NURS3008 Community Health Nursing

Question: Conference Presentation and Supporting Documentation Details of task: This is a clinical case study selected from clinical practice with the focus on the deteriorating patient. Requirements: This is a clinical case study selected from your current clinical placement. The focus of this assessment is the deteriorating patient. For this assessment you will need to choose a patient with whom you have cared for in your current placement. This patient will need to have had at least one episode of clinical deterioration during their current admission. Clinical deterioration can include any of the following: An acute or chronicdeclining state in the patient’s condition. Examples of this may be the presenting admission diagnosis; decline in clinical observations. While it is possible that the patient chosen for the clinical case study may have required a MET intervention it is NOT essential. The choice for your case study is any declining state in the patient’s condition. The purpose of this assessment is for you to explore and analyse this patient’s care in relation to their deteriorating episode. It is essential that all information about the patient and hospital is de-identified and a pseudonym is used. Answer: Introduction This is a case study of Eva. She is 74year old Australian. Her weight is 56kg and height is 143cm. She was a chain smoker, married and having 3 children. She lives with her husband Admission Details She was brought to the hospital on 10thof October, 2017. The event occurred during clinical placement. She was admitted at 09:00 hours. Upon admission, her medical history and vital signs were measured. Reason Of Admission To Hospital Suffering from type 1 respiratory failure. Having septic shock. Pneumonia in her right lung. Admitted to the ICU. History Of Illness She was not feeling well from last 3 days. She was unable to do her daily work. Feeling lethargic but no signs of chest pain. She used to smoke but does not drink alcohol. Her past medical history reveals that she was having asthma, pancreatic cancer and neuropathic pain. She is allergic to anti-histamines. Her body temperature was 38.8°C, having dry cough and dyspnoea. Present Treatment She is being given a combination of antibiotics. The antibiotics that were given Ceftriaxone and Azithromycin . She was put in an endotracheal intubation. The Deterioration Condition of Mrs. Eva is deteriorating very quickly after she was relocated from the ICU. Her oxygen saturation level dropped down to 83% and requires oxygen support. Her level of consciousness is decreasing gradually (10/15). Her blood pressure is also decreasing, i.e. 91/55 mmhg instead of 120/80 which is normal. Her respiratory rate was increased to 28 breaths per min. Her heart beat was also increased to 127 beats per min. Met Call Criteria Her deterioration and abnormalities in the vital signs made it essential to call for the medical emergency team in the AMSU ward. Pulse rate – 78bpm P. – 91/55 mm Hg Respiratory rate – 28bpm Oxygen saturation – 84% Blood glucose level- 7.5 mmol/L FEV1/FVC ratio- 62% Vital Signs No abnormalities were observed in the abdomen. Loose stool and appearing yellow. X – ray of chest shows congestion in the right lobe. Blood test shows an increase in platelet count, i.e. 17.6. Body temperature- 38.7° Nursing Management Eva patient was intubated and a tube was inserted into the trachea (Frerk et al., 2015). Suction is being provided twice a day to clear the congestion of the right lung. For reducing the infection Eva was given antibiotics, that are Azithromycin and Ceftriaxone. Oxymetry is being used for monitoring the oxygen saturation. Nursing Intervention Special nursing care is being provided by: Adding liquid food to the diet. Plenty of water and juices of fruits such as pomegranate, apple, grapes and carrots are being provided. Acetaminophen is administered. It is a mild analgesic and has given to reduce the high temperature and loosen the mucus in the lungs (Sanzone, 2016). This non-aspirin pain reliever will help in reducing the breathing problem. Decongestants such as, pseudoephedrine and oxymetazoline are being administered to relieve the congestion in the upper respiratory tract (Perrin et al., 2015). Eva is being kept in an elevated position in the bed. She is kept in Fowler position to promote chest expansion and subsequent oxygenation (Udayamala et al., 2016). This will improve breathing by facilitating the the relaxation of abdominal muscles. Spontaneous breathing trials are proposed to be conducted (Sklar et al., 2017). Holistic Care Eva is encouraged to do her daily activities. She is being advised to maintain her diet, follow regular exercise and change her lifestyle patterns to maintain good health. She is also being recommended to quit smoking. This will help to eliminate her chest congestion (Morton, Hudak & Gallo, 2013). Propofol is being administered to reduce oxygen demand (Loh & Nair, 2013). Noradrenalin is given to treat hypotension (Kee et al., 2015). Summary The main purpose of this nursing plan is to monitor the breathing problem, blood pressure, heart rate. A detailed analysis of the plan will help in lowering her symptoms. The daily care plan of Eva is being updated daily for improving her health. References Frerk, C., Mitchell, V. S., McNarry, A. F., Mendonca, C., Bhagrath, R., Patel, A., … & Ahmad, I. (2015). Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. BJA: British Journal of Anaesthesia, 115(6), 827-848. Kee, W. D. N., Lee, S. W., Ng, F. F., Tan, P. E., & Khaw, K. S. (2015). Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology: The Journal of the American Society of Anesthesiologists, 122(4), 736-745. Loh, N. H. W., & Nair, P. (2013). Propofol infusion syndrome. Continuing Education in Anaesthesia, Critical Care & Pain, 13(6), 200-202.. Morton, P. G., Hudak, C., & Gallo, B. (2013). Critical care nursing: a holistic approach (pp. 1408-1418). D. Fontaine (Ed.). Lippincott Williams & Wilkins. Perrin, S., Montani, D., O’Connell, C., Günther, S., Girerd, B., Savale, L., … & Chaumais, M. C. (2015). Nasal decongestant exposure in patients with pulmonary arterial hypertension: a pilot study. European Respiratory Journal, ERJ-00051. Sanzone, A. G. (2016). Use of nonopioid analgesics and the impact on patient outcomes. Journal of orthopaedic trauma, 30, S12-S15. Sklar, M. C., Burns, K., Rittayamai, N., Lanys, A., Rauseo, M., Chen, L., … & Brochard, L. (2017). Effort to breathe with various spontaneous breathing trial techniques. A physiological meta-analysis. American journal of respiratory and critical care medicine, (ja). Udayamala, E., Alaparthi, G. K., Augustine, A. J., Anand, R., Mahale, A., Zulfeequer, C. P., & Krishnan, S. K. (2016). Comparison of Diaphragmatic Excursion During Diaphragmatic Breathing Exercise, Volume and Flow Oriented Incentive Spirometer in Healthy Subjects: A Randomized Cross Over Trial. Online J Health Allied Scs, 15(3), 7. Young, P., Saxena, M., Bellomo, R., Freebairn, R., Hammond, N., van Haren, F., … & McGuinness, S. (2015). Acetaminophen for fever in critically ill patients with suspected infection. New England Journal of Medicine, 373(23), 2215-2224.

NURS3008 Community Health Nursing

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