Impaired Gas Exchange Case Study

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

I was able to gather a lot of information on my patient when I was taking his health history, giving his shift assessment, and reviewing his charts. I used this step to offer effective nursing care to determine the priorities of what is the most important issue for which the patient should be treated.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

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

Emmanuel and his mother live in an urban community-housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Emmanuel is five years of age and has suffered from asthma for the last two years. One evening, his mother poured him some milk and put him to bed. Shortly afterward, Emmanuel woke up wheezing and coughing. As he gasped for air, he became more and more anxious. His mother ran for his inhaler, but he was too upset and restless to use it. Emmanuel’s skin became moist with sweat, and as he began to tire, his wheezing became quieter. His mother called 911 and waited anxiously for the ambulance to arrive.

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

The team will navigate patients through the program, resources and pulmonary rehabilitation. The registered nurse will meet with the patient prior to discharge to evaluate and refer them to the appropriate services along with the social worker, which may find alternative way to pay for patients medication and other support services that may be offered. The nurse practitioner and the respiratory therapist will see the patient within 48 of hours upon admission into program. The nurse practitioner and respiratory therapist will evaluate the needs at home and enroll the patient in pulmonary rehabilitation, which will be part of the care offered to all patients. Resources for the patient will consist of a 24-hour hotline for patients who may need to seek medical advice prior to going to the emergency room. Patient will be supplied with emergency medications for home use if symptoms begin to appear. A nurse practitioner will be available to advice the patient in intervention with the emergency medications is indicated and advice if treatment may need to be continued in the emergency room. With the protocols in place for medications, the patient will be seen within 12 hours if use of the emergency medications were taken in the home. The nurse practitioner will update the electronic medical chart of the patient to document

The issue of consistency is raised when discussing how to ensure assessments are comprehensive, complete and that the data is recorded using the same guidelines as other nurses. To enable consistency of assessment, the same nurse should be taking the observations of a patient for the duration of a shift (Moore, 2007). This ensure that the interpretation of results don’t differ each time the vital signs are done. It also allows the nurse to detect subtle changes in the patients state that may not have been written down. For example, in most clinical environments the respiration rate is recorded as just a number, and the rhythm, degree of effort, quality of breathing and evidence of wheezing or other abnormal breathing sounds are not recorded. The rate may stay the same over a period of time while other aspects of respiration may change, and this is something that a nurse is more likely to notice if they have assessed that patient before. During handover, a nurse should tell the next nurse looking after their patients how they took observations and detail what tools they used to ensure consistency is maintained.

An important nursing intervention for a patient with COPD is to improve functional capacity of the lungs with oxygen use (ANA, 2012). An oxygen saturation value of 90% or higher is the optimal goal for the patient (ANT, 2012). Patients should be instructed on how to use oxygen properly and safely,

The incident happened on Nov 21st, 2017. The patient has sleep apnea and a health history of chronic bronchitis (no episode in recent 2 years). Her respiration rate was 16 and all lung fields were clear upon auscultation. After I took the patient’s vital signs, I noticed that her oxygen saturation was low (83%). Then, I notified the nurse and asked the patient to do take some deep breath. After that, we put her on 2L of oxygen and her oxygen saturation went up to above 90s. However, the patient had a bladder control problem (was incontinent), so I took the oxygen off because she went to the toilet for around 4-5 times in an hour. However, I forgot to monitor her O2 saturation right away. Instead, I checked her oxygen saturation after she finished her dinner, and it dropped to 86%. The instructor showed me how deep breathing exercise can help the patient increase her oxygen level quickly. I notified the nurse and we put the patient on 2L of oxygen, but again I forgot to check her oxygen saturation right away. Instead, I checked her oxygen around 7pm later.

The second priority problem is the poor gas exchange; this is evident due to Mr Jensen's oxygenation saturations of 95% on 6 litres per minute via a Hudson mask. A patient experiencing hypovolaemia has low cardiac output this stimulates

Gas Exchange is a physical process. During that physical process diffusion is involved which are two main gases oxygen (O2) which is needed for respiration, Carbon dioxide (CO2) that is produced in respiration.

Disorders of ventilation and gas exchange are diseases that disrupt the normal function of gas exchange of the lungs (Porth, 2015). The main function of our lungs is to remove carbon dioxide and to supply oxygen to the blood (Porth, 2015). The respiratory disease that I will be mainly focusing on is Bronchial asthma in children. Asthma is one of the most common chronic illnesses that children In the United States are rushed to the emergency department for; miss the most days of school, and are hospitalized for (Porth, 2015). “Asthma is a condition in which you airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath” (M.C, 2015).

Nurses are a vital component in patient care. The importance of conducting efficient nursing assessments is critical in order to provide both patient-centered care and safe, effective patient healing. Nurses are often responsible for taking care of patients with very complex disease processes. They frequently provide care to patients with illnesses such as Chronic Obstructive Pulmonary Disease (COPD). According to the Centers for Disease Control and Prevention, in 2014, approximately 6.8 million adults were diagnosed with COPD within the Unites States. The completion of proper assessments and initiation of interventions for these patients are crucial in order to prevent further complications of the illness.