Critical Care Nursing: Case Analysis Of A Patient With Severe Asthma (essay).

You need to choose one (1) of the clinical scenarios that have been provided to you in Module 1 of this subject (Jessica, Tyler or Jiemba) and answers the questions below. Throughout this case analysis, your responses need to be supported by current (less than 7 years), peer-reviewed, scholarly sources. The emphasis of this subject is the connection between theory and practice so you need to ensure that theory and evidence underpin all areas of your response.

Question 1.

Identify the systematic health assessment framework you would use to assess this patient. Apply this framework to your chosen case to identify the information that is present in the case and the assessments that you would need to perform to complete your assessment.

Question 2.

Identify the evidence for the safe administration of all of the medications, intravenous fluids and blood products (as applicable) that have been ordered for this patient to support appropriate nursing care of the patient.

Question 3.

Identify the legal, ethical and professional issues with this case and discuss the nurse’s role in addressing these issues.

Asthma Therapy Assessment Questionnaire

Critical care nursing refers to the field of the nursing that focuses on the care of the patients, who are critically ill due to diseases. On the other hand, the acute care refers to the branch that helps the patients when they need the short- term treatment due to vital medical condition (Rapino et al., 2013, p.48). This can help the patient to recover from the problem. In the first case scenario, Jessica has the problem of short breathness. Moreover, as she is the student of nursing, and she has to submit her assignment, she is suffering from anxiety and depression. In such case she needs the acute care. The assignment focuses on the systematic health assessment framework that can assess the condition of the patient. The study identifies the evidences for safe administration of the medication, blood products, and intravenous fluids. The legal, ethical, and the professional issues of the cases are addressed and discussed as well.

The asthma therapy assessment questionnaire helps to understand the condition of the patient and assess the problems of a patient. It is a brief, and self- administered tool, which is developed for identifying the condition of the patients. The tool depends on several questions, which the patient has to answer. The questions can be on self- perception of the asthma control, missed work, problems at night due to asthma, and time of using the in haler. The respondents are graded on the point basis that can indicate the problem of the patient. The scale is rated from 0 to 4. It helps to identify the problem of the patient and the barriers, which the patient is facing. However, in such case, Calhoun et al., (2014) mentioned that the nurses need to avoid the basic problems such as communication gaps, social and cultural barriers (p. 195). Before using the tool, the nurse needs to explain the usage and the benefits of the tool to the patient. From the case scenario, it is seen that Jessica has several problems. She did not take her medication properly and become restless due stress.

The reliability of the asthma therapy assessment questionnaire has been evaluated and cutoff value of the questionnaire is 1 (Bårnes & Ulrik, 2015, p. 460). If the cutoff rate is 3 then it can be said that the asthma is not controlled appropriately. Asthma is the diseases that are related to the heart rate of the patient. The nurse needs to monitor the patient timely. The follow up can help the nurse to make an appropriate medication for Jessica. The asthma therapy assessment questionnaire is evaluated with the usage of the correlation with the measures of the asthma impact, healthcare utilization, and health status. According to McLaughlin et al., (2015), the asthma therapy assessment questionnaire helps to demonstrate the strong internal consistency (p. 565). This hypothesized the relationships to the corresponding events from the existing tools. The asthma therapy assessment questionnaire provides satisfaction to the nurses about the assessment of the patient. In case of Jessica, as she is not in the good condition, she needs the help of the nurse. Hence, it is necessary to address the health concerns of the patient and also make the ill person healthy. The heart rate of Jessica is poor and she has the problem of short breathness. Her neighbor stated that she is spending the sleepless nights due to the stress of the assignments as she is the student of nursing.

Action taken

From the above discussion, it can be said that the asthma therapy assessment questionnaire is beneficial for the patient and she can answer it appropriately (Jia et al., 2013, p. 698).  Due to the short breathness, she cannot focus on her study and therefore she is anxious about her assignment. She is spending the sleepless nights. She has the problem of tachypnoea and audible wheezing. She did not use the inhaler, which could help her to reduce the problem. Jessica was intubated with the asthma in past. In such case, the Jessica needs the intensive care so that she can develop her condition.

