Question

Mrs. C., an independent, 96-year-old woman, has a history of rehospitalization because of atrial fibrillation resulting from CHF and hypertension.

After her most recent hospitalization, Mrs. C. was treated and released into home care at an agency in Washington. A home telemonitoring system that tracks and transmits patients’ vital signs was placed in her home. The primary goal of placing this patient on the telemonitor was to provide daily monitoring of her condition, thereby avoiding unnecessary rehospitalizations.

One morning, Mrs. C.’s telenurse detected an alarmingly low oxygen saturation level in the patient’s transmitted data. In response, the nurse telephoned Mrs. C. and asked her to retake her oxygen reading. The reading was confirmed and the telenurse contacted the patient’s physician, who requested immediate transportation of the patient to the hospital emergency room. Medics were called and Mrs. C. was taken to the hospital, where she was diagnosed with a pulmonary embolism.

The prompt response resulted from early detection and timely intervention enabled by the home telehealth equipment and a home health nurse’s oversight. One notable fact in this case is that although the primary goal of monitoring patients is to avoid unnecessary hospitalization, in this case the hospitalization was necessary for the patient as a result of her elevated blood pressure and compromised oxygen saturation levels. The patient was still asymptomatic at the time of detection. However, the telehealth intervention and subsequent hospitalization allowed for the embolism to be treated before any serious damage occurred.

Under the traditional home care model, this patient might have been seen by a nurse only two to three times per week, and the clinician does not have knowledge of the patient’s condition in between visits. However, having vital patient data tracked and transmitted daily allowed for rapid response that resulted in a positive outcome, perhaps a life-saving intervention for this patient.

• What assessment information in the patient situation is the most important and of immediate concern for the nurse?
• What patient condition(s) are consistent with the most relevant information?
• Which possibilities or explanations are most likely to be present in the patient situation? Which are the most serious or a priority?
• What actions would most likely achieve the desired outcome for this patient?
• Which actions are the most appropriate and how should they be implemented?
• What patient assessment would indicate your actions were effective?

Answer 1

The first test performed when pulmonary embolism is suspected is a blood oxygen level. The simplest way to measure the blood oxygen level is with pulse oximeter. Pulse oximetry is a noninvasive way to monitor the percentage of hemoglobin that is saturated with oxygen. A blood oxygen saturation level less than 95 percent is abnormal. It may be explained by a lung or heart problem already present, such as emphysema or pneumonia, or by PE (or both).un explained sudden desaturation is the sign of pulmonary embolism.patient may feel sudden shortness of breath.

There is possibilities in patient with chronic heart disease, or high blood pressure, atrial fibrillation may cause the pulmonary embolism.in AF Atrial fibrillation leads to platelet and coagulation cascade activation along with disordered fibrin turnover, promoting procoagulant state. So the stasis of blood may cause clot formation.another one thing is embolism will cause pulmonary artery hypertension.

Patient with past history of heart diseases such as hypertension, atrial fibrillation is th one of the cause of pulmonary embolism. Sudden fall in saturation is the main symptoms can be identified in pulmonary embolism. Aswell as hypertension. In pulmonary embolism patient may go with shock. So they may have anxiety, and it may leads to hypertension.

Early detection of symptoms is verymuch helpful to diagnose the conditions. Immediate hospitalization also helpful for the confirmation of disease. Also continous monitoring of the vitals and symptoms helps to prevent the worsening of patient's condition. Frequent monitoring helped her to identify the desaturation of patient and immediate hospitalizationand intervention helped the patient.

In pulmonary embolism patient may not be so much symptomatic if saturation level falls below 80%, but her oxygen level may low. So early detection and administration of oxygen helps to improve the oxygen level. Also the patient may have hypertension to be controlled. If it is becoming normal saturation and bp it indicates the effectivenes of her action.