Contexts of Practice: Health Alteration

Priority Problems for The Patient

According to the ABCDE framework for nursing assessments it is important for the nurses to assess the patient problems with priority (Smith and Bowden 2017). The ABCDE stands for the sequence of priority in respect to airway, breathing, circulation, disability and exposure. Primary priority for a nurse is to assess and treat conditions associated with airways which is then followed by assessment and treatment of life threatening breathing problems. Primary problem for the patient in the case study is dyspnea whereas the second problem for the patient if tachypnea. Dyspnea is basically shortness of breath which is linked with conditions of airway obstructions and tachypnea is fast and excessively rapid breathing (Zhang et al 2019).

Pathophysiology of These Priority Problems

COPD is one of the most common respiratory condition that results in conditions such as airways obstruction, breathlessness, wheezing, increased cough and sputum production (Robson 2017). It is also linked with conditions of tachypnea which is basically rapid and excessive breathing. The pathophysiology of Dyspnea and Tachypnea are somewhere linked with one another as it all relate to breathlessness and airway obstruction (James and BSca 2019). COPD is induced due to prolonged exposure to risk factors such as smoking and exposure to pollutants such as dust and toxic elements. Exposure to these elements lead to inflammation and secretion of mucus in the airways (Janssen et al 2019).

People suffering from COPD experience airway constriction due to hyper secretion of mucus in the lungs. This can lead to symptoms such as wheezing and increased production of yellow sputum during cough. Wheezing is a medical condition in which people experience sound during normal breathing (Janssen et al 2019). This sound is due to airway constriction in the patients. Presence of mucus in the lungs can lead to a V/Q mismatch and it can bring up conditions such as respiratory acidosis. This can result in conditions of dyspnea i.e. breathlessness. This can also lead to pulmonary hypertension that brings up stress on the heart. This basically contribute to reduced ability of the heart to pump enough blood and hence it can result in conditions such as Tachypnea.

Severe inflammation in the lungs can bring up conditions such as chest tightness, wheezing and stiffness (Zanobetti et al 2019). The inflammation in case of emphysema can be a result of inhaling smoke and pollutants that activates a number of macrophages in the lungs. These macrophages can destroy the capillary bed, alveolar walls and elastic recoil of the lungs. It can also lead to enforced breathing and thus condition of dyspnea. The clinical manifestations for Tachypnea involve rapid breathing, shallow breaths, nausea, vomiting, anxiety and inability to walk (Zanobetti et al 2019).

Increased stress on the lungs can lead to short and shallow breaths which makes it hard for the person to breathe properly and hence it results in fast and shorter breathing. Tachypnea is characterized by an increased breathing rate of 20 breathes per minute (Liu et al 2016). Normal breathes per minute ranges from 12-18. In COPD patients’ tachypnea can lead to oxygen and carbon dioxide imbalance that can further lead to hypercapnia. In patients with COPD, Tachypnea can be induced with strong exacerbations or can ever persist for longer duration after the exacerbations are over.

Interventions for The Priority Problems

Interventions for Dyspnea

Dyspnea is a pathophysiological condition which can be managed by a number of nursing interventions (Gundry 2019). These interventions contain strategies such as supplemental oxygen for fulfilling the oxygen demand, chest wall vibrations for greater oxygen supply, pulmonary rehabilitation, facial cooling, cognitive and behavioral treatment and narcotic based pharmacological interventions (Gundry 2019). The best interventions for management and treatment of dyspnea for the patients can be pulmonary rehabilitation and increasing the oxygen supply for the patient.

The first intervention that will be provided for dyspnea will be increasing oxygen supply for the patient. This is also termed as oxygen therapy for COPD. Treatment of dyspnea patients requires treating the underlying cause of the condition (Calverley 2017). However, breathlessness also continues following effective treatment of underlying disease such as COPD. This is known as persistent breathlessness. Supplemental oxygen therapy is thus an effective nursing intervention which is most usually administered via nasal prongs or a mask (Calverley 2017). And, it can be given consistently, during exercise, or in the form of a brief burst before exercise.

