Nursing Care of a Patient with a Respiratory Problem - Assignment Example

NUR250 Assessment 1 S1 2017 Assignment template It is recommended you do not delete the heading and the information below. Please note:As indicated in Assessment 1 information, a cover sheet, title and contents pages are not required Before you begin take a minute to fill in your details in the footer to ensure your document is identifiable. To access the footer, double click on the grey writing “Last name….” at the bottom of the page above. Once you have done that, double click here to come back to this page. Information about the requiredline spacing and font size and type is in the Assessment 1 information document in the Assessment 1 folder on NUR250 Learnline. Take a minute to check that this document meets those requirements. To avoid or minimise problems with formatting, it is recommended you Use the headings provided Don’t copy from another document onto this template Don’t delete the section breaks on the document Submission of your assignment means you have read and understood the University policies and procedures related to academic integrity Assessment 1 presentation guidelines Start to write your assignment here. Word count is calculated from this point. Task 1: Understanding nursing problems Ineffective airway clearance Ineffective airway clearance is the inability of an individual to clear any obstructions or secretions that may be blocking the respiratory tract compromising the maintenance of a clear airway. It interferes with the natural and effortless breathing process of an individual with chronic obstructive pulmonary disease (COPD) and is manifested as frequent coughing, which may or may not be accompanied by sputum, increased breathlessness and fatigue among other symptoms (Kallet, 2013). Impaired gas exchange Impaired gas exchange is problematic oxygenation and elimination of carbon dioxide at the pulmonary alveolar-capillary membrane. It is a disruption or alteration of the balance ventilation of the pulmonary alveoli through airflow and the perfusion of the capillaries in the lungs through blood flow. It is an indication that the diffusion of carbon dioxide and oxygen is not responding to the differences in concentration of the gases across the alveolar-capillary barrier. The condition is manifested as the presence of dead space found in the breath volume, which does not participate in gaseous exchanges whereby ventilation occurs without perfusion. Alveolar collapse and changes in the alveoli conditions are prevalent causes of the gaseous exchange impairment (Lemmens, et al., 2013). Risk of impaired ventilation Impaired respiration is the impairment of the respiratory function that is expected when breathing is occurring normally and sufficiently enough to support and sustain life. It is an internal and metabolic dysfunction of breathing process thus disrupting the airflow inside the lungs (Ozyilmaz, Ugurlu & Nava, 2014). The risk of impaired ventilation is heightened by ineffective patterns of breathing such as abnormal depths and depths of respiration and diminished expansion of the walls in the chest and lungs as well. Imbalanced nutrition: less than body requirements Imbalanced nutrition is availability of nutrients that are less than those required by the body. Nutrients become imbalanced when either few nutrients are ingested or when nutrients are lost from the body. Poor eating habits can cause nutritional deficiencies. In addition, medications, production of mucoid sputum and dyspnea can cause loss of valuable nutrients thus leading to deficiencies as well (Toy, et al., 2011). Risk for infection Infection is the unprecedented attack by pathogenic microorganisms, which increases the chances of contracting diseases. The risk of infection is heightened by malnutrition, the process of chronic diseases such as COPD, inadequacy in acquired immunity, and inadequacy in primary defences of the body such as stasis of secretions and decreased action of the cilia. Task 2: Care planning Nursing Care Plan: Neville Note: Dot points recommended in care plan. Click and type in each cell, click enter in a cell to make it longer A reminder that all information must be referenced Nursing problem: Ineffective airway clearance Underlying cause or reason: Inability to expunge excessive sputum Ineffective coughing Weakness due to fatigue Weakness of chest muscles Inadequate fluid intake (Hodson & Sherrington, 2014) Goal of care Nursing interventions/actions Rationale Indicators your plan is working To promote airway clearance that is effective Advice patient on effective coughing techniques such as taking deep breaths before coughing Encourage regular intake of fluids Discourage smoking Advice patient to increase activity Advice patient to change positions at least once every two hours and avoiding lying position whenever