In an acute care setting of the placement, an adult female patient was presented with the respiratory symptoms which got worsen over the last few hours. The patient was a female patient aged thirty-nine years old who presented to the emergency department from the rural areas adjacent to the hospital and it was seen that she was from indigenous cultural background. The patient has past history of being diagnosed with asthma since her childhood and she has been prescribed with Ventolin as her regular medication. Asthma is a chronic condition which is inflammatory and is present in the respiratory system (Pavord et al., 2018s). The reason for acute exacerbation is inflammation is attributed to the exposure to allergens like smoke, dust, pollens, smoking and respiratory tract infections which can either be viral or bacterial in nature (Strzelak et al., 2018).
When she was presented to the emergency department, she was breathing a little better and was able to speak in full sentences. As the time progressed, it was seen that her breathing worsened and she struggled to speak in complete sentences. In the nursing assessment, it was seen that she had developed tachypnea with the respiratory rate of 45 breaths per minute and the oxygen saturation had decreased to 85% and there was presence of characteristic wheeze. There was presence of crackling suggestive of use of accessory respiratory muscles and there was tracheal tug. The patient had developed tachycardia as her heart rate was 158 beats per minute. The blood gas analysis of the patient reflected that she was developing respiratory acidosis. The patient was accompanied by her spouse and he was the one was talking to the healthcare team. The patient could understand English but had limited capability to speak and this was making her anxious as she was not able to ask what she would want to know.
The patient was diagnosed with acute exacerbation of asthma and was transferred to the critical care unit. The diagnosis was made by the signs and symptoms of the presence of tracheal tug, characteristic wheeze, crackling, tachycardia and tachypnea (Fergeson et al., 2017). The oxygen saturation of the blood of the patient is reduced and to compensate for that, the respiratory rate is increased so that the oxygen demand is managed and results in tachypnea (Zhu et al., 2019). Cardiovascular system works closely with the respiratory system keep the body working in the optimum condition. As the oxygen reduces, the heart works more to make sure that more blood is available for oxygen exchange of gases and it is a compensatory mechanism (Ringdal & Gullick, 2019). The patient is unable to breathe properly and not able to speak because of this and it is because of this, the patient starts panicking. The nursing problems identified are decreased oxygen saturation of the blood, increased heart rate and respiratory rate, and education of the patient.
From the nursing goals that have been identified, it is required that nursing goals are established so that they can be achieved. In healthcare like other professions, it is required that the healthcare related goals are SMART, that is, specific, measureable, achievable, realistic and timely (Sibley et al., 2020). In the present case as well, the nursing goals that are made are made such that they are SMART goals. From the nursing assessment, it was seen that the oxygen saturation of the blood of the patient was reduced which led to increase in heart rate and respiratory rate. Blood gas analysis of the patient showed that the patient had respiratory acidosis and the analysis showed that pH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, and Lactate was 1.4. First goal, to improve the oxygen saturation of patient to be analysed by pulse oximeter which can be achieved by administration of oxygen and this should be achieved within one hour. Second goal, to reduce the respiratory rate of patient to be analysed by continuous monitoring of the patient and this can be achieved when oxygen level is regained and this should be achieved within one hour. Third goal, to reduce the heart rate of patient to be analysed by electrocardiogram which can be when oxygen level is regained and this should be achieved within one hour. Fourth goal, to educate the patient such that the similar episode in the future can be avoided and this can be achieved by patient education and should be achieved by the time the patient is discharged from the hospital.
The condition of the patient is informed to the doctor in charge for the care of the patient, documented and the orders for the intervention is obtained and then the medications are administered followed by which they are documented (Mykkänen et al., 2016). The patient is administered with salbutamol by the use of metered dose inhaler and it is a beta-antagonist which is a short-acting drug (Fergeson et al., 2017). Salbutamol acts on the beta receptors that are present in the respiratory smooth muscles which upon activation cause relaxation of smooth muscles and ease breathing (Bjermer et al., 2019). To reduce the inflammation that is present can be managed by the administration of hydrocortisone which acts on inflammatory cells reducing the inflammation and reduce the restriction present to the flow of air to the lungs (Castillo et al., 2017).
