Health Alterations Assessment Task 3 Case Study

Answer

Health Alterations Assessment Task 3 Case Study

Question 1: Priority Problems of the Patient

 ABCDE approach is a critical tool that nurses use to assess patients. The primary priority for Mr. Krum is the shortness of breath. Based on ABCDE framework, a patient must first be assessed for airways (Soltan & Kim 2016). The airways must remain open. Shortness of breath is an issue that threatens life, and thus must be assessed appropriately so that necessary treatment can be administered. Second, the breathing of the patient must be checked progressively in accordance with ABCDE framework. Mr. Krum complains of coughing and breathing difficulties which means that based on ABCDE framework, his breathing difficulty must be diagnosed as a primary priority. Essentially, the SOB or dysponoea’s pathophysiology is difficult since the condition occurs as a result of cardiovascular or respiratory impairments (Coccia et al., 2016). As such, increasing his breathing requires immediate activation of his chest wall and other receptors associated to both linked to lower and upper airways.

            The next primary priority for the patient is the exacerbation of CHF.  Apparently, Mr. Krum is fatigued and weak due to the pleuritic pain he experiences in his chest. Soltan & Kim (2016) contended that circulation is a critical phase of assessing patients according to ABCDE framework. As shown in the case study, Mr. Krum has a relatively high blood pressure that lowers his cardiac output, thereby hindering the flow of the blood and the subsequent pains he experiences.

Question 2: Clinical Manifestations

            Chronic Obstructive Pulmonary Disease (COPD) includes conditions such as chronic bronchitis, emphysema, as well as, small airway diseases (Braun & Anderson 2017). Mr. Krum depicts one of these conditions. In COPD, obstruction entails the shortening of the dimeter of peripheral airways, making it difficult and impossible for one to breath. Mr. Krum began feeling uneasy at rest because the diameter of his airways reduced the flow of air and prolonged his breathing out.  From the provisional diagnosis, Mr. Krum suffers from acute exacerbation of newly examined chronic obstructive airway illness because of upper respiratory tract infection. Carone et al. (2016) stated that individuals suffering from chronic obstructive airway disease usually depict a persistent dysponoea and minimal effort tolerance as evident in Mr. Krum’s history. Mr. Krum stands a higher risk of developing COPD due to various factors he is exposed to, including tobacco smoke. The patient has smoked for many years and currently depicts chronic cough, which is linked to mucoid sputum. Moreover, physical findings of vesicular breathing and hyperinflated chest also revealed the presence of obstructive airway disease.

            While being admitted to the hospital, Mr. Krum had acute shortness of breath. This was linked to a wheeze that was defined as noisy breathing. Abrupt deterioration of symptoms depicts a condition of acute exacerbation. Moreover, the history of upper respiratory tract infection signs reveals that it was the cause of this condition of exacerbation. Essentially, the patient has developed congestive cardiac failure as the major condition or as a problem of acute lung disease. He has a history of reduced effort tolerance. Driver and Gosian (2015) posited that patients suffering from congestive cardiac failure may experience wheeze or abrupt increase in dyspnoea. Moreover, physical examination of fine crepitation at the lungs further shows congestive cardiac failure.

Question 3: Interventions

             A major intervention for shortness of breath is the administration of oxygen. The doctor must prescribe for the oxygen therapy and required dosage. Educating and demonstrating to nurses on how to administer oxygen to patient and his family members is a critical component of nurses’ duty and thus nurses understand that. To ensure that the patient receives required oxygen, the nurse must check the patient’s vital symptoms and signs such as pulse oximeter. In case the oxygen is administered to the patient inappropriately, it can cause death and thus oxygen therapy must be recommended by the doctor. While treating the patient, the nurse should regularly monitor the oxygen and observe the BP, PR, RR, and level of patient’s awareness with vigilant consideration (Mayhob 2018).

The RN should clearly understand the targeted oxygen saturation, range of oxygen, indication, as well as, oxygen delivery equipment. The adequate level of oxygen is critical since high quantity may lead to fatality. It is therefore the role of the nurse to inform Mr. Krum and his relatives regarding the oxygen therapy dosage, as well as, the impacts of overdosing the therapy.  As such, the required quantity of oxygen therapy and involving the patient’s relatives through therapeutic relationship are the anticipated outcomes for the proposed intervention.  Therapeutic relationship would provide patients with quality life since his family members would have learned on how to respond quickly in case SOB takes place in the future. Nonetheless, the nurse should document the described steps in the patient’s care plan so that his family members or those caring for him can understand his medical history and previous treatment already administered.

