Managing Low Oxygen Saturation and Other Fundamentals of Nursing - Assignment Example

Case Study Name Institution Date Case Study Q1 There are some considerations that a nurse should take in order to facilitate priority setting for patient load. For instance, there is triaging patients in terms of severity of their conditions. First degree patient problems involve problems that are threats to the safety or immediate survival of a patient and call for urgent nursing intervention (Standing, 2008). This is why Phillip in case study 3 will require the first priority because his oxygen saturation level is 94%, which is below the normal oxygen saturation level that is between 95 to 99%. Low oxygen level is considered a threat to the patient as it may compromise body organ’s function, like the heart and brain, hence needs to be addressed promptly (Dirksen, 2011).Priority will focus on maintaining ineffective tissue perfusion, impaired gas exchange, ineffective airway clearance and any anxiety that may arise. Continued low levels of oxygen may result in cardiac or respiratory arrest. The major objective when managing low oxygen saturation is giving sufficient oxygen to make sure that the patient, in this case Phillip is safe and his condition does not deteriorate. On the other hand, while providing too little oxygen may lead to hypoxia, which may lead to death, excess therapy of oxygen can as well be dangerous for a couple of patients. Hence the nurse should assess and monitor oxygen therapy. Additionally, Dirksen (2011) states that a lot of patients that have COPD need controlled therapy of oxygen since there is a possibility that there will be retention of carbon dioxide and as a result develop respiratory acidosis that can be detrimental. The second level entails things such as acute pain, change in mental status, risk of infection, acute urinary elimination, untreated medical issues that require urgent attention (diabetic patient needing insulin), abnormal pathology lab outcomes, security or safety. Hence, the second priority will be given to Steven in case study 1 because he has fever and complains of abdominal pain following an emergency appendectomy. Stevens abdomen will be monitored frequently including his vital signs A fever, which is also referred to as a high temperature is by itself not an illness. It is normally an indication of an underlying condition, mostly an infection. Part of nursing care post-appendectomy is to watch for signs of fever as well as pain management (Carpenito, 2009). Intravenous infusion will also be maintained. Peter in case study 2 requires the third priority because he is complaining of nausea and mild right shoulder tip pain after endoscopic retrograde cholangiopancreatograghy. Nausea is mostly experienced post ERCP hence the patient should be monitored and the physician contacted. Normally, gallbladder conditions bring about right shoulder tip pain (Taylor, 2011).Peter pain level will be assessed and ordered medications will be administrated. The third level involve the problems that do not suit into the above named categories like monitoring for side effects of medication, patient with living activities problems, and poor patient knowledge (Carpenito, 2009). This is why John in case study 4 needs the fourth priority because he has been commenced on an IV heparin infusion and aspirin 100mg daily, hence maintaining the APTT between 50 to 75 seconds is important so as to identify any changes in terms of increase or decrease of APTT within the required range, or any side effects. Frequent vital observations will be maintained. Lastly Melinda is given the last priority because according to the GCS, she has a score of 15, which means that she is stable and hence her condition is not life threatening. Melinda’s observations will be monitored which includes neurological observations, and vital signs. This will help the nurse to establish any deterioration in the patient’s condition. Q2 Collaborative care involves various health providers working together with their patients and families to deliver excellent care. It entails engaging any provider of health whose knowledge can assist improve the health of a patient (Taylor, 2011). With regards to the case study, since the nurse is part of the interdisciplinary team, it is imperative that he or she communicates effectively with other team members, in this case the physician or the nurse in charge. The nurse should contact the physician for important matters that cannot be left pending until the next round, like persistent nausea and no antiemetic is ordered (Dirksen, 2011). The physician can then give a go ahead of ordering an antiemetic for the patient. Taylor, (2011) contends that the nurse should only accept telephone orders when circumstances need it and there is lack of other rational options. The organizational policy for accepting as well as recording such orders should be followed. Telephone orders are likely to be more prone to error compared to written orders because of the introduction of various variables absent when orders are done directly by the person prescribing (Taylor, 2011). There is the possibility of misinterpreting spoken language due to pronunciation or accent. Therefore, communication should be very clear and effective so as to avoid any preventable incidence. Effective communication is considered an art, although in current fast-paced arena of patient care, it is vital (Dirksen, 2011). Every member of the care team has a crucial role in outcomes