Question

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

B. Explain why would you have chosen to use this treatment?

C. Identify two clinical symptoms that support the ABG results of Amnah.

4. Amnah was diagnosed with health issues other than respiratory.

Identify two of these issues and give one diagnostic finding for each.

4. You are the nurse looking after Amnah. Explain five immediate nursing interventions.

5. Name three complications that Amnah must be monitored for.

Answer 1

1. Mrs. Amnah, 55 years old who was admitted in medical ward after experiencing shortness of breath, chesty cough, wheezing and chest discomfort. Her temperature is 38.7 C along with tachycardia PR is 100 beats /minute, SPO2 is 82 % in room air she has been diagnosed to have acute exacerbation of chronic obstructive pulmonary disease with pneumonia. Because of long standing   chronic obstructive pulmonary disease, pressure in the pulmonary becomes higher, causes fluid stagnation in the in the right lung and she developed right heart failure. The fluid that developed in the right lung, leading to infection in the lung. Because her temperature is 38.7 with a pulse rate of 100 betas / minute. Spo2 is 82%.

B. COPD is a chronic disease of respiratory system. Because respiratory failure she might have develops heart failure and both respiratory and cardiac causes derange of gas value in respiratory system, that’s why arterial blood gas test and chest XAY were ordered for her and she has right loop consolidation in chest x ray indicates fluid collection that causes infection. That’s why blood culture and sensitivity was ordered for her. Once heart failure begins that leads to other systems failure like renal system. That’s renal function test like urea and creatinine blood test were ordered.

C. CLINICAL SIGNS: she has been experiencing shortness of breath, wheezing. SPO2 IS 82% and cyanosis in the lips and nose due to insufficient of oxygen to meet needs of the body

4. She has been diagnosed to have heart failure and renal dysfunction. Heart and respiratory system are interrelated. When one get fails, other systems begin to deteriorate. When heart starts fail to do its function, it affects other system. That’s why she might have developed renal dysfunction. Diagnostic function of heart failure is edematous of lower limb and chest x ray shows cardiomegaly. Values of Urea and creatinine is 68 and 1.66 that indicates mild renal dysfunction

5. NURSING INTERVENTIONS

a. Elevate head end of the bed and make fowlers position to expand lung capacity

b. Educate her purse lip and diaphragmatic breathing, it helps to conserve her energy, reduce efforts of lungs and supply oxygen to various parts of the body

c. Relax her in order to reduce efforts of lung and reduce co2 retention by avoiding stimulation of respiratory center of the brain

d. Instruct her avoid activities that increase fatigue and Elevate the legs to promote venous drainage

e. Administer oxygen via nasal prongs or Continuous positive AIRWAY pressure ventilation to reduce CO2 retention. Because CO2 retention that stimulate respiratory center to produce oxygen

6.   Mrs. Amah‘s Arterial blood test showed RESPIRATORY ACIDOSIS. Her blood test showed deranged renal dysfunction and heart failure, pneumonia

sno	Patient value	Normal value
sodium	148	136-146mmm/l
potassium	4.8	3.5 -5.3mmm/l
Urea	68	7-22mg/dl
creatinine	1.68	0.7-1.5mg/dl
Hemoglobin	14.5	14-17gm/dl
Alkaline phosphates	321	30-110IU/L
Phosphorus	10.4	2.6-6.4mg/dl

ABG VALUE: Pa O2 IS 49

PaCO2 IS 58 mm of Hg

HCO3 is 27 meq/L Indicates respiratoryacidosis. and PH is low and PCO2 is excess.

PH is 7.25