Question

SITUATION: Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away. She has been dieting for several months and skipping meals. Ms. Singh mentions that in addition to her full-time job as a secretary she is attending college classes two evenings a week. She has smoked one package of cigarettes per day since she was 18 years old. Chest x-ray confirms pneumonia.

Physical Examination

Height: 167.6 cm (5960)

Weight: 54.4 kg (120 lb)

Temperature: 39.4°C (103°F)

Pulse: 68 beats/min

Respirations: 24/min

Blood pressure: 118/70 mmHg

Skin pale; cheeks flushed; Chills; use of accessory muscles; inspiratory crackles with diminished breath sounds right base; expectorating thick, yellow sputum

Diagnostic Data

Chest x-ray: right lobar infiltration

WBC: 14,000

pH: 7.49

PaCO2: 33 mmHg

HCO3 -: 20 mEq/L

PaO2: 80 mmHg

O2 SAT: 88%

Applying Critical Thinking and provide a thorough explanation:

1. The client already has some signs of respiratory distress. What signs might indicate that her condition was deteriorating into a more emergency situation? How would you handle this?

THANK YOU!

Answer 1

Food is one of the basic need of a person.According to this case the the patient Ms.Johti singh 39 years who was continously under the dieting by skipping her meals.First of all we have to provide a healthy health education to Ms.Johti about the misconception of Some peoples that only skipping food can be reduce the weight,but the reality is if we are planning to concentrate on our weight reduction we have to do the ecxercises along with eating balanced diet.Because we are not taking adequate food can be reduce our immunity power can lead to many diseases.

In this case she is a good smoker as she smokes one package of cigaret per day sine 18 years.So it may be a reason for the pneumonia.She has some signs of the respiratory distress such as,

• Diminished breaths
• Crackling sound while braething
• Think and yellow sputum
• PaCO2 is 80 mmHg(normal-38-42 mm Hg)

These are the signs indicating that her condition was deteriorating into a more emergency situation.

This patient can be handled by many ways

• Elevate the head end of the bed:- It will promotes the chest expansion and also the patient will feel free from breathing difficulty.
• Teach Ms.Johti about the deep breathing and coughing excersices:- It will help to improve the chest expansion and the expulsion of the sputum by coughing excersices.
• Suctioning:- The patient is having prodctive cough.So that through this suctioning procedure the sputum can be removed, the breathing difficuly can be managed upto some extent.It will help to remove the Crackling sound while breathing.Beacuse crackling sound is occuring when the air sacs of lungs are filled with the fluids or secreations as the patient is having pneumonia.
• Nebulization:-It also helps to improve the breating.
• Oxygen administration:- The patient's is having the O2 SAT-88%, the oxygen therapy is helping to mainatin the saturation above 93%.
• Administer the medications as per the doctor's order.
• Maintain fluidand electrolyte balance:- The patient will be dehydrated due to the dieting since several months.So it should be anaged by IV infusion and through maintaing a well balanced diet plan for the patient.