            The second intervention is the pharmacological therapy. Once the doctor has recommended the appropriate medication, it is the role of the registered nurse to carefully administer the recommended medications. Essentially, the nurse must administer the right medications and verify the medication based on the order issued. Given that the patient is under several medications, checking his allergies and history is critical. As such, the registered nurse must constantly check the patient file and understand whether the patient has any allergy and inform the doctor of such allergies before proceeding with administering the medications. In case the nurse established that the patient has an allergy, he or she should stress on the stated allergy in all communication with other healthcare practitioners working in the hospital particularly the doctor and inspire the patient to adhere to the recommended medication.

            Reports indicate that the nursing education often stresses on the importance of using 5Rs before administering any treatment or drug to any patient (Goharani, Miri, Kouchek & Sistanizad, 2017). The 5Rs encompasses right drug, right rout, right time, right dose, and right patient. The nurse must ensure that the patient follows the recommended medication therapy at the recommended time since patients suffering from CHF have a greater risk, and thus proper administration of their medication is necessary. Intuitively, the safe medication practice is a joint activity and, therefore, the patient and those caring for him should be involved.

Moreover, a clear communication may help reduce medication errors and ensure patient safety (Goharani et al., 2017). As such, the doctor will prescribe for the medication for symptomatic medication of the heart failure so that the nurse can administer the treatment as required. The nurse will then inform the patient about the drugs as well as side effects of such drugs. After administering the medications, the registered nurse should monitor the patient and write down any changes. Prudently, the registered nurse must have adequate knowledge about drugs, side effects and their therapeutic use. Understanding the drug hazards and drug safety measures of administering the drug minimize the risk of errors including being conversant with various techniques.

            Reportedly, cardiac drugs can have detrimental impacts and at times may cause death when administered incorrectly. For instance, Mr. Krum is using furosemide and the key side effects to take into account are mucosa and dry skin that can make the patient to dehydrate. For this reason, the patient must be monitored regularly for palpitation, imbalance serum potassium signs and muscle cramps (Hatchett et al., 2015). Further, the medication intricacy coupled with the volume may result in the growth of errors, and thus Mr. Krum must be checked after every medicine therapy. It is also important for the nurse to deal with any problem or sign of discomfort that the patient experiences since there might be medicine reactions and, which means the doctor must be informed about such changes so that errors may be minimized during treatment and patient safety improved through apparent communication.

Question 4: Discharge Planning

             The discharge planning begins immediately the patient is admitted to the hospital. The plan contains information regarding follow up procedures, information regarding patient’s frequent medical practitioner, as well as, present medications and future medical visits. Thus, it is the responsibility of the nurse to formulate and finalize the discharge plan. While doing this, the nurse must follow social justice framework. Essentially, using social justice principles will ensure a strong dedication to education and care that will last beyond hospital settings (Mayhob 2018). The discharge plan should encompass identification, assessment, goal formulation plans, implementation, coordination, and evaluation. As indicated in the case scenario provided, Mr. Krum is a male patient who has several comorbidities. In particular, he has reduced physiological reserve and, therefore, he is more likely to reject the changes. As such, the social setting where the patient will be discharged to must be assessed properly. Essentially, Mr. Krum’s discharge plan encompasses a collaborative process between the social team and cardiovascular team. Fore effective outcomes, the discharge plan will put more focus on activity/physical exercise, diet and suitable medication.

To begin with, it will be appropriate for the patient to engage in light exercises such as gardening and walking. This is because the more exercise the patient undertakes, the better impacts are those exercises on his physical wellbeing. The second aspect of the discharge plan will be diet. The patient must be restricted from taking meals with high salt content. It is also appropriate for him to be advised to avoid taking alcohol, but take more liquids instead. Moreover, the patient should be advised to avoid smoking because smoking increases MI and destroys blood vessels that transport oxygen to the heart. Medicine is the next element of the patient’s discharge plan. The patient should be advised on the need to take recommended dosage at the right time. The patient has a body mass index of 34 and he is considered obese. As such, he should be advised to frequently monitor his weight and seek medical assistance in case his weight increases beyond 2 pounds every day. As stated in the discharge plan, collaborative follow up appointments need to be established, including visiting dietitian. This should, however, be done a week after the discharge.