Students should add this coversheet, to the start of their assessment before submission through Turnitin.
Academic Misconduct / Plagiarism Declaration
By attaching this front cover sheet to my assessment I confirm and declare that I am the sole author of this work, except where otherwise acknowledged by appropriate referencing and citation, and that I have taken all reasonable skill and care to ensure that no other person has been able, or allowed, to copy this work in either paper or electronic form, and that prior to submission I have read, understood and followed the University regulations as outlined in the Academic Integrity Policy and Procedure for Academic Misconduct available at the following link: https://www.uclan.ac.uk/study_here/assets/assessment_handbook_2122.pdf
WELLBEING
SELF – REFLECTION This section suggested for inclusion if appropriate to the assessment; otherwise can be deleted
Introduction
52-year-old female ERM patient, single, comes to the emergency room for respiratory distress. She was admitted with a medical diagnosis of Asthma. Vital signs were monitored BP 132/82, P 120, R 22, T 36.0, SPO2 97%, weight 170 lbs. The following medications were administered: albuterol 0.83% 3cc of NSS every 15 min x 20 min # 3, atroven .002%, and soumedrol 15mg IM.
This case study has the purpose of applying the nursing process in its entirety to said client and whose primary objective is to assess the nursing process to a patient using the skills and tools taught in class. Next, we will talk in more detail about the application of the nursing process to this client.
Objective
Upon completion of this case study, we will be able to
Analyse the patient's profile
Understand the growth and development stage
Case-Study
Client Profile.
A. 52-year-old female ERM patient, single, comes to the emergency room for respiratory distress. She was admitted with a medical diagnosis of Asthma. Vital signs were monitored BP 132/82, P 120, R 22, T 36.0, SPO2 97%, weight 170 lbs. The following medications were administered: albuterol 0.83% 3cc of NSS every 15 min x 20 min # 3, atroven .002%, and soumedrol 15mg IM.
Growth and Development Stage Analysis.
Adulthood
• Age (25 to 65 years)
• Main Task
• Indicators of Positive Resolution
• Indicators of Negative Resolution (self-indulgence, concern for oneself, lack of interest and commitments)
 |
| Society, Health and Nursing Care |
Analysis
The 52-year-old ERM patient positively carried out the task until the time of the interview. The patient has a healthy personality and functions effectively in society, thus maintaining control of her life.
Medical diagnostic
Asthma.
Definition.
It is a disorder that causes the airways to swell and narrow, causing wheezing, shortness of breath, chest tightness, and coughing. It is a chronic inflammatory disorder in which many cells and cellular elements play a role. Chronic inflammation causes an associated increase in hyper bronchial responsiveness that produces recurrent wheezing symptoms, dyspnoea, chest tightness, and cough, particularly at night and in the early hours of the morning. These episodes are associated with a generalised and variable degree airway obstruction, which is reversible spontaneously or with treatment.
Inflammation: It is the result of a cascade of events that involve different cellular elements such as T lymphocytes, eosinophils, mast cells, neutrophils and macrophages, and mediators and factors that interact with each other. This produces the injury and repair of the bronchial epithelium, leading to structural and functional changes that result in obstruction and remodelling of the airways (Chong & Lee, 2017).
Hyper reactivity: It is a condition in which the airways narrow excessively in response to various stimuli.
Obstruction: Increased resistance to airflow secondary to inflammatory changes in the airway (a contraction of smooth muscle, oedema, inflammatory cell-like infiltrate, and mucus).
Signs and symptoms
Signs and symptoms are as follows: coughing, retraction or pulling of the skin between the ribs, shortness of breath, wheezing, rapid pulse, sweating, anxiety, chest pain, and tightness in the chest.
Cause.
Asthma is caused by inflammation of the airways. When an asthma attack occurs, the muscles around the airways tighten, and the airways' lining becomes inflamed. This reduces the amount of air that can pass.
Diagnosis.
Diagnosis is based on physical examination, arterial blood gas, blood tests, chest X-ray, pulmonary function tests, and peak flow measurements.
Treatment.
Obstruction: Increased resistance to airflow secondary to inflammatory changes in the airway (a contraction of smooth muscle, oedema, inflammatory cell-like infiltrate, and mucus).
