Delivery in day(s): 4
NUR250 Nursing Care Proof Reading Services
Task 1- Understanding nursing problems
The causes for the various nursing problems are:
1.Ineffective airway clearance: It is the inability of the patient to be able to maintain a clear airway in the respiratory tract. Airway spasm, increased secretions from the mucus glands, smoking tobacco and other intoxicants, retained secretions in the tract etc. are the causes of ineffective airway clearance.
2.Impaired gas exchange: It is the excess or deficit of oxygen or carbon dioxide in the alveoli capillary membrane in the body of the patient. The causes of impaired gas exchange in the lungs are alveoli collapse, respiratory infections,abnormal pH of arteries, hypoxemia, hypercapnia etc.
3.Risk of impaired ventilation:The patient’s energy reserves are disabled for breathing normally which is required to support life. Acute lung diseases like COPD, lung injuries, injuries in the bones of the rib cage, more than desirable consumption of drugs or alcohol, problem in the normal functioning or the muscles or nerves that are responsible for breathing etc. are the causes of impaired ventilation. (Andréjak, Nielsen, et al., 2012)
4.Imbalanced nutrition: When the intake of nutrition in the body is less than to what is required, it is called as imbalanced nutrition. A number of factors are responsible for imbalanced nutrition like less physical strength including pain in the muscles, substance abuse, activity intolerance, internal issues like burns, cancer, gastric trouble in the stomach, psychological factors like dementia, social and personal factors like the income or status of the patient, other factors are the religion and culture that the patient greatly decide his or her food habits. (Weiss, DeMeo & Postma, 2003).
5.Risk of infection: There is a risk of infection in the respiratory tract of the patient that is caused by severe COPD. The lungs or the respiratory tract are affected by bacteria and may cause exacerbations.
Task 2- Care Planning
The nursing interventions for the following problems are:
GOAL OF CARE
The goal of the safety care is that the patient is kept away from all sorts of threats and side effects.
Safety of the patient from the side effects of the medication and other respiratory infections is to be taken care off.
A chart of the medicines in the form of a checklist is made and hanged near the bed of the patient so that the doctor can visit and view it for routine check-up. The side-lines of the bed are raised so that the patient does not fall when he is anxious or restless.
It is important that the medicines be delivered to the patient in the supervision of only one nurse so that is no over or under dose of any drug.
Until now, the patient is in proper condition and is responding well to all the drugs given to him. This indicates that the patient is safe from all the threats and the nursing plan is working well. (Copd.com, 2017)
Hydration:- The goal is to give the desired support to the patient in terms of the fluid chart to be followed and the water servings.
The fluid chart id to be timely followed by the nursing staff. Keeping the body hydrated solves a number of problems related to respiratory diseases.
A person suffering from COPD need to consume lots of water and other fluids. It helps in the smooth functioning of the treatment given to him.
The fluid requirements of the patient are to be followed as prescribed by the doctor and the dietician.
The patient is found to be following the fluid chart and the prescribed amount of water intake. There are no problems arising due to dehydration in his body.
The goal of the nursing staff is to help the patient take proper rest so that he recovers soon.
Maximum recovery of the drugs takes place when the patient is resting. Giving the right atmosphere for the patient to rest is the responsibility of the nursing staff.
Proper positioning of the bed in the room, the right amount of light, the correct temperature of the room etc. all should be according to the patient. The control of the air conditioner and room heater should be kept near to the patient.
The problem arises of restlessness as a few medicines that are prescribed to the patient causes insomnia and irritability. This results in the reduction of the resting hours of the patient.
The patient is able to take the desired amount of rest in spite of the restlessness and insomnia caused due to the heavy dose of the medicines.
The room of the patient is to be kept warm and comfortable according to the requirement of the patient.
The bed of the patient should be at the correct position with respect to the air conditioner and the window. In addition, the bed of the patient should be inclined such that he is able to breathe properly and choking in the throat is prevented.
The patient is showing signs of improvement and has settled well in the room. He seems to be satisfied by the facilities of the room.
The goal of the nursing staff is to provide the right kind of environment to the patient so that he improves at a good speed.
The temperature of the room should be checked in short intervals. The lighting of the room is to be kept moderate and there has to be good ventilation in the room.
The goal to the feeding care is that the patient is served with the right amount of fluid and solid diet.
As per the prescription, his food is rich in carbohydrates and proteins.
The diet of the patient has to be according to the diet chart given by the dietician.
The nurse is supposed to communicate with the kitchen regarding the meals that will be served to the patient. The diet requirements are to be clearly mentioned to the cook.
The diet chart of the patient is hanged near the bed so that no other staff member feeds the patient with inappropriate food or at the wrong time.
The food allergies of the patient are taken care off and the dietician is happy with the daily weighing of the patient.
Task 3- Medication Manager
Neville has been prescribed the following medicines:
1.Oral prednisone: the medicine has been prescribed to the patient after the diagnosis of COPD in order to prevent severe exacerbations of COPD. The general dose is 40 mg of the drug once a day for minimum 10 days.
2.Ipratropium bromide:The disease is used to treat the patients of COPD and asthma. Used with a nebulizer or inhaler, it is used to clean and open up the airways of the lungs.
3.Oral amoxicillin:It is an antibiotic that is used to treat the infections that is caused due to the bacteria. It works on bacterial infections alone. It works similar to penicillin that is it prevents the growth of bacteria.
The following nursing interventions could be followed by the nursing staff to treat Neville:
1.Make the patient comfortable so that he is able to explain his sufferings in a better way.
2.Make the patient sleep with his head in midline with the flexion. This would open up the airways for proper breathing.
