The aim of this assignment is to find out and discus health related issues concerning Mr. Jim Cooper first week of the morning duties case study. Jim Cooper who is 68 year-old male patient was transferred from the emergency department to the respiratory medical unit as a result of history of SOB and productive Cough that lasted for one week. Additionally, it is discovered that Mr. Jim Cooper COPD was diagnosed with COPD 5 years ago and also hypercholesterolemia. The five main health issues concerning Mr. Jim Cooper includes, ineffective airwave clearance, impaired gas exchanger, risk for depression development, malnutrition as well as impaired physical mobility.
There is total lack of priority for Malnutrition as well as impaired physical mobility. Malnutrition is defined as the imbalance protein, energy and nutrients capable of causing severe effects on human body associated with over or under nutrition (Banner et al., 2016). Concerning Jim Cooper conditions, malnutrition is seen as under nutrition since he has a thin body with BMI of 18.7kg/m2. Jim could suffer malnutrition because of COPD complication. Often, individual suffering from COPD usually have symptoms of dyspnea as well as breathlessness capable of causing insufficient oral intake and deprived appetite. Additionally, environment, psychological and social factors also undermine nutritional intake. Since Jim retirement, he has been living along because his wife died 18 months ago. He state that sometime he felt lonely that got him down for the past few months thereby placing him at a high risk of malnutrition. Research indicates that malnutrition enhances mortality, hospitalization as well as readmission; however, it is capable of reducing muscle strength thus worsening the function of the respiratory muscle (Simon et al., 2016). In Jim Cooper case, malnutrition is not life-threatening. Dietician can manage and prevent through nutritional supplement prescription.
Consequently, there is no priority for physical mobility. Impaired physical mobility is the risk limitation experience of physical movement. Individual suffering from chronic illness have higher chances of experiencing impaired physical mobility as a result of side effects caused by medication (McKenzie, et al., 2013, p. 6). For example, corticosteroids, theophylline and bronchodilators are often the most used medication in managing respiratory diseases. However, they are often associated with side effects such decrease in muscle function, dizziness and bone mineral function loss. Therefore, Jim Cooper condition needs a continuing pharmacology management since it indicates that he has high chances of suffering from impaired physical mobility (IPM). Nevertheless IPM is a less life-threatening since it can be managed and prevented through undertaking mobility assessment, occupational therapy as well as physiotherapy when hospitalized or when at home after disc hared.
The greatest risk that Mr. Jim Cooper faces is the Impaired Gas Exchange (IGE). It is described as the deficit or excess in oxygenation within the membrane of alveolar-capillary. Individual experiencing respiratory diseases as well as smokers are at a greater risk of suffering from the impaired gas exchange (Hart et al., 2018, p. 153). The disease is characterized by abnormal breathing, pallor, dyspnoeic, abnormal arterial blood glasses, restlessness, elevated blood pressure as well as tachycardia. It is evidenced that Jim Cooper was an ex-smoker who suffers from COPD having reported to suffer from productive cough and SOB (Verma and Roach, 2010.P, 126). After being admitted, the possible outcome of the diagnosis is that it was community transmitted pneumonia. Addition outcome of the diagnosis would be that he is dyspnoeic as well as his breath was coming from neck muscle. Additionally, it is possible that he was experiencing a respiratory rate of 30 breaths / min as well as SpO2 89%. Therefore, this is capable of meeting the red zone for rapid response standards within the SAGO graph (Clinical Excellence Commission, 2014). Consequently, high temperature of 37.8oC, sinus tachycardia, and high blood pressure of 142/88 and heart rate of 12 beats per min. moreover, he also suffers from pallor. Going by the ABG result he had PH level of 7.32 while his PAO2 was approximately 70mmHg which were lower as compared to the normal range. Also his PACO2 55mmHg were higher than the normal range. Therefore, the above mention results indicated the signs of respiratory acidosis. The present symptoms together with the results from the test show that Mr. Cooper is suffering from Impaired Gas Exchange. The condition place Mr. Cooper at a higher risk of suffering from hypoxia as a result of decrease in oxygen diffusion from his alveoli to the blood system as in ACP. Moreover, Cooper, may also suffer from cardiac arrhythmias due to hypoxia death. Therefore, the primary cause of hypoxia is the impaired gas exchange. Thus, there is urgent need of medical attention as well nursing management.
Secondly, the next disease that must be given attention is the ineffective airwave clearance. It refers to the inability by the patient to clear obstruction or secretion region from the system of respiratory tract to help in maintaining clear airwave. High risk associated with inability to maintain clear airwave entails sputum production and chronic cough. Cooper has clear airwave history, however, the inability to speak full sentence, productive cough and suffering from COPD in both lungs indicates that there is possibility of him suffering from partial airwave obstruction. Airwave obstruction usually deteriorates gas exchange function; develop hypoxia and causes cardiac arrest (McPherson & Stephens, 2012). Thus maintaining airwave is often priority for nursing care since it can improve patient comfort, easy breathe and prevent further risks that are related to oxygenation problems.
