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Key Topics
- Requirement
- Case study
- 1. What data deviates from normal findings, suggesting a need for further investigation? Please include reasons why the data needs further investigation.
- 2. What additional questions could the RN ask to clarify symptoms? Please be sure to include the rationale for each question.
- 3. Which systems should you examine? Please list the physical findings in each area.
- 4. Please list the problems (Nursing diagnoses) you think this patient may have. Please include any psychosocial problems. Within the scope of your nursing practice, what would you include in this patient’s plan?
- 5. What health promotion/disease prevention interventions will you recommend?
- 6. What health promotion/disease prevention interventions will you recommend? Within the scope of your nursing practice, what would you include in this patient’s plan?
- References
Requirement
Total 6 pages with 5 sources need to be within 5 years
Sophia is a 66-year-old female complaining of shortness of breath. Listed below are initial data collected during an interview and examination. History Sophia says she’s had breathing problems “for years†but is getting worse. She tells the examiner that she gets short of breath with activity, adding that she can only do things around the hours for only a few minutes before she has to sit down to rest and catch her breath. She says she can sleep only a couple of hours at a time. She sleeps best with two pillows at night, but on some nights she just sits in a chair. Sharon does not currently use oxygen, but she thinks oxygen would help. She admits to smoking 1 ½ packs of cigarettes a day. She has never quit because she says she just can’t do it. Physical Assessment General Survey Alert and slightly anxious female, sitting slightly forward, with moderately labored breathing. Skin is pale with slight cyanosis around the lips and in nail beds. Appears extremely thin. Chest Wall Configuration Chest is round-shaped and symmetrical with increased AP diameter and costal angle greater than 90 degrees. Breathing Effort: Respiratory rate 24 and labored. Chest Assessment Chest wall expansion with respirations is reduced, but symmetrical. Chest wall tactile fremitus diminished. Sibilant rhonchi are auscultated throughout lung fields. Lung sounds are diminished in lung bases bilaterally. Vocal Sound Auscultation: Muffled tones auscultated.
Questions:
1. What data deviates from normal findings, suggesting a need for further investigation? Please include reasons why the data needs further investigation.
2. What additional questions could the RN ask to clarify symptoms? Please be sure to include the rationale for each question.
3. Which systems should you examine? Please list the physical findings in each area.
4. Please list the problems (Nursing diagnoses) you think this patient may have. Please include any psychosocial problems. Within the scope of your nursing practice, what would you include in this patient’s plan?
5. What health promotion/disease prevention interventions will you recommend?
6. What health promotion/disease prevention interventions will you recommend? Within the scope of your nursing practice, what would you include in this patient’s plan?
Case study
Sophia is a 66-year-old female complaining of shortness of breath. Listed below are initial data collected during an interview and examination. History Sophia says she’s had breathing problems “for years” but is getting worse. She tells the examiner that she gets short of breath with activity, adding that she can only do things around the hours for only a few minutes before she has to sit down to rest and catch her breath. She says she can sleep only a couple of hours at a time. She sleeps best with two pillows at night, but on some nights she just sits in a chair. Sharon does not currently use oxygen, but she thinks oxygen would help. She admits to smoking 1 ½ packs of cigarettes a day. She has never quit because she says she just cannot do it. Physical Assessment General Survey Alert and slightly anxious female, sitting slightly forward, with moderately labored breathing. Skin is pale with slight cyanosis around the lips and in nail beds. Appears extremely thin. Chest Wall Configuration Chest is round-shaped and symmetrical with increased AP diameter and costal angle greater than 90 degrees. Breathing Effort: Respiratory rate 24 and labored. Chest Assessment Chest wall expansion with respirations is reduced, but symmetrical. Chest wall tactile fremitus diminished. Sibilant rhonchi are auscultated throughout lung fields. Lung sounds are diminished in lung bases bilaterally. Vocal Sound Auscultation: Muffled tones auscultated.
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1. What data deviates from normal findings, suggesting a need for further investigation? Please include reasons why the data needs further investigation.
