Steven Tran S00142048 NRSG265 Assignment 1 slides PDF

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NRSG265 THIS IS A CASE STUDY ABOUT A 56 YEAR OLD FEMALE MS AALIYAH ABIMBOLA WHO HAS PRESENTED TO THE A&E VIA AMBULANCE AFTER EXPERIENCING SHORTNESS OF BREATH. Steven Tran S00142048

Hi my name is steven tran, Today I am going to discuss the given case study Ms. Aaliyah Abimbola. The provided Ms. Abimbola case study suggests that she is risk at developing multiple complications. This PowerPoint presentation will discuss about the COPD complication that he is likely to develop in COPD. In order to present my presentation, I am going to use clinical reasoning cycle, a systematic and cyclical process which enable nurses or other health professionals to care for and make clinical decision particularly in unpredictable, emergent and non-routine situations.

Concept Map

Working 50hrs/wk at flour mill

Aaliyah Abimbola 56years old

Single mother

3 female children aged 14, 17 and 18

Severe exposure to industrial dust

Emigrated from Africa 20 years ago

Lives in inner west Melbourne

Diagnosed with T2DM & hypertension 3 years ago

SOB while preparing breakfast

Presented to A&E via ambulance

Step 1 of the clinical reasoning cycle. A concept map shows us the overview of her situation, the concept map allows things to be put into perspective of a patient from handover. What we know, Ms Aaliyah Abimbola is a 56year old female, who has a past medical history of type 2 diabetes mellites, hypertension, COPD and suffers from moderate obstructive sleep apnea. She was brought in by ambulance with an acute respiratory distress while preparing breakfast. She presented symptoms of shortness of breath, fatigue, expiratory and inspiratory wheezing. She saw her GP 2 weeks ago, due to fatigue and increased shortness of breath, she was prescribed inhalers which had little to no effect.

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• Respiratory rate of 24 • Inspiratory and expiratory wheezing COLLECTING CUES/INFORMATION

• Shortness of breath • Blood pressure 142/96 • Blood glucose level of 9.6

Step 2 of the clinical reasoning cycle. On assessment Ms.

Abimbola’s observations showed that she has hypertension with a blood pressure reading of 142/96 mm of hg, tachycardia with a heart rate of 96bpm, tachypnea with a respiration rate of 24 bpm (basic vital signs 2019). She also had a fasting bgl of 9.6 and has inspiratory and expiratory wheeze, speaking in short phrases and taking 23 breath between each phrase.

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PATHOPHYSIOLOGY OF COPD • COPD is a chronic condition affecting the lungs and the ability to breathe

• COPD is a umbrella term for multiple conditions https://blogs.biomedcentral.com/on-medicine/2017/06/06/the-manyinflammatory-faces-of-chronic-obstructive-pulmonary-disease-copd-cannotbe-diagnosed-by-simple-testing/

Pathophysiology of COPD. COPD or Chronic Obstructive Pulmonary Disease begins with the damage of the airways and the alveoli in the lungs. The damaged airways results in the lungs becoming inflamed, this cause the body’s natural immune response to release mast cells, macrophages and neutrophils rushing to the site of inflammation. Which results to the build-up of pus or dead cells within the lungs making it difficult for the person the exhale and inhale (Roland 2018). With Ms Abimbola she is presenting signs and symptoms such as shortness of breath, inspiratory and expiratory wheeze, dyspnea, and tachypnea which is an indication that her signs and symptoms all contribute to COPD. The two most common forms of COPD are chronic

bronchitis and emphysema. These diseases affect different parts of the lungs. COPD is a disease that results from chronic obstruction of airflow within the lungs. The main issue here is that the limitation of airflow is due to the inflamed bronchioles, which become chronic overtime and eventually becomes deformed and narrowed. The second issue is that the excessive mucus produced with in the lungs limits the amount of oxygen into the bronchioles into the alveoli sac for gas exchange. It also reduces the amount of carbon dioxide coming out from the alveoli and not being able to exhale out. Also, the alveoli losses its ability to exhale completely due to the loss of its elasticity in the alveoli sac, hence there is no proper gas exchange (Higuera, 2019).