possible Administer medication to relieve pain Infrequent causing causes sputum and secretions to build up in the airway thus narrowing or blocking it Taking deep breaths before coughing increases oxygenation before undertaking controlled coughing Adequate fluids facilitate hydration, which not only liquefies sputum and other pulmonary secretions but also facilitated the expectoration of mucoid secretions Activity raises the heart rate increasing oxygenation Lying in a flat position shifts organs in the abdomen towards the chest cavity. This crowds the lungs and causes breathing to be laboured and become difficult (Kallet, 2013) Observation of regular expulsion of sputum or lack of sputum during coughing Observation f effective coughing Report on reduction of or total abstinence from smoking Observation of enhanced ease of breathing Observation of reduced sounds in the chest cavity Nursing problem: Impaired gas exchange Underlying cause or reason: Presence of dead space Ventilation that is not accompanied by perfusion Collapse of alveoli Prolonged periods of immobility Poor breathing techniques changes in the alveoli conditions (Hodson & Sherrington, 2014) Goal of care Nursing interventions/actions Rationale Indicators your plan is working To attain optimal gas exchange maintain oxygen therapy that was ordered by the physician monitor nasal prong oxygen to avoid supply of high concentration of oxygen help the performance of deep breathing and execution of controlled coughing schedule activity pace and rest period to minimize the occurrence of fatigue discourage smoking encourage rest when respiratory distress occurs monitor the colour of the mucous membrane in the mouth, the tongue and skin for indications of hypoxia monitor mental status and behaviour of patient High concentration of oxygen causes apnea, which is unsafe to the patient. On the other hand, if the patient is retaining carbon dioxide, hypoxia encourages the urge to breath Controlled coughing is facilitated by prior deep breath thus helping clear the airway and facilitate gaseous exchange and facilitate oxygenation Activities increase the consumption of oxygen, placing high demand for fast breathing Changes in behaviour and alterations of mental status such as lethargy, confusion, agitation and restlessness signal the onset of impaired gas exchange deep breathing as monitored from the readings of a spirometer Continuously monitor oxygen saturation using a pulse oximeter Reduction of behaviour change and maintenance of healthy mental status Nursing problem: Risk of impaired ventilation Underlying cause or reason: impairment of the respiratory function internal and metabolic dysfunction of breathing process abnormal depths and depths of respiration diminished expansion of the walls in the chest and lungs (Hodson & Sherrington, 2014) Goal of care Nursing interventions/actions Rationale Indicators your plan is working To reduces the risk factors for impaired ventilation by maintaining acceptable levels blood gases Maintain the prescribed oxygen therapy Discourage smoking High concentration of oxygen causes apnea, which is unsafe to the patient. On the other hand, if the patient is retaining carbon dioxide, hypoxia encourages the urge to breath Decrease in the results indicated by oxymetry figures Nursing problem: Imbalanced nutrition: less than body requirements Underlying cause or reason: ingestion of few nutrients inability to digest foods expulsion of nutrients release of sputum intake of medications that denature nutrients, facilitate excretion of nutrients and impair absorption of nutrients poor nutrition such as eating foods with low or inadequate nutrients poor feeding habits such as unwillingness to eat loss of appetite smoking (Hodson & Sherrington, 2014) Goal of care Nursing interventions/actions Rationale Indicators your plan is working To ensure that the patient has a nutrition regime that provides for all the nutrients required by him, while minimizing their unprecedented loss. Inform patient of the need to eat a balanced diet Review laboratory results indicating nutritional wellbeing Ascertain maintenance of health body weight appropriate for a 62 year old male my updating the food chart and performing daily weighs Assist patient to adhere to meals intake while monitoring calorie intake Encourage the maintenance of good oral health Encourage engagement in regular exercise Balanced diet supplies requisite and sufficient to sustain metabolic processes and sustain the body Laboratory tests reveal nutritional deficits and guide diet formulation and supplement needs Regular monitoring of weight can reflect on nutritional performance of patient Fatigued patients may lose appetite and maintain poor eating habits or even desist from feeding Good oral hygiene has a positive influence on the taste of food and on appetite of the patient