She looks to be anxious probable due to lack of adequate breathing. The respiratory rate is 24 with labor indicating that she is facing breathing problem. The value implies that the respiration is abnormal (Lars et al., 2016) and is forcibly inhaling. Due to lack of adequate oxygen, her lip and nail beds appears to be blue in color indicating cyanosis. No laboratory tests were performed to understand the blood picture and oxygen saturation. Therefore, further investigations pertaining to complete blood cells count is required. The proportion of basophiles and eosinophils needs to be assessed. In general, the proportion is low in health individual, exceeding 1 (Basophils) and 5% (eosinophils) contributes for asthma (Nadif et al., 2013). The vital parameters such as blood pressure, pulse, heart rate etc are required to be monitored to understand the impact of breathing on the vital parameters. Peripheral capillary oxygen saturation (SpO2) has to be determined to know the amount of oxygen in the blood. It is the reflection of oxygenated hemoglobin in comparison to the total amount of hemoglobin. The SpO2 should be about 95%. Below the value indicates that she is in need of oxygen and accordingly oxygen supplementation can be given. The additional testes help the health care team in understanding the severity of the problem.
2. What additional questions could the RN ask to clarify symptoms? Please be sure to include the rationale for each question.
Following are the additional questions can be asked the patient in the assessment
o Do you use a PEF instrument?
The crest expiratory stream (PEF), used to measure maximum expiration rate, would help the RN in understanding the lung function how it is reciprocating during respiration
o Do you take daily/regularly asthmatic medicines?
Being an asthmatic patient as she suffers from breathing, the details of medicines in use will help the clinician in prescribing the new medication.
o In case of inhalers, have you been instructed in how to inhale your asthma medication?
To manage the symptoms of asthma, doctors prescribe inhalers comprising of corticosteroids for inhalation to promote the relaxation of bronchioles. The inhalers must be used as per the instructions. The details are necessary how far she is using the instrument in a right direction
o At what time of the day, do you face suffocation or breathing problem?
This would help in directing the drugs on
right time.
o Do you face any breathing problem during nighttime?
In general, the asthmatic attacks are more in nighttime. This information will help in understanding and comparing the symptoms
o Did you participated ever any of the asthma management programs
Being a chronic disease, the patients are expected to participate frequent management programs to control the symptoms and to what extent she is following the precautions.
o Do you have an adequate knowledge pertaining to the causes of disease?
Knowledge pertaining to causes and symptoms would help Sophia in minimizing the precipitating factors
o Do you know the imprecations of smoking on asthma?
Smoking aggravates the bronchitis and congestion leading to asthmatic attacks. The information is required whether she is aware of the effect of smoking on asthma
o Do you face breathing problem after taking solid food?
The extent of solid food in stomach reduces the space available for lung movements and it further reduces lung functions.
3. Which systems should you examine? Please list the physical findings in each area.
Overall health needs to be determined. Among, the following systems can be examined to understand the extent of disease
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Sensory organs: Ears will be examined to check the possible signs of fluid secretion. Eyes will be examined to check allergic manifestations such as redness or discharge; any dark color around the eyes. Inside and outside the examination of nose and its cavity for any possible inflammation and blockade.
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Mouth exam to assess the hygiene of the gums and teeth; check for redness or inflammation of throat
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Examination of neck for perceptions of inflammation of lymph nodes.
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Examination of heart sounds for any abnormality in rhythm.
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Lung examination for the possible signs of wheezing, congestion, or any abnormal sounds.
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Chest examination to check for symmetrical movements (Lewis, 2014).
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Appearance of skin for possible blue coloration to assess the extent of cyanosis
4. Please list the problems (Nursing diagnoses) you think this patient may have. Please include any psychosocial problems. Within the scope of your nursing practice, what would you include in this patient’s plan?
The following is the list of problems that can be included in the plan of interventions
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Ineffective airway clearance associated from an excess production of antibodies and bioactive, that contributes for contraction of airways and resulting in asthma. This is frequently combined with bodily fluid development, which plugs the aviation routes, bringing on inadequate leeway of the aviation routes. T he problem is evidenced from the symptoms, anxiety, chest tightness, cyanosis and difficulty breathing (Avena et al., 2015)
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Ineffective Breathing Pattern: The nearness of bodily fluid in the aviation routes results in blockage of air to the lungs and the body. Powerlessness to keep the aviation routes clear because of bronchospasm is brought on by incitement of the receptors that are discharged in the nearness of aggravations or allergens.
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Impaired gas trade identifies with the diminished measure of air that is traded amid motivation and termination. Ventilation is disabled regardless of sufficient perfusion in the lungs.