Sources of oxygen include concentrators which are used to extract oxygen from the ambient air. The sources can also include compressed oxygen cylinders and liquid oxygen flasks. In-home and/or portable equipment may be stationary. Oxygen that is administered before or at the time of physical activity can supply the required amount of oxygen to the muscles (Boyd, Torrans and Tucker 2018). This can enhance aerobic metabolism for greater duration and it can also prevent muscle fatigue and formation of lactic acid. This can ultimately prevent the mismatch between the ventilator work and drive and it can hence prevent the severity of dyspnea.

The second intervention for management and treatment of dyspnea include pulmonary rehabilitation technique for management of severe breathlessness (Boyd, Torrans and Tucker 2018). The pulmonary rehabilitation is an intervention that helps a COPD patient with relaxation, breathing techniques, nutrition and dyspnea (Ranjita et al 2016). The pulmonary rehabilitation will involve some exercises that help the patients with certain exercises that ease breathing and treat dyspnea. The exercises are developed for lover body, upper body, breathing and strength enhancement.

The lower body exercises include exercises such as walking on treadmills which keeps the legs at the center of workout (Ranjita et al 2016). The upper body muscles are highly involved in breathing and exercises such as rising arms against the gravity can be useful. People with weak breathing muscles can be helped with breathing exercises such as blowing through a masterpiece. Most of the exercises are focused on developing strength and endurance in the patients and this include exercises such as weight lifts (Ranjita et al 2016). These exercises have significant pathophysiological impact over the patients and it develop greater resistance the alveolar muscles and hence it lead to greater management of dyspnea.

Interventions for Tachypnea

Tachypnea is increased rapidness of breathing and it can be managed by interventions such as identification and management of underlying cause of the condition. The underlying cause of Tachypnea for Krum is COPD. This can be managed by interventions such as pharmacological interventions including beta blockers. Inhaled medicines including beta blockers can be used to dilate and expend the alveoli in the obstructive lung disease and it can thus contribute to greater management of respirations in the patients (Criner et al 2019). The beta blockers are type of medication that are used to relieve symptom and exacerbations of COPD as they are used to relieve the heart rate for the patients.

Beta-blockers can be used to relieve respirations in Krum. Krum have respiration rate of 30 breathe per minute which is very high for the normal breathing. Use of beta blockers in the inhalers can help the patients manage their respiration rate to a minimum of 12-18 (Criner et al 2019). Pathophysiological studies have revealed that use of beta-blockers block the impact of epinephrine. Epinephrine is a hormone that is useful for increasing the respiratory rate and heart rate for the patients (Newsome et al 2018). Use of the medicine can certainly lower down the impact of the drug and hence be effective for the treatment and management of Tachypnea.

According to Rauch et al (2017), management of Tachypnea in patients with COPD require interventions that are specifically designed to manage and treat the pathophysiology of COPD. The condition can be managed by the use of bronchodilators such as 2-agonisrs, theophylline and anticholinergics. A combination of any of these drugs can also be used to manage the condition in the patients. The bronchodilators are used as per the needs of the patients. These bronchodilators work to reduce bronchial obstruction. Moreover, they are responsible for the management of airway obstruction (Rauch et al 2017). These drugs can reduce hyperinflation and they can also contribute to increase efficiency of the lungs to empty the gases. Emptying the lungs can help proper management of the carbon di oxide and oxygen in the body and it can ultimately result in better respiration management for Krum.

Discharge Planning Through the Social Justice Framework

A registered nurse have a major role in the planning of the discharge plan for the patient. It is important for the registered nurse to follow the social justice framework in order to plan an efficient discharge plan for the patients. The social justice framework is designed to be a set of certain principles which include components of self-determination, rights, equity, access and participation for the patients (Turner, Vernacchio and Satterly 2018). A registered nurse must consider these principles while developing a discharge plan for Krum. The patient is expected to show self-determination by having an active role in the program followed by dignity, respect and value for the needs of the patients. The discharge plan will include the concepts of available services for further care enhancement (Turner, Vernacchio and Satterly 2018).