Action taken:

Table 1: Action taken

Jessica is a 27 years old female, who have been admitted in the emergency department with severe asthma. From her medical history, it has been found that she was taking sedatives for two days and then moderately sedated until last night. She had a central venous catheter inserted in her left subcalvian vein, since her admission. An arterial line in the right artery has been done, which was removed, next day, as it became non-functional.

While administering medication via different routes of medication administration, nursing staffs were liable to follow some instructions. For instance, Jessica had a central venous catheter. Inserted in her left subclavian vein, however, central venous catheterization has been shown to be risky sites of infection acquisition. Thus, nurses need to take adequate precautions for maintaining the venous access (Sims et al., 2011, p. 218). Poor management can lead to significant uncorrectable bleeding, injury or thrombosis, inability to tolerate pneumothorax, assisted ventilation with high end-expiratory pressure. Nurses should have enough training and knowledge about the management of CVC. Dressing changes at least every 72 hours should be done. Previous literatures and evidences showed that the risk of major central venous line complications is lower, when the subclavian approach is used, especially the risk of developing line-related bloodstream infections are lowered (Walls et al., 2011, p. 350).

While positioning catheter tip, the tip should be within the SVC, 2 cm outside the cardiac shadow. The tip should be inserted above T2 vertebra, when inserted from the upper extremity, whereas it should be inserted above the L4/L5 vertebrae or the iliac crest (Teodorescu et al., 2015, p. 159). The nurses need to ensure that the tip of the catheter is placed at the junction of the vena cava and the right atrium. The most common complication is catheter related sepsis, for this nurses need to adhere to the strict aseptic protocol for central line care. In case of infection, antibiotic treatment should be implemented (Nayeemuddin, Pherwani & Asquith, 2013, p. 531). Hand hygiene is one of the crucial precautions that the nurses should maintain, while dealing with Jessica. Before and after palpating catheter insertion sites, before and after inserting, replacing, accessing, repairing or dressing an intravascular catheter. Nurse should not palpate the insertion site once antiseptic has been applied, until the aseptic technique is maintained. While changing the dressing, clean and sterile gloves should be wore. Dressing should be changed immediately if found loose or solid. Administration sets should not be replaced more frequent than 72 hours, where as tubing should be replaced within 24 hours of initiating the infusion (Tran et al., 2014, p. 538). Catheter migration of malpositioning should be prevented. Catheter removal should be done when no longer it is required, if there is sign of infection or sepsis. In Jessica’s case, her arterial line in the right radial artery has become non-functional and thus removed, for preventing infection (Hentrich et al , 2014, p. 939).

Table 1: Action taken

Jessica has been intubated; nurses are liable to monitor the ABG constantly. While intubating the patient, it is important to measure and control hyperinflation and auto-positive end-expiratory pressure for ensuring appropriate outcomes of asthmatic patient, reducing the risk of severe hyperinflation (Sims et al., 2011, p. 222).

In case of Jessica, the nurses were about the regulatory bodies. However, due to the arrival of the new patients, the nurse did not have enough time to provide Jessica. Nurse needs to protect the data of the patient to maintain the Data Protection Act (1998) (Bateman et al., 2015, p. 920). This can help the nurse to maintain the ethics of nursing. Moreover, the nurse needs to share the necessary information with the patient as there is no family member of the patient is present.  The nurse needs to provide the proper timing to the patient so that the patient cannot feel neglected. However, the nurse has provided the appropriate respect to the patient and avoided the harm. The nurse needed to be more careful about the hand hygiene and should provide more time with her. However, the nurse maintained the justice, and veracity. The nurse safely provided the care to the patient and injected the intravenous injections carefully (Bateman et al., 2015, p. 1460). They maintained the records of Jessica carefully and did not manipulate the information. The nurse used the sign language and applied the position changing strategy that helped Jessica. The central venous catheterization has been shown to be risky sites of infection acquisition (Voorend?van Bergen et al., 2014, p. 205). The nurse took the appropriate approach to avoid the infection and helped Jessica to be getting back in her regular life and continue her studies. The nurse removed the catheter when there was no use of it so that the infection can be avoided on the urgent basis. Jessica did not face any legal, ethical or professional issues with the nurse as the nurse took her care in well manner in the care setting.  