• Hypoxia • Tachypnea

PROCESSING INFORMATION

• Tachycardia • Increased work of breathing

Step 3 of the clinical reasoning cycle. Ms. Abimbola is

presenting with inspiratory and expiratory wheeze and showing signs of increased work of breathing which is an indication that there is a build-up of fluid within her lungs (Krause, 2019). Her respiration rate is at 24 breaths per minutes which suggests she isn’t getting enough air each time she breathes in. Ms Abimbola’s inability to get enough oxygen into her lungs due to her condition of COPD is the causative factor for her hypoxia (Cherney, 2019). Although her blood pressure is elevated this could be the norm for Ms Abimbola as she was diagnosed with hypertension 3 years ago.

• Breathing

IMPACT OF COPD ON ADL

• Mobilising • Working and playing

COPD can impact a person’s activity of daily living. The potential impact of COPD on Ms Abimbola activities of daily living can include breathing, mobilising, and working and playing. COPD can make it more difficult for Ms Abimbola to breathe. In COPD, the airways are inflamed causing an inflammatory response which involves the recruitment of mast cells, macrophages, and neutrophils to the inflamed area. Which then results in the build-up of dead cells or pus in the airways making it difficult for a person to breathe and increases the work of breathing to get the air into the lungs (King, 2015).

Working and playing can also be affected by COPD, as the lack of oxygen supply to the body can cause the lack of energy needed to play and work, as oxygen is needed in the body to break down sugar to produce the energy your body needs (Oxygen, carbon dioxide, and energy 2020). Just like working and playing, mobilising is affected just the same way. COPD affects the supply of oxygen to the body. Oxygen is crucial in everyday living as it is used in our body in breaking down sugar or carbohydrates for energy. Without enough supply of oxygen to the body, this can impact the supply of energy for mobilising (Stutsman 2018), in Ms Abimbola’s case it has resulted in, more than doubling the time it takes for her to walk to the station as according to the case study it previously took her 8 mins to walk to the station, now it takes her 20mins.

• Stabilise breathing • Maintenance of patent airway

NURSING PRIORITIES

• Managing/preventing respiratory infections

Step 4 of the clinical reasoning cycle. Three priority nursing issues that need to be addressed in Ms Abimbola’s current situation are stabilize breathing, maintaining a patent airway and prevent/manage respiratory infections (COPD, 2020). Stabilise breathing. As a patient may feel more anxious, their breathing rate may increase, leading to a decreased oxygen intake, thus leading to hypoxia and collapsing of the small airways (COPD, 2020). Maintaining a patent airway. As chronic inflammation of the airway due to COPD causes narrowing, this makes it harder

to maintain a patent airway, especially from mucus secretions thus, causing hyper-inflation and air trapping, which may lead to respiratory failure (Olson, 2020). Prevent/managing respiratory infections. People with COPD are at an increased risk of developing respiratory infections, as they have difficulty clearing the airways of bacteria, dust, and other pollutants in the air. This puts them at a greater risk for lung infections that could potentially cause further damage to the lungs (COPD, 2020).

REFERENCE LIST • Basic vital Signs. 2019. • https://www.ausmed.com.au/cpd/articles/vital-signs • Cherney, K. (2019). Understanding COPD Hypoxia • https://www.healthline.com/health/copd/hypoxia • COPD (2020) • https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679 • King, T, P. (2015) Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518022/#:~:text=Chronic%20obstructive%20pulmonary%20disease%20(COPD) %20is%20characterized%20by%20chronic%20lung,of%20emphysema%20and%20chronic%20bronchitis.

• Krause, L. (2019). What is pulmonary edema? • https://www.healthline.com/health/pulmonary-edema • Oxygen, carbon dioxide, and energy (2020) • https://www.ck12.org/book/human-biology-breathing/section/4.1/

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REFERENCE CONT • Olson, E. (2020) Hyperinflated lungs: What does it mean? • https://www.mayoclinic.org/diseases-conditions/emphysema/expert-answers/hyperinflated-lungs/faq 20058169#:~:text=Hyperinflated%20lungs%20can%20be%20caused,a%20disorder%20that%20includes%20emphysema.

• Roland, J. (2018) What is the pathophysiology of COPD • https://www.healthline.com/health/copd/pathophysiology#:~:text=Pathophysiology%20is%20the%20evolution%20of,COP D%20can't%20be%20undone.

• Stutsman, J. (2018) What is the purpose of breathing • https://sciencing.com/role-enzymes-cellular-respiration-5466091.html • Tuder, M, R. (2017) Pulmonary Vascular Remodeling in Pulmonary Hypertension • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408737/ •

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