Increased access to the support services, pulmonary rehabilitation services and exercise centers can certainly be helpful for the patient. Moreover, inclusion of equity in the healthcare through developing the discharge plan in a language specific manner can be effective for the patient. A registered nurse must always strive to provide effective and patient centered care to the patients. Inclusion of the principle of participation from the social justice framework can help a nurse deliver patient centered and effective healthcare.

The discharge plan will include all the vital information regarding the disease, cause of disease and preventive strategies. Including preventive strategies such as smoking cessation can help the patient identify the importance of avoiding cigarettes and this can in deed provide greater results (Turner, Vernacchio and Satterly 2018). Further, providing proper information regarding the medication and the strategies can educate the patient and it can result in better health outcomes.

Reference for Health Alteration

Boyd, C.E., Torrans, E.L. and Tucker, C.S., 2018. Dissolved oxygen and aeration in ictalurid catfish aquaculture. Journal of the World Aquaculture Society, 49(1), pp.7-70

Calverley, P.M., 2017. Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic. European Respiratory Journal, 50(3), p.1701376

Criner, G.J., Martinez, F.J., Aaron, S., Agusti, A., Anzueto, A., Bafadhel, M., Barnes, P.J., Bourbeau, J., Chen, R., Ewig, J. and Fabbri, L.M., 2019. Current controversies in chronic obstructive pulmonary disease. a report from the global initiative for chronic obstructive lung disease scientific committee. Annals of the American Thoracic Society, 16(1), pp.29-39.

Gundry, S., 2019. COPD 1: pathophysiology, diagnosis and prognosis. Nursing Times, pp.27-30.

James, M.D. and BSca, K.M.M., 2019. The Pathophysiology of Dyspnea and Exercise Intolerance Obstructive in Pulmonary Chronic. Exercise Physiology, An Issue of Clinics in Chest Medicine, Ebook, 40(2), pp.343-366

Janssen, D.J., van den Beuken-van, M.H., Verberkt, C.A., Creemers, J.P. and Wouters, E.F., 2019. Fentanyl nasal spray in a patient with end-stage COPD and severe chronic breathlessness. Breathe, 15(3), pp.e122-e125

Liu, J., Chen, X.X., Li, X.W., Chen, S.W., Wang, Y. and Fu, W., 2016. Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest, 149(5), pp.1269-1275

Newsome, B.R., McDonnell, K., Hucks, J. and Estrada, R.D., 2018. Chronic obstructive pulmonary disease: clinical implications for patients with lung cancer. Clinical Journal of Oncology Nursing, 22(2), p.184.

Ranjita, R., Hankey, A., Nagendra, H.R. and Mohanty, S., 2016. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Ayurveda and Integrative Medicine, 7(3), pp.158-166.

Rauch, D., Wetzke, M., Reu, S., Wesselak, W., Schams, A., Hengst, M., Kammer, B., Ley-Zaporozhan, J., Kappler, M., Proesmans, M. and Lange, J., 2016. Persistent tachypnea of infancy. Usual and aberrant. American Journal of Respiratory and Critical Care Medicine, 193(4), pp.438-447.

Robson, A., 2017. Dyspnoea, hyperventilation and functional cough: a guide to which tests help sort them out. Breathe, 13(1), pp.45-50

Smith, D. and Bowden, T., 2017. Using the ABCDE approach to assess the deteriorating patient. Nursing Standard (2014+), 32(14), p.51.

Turner, G.W., Vernacchio, A. and Satterly, B., 2018. Sexual Justice Is Social Justice: An Activity to Expand Social Work Students Understanding of Sexual Rights and Injustices. Journal of Teaching in Social Work, 38(5), pp.504-521

Zanobetti, M., Scorpiniti, M., Gigli, C., Nazerian, P., Vanni, S., Innocenti, F., Stefanone, V.T., Savinelli, C., Coppa, A., Bigiarini, S. and Caldi, F., 2017. Point-of-care ultrasonography for evaluation of acute dyspnea in the ED. Chest, 151(6), pp.1295-1301.

Zhang, G., Han, X., Ouyang, S. and Li, T., 2019. The Symptoms and Causes of Tracheobronchial Diseases. In Airway Stenting in Interventional Radiology (pp. 15-24). Springer, Singapore

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