of a patient, and creating an inclusive care plan necessitates that every discipline communicates recommendations effectively (Taylor, 2011). Q3 Berry et al (2010) state that therapeutic unfractionated heparin’s I.V administration is the most frequent reason for prolonged APTT in inpatients. During a prolonged APTT’s investigation like >150 seconds as seen in the case study, pre-analytical errors need to be ruled out first (Berry et al, 2010). The most frequent pre-analytical reason for a prolonged APTT is heparin contamination in a drawn sample from central or arterial line. Additionally, APTT is affected by altered ratio of plasma to citrate in blue top tubes of collection that might be seen with an elevated hematocrit (>55 percent), or a sample with a long or short draw (Berry et al, 2010). Other problems that are pre-analytical include formation of clot because of inadequate mixing, and dilution of a sample taken above an IV. Nursing implications during anticoagulant administration entail monitoring lab values before initiation and all through the therapy (Dirksen, 2011). APTT need to be maintained between fifty and seventy seconds. Heparin orders are frequently written for infusion rate adjustment based on the results of the lab. If not, the nurse should notify the physician once the APTT is not within the therapeutic range, so that there is adjustment of the dosage. Protamine sulfate is the overdose treatment (Berry et al, 2010). Since heparin is powerfully acidic, basically it is not compatible with several medications. Medication should not be mixed with heparin unless exclusively instructed by the physician or the pharmacist. Heparin’s abrupt withdrawal can lead to increased coagulability. According to Berry et al (2010) anticoagulants posses a narrow therapeutic phase of sufficient anticoagulation with no bleeding as well as a highly changeable dose response connection among people that need lab values’ monitoring. Q4 During observations’ taking, it is imperative for nurses to have the skills and knowledge to accurately carry out the assessment and to be able to identify and act suitably once clinical deterioration happens (Preston & Flynn, 2010). Nursing actions need to be guided by rationales that are evidence-based and can recognize abnormal and normal physiological parameters and offer a framework that suitable clinical judgment may be established, to decide when to call the physicians and with the extent of urgency (Taylor, 2011). Symptoms of lightheadedness, dizziness and fainting when standing up from lying down or sitting with a reduction in blood pressure may signify a condition referred to as postural hypotension and it is the initial indicator of hypovolaemia (Odell et al, 2009). A broad variety of underlying conditions might also bring about the symptoms. It is essential to identify the basis of hypotension so that suitable management can be provided. With regards to the case study, the patient is on nimodipine and its effects on blood pressure could be the cause of the patient’s hypotension. Hypotension is a typical late indicator of depletion in fluid (Odell et al, 2009). Nimodipine is administered for neurological outcome’s improvement through reduction of the occurrence and severity of ischemic insufficiencies in patients that have subarachnoid hemorrhage from the ruptured intracranial berry aneurysms in spite of their post-ictus neurological situation (Berry et al, 2010). Nimodipine is believed to have hemodynamic outcomes predictable of a calcium channel blocker, even though they are basically not marked. On the other hand, some of the unwanted consequences of nimodipine include hypotension, lightheadedness, dizziness, bradycardia, cardiac arrest, dizziness, and death. Clinically considerable hypotension as a result of nimodipine overdosage might call for active cardiovascular support using pressor agents. Definite treatments for overdose of calcium channel blocker need to be administered promptly (Berry et al, 2010). Blood pressure need to be monitored carefully in the course of treatment with nimodipine on grounds of its recognized pharmacology as well as known calcium channel blockers’ effects (Dirksen, 2011). In view of the fact that nimodipine is greatly protein bound, dialysis is not expected to be of usefulness. The nursing intervention is to encourage the patient to take sufficient fluids (Carpenito, 2009). Reference Berry, T. M., Carey, L., Cooper, J. C., Devlin, M. M., Gurvich, T., & Hallowell, T. (Eds.). (2010). Nursing 2010 Drug Handbook (30th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Standing, M. (2008). Clinical judgement and decision-making in nursing—Nine modes of practice in a revised cognitive continuum. Journal of Advanced Nursing, 62, 124–134. Dirksen, S. R. (2011). Clinical companion to Medical-surgical nursing: Assessment and management of clinical problems. (9th edition). St. Louis, Mo: Elsevier/Mosby. Carpenito, L. J. (2009). Nursing care plans & documentation: Nursing diagnoses and collaborative problems. (5th edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Taylor, C. (2011). Fundamentals of nursing: The art and science of nursing care. (7th edition) Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Odell, M., Victor, C. & Oliver, D. (2009). Nurse’s role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing, 65(10), 1992-2006. Preston, R. & Flynn, D. (2010). Observations in acute care: evidence-based approach to patient safety. British Journal of Nursing,19(7). Read More