Question

Ms. Aaliyah Abimbola; a 56-year old female who emigrated from Africa 20 years ago. Ms. Abimbola is a single parent with three female children, ages 14, 17, and 18. You are working on the respiratory ward and have been allocated to Ms. Abimbola who has been admitted with an exacerbation of COPD. Ms. Abimbola presented to A&E via ambulance at 8 AM after experiencing acute shortness of breath while preparing breakfast this morning.

Based on the information provided in this case study, you are required to discuss your initial assessment of Ms. Abimbola using Steps 1 and 2 the Levett-Jones’ (2018) Clinical Reasoning Cycle (CRC) before interpreting the information (Step 3 CRC) you have been given to identifying 3 nursing care priorities (Step 4 CRC) for Ms. Abimbola.

You are the RN on a morning shift on the respiratory ward of a large inner-city hospital. At 10:30 AM you receive a patient from the Emergency Department.

This is the hand-over you receive.

I	My name is Catriona and I am the A&E RN who has been caring for Ms. Aaliyah Abimbola. Thank you so much for taking this patient so quickly. We’re so busy we haven’t time to do much for her apart from getting her ready to bring up here.
S	Ms. Abimbola is a 56-year-old woman with a past history of COPD who was admitted to A&E via ambulance at 8am today in acute respiratory distress. She became acutely short of breath this morning while making breakfast and called an ambulance.
B	I only got the chance to ask her a few admission questions before I was told to bring her up here. She was able to tell me: She saw her GP two weeks ago due to increasing shortness of breath and fatigue and he gave her ‘some breathing medication’ (inhalers). She has had to use these with increasing frequency since then. Ms Abimbola has been working at the flour mill 50 hours per week recently. This has made it tough to look after her three daughters because she’s a single parent. She has a medical past history of moderate sleep apnoea for which she uses CPAP to sleep overnight, Type 2 Diabetes and hypertension diagnosed 3 years ago. She has never smoked but has a long history of severe exposure to industrial dust. Her children are at school but the oldest one knows she’s in hospital.
A	On arrival in A&E she was acutely short of breath with an expiratory and inspiratory wheeze. Her Sat’s were 93% on room air & her GCS was 15. We haven’t had time to do much for her apart from give her a couple of nebulisers. She has an interim medical diagnosis of acute exacerbation of COPD
R	Medical orders: 5mg salbutamol nebuliser as necessary, repeat every 20 minutes for 1 hour. O2 therapy to maintain SpO2 > 92%. Needs to have an ABG and a sputum sample collected for MC&S. Monitor vital ob’s half hourly and the respiratory medical team will be here soon to review her. Notify RMO if her condition gets worse.

Your initial assessment findings on the ward for Ms Abimbola are as follows:

Medications

Metoprolol 100mg daily, Aspirin 100mg daily, Atorvastatin 20mg mane, Glibenclamide (Daonil) 5mg orally daily before breakfast, Salbutamol sulphate (Ventolin) 100mcg inhaler as required for symptom relief (1-2 puffs as required), Fluticasone propionate/salmeterol xinafoate (Seretide) 50/25 inhaler (2 puffs BD)

Current vital observations:

BP 142/96mmHg

HR 96bpm

RR 24 bpm

SpO2 93% on RA

T 36.7C

Health assessment findings:

Height 158cm, Weight 93kg,

Total cholesterol level - 5.2mmol/L

Fasting BGL - 9.6mmol/L

Inspiratory and expiratory wheeze. speaking in short phrases taking 2-3 breaths between each phrase before continuing to speak.

Alert and orientated to time, place, and person.

Further information you gather from her medical history and as part of her admission questions:

Ms Aaliyah Abimbola is a 56 year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children (ages 14, 17 and 18) living in the inner-west of Melbourne.

Ms Abimbola went to her local health care clinic 2 weeks ago complaining of increasing shortness of breath and lack of energy. She says she was given some breathing medication (inhalers) by the doctor and told to take it easy for a few days. She has been struggling to get from the ground floor living area to the upstairs bedrooms without resting half-way to catch her breath. She says sometimes the medication helps her catch her breath but she still has to rest half way even with the medication.

Ms Abimbola has been working at the local flour mill since she arrived in Melbourne from Africa 20 years ago. She has never smoked but says the dust at the flour mill often makes her cough. Her job for the first 3 years was filling bags with flour until that process became fully automated. She then got promoted to running one of the flour grinding machines. 2 years later she got another promotion to shift supervisor in the milling and packaging section. She says her clothes were always covered in white dust at the end of every shift. "I used to look like a ghost at the end on my shift. We all did!" The flour mill made it mandatory to wear a mask and other protective equipment when you're working in the factory about eight years ago. However, Ms Abimbola has been working in the office for the last 6 years and no-one wears protective equipment in the office as it's not necessary. She says there's always a fine layer of dust on the paperwork in the office because the 'flour just gets everywhere no matter how often you clean or how careful you are."

