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.
- Pneumonia in her right lung.
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.
- Blood glucose level- 7.5 mmol/L
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.
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.
