Nursing Care for Acute Exacerbation of COPD

Nursing Cargon for Acute Exacerbation of COPD psychiatric hospitalThis essay is foc exercised on the signification of health taxment throughout the nursing process of a scenario of patient (Mr lee side) who diagnosed with acute exacerbation of COPD and extend how health assessment and emergency assessment help oneself to plan a suitable nursing cargon for Mr lee.BackgroundFirstly, lets appoint of Mr. Lees health status.Mr. Lee, aged 70, graduated from high school, retired. He guard a son and living with wife and son. He had fastball robes (2 packs / day), plainly had been quit recently. He in every case has make whoopieing habit (2 beers per week). He has allergic history of medicate Sulfonamides.For the onetime(prenominal) history, Mr. Lee had myocardial, hypertension, left-sided soreness failure and fractured ankle. He too previously diagnosed with emphysema.Mr. Lee admitted hospital with wheelchair at 2330 hour on 23 Jan 2014 by cathexis of impr everywhered co ugh and dig airing at home for past 24 hours. Pain rated 4/10 (10 is being the worst) with cough and mucous secretion sputum. Dyspnoeic breathing, breath sounds heard on the bilateral lung field.Vital signs analyze temperature 37.3 , caprice 90/ min, ventilating system 22 /min, blood pressure cxxx/84 mmHg, SpO2 95% on room air. Urine test results normal. familiar condition fair and conscious, emotion stable just now showed anxious and consume had insomnia. Mr. Lee is obese BW 84kg, Height 1.6m (BMI 32.8), he also has oedematous on both ankles (size ++). His lot and hearing are normal.Mr. Lee speaks Cantonese with clear communication. proclivity normal with denture which kept by patient, special diet lower-ranking sodium 4g should be snuff itn to patient. Elimination is normal, bowel warning vulgar habit once per day. For the mobility part, Mr. Lee ambulates independently with fairly steady gait. He did not have disability but indispensability to assist the self-care a bility. medical checkup exam ordersAt 0130 of 24 Jan 2014 MO (Dr Chow) went to see Mr. Lee and decreed some medical orders as belowPrednisolone (steroid, 80mg po daily) purify respiratory function and oxygenation by reduce inflammation. However sever unfavorable work may occur by taking oral steroids, much(prenominal) as hypertension, fluid retention, GI upset, anxious etc. Nurse use up to assess and close monitor BP, in/out put, emotion and constitute low sodium diet for patient.Due to Mr. Lee have MI history, Aspirin (Salicylate, 80mg po daily) prescribe for inhibit platelet aggregation bend MI relapse. Nurse need to assess coagulation function and colored function.Prescription of two bronchodilators Atrovent (2 puffs t.i.d.) and Ventolin (2 puffs q6hr prn) are for COPD daintinessment by train bronchial smooth muscle relaxation. Nurse need to assess the technique of inhalation and impediment breathing.Furosemide (diuretic, 40mg po daily) prescribe for removes the for eplay of sodium, chloride absorption beca use of goods and services of Mr. Lee has oedematous on both ankles. This drug causing a profound increase in urine output, Nurse need to assess the in/output balance and electrolyte level.metoprolol (Beta-blocker, 50mg po daily) causing vasodilation to treat hypertension and pr notwithstandingt eye attack. Nurse need to assess the BP and heart rate before given.Mr. Lee has left-sided heart failure history, MO prescribes digoxin (cardiac glycoside, 0.125mg po daily) which help maintain normal heart rhythm and meliorate blood circulation. Nurse need to assess the apical rate make sure 60/min before given.To make sure the above drugs are safety administer to Me. Lee, not only abide by the special precautions of separately drug state as above and apply three rafter five right in giving medication, hold dear also should give assessment for patients health history especially allergy history command survey such as vital signs q4hr and p.r.n. , I/O map physiological assessment e.g. breathing pattern and follow laboratory results (CXR, CBP, R/LFT, ABG, Urinalysis), assess and detect any abnormal finding before drug given, assess the drug efficacy and side effect after capture drugs.Oxygen therapyExcept oral drug, Dr Chow also prescribes oxygen to Mr. Lee with maximum 4L/min to keep pulse oximetry90%. During administering oxygen, hanging notice near Mr. Lee, let everyone know he is on oxygen therapy and the hunt down rate. Nurse should be awareness that COPD patients can cause respiratory drop-off or acidosis (pHNurse should ensure the setting of oxygen delivery is smooth, on the