Ms Abimbola is currently averaging 50 hours/week which means she needs to work on most weekends. Since the Covid 19 lockdown the factory has increased production to 24 hours a day 7 days a week. That means the office is also extremely busy. Ms Abimbola has always accepted any overtime on offer to help pay the rent for their house and cover the school fees for the Catholic school her children attend. She is adamant that she wants them to get a good education so they can make the most of the opportunities she never had in Africa. She has always been socially active within her Church community, but due to her increased working hours this has restricted her ability to attend mass and contribute to her community. She states that she needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”. She has two close friends at church who help with looking after her children when she has to work late or on weekends.

Ms Abimbola states that she tries to exercise when she has time and walks to the train station every day to get to work. It used to take 8 minutes each way but lately it takes at least 20 minutes including rest stops to catch her breath. She also does a lot of walking at the flour mill taking paperwork to the production supervisors and picking up reports for processing. However, she has had to ask one of the younger staff to get the reports and deliver the orders more and more over the last year or so as she get's too short of breath when she walks too far too quickly.

Ms Abimbola has not spoken to her husband since she and the children left him 6 years ago. She says he used to work at the flour mill but was sacked for being drunk at work eight years ago. He had a hard time finding work so drank heavily and became violent. She took the children and left him after he hit the middle child for spilling his coffee. She doesn't know where he lives and has had no contact with him for over 4 years.

Family history

Her father died from a stroke in 2005.

What can be the best conclusion for this case study?

Answer 1

CONCLUSION FOR THE CASE

This is the case study regarding COPD (Chronic Obstructive Pulmonary Disease).

In this case Mis Aaliah Abimbola 56 years old female admited with acute exacerbation of COPD.On admission she has the complaints of shortness of breath,her saturation is 93% in room air.Her GCS15, alert and oriented to tie place and person. she working in a flour mill for several years and chronic exposure to the dust i the mill.On admission her vitals are BP:146/96,HR:96 b/m,RR:24 b/mTemperature 36.7,She is a known case of Diabetes mellitus,cholesterol and hypertension and on medication

COPD

Chronic Obstructive Pumonary Disease is a disease that produse obstruction of air flow caused by chronic exposure to allergic material like smoke dust etc. COPD is a progressive disease and clinical manifestations develop slowly.This is not fuly reversible .COPD is one of the main cause of death globally.COPD includes Asthma,chronic bronchitis and pulmonary emphysema.

CHRONIC BRONCHITIS is a clinical disorder charecterised by excessive mucose secretion in the bronchial tree. and manifested by chronoc recurrent cough

COPD is mainly caused by smoking and also caused by occupational exposure to allergens.It will irritate bronchiolar wall and result in the development of chronic bronchitis

ASTHMA is a disease charecterised by an icrease responsiveness of trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airway

PULMONARY EMPHYSEA is the anatomical alteration of lungscharecterised by an abnormal enlargement of airspaces distal to the terminal non respiratory broncheoles accompanied by distructive changes of alveolar wall

As COPD progressesfunctional residual capacity increased and cause chest hyperextension and patient may develop barrel chest.Hypoxemia and hyper capnia ay result from decreased gas exchange

TREATMENT

Treatment includes,

Broncho dilators

Intermittent positive pressurebreathing

Oxygen therapy

Pulmonary physiotherapy

  

Patients with severe COPD require hospitalisation,they need oxygen therapy,treatment with nebulisers ,bronchodilators and inhalers.Treatment goals to improve ventillation to ovrcome hypoxia. The patients with carbondioxide retentionflow rates are adjusted so that the inhaled concentration of oxygen is not more than approximately 30%

NURSING PRIORITIES

Maintain airway patency

Facilitate gas exchange

Enhance nutritional intake

Prevent complication

Provide information about disease process,prognosis and treatment regimen

NURSING MANAGEMENT

Administration of bronchodilators as prescribed

Instruct the patient in direct or controlled cough

provide psychological support

Patient teaching

  PATIENT TEACHING INCLUDE -Respiratory muscle training

Managed daily activities

Pursed lip breathing

Exercise training

Diaphramatic breathing

  

The above mentioned patient MS.Aaliyah Abimbola recieved proper treatment as prescribed,after recieving nebulisers she feel comfortable,vital signs stable ,she is concious and oriented to time,place and person,GCG 15,Proper health education given to the patient