Activity improves the utilization of nutrients and the process of metabolism Improvement of appetite Non-selection of foods Maintenance of body weight normal for the patients age (62 years) and height Maintenance of recommended calories recommended for a 62 year old male Nursing problem: Risk for infection Underlying cause or reason: malnutrition process of chronic diseases such as COPD inadequacy in acquired immunity inadequacy in primary defences of the body such as stasis of secretions and decreased action of the cilia contact with agents that are contagious (Hodson & Sherrington, 2014) Goal of care Nursing interventions/actions Rationale Indicators your plan is working To reduce the risk of the patient contracting infections Instruct patient to reduce exposure to people suffering from respiration infections Monitor and encourage adherence to proper nutrition Monitor response to medication Contact with people or agents that have contagious microorganism can increase the risk to becoming infected Poor nutrition may compromise cellular immune responses Come medications can reduce immunity Absence of opportunistic infections Adherence to prescribed nutritional requirements Absence of adverse reactions from medication Task 3: Medication management (350) Oral prednisone Prednisone, in pill form, was prescribed to reduce Neville’s airway inflammation and in turn, ease his breathing considering that he exhibits laboured breathing and coughing with production of sputum (Celli, 2004). Prednisone is a steroid that it employed to reduce swellings in the airway and reduce production of mucus, facilitating the improvement of lung function. In its oral or tablet form, prednisone was prescribed to treat COPD from which Neville was suffering, particularly because this condition was worsening and other medications were proving to be ineffective. For administration of prednisone, the nurse should ensure that the patient adheres to the prescribed dosages by explaining them clearly to Neville and his family. The nurse should also explain the benefits that would accrue to Neville by adhering to the prescription by explaining the mechanism of action of the medication to Neville and his family. Further, the nurse should also help Neville access refills once his prescription is finished. Upon administration of the medication, the nurse should be vigilant for allergic reactions by Neville, which would be manifested as swelling of the throat, tongue, lips and face, increased breathing difficulty, and hives. In addition, the nurse should look out for or inform Neville and his family to look out for very high blood pressure, manifested as severe headache, bloody coughs, extreme mood swings, uneven heartbeats, shortness of breath and seizures among others, upon which the nurse should be informed immediately. Ipratropium bromide via nebulizer Ipratropium bromide was prescribed to ease the breathing of Neville. Considering that Neville was afflicted by blocked airway and production of sputum, the Ipratropium bromide was to act by dilating the bronchi and preventing the secretion of mucus as well. When administered via a nebulizer, Ipratropium bromide goes straight to the airway and is thus fast acting as a bronchodilator (Miravitlles, et al., 2013). The nurse should inform Neville and his family on the correct dosage of the mediation, the need to adhere to correct dosages and avoid excessive inhalation, and what to watch out for in case of occurrence of adverse reactions to the medication, upon which the medication should be ceased and the nurse informed immediately (Wei, et al., 2014). Specific side effects to watch out for include severe headache, tachycardia, palpitations, nausea, throat irritation and flushing of the skin. The nurse should also advise Neville and his family on how to maintain hygiene of the nebuliser to avoid opportunistic infections using a mixture of warm water and white vinegar. Oral amoxicillin Amoxicillin was prescribed to combat pathogenic bacteria and the infections they would cause. It acts as a broad spectrum antibiotic that is able to treat infections of various types of disease causing bacteria, which could find their way into Neville’s airway through the nose and mouth, and through the nebulizer and oxygen nasal prong particularly if they are not maintained hygienically (Zakrisson, et al., 2011). The nurse should encourage proper adherence to the prescribed dosage and inform of the adverse side effects, upon which the medication should be discontinued if they are severs. Therefore, the nurse should inform Neville and his family to watch out for skin rush that is painful, skin blistering and flu-like symptoms. Task 4: Patient teaching (250) Neville needs to the encouraged to stop smoking. To motivate Neville the specific information regarding smoking that he needs to know includes, firstly, the danger