3.Train the patient with deep coughing and breathing exercises.
4.The right drugs to be given at the right time in proper intervals of time.
5.Focus on oxygenation and increasing secretions in the patient’s body.
6.Prednisone should not be given to a patient if he or she has a fungal infection or allergic to this particular drug. (Roche, Zureik, et al., 2008).
Side and adverse effects of the medicines given to the patient of COPD:
1.Oral prednisone: the side effects of prednisone are insomnia, headaches, dizziness, weight gain, skin ailments like acne or dry skin, stomach pain etc. The adverse effects of prednisone include thinning of the skin and easy bruises, impotence, hormonal problems or sugar related disorders.(van, Jacobs, et al., 2002)
2.Ipratropium bromide: Pain in the chest and head, dryness in the mouth, digestion related problems, cough, bronchitis, abnormal bowel movements, sinus problems, urinary infections etc. are the side effects of the drug. The adverse effects are swelling and allergies in the throat, low blood pressure, pain and irritation in the eyes, itching and hives.
3.Oral amoxicillin: Side effects of amoxicillin include vomiting, nausea, diarrhoea, abnormal and hairy tongue, head and stomach pain etc. (Pauwels, Buist, et al., 2012)
Task 4- Patient teaching during Neville’s hospital admission
The patient is needed to be updated for the following:
Habit of smoking:
Neville is an old man who is addicted to tobacco smoking since a long time. The consumption of nicotine since so long has led to serious implications in his health. He also understands the effects of his addiction and is trying to quit his habit.
Smoking Cessation: Smoking the major cause of deaths due to heart diseases and lung cancer. Majority of the smokers in the world are trying to quit tobacco smoking, called as smoking cessations. The attempts that are made without assistance are not successful most of the time. However, the assisted efforts that are made by the use of addiction breaking techniques like nicotine replacement therapy, cytisine etc. are found to be successful. (Silagy, Lancaster, et al., 2004)
It is important for Neville to quit smoking, as it has already become the reason for such a severe disease, COPD. Being in the middle ages of his life, his addiction of smoking has already made ample of harm to his body, which is beyond cure. Although he is trying to curb this addiction by reducing the amount of consumption but 10 cigarettes, a day is still a life threatening number. In addition, his addiction is disturbing his family life as well. He needs behavioural counselling in order to be able to completely overcome his disease.
Neville must go for smoking cessation is some way so that he can avoid death at least due to this addiction and the smooth family lifestyle.
Task 5- Clinical judgement and handover
On finding the mentioned reactions on Neville, it seems that the consumption of salbutamol has led to side effects in his body. Either this could be due to over consumption of the drug without being prescribed from the doctor or the patient might be allergic to the drug. In either case, the patient needs immediate assistance.
1.Firstly, the patient is made to recline in a comfortable posture. Give oral treatment of gurgle to reduce the effect of the drug. Monitor ECG and other devices to ensure the other adverse effects of the drug. Auscultate the lungs of the patient to bring rest in the body. Make sure that there is one assistant always present in the room in case of emergency. Raise the side rails to prevent the patient from following out from the bed. Note the breathing pattern and give oxygenation to the patient. There is a need for a skin specialist as it has become diaphoretic. Bring the doctor in charge as soon as possible.
2.Immediate nursing is required by the patient to curb the side effects of the patient. The nursing interventions were needed to prevent the adverse effects of the drug reaction.
The handover in the ISBAR format:
1.Patient Name: Neville
The handover is written by the nurse in charge of the patient for the day.
2.The reason for the handover is that the patient has consumed salbutamol inhaler, which has given side effects to his body.
3.The patient was suffering from chronic obstructive pulmonary disease. He has been smoking tobacco since a long time. When he was admitted to the hospital and treated here, he is still reporting dyspnoea and shortness of breath. There was an emergency when he consumed salbutamol and there were negative reactions of it in his body.
4.The patient’s condition was brought near to normal by a few nursing interventions. The result of some tests would be coming tomorrow. The exact reason of the reaction due to salbutamol is still not confirmed.
5.Could you please come to visit the patient as soon as possible and so that the reason could be confirmed.
1.Andréjak, C., Nielsen, R., Thomsen, V. Ø., Duhaut, P., Sørensen, H. T., & Thomsen, R. W. (2012). Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis. Thorax, thoraxjnl-2012.
2.Pauwels, R. A., Buist, A. S., Calverley, P. M., Jenkins, C. R., & Hurd, S. S. (2012). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine.
3.Silagy, C., Lancaster, T., Stead, L., Mant, D., & Fowler, G. (2004). Nicotine replacement therapy for smoking cessation. The Cochrane Library.
4.SA Health, (2017) ISBAR- Identify, Situation, Background, Assessment and Recommendation. (online) available onhttp://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/clinical+handover/isbar+-+identify+situation+background+assessment+and+recommendationaccessed on 30-3-17.
5.van Everdingen, A. A., Jacobs, J. W., van Reesema, D. R. S., & Bijlsma, J. W. (2002). Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Annals of internal medicine, 136(1), 1-12.
6.Copd.com, (2017) Make A COPD Plan (online) available onhttp://www.copd.com/copd-care-plan/accessed on 31-3-17.
7.Roche, N., Zureik, M., Soussan, D., Neukirch, F., & Perrotin, D. (2008). Predictors of outcomes in COPD exacerbation cases presenting to the emergency department. European Respiratory Journal, 32(4), 953-961.
8.Weiss, S. T., DeMeo, D. L., & Postma, D. S. (2003). COPD: problems in diagnosis and measurement. European Respiratory Journal, 21(41 suppl), 4s-12s.