Diagnosis: Bronchial asthma worldwide is a clinical entity underdiagnosed, especially in children, the elderly, individuals with recurrent cough, and individuals with occupational exposure. This has been attributed in part to the intermittent symptoms that favour tolerance of the same by the patient and due to their nonspecific nature: the clinical history and pulmonary function tests can determine the reversible nature of the abnormalities. Measurement of symptoms and lung function are essential parameters to assess bronchial asthma characteristics for each patient. With regard to the medical history, the diagnosis should be considered when there is episodic dyspnea, wheezing, a sensation of chest tightness when there is a history of seasonal variability, atopy, and a family history of asthma (Weiss et al., 2006). The most critical parameters in the measurement of lung function to determine if there is airflow limitation in people over five years of age are: Forced Expiratory Volume to the first second (FEV1), Forced Vital Capacity (FVC), FEV1 / FVC ratio, and Flow Forced Expiratory (FEF) or peak flow. The physical examination contributes little to the diagnosis; However, the most frequent alteration found through it is the presence of wheezing. Some questionnaires with key questions that guide the diagnosis of the disease have been used in epidemiological studies: The most important parameters in the measurement of lung function to determine if there is airflow limitation in people over five years of age are: Forced Expiratory Volume to the first second (FEV1), Forced Vital Capacity (FVC), FEV1 / FVC ratio and Flow Forced Expiratory (FEF) or peak flow. The physical examination contributes little to the diagnosis; however, the most frequent alteration found through it is the presence of wheezing. Some questionnaires with key questions that guide towards the diagnosis of the disease have been used in epidemiological studies: The most important parameters in the measurement of lung function to determine if there is airflow limitation in people over five years of age are: Forced Expiratory Volume to the first second (FEV1), Forced Vital Capacity (FVC), FEV1 / FVC ratio and Flow Forced Expiratory (FEF) or peak flow. The physical examination contributes little to the diagnosis; however, the most frequent alteration found through it is the presence of wheezing (Chong & Lee, 2017). Some questionnaires with key questions that guide towards the diagnosis of the disease have been used in epidemiological studies:
Questionnaire
Does the patient have a recurrent episode or episodes of wheezing?
Does the patient have a bothersome cough at night?
Does the patient have a cough or wheezing after exercise, laugh or cry?
Does the patient have chest tightness, cough, or wheezing after inhalation of allergens, strong odours, air pollutants, and others?
Do flu symptoms go "to the chest," or do they last for more than ten days?
Do they improve symptoms with bronchodilators and steroids
Measurement of lung function
Measurement of reversibility provides direct evidence of airflow limitation, and measurement of variability provides indirect evidence of the airways' hyperresponsiveness, which are, in turn, the consequence of the inflammatory disorder.
Spirometry
It is a reproducible, effort-dependent procedure, influenced by prior instruction to the patient. Spirometry is limited to some clinical centres as it is relatively expensive equipment. Your predicted values are affected by age (especially extreme ones), gender, height, and race. The highest values are taken from two to three measurements. It has the disadvantage that it loses sensitivity with FEV1 values <1 litter; Furthermore, FEV1 can be altered by diseases other than those that cause airflow limitation, so the FEV1 / FVC ratio is vital to establish the diagnosis, for example, in adults, if this value is <80% and in children, if it is less than 90% it is suggestive of airflow limitation. The diagnostic criterion for asthma is an improvement in FEV1 greater than or equal to 12% of that predicted, which may be spontaneous, after inhalation of Beta 2 agonists or after a cycle of steroids. Spirometry is also used to assess asthma activity (severity), assess asthma progression, and respond to treatment in long-term management. This study is much more sensitive than Peak Flow, especially in certain populations (older adults) and in the presence of other associated broncho-pleuro-pulmonary pathologies.
Forced Expiratory Flow (FEF) or Peak Flow
It is an important aid in the diagnosis and treatment of asthma. It can be used at the household level. It is cheap and portable. It is a reproducible, effort-dependent procedure, influenced by patient education.
Its values do not always correlate with other methods that assess lung function to determine the severity of the condition. It should always be compared with the best value obtained previously for each patient. To make a diagnosis, at least 15% improvement is required in the measurement after inhalation with bronchodilators or after a cycle of steroids. Peak Flow measurement is also useful as it allows monitoring of asthma when spirometry is not available; at the household level, it allows detecting early signs of deterioration, allows assessing the severity and response to treatment in the short and long-term management, and is useful to detect not only airflow limitation but also 24-hour variability (Taburet & Schmit, 1994).
