92445 Integrated Nursing Practice

Question:

Prioritisation of complex patient health issues

  1. Choose one of the case studies from the lab sessions in Integrated Nursing Practice State the case study that you have chosen including whether the assignment addresses part one (morning shift) or part two (evening shift) of the case

Identify a total of five patient health issues from the case study that nurses can address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health issues.

Select the three highest priority patient health issues from the five health issues that have been identified.

  1. Rank the three patient health issuesthat were selected in part 1 in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current
  1. Outline the nurse’s role in addressing the top three priority patient health issuesusing assessment, coordination of care and provision of care. Relate the discussion to regulatory frameworks of nursing and health department policies e.g. RN Standards for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards

Anwer:

In my assignment, I have decided to write about a case study about the patient transferred from the Emergency Department to the Respiratory Medical Unit. The scenario took place on 30th July 2018 at 10AM and that means it was a morning shift. The identity of the man was Jim Cooper and he was 68 years old. The patient presented on an early morning and had a medical history of productive cough for a week as well as SOB which seemed more than the usual level. His medication included GP for Oral AB. The patient further claimed that he had been sitting in his chair during the night and that it is becoming very difficult for him to care for himself while at home. The patient further claimed that he stays alone and that regular drinking assists him to calm down. The patient also noted that he feels lonely and that it has been getting him down of late. The past medical history include COPD that was diagnosed 5 years ago, reflux and finally Hypercholesterolemia. On assessment, the following signs were vital that necessitated admission at the Emergency department. The Heart rate was at 118 beats/min, the RR was at 36 breaths/min,SpOwas 88% RA-93% 2L ONP while the Blood pressure was at 146/92 mmHg. The oral temperature was 38C. Finally the Auscultation was characterized by scattered whizzes throughput both the two lung fields. The recommendations included treatment with oxygen, IV fluids, IVAB, Prednisolone and finally the physiotherapy.

Patient Health Issues

From the case study presented above, there arises several health issues which Nurses can address within their scope of practice. The health issues identified include:

  • Impaired social interaction
  • Possible alcohol withdrawal
  • Potential for hypoxia.
  • Compromised airway clearance

Ranking Of The Health Issues By Priority.

Compromised airway clearance is the first priority because COPD is an umbrella of different conditions that affect the airways and lungs like asthma. The condition according to studies, makes breathing very difficult (Sessa et al., 2017 p.126). The condition is characterized by inflammation in the air passages and this leads to narrowing of the same airways and this makes it difficult for oxygen to reach the lungs. It is the inflammation that compromise the airway clearance and that is why the initial step to manage the condition is improving or rather correcting on the compromised airways.

According to different studies, bronchodilators and corticosteroids are the ones used to reduce inflammation. There are different classes of bronchodilators and they include the beta-2 agonists, the anticholinergics and finally the methylxanthines (O’Donnell, 2008p.25). The mentioned drugs are usually introduced step by step beginning with the Beta-2 Agonists. The role of this drugs is to ensure that the airway muscles are smooth enough. The beta 2 agonists are also divided into short and long acting. An example of the short acting beta-2 Agonists are albuterol and the formoterol are the long acting beta-2 Agonists.

Anticholinergics are introduced after the beta-2 Agonists. The role of this drugs is to reduce inflammation by facilitating bronchodilation through blocking of the acetylcholine that is found on the postganglionic cholinergic nerves. An example of such a drug is the Tiotropium which is also called Spiriva and it is a long acting anticholinergic that has duration of over 24 hours (Giembycz, 2015). This is the only drug needed once on a daily basis. The final drug to reduce inflammation is the Methyxanthines. Studies have shown that this drugs prevent phosphodiesterase thus elevated levels of the cyclic adenosine monophosphate and this leads to bronchodilation (Chung, Lin, & Kao, 2015, p. 54). Studies though show that the corticosteroids have no value in handling COPD but they only reduce inflammation for subsequent management steps.

Potential for hypoxia is the second priority health issue and it is usually reserved to patients with hypoxia. According to studies, the oxygen therapy does not improve lung function but only boosts survival in patients with hypoxia. The objective of this process according to studies is to achieve an oxygen saturation level of around 90%.It is the arterial blood gas value and desaturation as well nocturnal desaturation that determine the oxygen prescribed.

Impaired social interaction is ranked third among the health issues. Patients suffering from COPD are known to have impaired social status and they should be assisted as well. According to studies, medical management cannot reduce symptoms of the COPD in any way and they can’t reverse the pathological changes as well. In this case, the health care providers often prescribe what is called pulmonary rehabilitation whose objective is to ensure that the patients improve on both their physical and the social functioning.