Cardiopulmonary Edema Case

In the first step of the Tanner (2006) model nurses use their personal knowledge and experience to notice whether the patient requires attentions based on their expectations and looking at environment of the patient. Therefore, for an experience nurse it is easier for them responding to the similar situation if she or he revisit because the knowledge is already there through experience. In the case of Mr Devi, assessment will perform using systematic assessment based on the ABCDE approach (Airway, Breathing, circulation, Disability and Exposure). The ABCDE approach is an evidence-based practice widely accepted and used by all the members of a multidisciplinary team (MDT) to assess an acutely ill patient (Harrison and Daly 2011). First, life-threatening

On the early morning of August 17, 2002, James C., a patient in one of the wards under the supervision of Ellen Hughes Finnerty, RN, went into respiratory depression. Between 3:00 and 4:00 a.m., Ann Mugi, the patient’s primary nurse, sought the assistance of a respiratory therapist, Hiran Obeyesekere, to help her care for the patient. As Obeyesekere suctioned the patient airway, Mugi called the service of the patient’s primary care physician, Dr. Jackson, to report the changes in the patient’s respiratory status, e.g., respiratory rate of 40 breaths per minute and low urine output.

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

Patient Sallie Mae Fisher was released from the hospital last Saturday. This patient is eighty two years old and lives alone as her daughter lives too far away to be helpful. Her medical history includes chronic congestive heart failure (CHF), atrial fibrillation (AF), and hypertension (HTN). She has been hospitalized four times for CHF exacerbation in the last six months. She was discharged from the hospital after being there three day to treat increased dyspnea, an eight pound weight gain, and chest pain. This paper will identify, prioritize, and describe at least four problems with evidence for each problem and identify at least four medical or nursing interventions with rationale for the interventions included.

Mr. Joseph is a 56-year-old has 30 smoking pack years. He was diagnosed 10 years ago with asthma/chronic bronchitis, arthritis of the knees, and congestive heart failure (CHF). Mr. Joseph weighs 350 pounds with a height of 6 feet, making his body mass index (BMI) of 47.5, much more than the recommended 25, and in fact his BMI places him in the morbid obesity classification. He takes medicines for his pulmonary conditions, along with a diuretic.

Medical involvement included pharmacological intervention. An infusion of Sotalol 40mg was administered intravenously at approx 0930 over thirty minutes with continuous cardiac monitoring. Sotalol, an antiarrhythmic drug, depresses the sinus heart rate, decreases atrioventricular conduction, decreases cardiac output and decreases systolic and diastolic blood pressure (Bryant, Knights, & Salerno, 2003). As the patient was already hemodynamically compromised, a bolus of fluid (Gelofusion 500mls) was administered prior to the Sotalol infusion. The aim was to increase the circulating volume and raise blood pressure. Vital signs remained stable during the infusion, however the heart rate was neither converted to sinus rhythm or reduced to a normal rate.

The most serious health problem that the client has is impaired gas exchange. According to Sue Galanes (2007), impaired gas exchange is result from the balance between ventilation and perfusion is offset by a certain condition which affects the efficiency of the gas exchange. On account of client has congestive heart failure that can contribute to dyspnea, which means the efficiency of gas exchange is decreased. One of the significant defining characteristics of impaired gas exchange is dyspnea (Sabtu, 03 Agustus 2013). In addition, it was hard for the patient to talk in long sentence due to difficulty in breathing. Hence, impaired gas exchange is one of the health problems that the client suffered from. In regards of O2 is the basic element that all of cells and organs need, it can be considered as a fuel of human body. Therefore, impaired gas exchange is the most severe health problem the patient has currently.

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

The aim of this essay is to explore evidence based nursing intervention in the care and management of chronic obstructive pulmonary disease (COPD) in an acutely ill patient. The acutely ill patient involved in this essay was admitted to hospital due to cerebrovascular accident and had a past medical history of myocardial Infarction, left Ventricular failure, peripheral vascular disease and duodenal ulcer as well as chronic obstructive pulmonary disease. This essay will provide a rationale for the chosen aspect of care (COPD) and reason will be given why it is a priority. In particular the essay will examine the significance of the underlying pathophysiology of the disease relating to the acutely ill patient other

A degree of evidence related to protocol usage and outcomes was collected to determine if a researchable problem was obtainable and valuable. According to Davies (2011), research questions should concentrate on "real-world problems" (p. 75). Patients in the intensive care unit who are mechanically ventilated receive intravenous sedation on a regular basis. According to findings by Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30-60% of intensive

Nursing interventions are focused on nursing behaviors to guide the patient in the direction of the most preferred outcome (Johnson et al., 2012). Fluid management, fluid/electrolyte management, and hypervolemia management are the major interventions in effective management of CHF. Fluid management is the most difficult intervention for all patients suffering from CHF. Evaluation of the patient’s ability to make the appropriate lifestyle changes required to

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

I stayed close to the patient during this whole period, but I was not paying enough attention to her low oxygen level. The patient was a healthcare aid and she kept telling me that, “It’s ok, I am always a shallow breather”. However, I should have my own judgement ability and provide more competent care with timely evaluation of the effectiveness of the interventions.

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last

The oxygen saturation was recorded to be 84% on air using a pulse oximeter. The nursing goals planned for Jack were: that his breathing would be within his normal limits, for his oxygen saturations to be maintained over 90% and for his cough to be less problematic. To assist in achieving these goals Jack would be fully involved with the planning of his care. The nursing and medical staff would perform lung function tests to determine the cause of his symptoms. It was ensured that prior to any medical test detailed explanations would be given to Jack. Hayward (1975) suggests that information given to and understood by the patient can aid to reduce anxiety. He was commenced on prescribed humidified oxygen therapy at 24% when required to alleviate attacks of acute dyspnoea. A referral was made to the physiotherapist for chest physiotherapy, which would facilitate the clearing the lungs of accumulated mucus. As Jack was experiencing difficulties maintain his hygiene, it was planned to assist Jack in achieving his personal hygiene needs. He was provided with the facilities daily for personal cleansing at his bedside. To ensure Jack's privacy and dignity the curtains were closed whilst he washed. Jack was advised on how to use the nurse call system to request help if required. It was ensured that his personal items and the nurse call were assessable. Clean pyjamas were provided.