Case study Oxygenation PDF

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Walsh University, Case study on Oxygenation...

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Oxygenation and Perfusion Please complete the following case studies, complete in a word document. Upload the document to drop box by Thursday, October 30th at 2359. Late submission will not be accepted. This will count as a quiz grade. You are a nurse caring for your newest admission, a 68-year-old retired teacher who has a 50 pack-year history of smoking, which resulted in emphysema. She attends exercise classes at her local gym seeking to maximize her oxygenation. Recently, the patient has begun to contemplate the use of portable oxygen to decrease her workload to breathe. (Learning 1. What respiratory accommodations would you expect to observe in your patient due to her COPD? Ans: Due to her COPD respiratory accommodations are visible such as shortness of breathing, chronic cough, difficulty in breathing, sputum production can be seen, weght loss, dyspnea, present of wheezing sound. 2. How do the effects of emphysema increase respiratory workload? Ans: Because of emphysema, lung tissue is destroyed. The air sacs at the end of the respiratory passages lose their flexibility making it hard to breathe carbon dioxide out of the lungs. Destruction of the tissue causes the airways to become narrower, which decreases airflow. All these changes lead emphysema to cause shortness of breath and therefore, wheezing occur causing an increase functional residual capacity. The increase function residual capacity leads to increase tidal volume which in term increases workload on respiratory muscles. 3. As her condition becomes chronic, what effects would you expect to develop? Ans: As her condition becomes chronic, it will lead to the respiratory infections recurrently such as lung failure, heart failure, poor gas exchange, depression and anxiety and may be lung cancer. 4. Considering her medical history, for which illnesses is she at greater risk? Ans: She is at greater risk for chronic respiratory failure and collapse which is a life-threatening condition. 5. Describe the lung sounds you would anticipate auscultating. Ans: There are various lung sounds that can be anticipated such as wheezing (high pitched sound when air passes through the narrow airways), Stridor (almost wheeze like produced due to the blockage in trachea), Rhonchi (low pitched, rattling lung sounds that often resemble snoring), and Pleural rub (squeaking or grating sounds of the pleural linings rubbing together). 6. How would your patient’s COPD impact her dietary needs? Ans: Patients suffering from COPD need some dietary modifications which includes good source of protein for example meat, fish, poultry, nuts, eggs, cheese that help to strengthen the

respiratory muscles and fiber sources such as bread, pasta, nuts, seeds, vegetables and fruits. Most important for them is to drink more fluids. 7. Outline measures that would promote your patient’s comfort. Ans: -We can encourage our patients to avoid smoking so it can help to get better -Advise them to maintain a healthy, well-balanced diet to maintain adequate energy to breathe and complete their daily activities. -Improving the quality of their indoor air will help keep the air they breathe cleaner and healthier. -Getting adequate rest is important to overall health. -They should take their medicines as described by physicians and should not take OTC drug without consulting. -They should avoid any types of infections because they are at increased risk of lung infections. -They should take a deep breath and hold it for 3 seconds. Use their stomach muscles to expel the air and avoid a hacking cough or just clearing their throat can help them breathe.

8. Why would it be helpful to encourage adequate fluid intake? Ans: In the COPD patient the mucus which is produced by airways and their lung is thick, sticky, difficult to expel out by coughing so taking adequate fluid causes the thick mucus to become thin and it is easier to be expelled out and it gives more space to air that helps breathing. Drinking enough water can also help the patient to fight off infections better. 9. What exhalation technique would be helpful to your patient? What are its benefits? Ans: Pursed lip breathing is especially helpful to people with COPD. The pursed-lip breathing is breathing in through the nose and out through pursed lips. It is useful when the patient’s shortness of breath flares up. Pursed lip breathing had more endurance, a more controlled breathing rate, more oxygen in their blood, and less lung hyperinflation during the exercise. 10. How could abdominal breathing assist your patient in oxygenation? Ans: Diaphragmatic or abdominal breathing is a breathing exercise that helps to strengthen our diaphragm, which is the most important muscle used in breathing. Diaphragm helps expel air from our lungs when we exhale, so when air gets trapped in the airways in the patient who are going through COPD, the diaphragm has hard time functioning properly and it becomes less useful. Hence, the more we do these types of breathing techniques, the more nature we begin to feel and the easier it becomes for us to breathe. 11. Why is it important to monitor oxygen flow rate in patients with COPD?

Ans: Monitoring oxygen flow rate in patients with COPD is essential because it is life saving for these patients. As there is Chronic obstruction in the airways, it can cause problem in patient if the flow rate becomes lower than it is required as well as it causes hypoxia when flow rate is higher than the normal level. The proper flow rate is needed because it reduces the workload and provides better compliance on patient. If the oxygen flow rate is not normal, it can lead to imbalance in carbon dioxide level and lead to mortality.

2. Your patient is a 75-year-old man who immigrated to the United States from Russia as an adult and has limited English skills. He has a history of diabetes, cardiovascular disease, and a severe stroke that impaired his ability to speak and swallow. He has a well-healed tracheostomy tube but requires frequent suctioning due to thick secretions. (Learning A) List possible nursing diagnoses for this patient’s respiratory status. Ans: Ineffective airway clearance related to the thick and excessive mucus. B) What are possible nursing interventions that could address this patient’s respiratory care concerns? Ans: -Monitor for bedside parameters such as vital signs, ABG, tidal volume, and pulse ox. -Position the patient to the position Fowler’s to prevent aspiration. -Hyperinflate and hyper oxygenate before and after suctioning -Suction only for 10 seconds in order to avoid trauma to mucosa -Ensure adequate humidification while oxygenation. -Reposition the patient in every 2 hours -Assess color, consistency and amount of mucus for any abnormality

C) Discuss desired outcomes for this patient. Ans: The patient’s outcome would be thin and productive mucus, bilateral clear breath sounds, and normal vital signs. Part 2 Complete the following dosage calculatons. Round to the nearest tenth unless otherwise indicated. Answers must be labeled correctly.

1. 100 mL ¼-strength hydrogen peroxide solution for wound irrigation.

_______25_______ mL hydrogen peroxide _75____ mL sterile water

2. The order is for 25 mL of NS to infuse over 15 minutes. The drop factor is 15 gtt/minute

The nurse will adjust the rate to ___25__gtt/minute.

3. The order if for 100 mL of NS to infuse over 30 minutes.

The nurse will set the rate of infusion on the pump at ___200____ mL/hr

4. The order is for 50 mL of NS to infuse over 15 minutes.

The nurse will set the rate of infusion on the pump at ___200__ mL/hr

5. Read the label below, the order is for Verapamil 240 mg po daily. The nurse will give: 2 capsules.

6. The order is for Ancef 225 mg IM every 6 hours. In stock there are three vial sizes of powder: 250 mg, 500 mg and 1gram. The following are the reconstitution instructions.

Vial size

Amt diluent

250 mg

2.0 ml

Approx concentration 125mg/ml

Approx available volume 2.0 ml

500 mg

2.0 ml

225mg/ml

2.2 ml

1 gram

2.5 ml

330mg/ml

3.0 ml

The nurse will select___2.0 mL____

Add______125 mg/ml__

Give_______1.8 mL__...