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The liquid amassing in the lungs can make her weariness
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Activity prejudice because of lacking oxygen in the body, which can prompt shortcoming in the muscles. The patient is not ready to endure exercises because of low oxygenation coming about because of insufficient lung development (Hanania et al., 2011).
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Imbalanced sustenance: This nursing conclusion for asthma identifies with a patient's having not as much as body necessities because of shortness of breath and movement narrow mindedness
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Psychosocial issues: Sophia is demonstrating some second rate complex making her less contacts with other individuals. The blameworthy feeling and association with companions causes loss of self-governance and autonomy.
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Place Your Order5. What health promotion/disease prevention interventions will you recommend?
The following are the interventions can be recommended for the prevention of asthma
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Administer drugs and nebulization as coordinated by doctor; in removing bodily fluid.
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Encourage the patient to utilize diaphragmatic breathing and work on hacking works out.
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Ensure satisfactory hydration.
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Teach patient to perceive early indications of disease; to maintain a strategic distance from respiratory aggravations like vaporizers, smoking and extremes of temperature.
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Assess the patient's breath rate and degree.
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Elevate the leader of the informal lodging the patient's position like clockwork.
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Monitor the patient's vital signs and utilize beat oximetry.
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Create a casual disposition and utilize a casual outward appearance.
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Instruct the family to go about as an emotionally supportive network for the patient amid an asthma assault.
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Collaborate with the nutritionist for the patient's most loved dinners.
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Encourage patient to eat incessant, little dinners.
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Evaluate the patient's sustenance inclinations and eating routine suggestion.
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Monitor patient's oral admission and include parenteral sustenance if lacking.
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Provide a casual environment for feasting
6. What health promotion/disease prevention interventions will you recommend? Within the scope of your nursing practice, what would you include in this patient’s plan?
Yes, the following are the interventions within the scope and can be included in the plan can
Management
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Assess the patient's respiratory status by checking the seriousness of indications, breath sounds, top ?ow, beat oximetry, and key signs.
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Administer pharmaceuticals as endorsed and screen the patient's reactions to those drugs (Jimmy and Jose, 2011).
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Administer ?uids if the patient is got dried out.
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Monitor for breaking down respiratory status and note sputum attributes.
Educating and proceeding with consideration
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Teach patient and family about asthma, reason and activity of prescriptions, triggers to evade and how to do as such, and appropriate inward breath method.
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Teach understanding how to execute an activity arrangement and how and when to look for help.
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Remind patients and families about the significance of wellbeing advancement methodologies and prescribed wellbeing screening.
Discharge goals
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Ventilation/oxygenation satisfactory to meet self-mind needs.
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Nutritional admission addressing caloric necessities.
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Disease procedure, anticipation, and restorative regimen caught on.
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Plan set up to address issues after release.
References
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Avena, MJ., Da Luz, GPM., Herdman, T & Gutierrez, M (2015) Respiratory nursing diagnoses: Presenting evidence for identification of the defining characteristics in neonatal and pediatric populations. Int J Nurs Knowl. doi: 10.1111/2047-3095.12098.
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Hanania, NA., King, MJ., Braman, SS., Saltoun, C., Wise, RA., Enright, P., Ann, AF., Sameer, K M., Joe, W.R., Linda, R., David, AS., John, JL., James, EF., Sandra, RW., Cynthia, B., Kushang, VP., Charles, GI., Barbara, PY., Ethan, AH., Stephen, IW., Mark, FS., William, B E & Dennis, KL (2011). Asthma in the Elderly: Current Understanding and Future Research Needs: A Report of a National Institute on Aging (NIA) Workshop. The Journal of Allergy and Clinical Immunology, 128(3 Suppl), S4–S24.
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Jimmy, B & Jose, J (2011). Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal, 26(3), 155–159. http://doi.org/10.5001/omj.2011.38
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Lars, T., Lien, MD., Thomas, H & Trond, M (2016) Respiratory rate during the first 24 hours of life in healthy term infants Pediatrics 137(4) DOI: 10.1542/peds.2015-2326
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Lewis, ML (2014). A comprehensive newborn exam: part II. Skin, trunk, extremities, neurologic. Am Fam Physician. 90(5) 297-302.
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Nadif, R., Zerimech, F., Bouzigon, E & Matran, R (2013) The role of eosinophils and basophils in allergic diseases considering genetic findings. Curr Opin Allergy Clin Immunol. 13(5) 507-13.
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