Depression development risk should be considered the third priority for Mr. Cooper. Depression is always common in most of the disease groups as compared to the general population (Stahl, Albert, Dew, Lockovich and Reynolds, 2014, p. 499). Since Mr. Cooper suffers from COPD, he has higher chances of suffering from depression. Life events such as passing of his wife 18 months ago also contribute to depression development. The social background of drinking of 25 units per week, feeling lonely and confirm to being anxious during admission to the ED indicates that he has higher risk of depression development (Butow, 2015, p. 987). Additionally, depression prevalence also enhances with increase of COPD. Patient experiencing severe COPD with depression has a likelihood of undergoing exacerbation as well as worse survival. Studies also indicate that patients suffering from depression have problem of poor appetite and physical mobility capable of causing malnutrition and physical mobility. Hence monitoring Cooper’s mental status as well as preventing depression development is essential.
Nurses play significance role when it comes to assessment and management of the above mention health issues (Cuijpers, Reynolds III, Donker, Andersson, and Beekman, 2012, p.855). In impaired gas exchange as well as risk associated with development of airwave obstruction, there is a need for nurses to assess the rate of respiratory and depth together with auscultate breathe sound since it’s vital when evaluating respiratory distress levels as well as patency of airwaves. Moreover, nurses should encourage suction, efficient coughing exercise, sputum expectoration when necessary since sputum is one of the greatest contributor to impaired exchange of gas within the airway and capable of causing airwave obstruction. There is also a need to monitors cardiac rhythm due to change in blood pressure and tachycardia to examine cardiac function and effects resulting from systematic hypoxemia. Nevertheless, nurses should conduct A-G assessment before starting there shift to ensure that patients are safe (Dawson, King and Grantham, 2013, p. 398). Full set of the observation should always be carried out after every 8 hours. However, doo due Cooper condition observation should be conducted after every 4 hours to ascertain his airwave patency and if there is enough oxygenation. Concerning depression development by Mr. Cooper, there is need for nurses to assess and understand his pattern of sleep. Moreover, nurses should monitor his appetite and weight through application of food chart because they the main symptoms of depression (Stahl, Albert, Dew, Lockovich and Reynolds, 2014, p. 499). Additionally, nurses should observe Mr. Cooper’s emotion and behavior since extreme sadness, loss of motivation as well as anxiousness are depression symptoms. Finally, there is need to monitor Mr. Cooper background since it can be a risk factor to depression development
Banner. J, Bowden. M, Cotton. J, Holdoway. A, King. S, Nathan. A, Potts. O, Weekes. E and Ko, F.W., Chan, K.P., Hui, D.S., Goddard, J.R., Shaw, J.G., Reid, D.W. and Yang, I.A., 2016. Acute exacerbation of COPD. Respirology, 21(7), pp.1152-1165.
Butow, P., Price, M.A., Shaw, J.M., Turner, J., Clayton, J.M., Grimison, P., Rankin, N. and Kirsten, L., 2015. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho?Oncology, 24(9), pp.987-1001.
Clinical Excellence Commission, 2014, ‘NSW Health Standard Observation Charts’, Between the Flags Keeping patients safe, reviewed on 4th September 2016, <https://www.slhd.nsw.gov.au>
Cuijpers, P., Reynolds III, C.F., Donker, T., Li, J., Andersson, G. and Beekman, A., 2012. Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depression and anxiety, 29(10), pp.855-864.
Dawson, S., King, L. and Grantham, H., 2013. Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia, 25(5), pp.393-405.
Hart, D., Rush, R., Rule, G., Clinton, J., Beilman, G., Anders, S., Brown, R., McNeil, M.A., Reihsen, T., Chipman, J. and Sweet, R., 2018. Training and assessing critical airway, breathing, and hemorrhage control procedures for trauma care: live tissue versus synthetic models. Academic Emergency Medicine, 25(2), pp.148-167.
McKenzie, D.K., Abramson, M., Crockett, A.J., Glasgow, N., Jenkins, S. and McDonald, C., 2013. The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease 2009. Med J Aust, 178, p.6..
Simon, S.T., Higginson, I.J., Booth, S., Harding, R., Weingartner, V. and Bausewein, C., 2016. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev, 10, p.CD007354.
Stahl, S.T., Albert, S.M., Dew, M.A., Lockovich, M.H. and Reynolds III, C.F., 2014. Coaching in healthy dietary practices in at-risk older adults: a case of indicated depression prevention. American Journal of Psychiatry, 171(5), pp.499-505.
Verma, A.K. and Roach, P., 2010. The interpretation of arterial blood gases. Aust Prescr, 33(4), pp.124-129.