This task is an instance based written survey. The case included is circumstance three and is dependant on a 50 yr old man by the name of Cedric who was diagnosed with COPD five years back. He has offered worsening dyspnea, cough and also increasing purulent sputum creation within the last three days. Throughout this task you will see home elevators the pathophysiology of the presenting conditions, education and psychosocial support for the patient, diagnostic tests that need to be done, medical and risk assessments and the discussion of some of the medications that Cedric is on. This task also consists of a nursing attention plan for this patient.
PATHOPHYSIOLOGY OF DYSPNOEA, A COUGH AND PURULENT SPUTUM.
The incident of dyspnoea is when the ventilatory demand is not and cannot meet the body's ability to respond to it. The development of dyspnea happens when there is a divergence between the central respiratory engine activity and the incoming afferent information from the airway receptors and also the lungs and the upper body wall formation (Periyakoil 2006). Therefore the respiratory effort increases when the central motor unit order to the respiratory muscles need to be increase meaning that when there is an increase in mechanised work insert or the muscles are weakened there is an increase in the work of respiration (Periyakoil 2006).
The experience of shortness of breathing is this is of dyspnoea, and the person included may or may well not be suffering (Hallenbeck 2003). The cause of dyspnea is that there is a CO2 build-up and gleam deprivation in oxygen. A persons having carbon dioxide elevation can activate dyspnea much more than a person having their air levels low and the partial pressure elevation of atrial skin tightening and levels are located to possess been a stimulus of dyspnea (Hallenbeck 2003)
In respect to the cough that Cedric offered, it is a defense mechanism that is important in participating in a major role in upholding the integrity of your airways; this security mechanism can be involuntary or voluntary. When someone coughs it is the trigger with a mechanical or chemical type activation in the pharynx, larynx, trachea and the bronchi and the receptors in them (The Snowdrift Pulmonary Foundation 2000). If one has a continual cough they can cough up mucus which really is a sputum sample and it is coughed up from the lower airways. And purulent sputum is generally a yellow, inexperienced or dirty gray shade (family practice notebook 2010).
NURSING ASSESSMENTS
Assessments which will be performed on the patient are an individual history, physical exam and diagnostic exams. When going for a patient history it's important to learn their behaviors such as smoking or drink so the nurse can understand whether or not these habits have anything to do with the delivering condition. Additionally it is important to really know what their past medical history is so that it can help the nurse formulate a diagnosis and also to provide appropriate good care to the individual. It is also very important to know if the individual is allergic to anything because if they're and the medical professionals don't know about it then they may just proscribe medication that they cannot have and have an allergic reaction to it. In an individual history additionally it is important to know what medications your client is on. The medications that the individual is taking may be causing the presenting condition or hindering the restoration, so if the doctors find out about the medications they would be able to do some investigations with regards to the medications.
Another assessment that should be completed is a physical diagnosis. A physical evaluation is a systematic process for collecting objective either through a head-to-toe or a systems assessment (medical examination department 2007). The goal of doing a physical evaluation on Cedric is to acquire a baseline physical in addition to a baseline mental data. It is also beneficial to question or verify any or question any information that is obtained during the history taking. Additionally it is useful in gaining data that will allow the nurse to make nursing diagnoses and also to also plan the patients care (medical examination division 2007).
EDUCATION AND PSYCOSOCIAL SUPPORT
Cedric shown to hospital with dyspnoea so that it is the nurses job to provide information about the problem to help the individual have a much better knowledge of what it is and also how to keep it in the best way possible. When it comes to dyspnea the nurse would be able to notify Cedric about the positioning that he should be in to help along with his breathing. In cases like this it might be to remain up and also have your muscles relaxed (patient education 2010). The nurse would also have the ability to notify Cedric to rate his breathing, this will prevent or reduce a shortness of breath (patient education 2010). It's important for patients never to only receive information but to all or any obtain psychosocial support. The reasoning behind psychosocial support is to prevent the distress and also hurting developing into a problem more severe. It will also help the Cedric cope better in the problem and help him job application to his normal life once discharged (IFRC 2011). Specific psychosocial support that can be designed to Cedric is justification and education, support of reality, assisting with communication, having treatment for symptoms such as stress and anxiety and mood disturbance. The nurse will also be in a position to help the patient structure their day and also be able to combine the family in the problem (sign 2005).
DIAGNOSTIC TESTS
There are a variety of diagnostic tests that will aid with the diagnosis and management of Cedric. Patients who present with dyspnoea are usually given a torso x-ray and also an electrocardiography to help the doctor assess the problem (health 2011). These lab tests will show up any abnormalities of the upper body wall, they'll show up the positioning of the diaphragm, any possible fractures of the ribs, additionally, it may arrive an irregular heartbeat and the amount of blood circulation to the heart. Another test includes a spirometer which shows up any airway disorders. Insufficient oxygen can be a reason behind dyspnea so by performing a measurement of blood vessels oxygen saturation it will show up set up blood oxygen is low of course, if so then the appropriate treatment can be produced (Thomas and Gunten 2000). Another test that can be done for diagnostic reasons is bloods lab tests and arterial blood vessels gases, these assessments will rule out anemia, it will eliminate hyperventilation from a thyroid dysfunction or from an panic attack (health 2011). Finally, another diagnostic test that should be done can be an echocardiogram. An echocardiogram creates images of your heart by using sensible waves. This test will present information on the scale and also the condition of Cedric's heart and soul. This test will also arrive how well Cedric's chambers and valves will work in the center (American college of cardiology foundation 2010).