Peak flow: Measurement of variability
It is an indirect data of the hyperactivity of the airway. Ideally, it should be taken very early in the morning since its measurement would be close to the lowest value; and before going to bed, your result would be close to the highest value.
The diagnostic criterion is when a daily variation of 20% or more is found; this makes asthma diagnosis. The magnitude of the variability is correlated with the severity of the disease; however, in intermittent or severe intractable asthma, the variability of the peak flow may not be present or may have been lost (Yıldız, 2019). Sometimes in severe asthma, both variability and reversibility become apparent up to several weeks after a course of steroids. Peak flow monitoring serves in the short term to establish the diagnosis, identify environmental triggers, and evaluate changes in treatment. In the long term, it allows the monitoring of patients with severe asthma, with a poor perception of the severity of their symptoms, and with frequent hospitalisations.
Other diagnostic methods
Airway hyperreactivity can be determined in patients with suspected asthma symptoms but who have normal pulmonary function tests by performing bronchoprovocation tests for histamine, methacholine, and physical exertion. These measurements are very sensitive but not very specific, that is to say, that a negative test excludes the diagnosis. However, a positive result does not necessarily indicate asthma; it can be other diseases such as cystic fibrosis (mucoviscidosis), bronchiectasis, COPD, etc. The measurement of inflammation parameters by non-invasive methods includes the detection of eosinophils in sputum and metachromatic cells and the determination of exhaled levels of nitric oxide and carbon monoxide its usefulness in the diagnosis of asthma has not yet been determined (Heaney & Robinson, 2005).
Differential diagnosis of bronchial asthma Bronchial.
Asthma is one of the most common diseases that produce respiratory symptoms. It is characterised by the demonstration of reversible and variable airflow limitation through spirometry. The differential diagnosis includes the following causes:
Infectious: Flu symptoms, bronchiolitis, pneumonia, tuberculosis, opportunistic germs
Differential diagnosis of bronchial asthma Bronchial.
Asthma is one of the most common diseases that produce respiratory symptoms. It is characterised by the demonstration of reversible and variable airflow limitation through spirometry. The differential diagnosis includes the following causes:
Infectious: Flu symptoms, bronchiolitis, pneumonia, tuberculosis, opportunistic germs
Other obstructive diseases.
Located: vocal cord dysfunction, vocal cord paresis, laryngeal, tracheal and bronchial cancer, foreign body, bronchopulmonary dysplasia.
Generalised: Chronic obstructive pulmonary disease, obliterative bronchiolitis, cystic fibrosis, bronchiectasis
Postnasal drip, gastroesophageal reflux, use of ACE inhibitors, Left heart failure ("cardiac asthma")
Special groups that offer diagnostic difficulties.
In these cases, the measurement of airflow limitation and variability are extremely useful for making the diagnosis. Several essential groups include children, the elderly, occupational asthma, seasonal asthma, and cough as an asthmatic equivalent (Heaney & Robinson, 2005).
Estimated
Laboratories
At the moment, no laboratory had been performed.
Medicines
The patient takes the following medications at home Paxil, Klonopin, Synthroid, Clonazepam. In the hospital unit, the following treatment was offered:
List of Needs
Ineffective breathing is related to deterioration and gas exchange manifested by respiratory distress, dyspnea, anxiety, and hyperventilation.
Chest pain is related to respiratory distress manifested by discomfort, irritability, restlessness, expression, and pain verbalisation.
Care Plan
Respiratory Difficulty
Asthma management.
The goals for successful asthma management are:
Obtain and maintain control of symptoms.
Prevent exacerbations.
Keep lung function close to normal (when possible).
Maintain normal levels of activity, including exercise.
Avoid adverse effects of medications.
Prevent the development of irreversible airflow limitation.
Prevent mortality from asthma.
Asthma treatment has six interrelated parts, which are:
Educate patients to take an active part in managing their disease.
Assess and monitor the severity of asthma with the report of symptoms and lung function measurement (Peak Flow).
Avoid exposure to risk factors.
Establish individual medication plans in the long-term control of pediatric and adult patients.
Establish individual plans for the management of exacerbations.
Give regular follow-up to each case.
Education
It needs to be an ongoing process. In order to ensure the patient can make effective improvements to diabetes treatment, the patient and his families can get quick knowledge and instruction, know how to tailor the medications to the health care workers' schedule, and sustain a high quality of life (Yıldız, 2019). The priority should be to ensure that health professionals, patients, and the patient's families are well connected.
