The paper deals with the case study of Jim Cooper, a 67-year-old male an emergency department patient transferred to respiratory medical unit. The assignment addresses the part one of the case study that is the morning shift. The paper aims to identify the five patient health issues that can be addressed by nurse as per scope of practice. The three health issues that are of highest priority will be discussed along with rationale supported with the current literature. The paper will outline the nursing role in addressing the top three priority patient health issues identified from the case study. The health issues will be addressed using assessment, coordination of care and provision of care.
Identification Of Patient Health Issues
When Jim was presented to the respiratory unit, the past medical history reported of productive cough and shortness of breath that is more than usual. He has been to GP for oral AB and has been reported to face difficulty in caring for himself recently. He was experiencing trouble in sitting in chair for past few nights. As per the past medical history, Jim was diagnosed with COPD, 5 years ago, and in addition, reflux and hypercholesterolaemia were mentioned in the past medical history. Based on the assessment, the vital signs include heart rate of 118 beats/min, respiratory rate of 36 breaths/min, SpO2 88% RA – 93% 2L O2 NP and BP 146/92 mmHg and temperature 38?C oral. The auscultation report showed scattered wheezes throughout both lung fields. The case details recommend on treatment with oxygen, IV fluids, IVAB, Prednisolone and physiotherapy.
Based on the above data collected, the five health issues of the patient identified are-
Risk of increased cough due to ineffective airway and COPD
Troubled breathing related to shortness of breath
Risk for increased anxiety and depression due to social isolation
Risk of infection in the respiratory tract
Exacerbation of COPD due to alcohol consumption
These five health issues are chosen as they can be addressed by the
Out of the five patient health issues, the three priority issues are-
Troubled breathing related to shortness of breath
Increased cough due to ineffective airway and COPD
Risk of infection
Priority Health Issues
1.Troubled breathing related to shortness of breath
This is the priority nursing issue and it needs to be addressed immediately as it may lead to patient death due to low oxygen. Impaired gaseous exchange leads to the incomplete release of carbon dioxide. This leads to trapped air and increases the shortness of breath, which increases blood pressure, increases tightness in chest and tachycardia. If untreated it will make the patient fatigue and weak. Untreated dyspnea will increase significant imbalance between carbon dioxide and oxygen and consequently death (Burt & Corbridge, 2013). Therefore, this health issue is ranked 1 for nursing intervention
2.Increased cough due to ineffective airway and COPD
Ineffective airway clearance increases the cough, and sputum production. If this condition is left unattended, it will increase the difficulty in breathing and weakness. Hence, it is ranked second in the nursing priority for care. This issue if untreated will lead to bronchospasm and excessive production of secretion, which may thicken the bronchial wall (Kim & Criner, 2013). In effective airway clearance and cough does not lead to immediate death as shortness of breath. Therefore, the former is the second priority and the later is the first priority.
3.Risk of infection
The patient has visited the GP for the oral AB. With the increase in the severity of COPD, the severity of infection also increases and is manifested as cough and irritation. With the impairment of immunity, bacterial colonisation is accelerated (Matkovic & Miravitlles, 2013). If untreated, the infection will increase the fever. The health issues is ranked third as infection will exacerbate the above two health issues that is increased cough and breathlessness.
The risk of anxiety and depression has not be chosen in first tree nursing priorities as decreasing the social isolation is the long term care. It can be addressed immediately and is the slow process. The intervention for social isolation can be given after the discharge. It does not pose risk for death. Similarly, alcohol consumption can be addressed over a certain a period of time. It is the risk factor for COPD, and patient can be prevented by creating awareness. Since, alcohol abuse is the psychological issue it needs rehabilitation and counselling. Therefore, these issues are given last priority as they do demand emergency care.
Role Of Nurse
The role of the nurse is to restore the normal breathing pattern in Jim. The role of the nurse is to teach the client with the diaphragmatic breathing exercises with pursed lips. It will increase expiratory tidal volume and reduce the respiratory rate. At an intersperse periods of activity the nurse must give boosts to the Jim. Jim must be allowed to make decision about the treatment. Physiotherapy will promote the mobility of thorax, shoulder girdle and neck. It will help establish the coordinated pattern of breathing. The nurse must start with physiotherapy sessions to promote relaxation and improve body posture. It will help Jim to overcome his uneasiness in caring for himself and sitting in chair (North American Nursing Diagnosis Association, 2015).
It is in the code of ethics to preserve the autonomy of the patients. The principles of ethics deals with respecting patient’s autonomy, adhering to beneficence and non-maleficence. It means caring for the patient without compromising the greater good. There should not be any harm caused to the patient (Kim & Criner, 2013). Hence, the treatment should be based on the patient’s tolerance level. Further, shortness of breath can be minimised in Jim by encouraging the use of respiratory muscles exercise in case required. The nurse must monitor the administration of oxygen and maintain the oxygen saturation above 90% to prevent hypoxemia. The nurse must follow the recommendation in the chart (Corrado et al., 2016).
The role of the nurse in this case is to improve the gaseous exchange to prevent ventilation perfusion inequality. The nurse may care for Jim by detecting the bronchospasm at auscultation. The client’s hypoxia and dyspnea must be monitored (Brien et al., 2016). The nurse can administer the drugs and corticosteroids bronchodilators as prescribed by the physician. The nurse must educate the patients about side effects of the medication for immediate intervention. The nurse can give aerosol therapy to the patient, before meals. This therapy helps to improve the lung ventilation by thinning secretions. Once the oxygen saturation is reached to the normal level, it will restore the normal heart rate, and decrease tachycardia. It will decrease the high blood pressure (Uronis et al., 2015).
The nurse must follow the recommendations in the chart, which says treatment with IV fluids and IV AB. It is important to prevent dehydration and infections. Administering the fluids is necessary as dehydrations will increase the viscosity of secretion. The nurse must monitor the input and output of the patient. The patient is expected to have reduced distress and irritation after this intervention (Ghosh et al., 2015). The nurse must monitor the body temperature of the patent as infection increases the fever. Antibiotics will fight the bacterial infections in the respiratory tract. Oral medicine prednisone should be administered as it has anti-inflammatory effect. This glucorticoid is found effective in improving the lung function. It will decrease the allergic reactions. The nurse must educate the patient about the side effects of prednisone, which include depression, heart burn, increased sweating and sore throat (Abroug et al., 2014).
The nurse must monitor the patient’s body temperature to reduce fever. Pulmonary infection can be determined by character, colour, and odour of sputum. The patient must be taught to frequently change the position and increase fluid intake (Jellington et al., 2016). These interventions together with the breathing exercises and effective cough will promote mobilisation. It will promote the expectoration of secretions and decrease in infection. It is necessary to maintain the balance between the activity and rest as it will promote quick healing. It will increase resistance to infection. The nurse can assist Jim in having balanced diet as appropriate for age. Malnutrition may decrease resistance to infection (Atkins et al., 2017).
For fast relief, the nurse must implement patient centred care. This care refers to respecting the client’s beliefs, values and preferred needs. The nurse can involve the family members to decrease the feeling of powerlessness and vulnerability. Involving Jim’s community members will enhance the emotional support and reduce the loneliness. It will help to build the therapeutic relationship between Jim and nurse is based on understanding the patients and on mutual trust between care providers and users (Disler et al., 2013).
In the given assignment, the case study of Jim is undertaken for determining the five patient health issues and three of them has been ranked as highest priory issue. The prioritisation is based on critical thinking of the presenting conditions and evidence. Based on the priority health issues the nursing role pertaining to this case is discussed.
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