RISK ASSESSMENT
The risk assessment tool that is conducted on Cedric is a comes risk. The examination will determine if he is at risk of having a land within the next twelve months. The reasoning behind doing a falls risk evaluation on Cedric is that he offered a blood pressure of 130/84 which is known as to be borderline high blood circulation pressure and should be closely checked (Nemours 2011). High blood circulation pressure will often cause dizziness and nausea so theoretically this can cause a land (Nemours 2011). The comes risk assessment figured Cedric is merely at a seven percent risk of having a fall next a year.
CLIENT MEDICATIONS
INDAPAMIDE:
Action: it is an antihypertensive agent that is used orally. Idapamide exerts its antihypertensive action and it has not been completely elucidated. If a medication dosage of 2. 5mg is used the renal ramifications of the medicine are minimal and also the antihypertensive aftereffect of the medication is attributed to a reduction in the vascular reactivity to pressor amines (Mims 2011).
Use: Idapamide is part of the diuretic family. This particular medication works by making your body lose excess salt and normal water (Medi Tool 2011).
Relevant connections: interactions probably will occur with lithium, digoxin, alcohol, narcotics and also barbiturates (Mims 2011).
Adverse results: most reactions are moderate and those being asthenia, dizziness, frustration, fatigue and muscle cramps. The more serious but common adverse effect is an electrolyte imbalance.
Nursing items/precautions: whenever a person is taking this medication a nurse should be careful and aware if the patient has kidney problems, diabetes, gout, liquid or electrolyte problems, and also any allergies that the patient may have. Another nursing point is the fact I might be considered a good idea for the patient taking the medication to also eat and drink different foods which have high potassium levels; it may also be just like easy to adopt potassium supplements (drugs information online 2011).
SALBUTAMOL:
Action: the action of Salbutamol is a direct acting sympathomimetic agent that mainly has beta-adrenergic activity and also a high degree of selectivity for beta2-adrenoceptors (Mims 2011).
Use: the use of Salbutamol is to relax the simple muscle that is in the lungs and also opens the airways to enhance the breathing patterns of an person (medication world wide web 2011).
Relevant interactions: beta blockers specifically antagonize the action of sabutamol on the airways. And generally this medication is also contraindicated in asthma because they tend to boost the airways amount of resistance (Mims 2011).
Adverse effects: Common adverse effects of sulbutamol are tachycardia, hypertension, muscle tremors. You can also obtain headaches and dizziness (medsafe 2009).
Nursing items/precautions: the excess use of sulbutamol is potentially hazardous when you exceed the recommended dose. A precaution for sulbutamol is the fact it could cause cardio necrosis, it is also said to have pharmacological effects (Mims 2011).
NURSING Care and attention PLAN
Nursing diagnosis
Ineffective respiration patterns
goals
To have Cedric's breathing maintained and have a regular respiratory rate.
Interventions
To position the patient with right body alignment for best possible breathing patterns.
Apply air to Cedric
Rationale
This will allowed for Cedric to obtain good lung excursion and also breasts expansion
To ensure that Cedric's oxygen saturation doesn't decline
evaluation
To hold the nurse or a doctor assess if the oxygen or the placement of Cedric has upgraded his breathing.
Nursing diagnosis
Ineffective airway clearance.
Goals
To have a respiratory tract also to maintain airway potency.
Interventions
Assist Cedric in doing coughing and breathing exercises
The positioning of Cedric
Rationale
This can help improve the productivity of the cough
This will promote better lung expansion and also to also improve air exchange.
evaluation
The improvement will be evaluated by a doctor and if there is no development then more hostile techniques may be recommended by the physician.
Nursing diagnosis
High pulse rate
Goals
To hold the pulse rate lower over a daily basis
Interventions
Exercising on a normal basis
Rationale
If cedric exercises on a regular basis then he will not only be able to increase his fitness but also fortify his center muscle and decrease his heart rate.
evaluation
Have cedric go to his medical doctor monthly to get his pulse rate taken and to assess whether the exercise has decreased his pulse rate.
Nursing diagnosis
Increase bloodstream pressure
Goals
To lower Cedric's heart rate so that it isn't borderline on high.
Intervention
Increase in exercise frequently will also help in the avoidance or reduction in high blood circulation pressure as well as a high pulse rate.
Rationale
So again if Cedric can exercise frequently then he is not only going to be able to increase his fitness but also like a better lifestyle and also reduce or prevent high blood circulation pressure.
evaluation
Cedric will also be in a position to see his medical doctor on a monthly basis to screen his blood sugar and to make sure that he is on the right course.