The administration of oxygen will improve the saturation of oxygen in the blood of the patient.The evaluation of this can be done by the use of pulse oximeter to know the oxygen saturation and continuous monitoring of the patient for the vital signs (Stenson et al., 2019). To know the improvement of the patient oxygen level, blood gas analysis should be conducted and it should be done after each two hour.The nurse who is in charge for the care of the patient should educate the patient about the pathophysiology of the disease and the things that should be avoided such that similar things can be avoided in the future (Yeh et al., 2018).This can be evaluated be the method of teach-back but as there is linguistic barrier liaison officer can be used or the husband can be asked to act as interpreter so that effective education can be produced (RanjbarEzzatabadi et al., 2016).
Bjermer, L., Abbott-Banner, K., & Newman, K. (2019). Efficacy and safety of a first-in-class inhaled PDE3/4 inhibitor (ensifentrine) vs. salbutamol in asthma. Pulmonary pharmacology & therapeutics, 58, 101814.https://doi.org/10.1016/j.pupt.2019.101814.
Castillo, J. R., Peters, S. P., &Busse, W. W. (2017). Asthma exacerbations: Pathogenesis, prevention, and treatment. The Journal of Allergy and Clinical Immunology: In Practice, 5(4), 918-927. https://doi.org/10.1016/j.jaip.2017.05.001.
Fergeson, J. E., Patel, S. S., &Lockey, R. F. (2017).Acute asthma, prognosis, and treatment. Journal of Allergy and Clinical Immunology, 139(2), 438-447.https://doi.org/10.1016/j.jaci.2016.06.054.
Mykkänen, M., Miettinen, M., &Saranto, K. (2016). Standardized nursing documentation supports evidence-based nursing management. In Nursing Informatics (Vol. 225, pp. 466-470).
Pavord, I. D., Beasley, R., Agusti, A., Anderson, G. P., Bel, E., Brusselle, G., ...& Frey, U. (2018). After asthma: Redefining airways diseases. The Lancet, 391(10118), 350-400. https://doi.org/10.1016/S0140-6736(17)30879-6.
RanjbarEzzatabadi, M., Mahdian, M., Eslami, H., &Amini, A. (2016).Patient education barriers from nurses’ opinions. Journal of Holistic Nursing and Midwifery, 26(3), 36-45. http://hnmj.gums.ac.ir/article-1-752-en.html.
Ringdal, M., &Gullick, J. (2019).Respiratory assessment and monitoring. ACCCN's Critical Care Nursing-E-Book, 418-455.
Sibley, C., Ayers, C., King, B., Browning, T., & Kwon, J. K. (2020). Decreasing patient dwell times for outpatient cardiac nuclear medicine studies: The benefits of SMART goals, scope limitations, and society guidelines in quality improvement. Current Problems in Diagnostic Radiology.https://doi.org/10.1067/j.cpradiol.2020.02.004.
Stenson, B. J., Donoghoe, M., Brocklehurst, P., Davis, P. G., Juszczak, E., Marschner, I. C., ...& Tarnow-Mordi, W. O. (2019). Pulse oximeter saturation targeting and oximeter changes in the benefits of oxygen saturation targeting (BOOST)-II Australia and BOOST-II UK oxygen trials. The Journal of Pediatrics, 204, 301-304. https://doi.org/10.1016/j.jpeds.2018.08.033.
Strzelak, A., Ratajczak, A., Adamiec, A., &Feleszko, W. (2018). Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: A mechanistic review. International Journal of Environmental Research and Public Health, 15(5), 1033. https://doi.org/10.3390/ijerph15051033.
Yeh, M. Y., Wu, S. C., & Tung, T. H. (2018). The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 39, 11-17.https://doi.org/10.1016/j.apnr.2017.10.008.
Zhu, Y., Yin, H., Zhang, R., Ye, X., & Wei, J. (2019). High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: A systematic review and meta-analysis. Critical Care, 23(1), 180.https://doi.org/10.1186/s13054-019-2606-3.
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