positive (>107 CFU/ml). The isolated species responsible for the sputum infection were Haemophilus influenza, Streptococcus pneumonia, and Moraxella catarrhalis. References: Aronson, J. (2010) Side Effects of Drugs Annual: A Worldwide Yearly Survey of New Data and Trends in Adverse Drug Reactions. Elsevier, p.200-203 Baillie, L. (2001) Developing Practical Nursing Skills. London: Arnold, p.132. Barnes, P. et al. (2008) Asthma and COPD: Basic Mechanisms and Clinical Management. 2nd ed. Academic Press, p.569-581 Bassett, C. and Bassett, C. (2004) Nursing Care: From Theory to Practice. Whurr, p.98-103. Best Buy Drugs (2011) NSAIDs Compared. Consumer Reports Health , p.13-17. Bouros, D. and Pneumatikos , I. 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(2007) 'Pharmacotherapy, Opioid, NSAIDs, adjutants and analgesics equivalent.' Clinical Pain Problems, 13 (3), p.2-4. Morie, A. (2004) 'The Diagnosis and Management of Chronic Cough'. European Respiratory Journal , 24 (3), p.481-492 Pierson, D. (1996) 'Complications of mechanical ventilation: a bedside approach'. Clinics in Chest Medical, 17 p.439-452 Pierson, D. (2000) 'Pathophysiology and Clinical Effects of Chronic Hypoxia'. Respiratory Care, 45 (1), p.39-42 Schutz, S. (2001) 'Oxygen Saturation'. American Association of Critical-Care Nurses, 23(2) p.1-5. Sin, B. et al. (2006) 'Differences between asthma and COPD in the elderly'. The Journal of Investigational Allergology and Clinical Immunology (J Investig Allergol Clin Immunol), 16 (1), p.44-50 Read More