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Requirement
Write about maintain adequate level of oxygenation for the patients in the clinical scenarios. For the nursing intervention you select, develop a discussion of the specific differences and similarities required in provision of nursing care for Mr. Stevens as compared to Jane.Particularly focus on discussing how nursing care will need to be modified for the intervention selected, based on the age and developmental considerations for each of the patients. Use a mix of contemporary text and research articles to support your discussion points. It is suggested that you use only a brief introduction and conclusion and employ the majority of the word length in addressing the focus of the assessment task.
Solution
Maintain an Adequate Level Of Oxygenation For The Patients
Here maintenance of oxygen levels in patients with two different age groups has been discussed. Both of them are suffering from the same type of illness that is Influenza A but due to the difference in age, the methods of caring and maintaining oxygen levels will vary to a great extent. Maintaining adequate oxygen level is very important for prevention of permanent tissue damage.
There are many conditions in which Mr Stevens require oxygen. He is having cough and fever. Due to a cough, he gets exhausted causing difficulty in breathing. The vital signs with raised respiratory rates laboured breathing show need for oxygen. There are certain precautions which we need to follow. Like never allow more that 2-3 litres of oxygen per day. Also, it is required to check that both the prongs are in patient nares. As here we can see that Mr Stevens have taken out his masks hence he has been changed to prongs. It is important to ensure that his prongs are well in place. Also, it is important to monitor the signs of hypoxemia.( Gould, L., Abadir, P., Brem, H., Carter, M., Conner?Kerr, T., Davidson, J., ... & Grice, E. (2015). As in the case of Mr.Stevens, it is at Sa0295%. It is borderline oxygen saturation. Below 95% can cause tissue damage . Also, it is required a check that MrStevens is getting disoriented. There might be chances that his oxygen saturation levels are going low causing disorientation. Hence it is important to monitor the oxygen levels.
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In the case of Jane, she is only 4 years old. Her parameters are clear indicative that her oxygen saturation is also on borderline. The main cause is Influenza A, which is an acute respiratory infection causing hypoxemia in children. It can be life-threatening in the case of children. Her oxygen saturation is also at borderline and requires to be improved. There are many signs of hypoxemia in children. In this case, we can notice that Jane is unusually quiet and wants to stay in bed. Her reduced activities are a sign of low oxygen saturation. The nasal prongs have already caused destruction to the mucous wall of the nose which is causing pain to her while removing it for cleaning. The normal capillary refill takes about little less than two seconds. In the case of Jane, it is almost normal at two seconds. Prolonged capillary refill is may be a sign of shock. Here her respiratory rate is 124 beats / per minute which s little higher than normal. The oxygen saturation needs to be increased. (Ward, J. J. (2013)
Jane is having a frequent cough and running nose . This is causing her problem with the nasal prongs. With frequent coughing, it is difficult to maintain. Here a nurse has to constantly check if the prongs are in place also if there is some nasal wall destruction due to the administration of prongs it can be taken care of. (Sjöberg, F., & Singer, M. (2013).
In Mr.Stevens case as he is becoming disoriented at night, it is important to evaluate him every 30 minutes. It is important to follow the prescription of oxygen. Oxygen is a drug and every patient has a different required quantity hence the oxygen prescriptions need to be followed. In Mr.Stevens case his each and every change in condition has to be noted down. He requires an hourly check of the oxygen flow rates , also the placement of his nasal prongs at correct place need to be assured. His pulse is on a higher side. The regular monitor of his pulse rate needs to be done. The current respiratory rate is 28/minute. If it goes any higher then condition needs to be checked. His respiratory rates require close monitoring. Mr Stevens also has laboured breathing and he has a pale appearance.( Lee, N., Lui, G. C. Y., Wong, K. T., Li, T. C. M., Tse, E. C. M., Chan, J. Y. C., ... & Ngai, K. L. K. (2013) All these suggest that he requires the supply of oxygen. His face mask is causing him discomfort. Hence he has been given nasal prongs. The nasal prongs can be given without humidification. He has not had any nasal discharge or irritation. Oxygen therapy needs to be closely monitored and assessed. If high levels of oxygen are administered then it can damage the lungs. Hence monitoring is essential. Also in his case of Mr.Stevens if he uses nasal prongs he can continue eating and drinking. This was not possible with a mask. The proper placement of the prongs is important in both the cases. As in case of Mr.Stevens he is disoriented and can remove his prongs and in case of Jane she is irritated by the prongs hence its displacement can be possible
In the case of Jane prongs with humidification is required. She is crying and angry while her mucus is being cleaned. This suggests that her prongs have eroded her nasal skin. Also, she has mentioned that it hurts when she coughs . (Hough, J. L., Pham, T. M., & Schibler, A. (2014). It can be due to infection. In this case, as it might be due to low oxygen saturation in the body the chest is strained while breathing causing pain while coughing. As the capillary refill is slightly delayed it is important to monitor her condition. Like Mr Stevens, she is also having raised respiratory rates. For her age, it is higher. Her breathing is also on higher side. This also shows borderline oxygen saturation. Like Mr Steven her oxygen saturation is also at 95%. Both of them require being monitored regularly. Both of them are having almost similar vitals, but as per the age showing different manifestations. Jane has been unusually quiet and staying in her mother’s lap. On the other hand, Mt Stevens is showing disorientation. Both of them are having the same disease with similar signs. They have fever and coughing. Mr Steven also has malaise as per his age and Jane is having a running nose . Here capillary refill time is delayed in older adults. Hence might not be considered a parameter for Mr Steven. In the case of Jane, it is very important to examine capillary refill. Both of them showing variations and similarities in their situation.( Frat, J. P., Thille, A. W., Mercat, A., Girault, C., Ragot, S., Perbet, S., ... & Devaquet, J. (2015).
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Ward, J. J. (2013). High-flow oxygen administration by nasal cannula for adult and perinatal patients. Respiratory care, 58(1), 98-122.
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Hough, J. L., Pham, T. M., & Schibler, A. (2014). Physiologic effect of high-flow nasal cannula in infants with bronchiolitis. Pediatric Critical Care Medicine, 15(5), e214-e219.
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Sjöberg, F., & Singer, M. (2013). The medical use of oxygen: a time for critical reappraisal. Journal of internal medicine, 274(6), 505-528.
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Gould, L., Abadir, P., Brem, H., Carter, M., Conner?Kerr, T., Davidson, J., ... & Grice, E. (2015). Chronic wound repair and healing in older adults: current status and future research. Wound Repair and Regeneration, 23(1), 1-13.
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Lee, N., Lui, G. C. Y., Wong, K. T., Li, T. C. M., Tse, E. C. M., Chan, J. Y. C., ... & Ngai, K. L. K. (2013). High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clinical infectious diseases, 57(8), 1069-1077.
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Frat, J. P., Thille, A. W., Mercat, A., Girault, C., Ragot, S., Perbet, S., ... & Devaquet, J. (2015). High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. New England Journal of Medicine, 372(23), 2185-2196.
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