Nursing论文模板1 – Clinical Deterioration

According to (Mebazaa et al., 2018), hypoxia is a condition characterized by insufficient amounts of oxygen at the tissue level to maintain adequate homeostasis. The reason for this can be an inadequate supply of oxygen to the tissues caused by either low oxygen content in the blood or insufficient blood supply. Its intensity can vary from mild to severe. This case study focuses on Adam, a 17-year-old teenage boy who was recently admitted to the respiratory ward from ICU with a diagnosis of a hypoxic brain injury. During his admission at ICU, Adam was diagnosed with non-focal seizures caused by hypoxia and is currently controlled with sodium valproate, a medicine used to treat epilepsy and bipolar disorder and occasionally used to prevent migraine headaches. In the past, Adam has had several hospital admissions related to his asthma. In addition, he has also had complications related to his asthma treatment, including steroid-induced diabetes Mellitus secondary to prolonged and repeated use of corticosteroids (Seckel et., al 2014). Therefore, this essay aims to discuss chronic asthma in teenagers, relating to Adams case study by; critically discussing Adam’s two current problems of impaired gas exchange and lack of knowledge and confidence related to asthma management, describing the pathophysiology of the two issues, develop two interventions for each of the two problems, and evaluate all four interventions that could relieve Adam’s asthma exacerbation. This is important to help prevent adverse issues that may arise when an individual bearing a similar condition is not attended to.

Adams’s major complication is impaired gas exchange related to fluid and exudate accumulation at the capillary-alveolar membrane evidenced by coarse crackles, coughing more, creamy secretions from tracheostomy, restlessness, and confusion. Adam generally does not seem okay while coughing more and his hands feeling cool. He is also seen shivering despite Meryl adding blankets over him. The major two symptoms are coughing more and shivering. His body temperature of 37.90C portraying a high fever in a teenager. As indicated from 36.60C to 37.90C, the rising body temperature suggests that Adam has a fever.

The symptoms and pathophysiology of pulmonary oedema are as follows: Pulmonary hydrops is associated with a deficiency of type II alveolar cells, leading to a loss of surfactant. Without surfactant, the alveoli will collapse. Pulmonary oedema is due to pulmonary hypertension shifting fluid to alveoli from capillaries. (Mebazaa et al., 2018). The amount of fluid that fills a lung depends on the severity of the condition and anywhere from a few millilitres to several litres of fluid (Purvey & Allen, 2017). The accumulation of this fluid causes some abnormalities in lung function, including abnormal respiratory rates, breathing difficulties, shallow breaths, shortness of breath and eventually complete inability to breathe or death if not treated immediately (Dr Mary Harding, 2018). When there is no enough oxygen in the body, the body will not work, and this condition can be fatal if severe in the short term. In addition, if it persists over a long time, it can affect the heart or brain. That is why it is vital to address this situation immediately to prevent more damage to our bodies.

Moreover, when a patient experiences difficulty breathing with or without pain, it can lead to obstructive shock. Which results in decreased heart function and eventually leads to death if not treated immediately. The most accurate term to describe a condition of shock is “hypovolemic shock”.  A patient with hypovolemic shock will suffer from “weak” or “lacking strength,” and a loss of energy due to an insufficient flow of oxygen (Standl et al., 2018). Once the heart fails, it cannot supply oxygenated blood to the body. Hypovolemic shock is a life-threatening condition that requires immediate treatment. The patient should receive fluid and blood volume quickly to save their life. When trying to determine if a patient is suffering from hypovolemic shock, there are three main things you can look for: signs and symptoms, signs of hypovolemia, and physical exam findings in addition to lab results (Malbrain et al., 2018). Prevention of this condition helps an individual live a healthy life. An individual will be safe from any side effects that come with impaired gas exchange, like damage of the brain and tempering with the functioning of the heart, which may lead to death (Ware et., al 2019).

In the first intervention, it is advisable for patients with difficulty breathing or impaired gas exchange to be subjected to high flow oxygenation equipment, a process known as oxygen therapy. This equipment helps an individual receive oxygen to their body. Oxygen from the source is humidified and then administered to the patient through a wide nasal cannulae.  Although the equipment can be administered on an unmonitored floor, it is advisable to be applied in a monitored setting like ICUs, emergency departments or intermediate care units‌(Chandni Ravi et., al 2021.). The equipment is well-tolerated, and it can be used for prolonged periods. Two major parameters need to be set before an individual is subjected to the equipment. These include the flow rate (in most cases at 20 to 35 L/minute) and the fraction of inspired oxygen (FiO2), usually between 21 to 100 percent. If the respiratory rate fails to improve, the flow rate can be increased to 5 to 10L/minute. Besides, if the patient is improving the trajectory of oxygen required is reduced, HFNC can be administered in a less monitored setting. according to (Malek & Shadi Soufi, 2021), recent studies suggest that oxygen therapy is effective in patients with Hypercapnia and improvement in ventilator parameters

The second intervention is suction for the tracheostomy patient. This involves removing thick mucus and secretions from the lower airwave and trachea that you are unable to clear by coughing (‌Mary, 2018). The equipment needed for this process includes the suction machine, clean basin, distilled water, one non-steric clean glove connecting tubing, clean small paper cup and disinfected suction catheter. The process can be done by positioning the patient comfortably with their head and neck well supported. The process does not hurt the patient.

