The case I will discuss comes from the Journal of General Internal Medicine and is as follows: the patient is an 80-year-old woman who suffers from nonresectable lung cancer and has been diagnosed with lobar pneumonia. Other conditions present are: hypertension, diabetes, chronic renal insufficiency and severe degenerative joint disease. While improvement was seen with initial treatment, the patient suffered worsening hypoxemia, level of consciousness obtunded, and developed acute renal failure. Thus, the only means to prevent death was intubation with
Include one intervention to address each nursing diagnosis that are still applicable. Impaired gas exchange should still be kept in the plan of care for the resident as they have not meet the expected outcome of oxygen saturation of 95 % in 24 hours. One intervention I would add to this diagnosis would be for the nurse to assist and instruct the patient to deep breathe and perform
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 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.
3.1 Impaired gas exchange. 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.
Examination has revealed an oxygen saturation of 92% and chest auscultation is notable for reduced breath sounds with scant basal crackles.
Living beings need oxygen for survival, the body needs oxygen to perform anything from breathing to activities of daily living. Unfortunately patients that are diagnosed with COPD, their ability to breathe normally is significantly reduced therefore needing supplemental oxygen.
A review of his medical record indicates that he suffers from COPD-chronic-oxygen dependent. He suffers from an old CVA with left hemiplegia as a result he spends most of his days in bed. He has a history of seizure disorder that is stable with medication, he has not
Observation will be the next tool to help identify those patients with dysfunctional breathing as a result of a poor ZOA. Other authors recommend assessment in supine with a comparison made between sitting and supine. Issues will be more pronounced in supine. A reduction in vital capacity (perceived breathlessness) or reports of orthopnea is another indicator of DD. McCool2
By knowing this information, I had a better understanding of his treatments of Heparin and O2. During my assessment, I understood that my patient would have diminished breath sounds as it’s in result of his respiratory insufficiency. As I got to review more of my patient’s chart, I was able to further understand that his respiratory insufficiency is the result of pulmonary embolism (PE). With PE, “large emboli obstruct pulmonary blood flow, leading to reduced gas exchange, reduced oxygenation, pulmonary tissue hypoxia, decreased perfusion, and potential death” (Ignatavicius & Workman, 2016); that’s to name some factors that are affecting my patient. As the emboli disrupts oxygenation and causes hypoxia, seeing how the treatment of O2 and Heparin were significant to my patient was
Mucormycosis “refers to several different diseases caused by infection with fungi in the order of Mucorales” (Crum-Cianflone, N. F. 2015). Mucormycosis infections are life-threatening and a severe infection affecting the facial sinuses, and subsequently the brain, is common. Mucormycosis is a Fungi found in soli and decomposing such as wood
• Prescribe prophylactic antibiotics to reduce the risk of infection b. Does this patient require antibiotics? a. What is your plan, both immediate and long-term? • Immediate Treatment o The first step is to provide oxygen therapy to this patient who is struggling to breathing.
Oxygen therapy has been used a treatment for patients for many respiratory conditions since its introduction in 1922. Oxygen therapy is prescribed to patients who are hypoxemic and have oxygen saturation level below 92%. It is recognised as drug and as such can have both benefits and side effects.
Oxygen therapy is the administration of oxygen as a medical intervention. It can be used for several purposes in both chronic and acute patient care. While oxygen is essential for cell metabolism, high blood and tissue levels of oxygen can be harmful or helpful depending on the circumstances of administration. Oxygen is used medically to benefit the patient by increasing the supply of oxygen to the lungs, thereby increasing the availability of oxygen to the body tissues, especially when the patient is suffering from hypoxia. Oxygen can be administered in pre-hospital, hospital, or entirely out-of-hospital settings depending on the needs of the patient and professional medical opinion. Pre-hospital providers have long treated oxygen administration as a “catch-all” treatment. Cheap, clean and easy to use, oxygen is considered safe enough to administer to everyone, regardless of diagnosis to provide comfort as well as to prevent and treat hypoxia. Current trends in pre-hospital medicine have EMS crews adopting more and more clinical skills. This has served to create a need for the re-evaluation of oxygen administration in a pre-hospital setting. Like with any other drug, oxygen should be administered by providers who understand the risks and benefits associated with its use.
- 15 Litres (Chrisp & Taylor, 2011) 11. What is the appropriate amount of oxygen that nasal prongs should deliver? - 3 Litres (Chrisp & Taylor, 2011) 12. What is a Tracheostomy? - Invasive airway, through the windpipe to gain access 13. Give 3 reasons for a Tracheostomy? - Acute obstruction - Oral and maxillofacial Identify 3 complications associated with indwelling and intermittent catheters. - Invasive - Infection - Perforation of the bladder - Perforation of the prostate (Chrisp & Taylor, 2011) 34. What is intravenous therapy? - Medication or nutrients deposited directly into the vein for the fastest form of absorption (Chrisp & Taylor, 2011)