Assess and monitor the severity of asthma with the report of symptoms and measurement of lung function
By measuring symptoms, lung capacity and drug needs may be used to measure asthma severity. There have not been validated standardised questionnaires against other target asthma gravity steps, but the questionnaires are vulnerable to asthma degradation. In determining treatment responses, basic and especially crucial questions are: How much do you use quick-relief medicines? How many night times' signals such as coughing, wheezing or dyspnea do you experience? It may also help to ask the patient about everyday task limits. The diagnosis and severity determination of asthma in patients above five years of age include lung function tests. This gives us an informal indicator of the airway's hyperactivity, which can be associated with the extent of inflammation. The disease course and patient reaction to care should also be controlled (Bender, 2002).
For an office, ambulatory, emergency room, hospital rooms, and home surveillance, Peak Flow measurement are essential. The test is used to determine the magnitude and degree of diurnal lung changes, monitor care response during the crisis, diagnose asymptomatic decline in lung function at home and the workplace. The measurements enable early intervention; monitor the response to chronic therapy.
Its use is recommended in:
The offices of the health personnel involved.
During acute exacerbations in the office or the emergency department.
Long-term for patients who have required hospitalisation.
For patients who are not able to perceive the decrease in airflow adequately.
Avoid exposure to risk factors.
Since the pharmacological procedure for treating asthma effectively controls symptoms and enhances the quality of life, preventive steps for this chronic condition must be paid careful consideration. Different risk factors, such as allergens, air contamination, diet, drugs, and other factors may cause asthma. Asthma.
Primary prevention.
The primary prevention of this condition has not been possible; it is clear that the most frequent precursor for developing asthma is allergic sensitisation, but it can occur well before puberty, and at this point, prenatal steps are not recommended. Substantially decreases atopic eczema by prescribing diets that prevent anti-antigen in high-risk women, but better research is essential. Mother children who smoke are four times more likely in their first year of life to experience a wheezing disorder (Horne, 2006). In the meta-analysis, there is no evidence that mother-to-smoke impacts allergic reaction during breastfeeding. Yet, it is shown that smoking during breastfeeding induces pulmonary development issues and raises childhood non-allergic whetting. Thus, exposure to pre-born and post-born cigarette smoke has a detrimental effect on the wheezing disease (Horne, 2006).
Conclusion
Finally, the treatment process is an essential instrument for assessing patient care. The caregiver works with the patient to collect the appropriate documentation for the clinical process and fulfill the patient's needs. It should be remembered that at the outset, all the aims suggested for this case study and the objectives proposed in the nursing process were accomplished.
References
Horne, R. (2006). Compliance, adherence, and concordance: implications for asthma treatment. Chest, 130(1), 65S-72S.
Bender, B. G. (2002). Overcoming barriers to nonadherence in asthma treatment. Journal of Allergy and Clinical Immunology, 109(6), S554-S559.
Heaney, L. G., & Robinson, D. S. (2005). Severe asthma treatment: need for characterising patients. The Lancet, 365(9463), 974-976.
Durrani, S. R., Viswanathan, R. K., & Busse, W. W. (2011). What effect does asthma treatment have on airway remodeling? Current perspectives. Journal of Allergy and Clinical Immunology, 128(3), 439-448.
Taburet, A. M., & Schmit, B. (1994). Pharmacokinetic optimisation of asthma treatment. Clinical pharmacokinetics, 26(5), 396-418.
Choi, I. S. (2011). Gender-specific asthma treatment. Allergy, asthma & immunology research, 3(2), 74-80
Weiss, S. T., Litonjua, A. A., Lange, C., Lazarus, R., Liggett, S. B., Bleecker, E. R., & Tantisira, K. G. (2006). Overview of the pharmacogenetics of asthma treatment. The pharmacogenomics journal, 6(5), 311-326.
Avery, G. (2016). Law and ethics in nursing and healthcare: an introduction. Sage.
Chong, Y. R., & Lee, Y. H. (2017). Affecting factors of the awareness of biomedical ethics in nursing students. The Journal of Korean Academic Society of Nursing Education, 23(4), 389-397.
Yıldız, E. (2019). Ethics in nursing: A systematic review of the framework of evidence perspective. Nursing Ethics, 26(4), 1128-1148.
No comments:
Post a Comment