In most cases, the process is usually administered when you have difficulty breathing, like in the case of Adam, when an individual is unable to effectively clear secretions from the throat and when the patient has a moist cough that does not clear secretion (Antoine, 2020). Effective suctioning can be assessed by good pulse oximetry readings, improved breath sounds, clearance of secretions and improved respiratory distress in a patient (Abbasi, 2019). Moreover, removing the thick viscous secretions helps prevent cases of atelectasis collapse of lung lobes and decrease in oxygenation.

In conclusion, this essay aims to discuss chronic asthma in teenagers, relating to Adams case study by critically discussing Adam’s two current problems of impaired gas exchange and lack of knowledge and confidence related to asthma management, describing the pathophysiology of the two problems, develop two interventions for each of the two problems, which included high flow oxygenation equipment (oxygen therapy) and suction of tracheostomy patients and lastly evaluate all four interventions that could relieve Adam’s asthma exacerbation. Overall the interventions help Adam improve his general health status and prevent any future asthma exacerbation occurrences.

References

‌Abbasi, N., & Ryan, G. (2019). Fetal Pleural Effusions and Pulmonary Pathology: Pathophysiology and Clinical Management. Fetal Therapy, 438–448. https://doi.org/10.1017/9781108564434.043

‌Antoine, M., & Mouna Mlika. (2020, August 15). Interstitial Lung Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541084/

‌Chandni Ravi, & McKnight, C. L. (2021, July 31). Chest Tube. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459199/

‌Dr Mary Harding. (2018, November 16). Pulmonary Oedema. Patient.info. https://patient.info/heart-health/pulmonary-oedema

Lee, F. L., Said, N., Grikscheit, T. C., Shin, C. E., Llanes, A., & Chmait, R. H. (2014). Treatment of Congenital Pulmonary Airway Malformation Induced Hydrops Fetalis via Percutaneous Sclerotherapy. Fetal Diagnosis and Therapy31(4), 264–268. https://doi.org/10.1159/000336226

‌Malbrain, M. L. N. G., Van Regenmortel, N., Saugel, B., De Tavernier, B., Van Gaal, P.-J., Joannes-Boyau, O., Teboul, J.-L., Rice, T. W., Mythen, M., & Monnet, X. (2018). Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Annals of Intensive Care8(1). https://doi.org/10.1186/s13613-018-0402-x

‌Malek, R., & Shadi Soufi. (2021, April 26). Pulmonary Edema. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557611/

Mebazaa, A., Combes, A., van Diepen, S., Hollinger, A., Katz, J. N., Landoni, G., Hajjar, L. A., Lassus, J., Lebreton, G., Montalescot, G., Park, J. J., Price, S., Sionis, A., Yannopolos, D., Harjola, V.-P., Levy, B., & Thiele, H. (2018). Management of cardiogenic shock complicating myocardial infarction. Intensive Care Medicine44(6), 760–773. https://doi.org/10.1007/s00134-018-5214-9

‌Purvey, M., & Allen, G. (2017). Managing acute pulmonary oedema. Australian Prescriber40(2), 59–63. https://doi.org/10.18773/austprescr.2017.013

Seckel, M. A. (2014). Oxygen and Oxygenation. Critical Care Nurse, 34(5), 73-74.       doi:10.4037/ccn2014745

Smith, D., & Bowden, T. (2017). Using the ABCDE approach to assess the deteriorating patient.      Nursing Standard, 32(14), 51-63. doi:10.7748/ns. 2017.e11030

‌Standl, T., Annecke, T., Cascorbi, I., Heller, A. R., Sabashnikov, A., & Teske, W. (2018). The Nomenclature, Definition and Distinction of Types of Shock. Deutsches Aerzteblatt Online. https://doi.org/10.3238/arztebl.2018.0757

Ware, L. B., Fremont, R. D., Bastarache, J. A., Calfee, C. S., & Matthay, M. A. (2019). Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio. European Respiratory Journal35(2), 331–337. https://doi.org/10.1183/09031936.00098709

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