Nursing Case Study Essay

(2012) states that when oxygen is administered in a timely and appropriate manner it is fundamental to quality patient care. Current research states that critically ill patients should receive supplemental oxygen for the prevention or treatment of hypoxaemia, and failure to correctly administer oxygen places a patient at risk of hypoxaemia, respiratory dysfunction and eventual death. Although research has proven that hyperoxia can be detrimental to patients, due to the reduction of tissue oxygen delivery through hypoxic pulmonary vasoconstriction, absorption atelectasis and generation of oxygen free radicals (Eastwood et al.,

-02 has an irritating effect in mucous membranes and dries secretions, therefore it is important that a high liter of flow of 02 delivering 35-50% be humidified when administered.

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.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

Cari’s po2 is 54 mm Hg so therefore her lungs were working as if she was doing intense exercise although she wasn’t. Decreased oxygen saturation and PO2, decrease the efficiency of gas exchange between the arterial blood and tissues of the body.

• Pulse Oximetry - Tests the percentage of oxygen in the blood. 95% or more is a normal level,

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,

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min

Most patients who end up in intensive care unit are most of the time so unstable that any little movement will put them at risk for further complications which can lead to death. However, finding a way to prevent pressure ulcer in the most critical ills patients in the healthcare system is very crucial.

20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure

circulated properly, when there is a breach in blood circulation, and when this happens Lung