Plan of Care: Medical-Surgical Nursing - Assignment Example

Plan of Care Assignment: Medical Surgical Nursing 2 A: Assessment 1. a) What signs and symptoms indicate to you that Jenny has moderate to severe asthma? 1. a) The signs and symptoms that indicate that Jenny has moderate to severe asthma are the increased frequency in acute asthma of about once a week, the triggers of exercise, stress and anxiety and the presentation of the patient with laboured breathing (Boushey, 2005). 1. b) What other assessments/observations may you as a nurse undertake to help determine the severity of Jenny’s asthma? 1. b) The other assessment/observations that may be included are making an assessment of the known allergens and medication being used; making an assessment of whether Jenny indulges in smoking or whether she is exposed to cigarette smoke at home or in the school environments; making an assessment of the frequency and regularity of medical check ups; observing for signs of allergic rhinitis, as it occurs frequently with asthma and has an impact on the management; using spirometry to assess the severity of asthma and the extent of asthma control from medication used and a chest x-ray assessment to rule out the possibility of pneumonia, as Jenny is just recovering from an attack of influenza (Asthma Management Handbook). 2. What signs and symptoms indicate to you that Jenny has dyspnoea? 2. The signs and symptoms indicative of Jenny having dyspnoea include laboured breathing, upright sitting position, anxiety, heart rate of 104 bpm, respiratory rate of 32 per minute and SpO2 of 92% in room air (Indelicato, 2006). B: Nursing Issues 1. Identify for Jenny a) Three actual issues/problems 1. a) The three actual issues or problems that Jenny has is the dyspnoea that she is suffering from as a result of asthma, the poor control of asthma in spite of the use of a bronchodilator and inhaled corticosteroid, and the weakening of the respiratory system, a result of the recent attack of influenza (Fleming, Wilson & Bush, 2007). b) Two potential issues/problems 1. b) The two potential issues/problems that Jenny faces are the possibility of the moderate to severe asthma that she has progressing to near-fatal asthma, if her current condition is not managed properly (Restrepo & Peters, 2008) and the possibility of the development of psychological disorders like anxiety and depression that could aggravate the asthmatic condition further (Fleming, Wilson & Bush, 2007). C: Nursing Plan of Care: a) Jenny has dyspnoea. Identify three nursing actions (interventions) that aim to improve dyspnoea. a) Three nursing actions or interventions that are aimed at improving dyspnoea in Jenny are clearly assessing the level of dyspnoea; implementing non-pharmacological interventions in the management of dyspnoea; and communicating with the patient on the condition of the patient and steps being taken to alleviate the condition and educating the patient on the proper use of the medications (Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)) b) Give a clear rationale for each action/intervention b) Dyspnoea is a subjective experience that is encompassed by physiological and psychological factors. Interventions to alleviate this subjective experience, including therapeutics and other interventional supports, depend on a clear understanding of the level of dyspnoea. This clear understanding calls for the use of objective tests like pulse oximetry and pulmonary function tests for objective assessment of the physiological factors and subjective assessment of dyspnoea using an analogue scale or a numeric scale to provide. It is this clear understanding of the physiological factors involved in dyspnoea and the subjective experience of the patient that provides clarity in the interventions needed to provide satisfaction in the care provided in alleviating dyspnoea (Indelicato, 2006). Besides administration of pharmacological interventions as prescribed by the clinicians, there are non-pharmacological interventions that can be put in place by the nursing professional. The rationale for this lies in it being a simple means to provide relief to the patient. These steps include teaching the patient on the use of pursed lip breathing. Pursed lip breathing increases the amount of air moving out of the lungs and enhances air pressure, which results in maintaining an open airway. Encouragement of the patient to breathe slowly reduces the effort required for breathing and enables more efficient breathing. Enhancing the environment to lessen the experience of breathlessness and helping the patient to cope with the emotional component of dyspnoea that leads to anxiety and exacerbates the feeling of breathlessness. These steps complement any pharmacological interventions put in place (Indelicato, 2006). Informing the patient of their condition enables the patient to understand better the difficulty that is being experienced and communication of the interventions planned enables the patient to understand the implications of the management strategy and hence gets their cooperation. Oral and inhaled medications are an essential part of the pharmacological approach to the treatment of dyspnoea. The oral drugs include opioids and anxiolytics, while the inhaled medications include anti-inflammatory drugs and bronchodilators. Many patients are not conversant with the proper use of the inhaler devices and nebulizers involved in the taking of inhaled medications. In case these inhaler devices are not used properly it could lead to suboptimal drug delivery and poor relief from symptoms that the patient is experiencing, leading to dissatisfaction in the treatment regimen (Scarpaci, Tsoukleris & McPherson, 2007). c) Briefly and clearly describe one nursing research study that has investigated the management of a person with asthma c) The research article chosen is Yang et al, 2005, Effects of nursing instruction on asthma knowledge and quality of life in schoolchildren with asthma. Asthma in children is frequently encountered, which has a detrimental effect on the quality of life of these children. Nursing instruction and education efforts targeted at school children have been considered as a means to enhance the knowledge of asthma among school children and through that improve the quality of life of these children. The aim of the research undertaken by the authors was to investigate the premise that nursing instruction efforts improves the knowledge and quality of life among schoolchildren. The authors used a quasi-experimental design for the purposes of the study. School children with asthma were included in the study. These children were divided into two groups consisting of the control group and the test group. The control group was provided with no nursing instruction on asthma, while the test group was provided with nursing instruction on asthma. Data required for the study was collected by the means of two key instruments, which were the Asthmatic knowledge Questionnaire and the Childhood Asthma Questionnaire, which were administered prior to the nursing instruction effort and after the nursing instruction effort. The data collected through the questionnaires was collated and statistically analysed for significant factors and correlation. Statistical analysis of the data provided the results that showed that the children in the test group, who had received instruction from nursing professional showed a significant improvement in their knowledge of asthma (mean pre/post test = 22.20/31.87, p Read More