and outcomes associated with smoking, including knowing that about 40 Australians died from smoking related diseases such as COPD, lupus, heart diseases and cancer. In some Australian states such as Victoria, smoking cause more deaths that those emanating from alcohol, drugs and road accidents put together (Gellert, Schöttker & Brenner, 2012). In addition, smoking changes the brain in a manner similar to that caused by cocaine or heroin, thus causing addition and diminishing of mental capabilities. Second, the benefits to be accrued from cessation of smoking including enhancement of health, improvement of lifestyle and elongation of life as well. This information is pertinent to Neville’s care because it would increase the effectiveness of the interventions undertaken to combat COPD and ultimately improve his health wellbeing such that he can return to full functioning as a member of his community (Fletcher & Dahl, 2013). Indeed, cessation of smoking would not only reduce airway and alveoli blockage but also prevent the onset of diseases such as cancer, which would complicate his health further than its present condition. By using vivid illustrations regarding the condition of the lungs of a smoker and the vagaries of cancer caused by smoking would help emphasise the importance of smoking cessation. In addition, by encouraging him to stop smoking, using different approaches than those he had tried earlier would help Neville achieve his goal. In this case, encouragement to remain committed to smoking cessation and explaining the process of withdrawal to be expected is vital to the success of the cassation process. Ensuring that Neville understands and complies would be facilitated by behavioural change and change of mental state as well (Fromer, 2011). For instance, if Neville asks questions to clarify information, displays willingness to act on his smoking and actually makes attempts to adhere to advice would be indicative of his comprehension. Task 5: Clinical judgement and handover (300) Part A It is possible that the salbutamol medication has induced hypokalaemia by drastically reducing the level of potassium in Neville’s blood, a condition that may been exacerbated by administration of prednisone. Indeed, the symptoms observed can be associated with low potassium levels in the blood, whereby potassium acts as an electrolyte, which facilitates the maintenance of healthy fluid balance and transmission of electrical impulses so that nerves and muscles can function properly. It is also possible that Neville was experiencing the onset of hypercapnic respiratory failure, which may have been accompanied by acidosis, because of the oxygen saturation level being increased to 98 %, which also manifests with similar symptoms. The immediate action would be to discontinue the administration of the salbutamol medication followed by checking the level of arterial blood gases. The nurse should also lower the oxygen saturation to 92 %, which is recommended as the maximum for patients with COPD and not at risk of developing hypercapnic respiratory failure. Thereafter, the physician should be contacted for further intervention directions. Part B I – Neville, 62 year old male S – diagnosed with COPD, presents with incoherence, flushed skin, anxiety and restlessness B – Patient has a history of COPD and smoking. He had been place under nasal oxygen prong maintained at between 88 % and 92 % at 2 L/min although this was increased to 98 % saturation level upon patient’s complaints of breathing difficulty. Salbutamol was administered to ease breathing and the patient was under prednisone as well. Symptoms developed after the administration of salbutamol. The patient continues to smoke. A – The patient appears to be deteriorating. I think he on the verge of experiencing hypercapnic respiratory failure. Salbutamol medication was discontinues and oxygen saturation level reduced to 92 % upon stabilization. R – Urgent measurement of arterial blood gases, oxygen saturation levels in the blood and any other appropriate test. Recommends biPAP. References Celli, B. R., MacNee, W. A. T. S., Agusti, A. A. T. S., Anzueto, A., Berg, B., Buist, A. S., ... & Fein, A. (2004). 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Treatment of COPD: relationships between daily dosing frequency, adherence, resource use, and costs. Respiratory medicine, 105(3), 435-441. Wei, L., Yang, X., Li, J., Liu, L., Luo, H., Zheng, Z., & Wei, Y. (2014). Effect of pharmaceutical care on medication adherence and hospital admission in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled study. Journal of thoracic disease, 6(6), 656-662. Zakrisson, A. B., Engfeldt, P., Hägglund, D., Odencrants, S., Hasselgren, M., Arne, M., & Theander, K. (2011). Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Primary Care Respiratory Journal, 20(4), 427-433. Read More