Question

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Chemistry	Patient Value	Normal Values	ABG & CXR
Sodium	148	136-146 mmol/L	pH 7.25 PaO2 49mm Hg PaCo2 58mm Hg HCO3 27mEq/L
Potassium	4.4	3.5-5.3 mmol/L
Chloride	106	98-108 mmol/L
BUN	68	7-22 mg/dl
Creatinine	1.66	0.7-1.5 mg/dl
Blood culture and sensitivity	streptococcus pneumoniae		CXR: opacity of right lower loop with consolidation and pleural effusions with cardiomegaly
Calcium	7.8	8.9-10.3 mg/dl
Phosphorus	10.4	2.6-6.4 mg/dl
Alkaline Phosphatase	321	30-110 IU/L
Hemoglobin	14.5	14-17 gm/dl

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1-You are the nurse looking after Amnah. Explain five immediate nursing interventions?

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Answer 1

FIVE IMPORTANT NURSING INTERVENTIONS

1)AIRWAY MANAGEMENT AND INTUBATION

The most effective  action is immediate  intubation and oxygenation. Assurance of an adequate airway is vital in a patient with impaired respiratory function. Endotracheal intubation serves as an connection between the patient and the ventilator.It is used to force air into the lungs with the help of a ventilator  and reduce fluid in the air sacs.

2)ADMINISTER OXYGEN

Administer oxygen  and as indicated and prescribed.oxygen administration helps to relieve hypoxia.pulseoximeter must be connected and SPO2 must be closely monitored and ensure that SPO2 level must be above 90% with oxygen support.Supply the patient  with enough oxygen to maintain a near normal saturation and do not be concerned about oxygen supplementation leading to clinical deterioration. If the patients  condition is that critical, intubation most likely is needed anyway.

3)ADMINISTER MEDICATIONS

* For wheezing : salbutamol ,ipatropium bromide ,

* Bronchodilators (and steroids eventually)

* For hives: intramuscular   Epinephrine.

* For crackles with normal or high blood pressure: Nitroglycerin and CPAP

4) PROVIDE SEMI -UPRIGHT POSITION

The semi upright position is an easy, effective and safe treatment for mechanically ventilated patients. This position is effective in the bundle prevention of ventilator associated pnuemonia, is the first step in progressive early mobility and is also effective in oxygenation and ventilation in mechanically ventilated patients.

5)RESTRICT FLUIDS AND MONITOR VITAL SIGNS

Monitor respiratory status , tidal volume and the vital signs. If the patients condition is getting worse or deteriorates, anticipate the need for more aggressive measures.
• Assess, treat and reassess pain.
• Closely monitor for dyspnea or for other discomfort
because they may require additional support or repositioning.