Question

Ms Aaliyah Abimbola is a 56-year-old female who emigrated from African 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. 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. 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 the medication helps her catch her breath sometimes but she still has to rest halfway 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 of 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 “prioritize 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 moreover the last year or so as she gets 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. Ms. Abimbola has a history of moderate Obstructive Sleep Apnoea (OSA) and requires CPAP for overnight sleep. She was diagnosed with Hypertension and Type 2 Diabetes 3 years ago. Family history Her father died from a stroke in 2005. Medications Metoprolol 100mg daily Aspirin 100mg daily Atorvastatin 20mg mane Glibenclamide (Daonil) 5mg orally daily before breakfast Salbutamol sulfate (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. Could you please answer the below question for above case study..

Interpret the information you have been given about her condition (Step 3 of the CRC) and identify three priority nursing issues you must address for Ms Abimbola (Step 4 of the CRC). Justify why they are priorities and support your discussion with evidence.

Answer 1

ANSWER 1: DUE TO WORKING IN FLOUR MILL WITHOUT ANY PPE OR PREVENTIVE MEASURES SHE HAS TO SUFFER FROM:

• COPD
• Hypertension
• Diabtere type 2
• HISTORY OF OBSTRUCTIVE SLEEP APNEA

COMPLAINTS: Ms. Abimbola came with complaints of shortness of breath, and fatigue.

MEDICATION:

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

ABNORMAL FINDINGS:

• BP: 142/96mmHg
• BMI: 38.4 KG/M2
• Total cholesterol level - 5.2mmol/L (BODERLINE)
• Fasting BGL - 9.6mmol/L

ANSWER 2: NURSING PRIORITIES ARE

• ineffective breathing pattern related to retained secretions
• Imbalanced nutrition intake : more than body requirement related to disturbed dietary intake
• Activity intolerance related to decreased oxygen supply
• impaired carbohydrate metabolism related to decrease insulin production

NURSING INTERVENTIONS:

1. Assess the respiratory pattern, rate of the client
2. Assess vitals and other lab findings or do ABG if dr. order is there
3. Provide comfortable position that is semi fowlers position
4. Administer oxygen if required
5. Collaborate with dietician for planning diet for patient
6. regular check BMI and set short term goals
7. Provide chest physiotherapy, postural drainage
8. encourage client to drink more and more fluids, and encourage to cough out the secretions
9. Administer nebulizer and steam if required.
10. Promote physical exercises and adqeuate rest in between of activity period, allow patient to sleep for enough hours.
11. Regular check RBS and administer insulin and hypoglycemic agents.
12. Teach client about sign of hypoglycemia and ways to prevent it.