Conclusion:

Based on the above discussion, it can be said that Jessica was taking sedatives for two days and then moderately sedated until last night. She had a central venous catheter inserted in her left subcalvian vein, since her admission. An arterial line in the right artery has been done, which was removed, next day, as it became non-functional. Jessica has been intubated and the nurses are liable to monitor the ABG constantly. The asthma therapy assessment questionnaire is evaluated with the usage of the correlation with the measures of the asthma impact, healthcare utilization, and health status. The respondents are graded on the point basis that can indicate the problem of the patient. It has ensured outcomes of asthmatic patient, reducing the risk of severe hyperinflation. Catheter removal should be done when no longer it is required, if there is sign of infection or sepsis. It can be expected that Jessica will follow the instruction of the nurses.

References

Bårnes, C. B., & Ulrik, C. S. (2015). Asthma and adherence to inhaled corticosteroids: current status and future perspectives. Respiratory care, 60(3), 455-468.

Bateman, E. D., Buhl, R., O'byrne, P. M., Humbert, M., Reddel, H. K., Sears, M. R., ... & Eriksson, G. (2015). Development and validation of a novel risk score for asthma exacerbations: the risk score for exacerbations. Journal of Allergy and Clinical Immunology, 135(6), 1457-1464.

Bateman, E. D., Esser, D., Chirila, C., Fernandez, M., Fowler, A., Moroni-Zentgraf, P., & FitzGerald, J. M. (2015). Magnitude of effect of asthma treatments on Asthma Quality of Life Questionnaire and Asthma Control Questionnaire scores: Systematic review and network meta-analysis. Journal of Allergy and Clinical Immunology, 136(4), 914-922.

Calhoun, W. J., Haselkorn, T., Mink, D. R., Miller, D. P., Dorenbaum, A., & Zeiger, R. S. (2014). Clinical burden and predictors of asthma exacerbations in patients on guideline-based steps 4-6 asthma therapy in the TENOR cohort. The Journal of Allergy and Clinical Immunology: In Practice, 2(2), 193-200.

Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P. (2013). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013.

Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I., Mousset, S., Buchheidt, D., ... & Christopeit, M. (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 25(5), 936-947

Jia, C. E., Zhang, H. P., Lv, Y., Liang, R., Jiang, Y. Q., Powell, H., ... & Wang, G. (2013). The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: systematic review and meta-analysis. Journal of Allergy and Clinical Immunology, 131(3), 695-703.

McLaughlin, K., Kable, A., Ebert, L., & Murphy, V. E. (2015). Barriers preventing Australian midwives from providing antenatal asthma management. British Journal of Midwifery, 23(2), 565.

Nayeemuddin, M., Pherwani, A. D., & Asquith, J. R. (2013). Imaging and management of complications of central venous catheters. Clinical Radiology, 68(5), 529-544.

Rapino, D., Attanasi, M., Consilvio, N. P., Scaparrotta, A., Cingolani, A., Cerasa, M., ... & Chiarelli, F. (2013). Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children. Multidisciplinary respiratory medicine, 8(1), 48.

Sims, E. J., Price, D., Haughney, J., Ryan, D., & Thomas, M. (2011). Current control and future risk in asthma management. Allergy, asthma & immunology research, 3(4), 217-225.

Teodorescu, M., Barnet, J. H., Hagen, E. W., Palta, M., Young, T. B., & Peppard, P. E. (2015). Association between asthma and risk of developing obstructive sleep apnea. Jama, 313(2), 156-164.

Tran, N., Coffman, J. M., Sumino, K., & Cabana, M. D. (2014). Patient reminder systems and asthma medication adherence: a systematic review. Journal of Asthma, 51(5), 536-543.

Voorend?van Bergen, S., Vaessen?Verberne, A. A., de Jongste, J. C., & Pijnenburg, M. W. (2015). Asthma control questionnaires in the management of asthma in children: a review. Pediatric pulmonology, 50(2), 202-208.

Walls, R. M., Brown, C. A., Bair, A. E., Pallin, D. J., & Near II Investigators. (2011). Emergency airway management: a multi-center report of 8937 emergency department intubations. The Journal of emergency medicine, 41(4), 347-354.

Watkins, K., Fisher, C., Misaghian, J., Schneider, C. R., & Clifford, R. (2016). A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care. Asthma research and practice, 2(1), 8.