Nursing Care Case Studies

The patient will be able to tolerate ambulation to the bathroom and to the shower with minimal shortness of breath

Establish a Plan of Care for each patient assigned, integrate the patient and family members in the plan of care, and have the ability to modify plan as needed.

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,

However one would be lax if they didn’t take this as a serious situation. A patient with a partial airway obstruction can be presenting in a couple different ways. In the stable patient the signs may be mild and mostly just worrisome and irritating to the patient. In these cases even thou there is a need to obtain definitive care in is imperative to remain calm so as not to worry the patient. One should consider immediate administration of oxygen by non rebreather to make sure the patient remains stable along with encouraging the patient to cough if the feel the need. However in an unstable patient you would expect to hear noisy respirations, coughing and gagging. As the patient continues to deteriorate the coughing will become feeble and signs of respiratory distress such as anxiety, lethargy and even cyanosis will become apparent.[Joynt 2015] In these cases it is imperative to initiate aggressive oxygen therapy immediately. In cases such as these a paramedic could employ several different methods to ensure the patient doesn’t progress to a complete obstruction. First would be to visualize as much of the airway as possible with the naked eye and remove any obstruction visible. However this is not too be confused with the blind figure sweep of the past. One should never attempt to remove an object that they can not see. Another

Intervention for COPD is focused on managing underlying conditions. The goal is to improve airway function. Some strategies include using antibiotics to treat infection, diuretics which reduce pressure on the heart and lungs, some bronchodilators to help expanding the airways, as well as corticosteroids to reduce inflammation, and last in severe cases use of mechanical ventilation can be efficient and effective to keep oxygenation in an optimal level

For the appropriate care to be planned for a patient it should be looked at in a holistic manner (NMC

Ineffective airway clearance related to adventitious lung sounds, rhonchi auscultated bilaterally at the patient’s bases as evidence by CT scan displaying pleural effusion and basilar atelectasis. Y.B.’s ability to clear his airway is ineffective due to his current disease state. His alveoli are deflated due to pleural effusion. The pleural effusion is a result of blocked lymphatic drainage from the pleural cavity, possible caused by malignant cells (Lewis, Dirksen, Heitkemper, & Bucher, 2014). The goal for Y.B. is to maintain a clear, open airway, and improvement in lung sounds before discharge. Ensuring the patient uses the upright position, maintaining the head of the bead above 30o, will keep his abdominal contents from inhibiting lung expansion. This intervention will be evaluated by assessing lung sounds, pulse oximetry, assessing if Y.B. is using accessory muscles to breath, and a chest X-ray. In the article titled,

The care of a client is carefully planned from initial contact to the conclusion of the specific health problem.

The defining feature of chronic obstructive pulmonary disease is the limited airflow during forced exhalation that is not fully reversible(R. Higginson, 2010). On assessment of Terry’s condition it was found he has a moderate work of breathing, a respiratory rate of 30, diminished breath sounds, has a barrel chest and uses tripod positioning. The inability to expire air is a major concern and characteristic of copd(Di Brown, 2015). The primary site of airflow is limited and the airways are reduced in size, reducing the amount of air that can get in and out of the lungs(R. Higginson, 2010). As the airways become smaller and obstructed, air is trapped during expiration due to the volume of residual air greatly increasing, destroying the alveoli attached to small airways(R. Higginson, 2010). The residual air and loss of elastic recoil makes it harder to exhale air. If an individual is unable to perform levels of expiration then the air becomes trapped in the lungs, making the chest hyper expand and become barrel shaped. Having a barrel shaped chest, decreases the respiratory muscles to work effectively and the functional

In this assignment, a case study will be discussed regarding a patient who is admitted for pneumonia and has a chronic obstructive pulmonary disease (COPD) as the comorbidity. To begin with, the epidemiology will be explored along with the NHS medical costs of pneumonia and COPD as the main rationale for the selected patient. Secondly, COPD and pneumonia 's pathophysiology will be looked at and the bio-psycho-social model will be used to present the impact on the patient. Thirdly, a systematic approach (ABCDE model) will be used to identify the patient 's complex care needs, by which breathing is the primary focus. Additionally, varieties of nursing assessments (eg. oxygen saturations, respiratory rate) for breathing will be considered, in conjunction with diagnostic assessments such as chest x-rays. Moreover, different nursing interventions, both pharmacological (e,g, bronchodilators, antibiotics) and non-pharmacological (eg. pulmonary rehabilitation) will be covered for the management of breathing. Last of all, the promotion of patient partnership in their decision-making process and the importance of inter-professional team working will be mentioned through the whole of this essay.

The positive outcome of the acute treatment of the patient helped me feel more confident in communicating with patients. The patient commented on his appreciation of having the ambulance service available, in his time of need. I told the patient this was my first week on the road, and he said that he was happy with my performance. My paramedic mentor gave me positive feedback on my ability to communicate well with the patient. The treatment package contributed to a good understanding of how the therapeutic respiratory drugs worked and how quickly they became effective. I found out that COPD patients should only permitted to have increased oxygen levels for no longer, than six minutes as stated in (section 27 of B R O’Driscoll, etal

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

Elimination of patient falls is not an easy task otherwise they would have been eliminated by now. Patient falls unfortunately continue to be a challenge and occur within the hospital and nursing home settings at alarming and sometimes deadly rates. The Center for Disease Control estimates that 1,800 older adults living in nursing homes die each year from fall-related injuries. Survivors frequently sustain injuries resulting in permanent disability and reduced quality of life. Annually, a typical nursing home with 100 beds reports 100 to 200 falls and many falls go unreported (CDC, 2015). Falls occur more often in nursing homes because patients are generally weaker, have more chronic illnesses, have difficulty ambulating, memory issues,

“Teaching patients about promoting, maintaining, and restoring their health is a required nursing skill that most often results in a positive outcome, enhancing the patient 's quality of life” (Lewis et al., 2014, p.52). The intent of this analysis is to educate patients with chronic obstructive pulmonary disease on means that can enhance their quality of life and avert the progression of their disease. More specifically, it will focus on the aspect of teaching Mrs. N, a patient, how to effectively handle certain symptoms experienced with techniques like pursed-lip breathing and also, to upsurge the client’s awareness on preventative measures to abate the possibility of acute exacerbations. Mrs. N is a 100-years-old woman of Canadian and Arabic background. In mid-September, she was rushed to the hospital after experiencing worsening dyspnea and a fever. The doctors deduced a diagnosis of pneumonia and therefore, she was transferred to the medical unit at the Lakeshore hospital in order to be treated with intravenous antibiotics. Mrs. N has a past medical history of chronic obstructive pulmonary disease, hypertension, anemia, deep vein thrombosis and mixed dementia. Mrs. N is a retired widow with two daughters, who come and visit her on a daily basis at the hospital and encourage her to mobilize and eat because she has an extremely poor appetite on most days. She’s well cared for by a team of care workers in the nursing home where she lives and her daughters and

Her ideas revolve in having the nurse and the client work on these needs for improving health condition. In the nursing profession, assessment is very critical for the plan of care. The success of our interventions would greatly depend on how substantial our assessment to our client. Henderson’s 14 basic needs would be a good reference in assessing our client’s needs for care.