right type i.e. low-flow devices and method i.e. nasal cannula or simple mask. task and monitor pulse oximetry level and respiratory rate closely. Keep vision observation of presentation of Mr. Lee such as pecker. Follow the medical review and the ABG result which may affect the need and level adaptation of oxygen.Assessment of son of a bit chBase on the chief complain of laboured breathing for Mr. Lee, nurse need to pay more attention on his clinical presentation. If patient suffering short of breath (lack of oxygen and/or excess carbon dioxide in the blood) notes include breathing rate sound faster and shallow, tachycardia, unable to speak long sentences, cyanosis, use accessory muscles of respiration. tolerant also may have actors assistant pain or acquire confused.Besides, nurse can apply assessment tool COLDSPA asking the symptoms of diddlyshit as belowCharacter carry Mr. Lee to describe the difficulty breathing. Onset Ask whether the onset of difficulty breathing is sudden or gradual. Location Ask have chest pain or not and the manifestation and stationary or moves. Duration Ask how long the SOB lasts, does it appear when walk or doing activities. Severity Ask how much it b otherwises Mr. Lee. condition Ask what cause SOB being better or worse. Associated factors Ask is there any symptoms occur with it an d does it affect patient.Physical assessment also can use to assess SOB includes four parts oversight to give observation of skin (shin skin, cyanosis), body weight (fat, oedema), breathing pattern (faster respiratory rate, using accessory muscles), chest wall (barrel chest).Palpation principally focus on the degree of expansion of chest, COPD patient may symmetrically reduced lung expansion.Percussion which to tap the lung and produced sounds. Different types of sound mean the chest filled with air, fluid or solid. Mr. Lee with SOB may have full of air in the lung, the tapping sound will be hyper resonant.Auscultation is use stethoscope to listen the sound of breathing. Mr. Lee with SOB, the breath sound would be respire and crackles.Nursing action on N shiftBase on the assessment, the nurse should keep close observation of Mr. Lee clinical presentation, pulse Oximetry and vital sign monitoring. appoint Ventolin puff if patient SOB. sterilise NS block for used. Chart I/O for th e fluid balance. Pend investigations such as CXR and blood taking as quick as possible.Important randomness hand over to A shift nurseThe information of Mr. Lees health history, general survey and physical assessment and the nurse action do at night shift should be hand over to A shift nurse. Also told the nurse that Mr. Lee dyspnea at night, indicate chasing lab results, suggest doctor order sputum test and natural elevation flow rate checking.Important health occupation identificationTo grade the main problem of Mr. Lee, nurse need to compare the objective and unverifiable data of the below groups.Oxygen (subjective data) Mr. Lee complaint dyspnoeic gradually, increase cough with mucus sputum, labored breathing at home 24hours. write up of smoking 2 packs/day, quite recently. (Objective data) Mr. Lee diagnosed acute exacerbation of COPD, GC fair, dyspnea at night shift, pulse Oximetry from 95% reduce to 88%, effect Rate from90/min increase to 110/min and Respirations are difficulty at 30/min with right lower lobe crackles and asthmatic bilaterally.Fluid (subjective data) Mr. Lee have denture kept by himself, drink 2beers/week. No complaint of eating and drinking, (Objective data) He is obesity with BMI 32.8 abnormal level , there also oedematous on both ankles. At night Mo prescribe Furosemide (40mg Po QD) and offer special diet (low sodium 4g). His I/O is positive balance, NS block setup and voiding per urinal. gumshoe of physical and psychological (subjective data) Mr. Lees vision and hearing are normal, non disability but pain rated 4/10 (10 is being the worst) with cough. He also claims insomnia. (Objective data) Mr. Lee doesnt tolerate get up to restroom need to use voiding per urinal. For mobility, he ambulates independently with fairly steady gait but self-care ability need assisted. He has hypertension history BP 130/84, Metoprolol (50mg po daily) prescribed for him. His mental stable but emotion shows anxious. He suffers dyspnea at night w ith Pulse Oximetry 88%, Fast Heart Rate 110/min and RR 30/min.Comparison with three groups data, the more or less important health problem for Mr. Lee is Gas Exchange, Impaired link up to altered oxygen supply and the evidence already showed above. Although Mr. Lee also has excess body fluid and risk of safety problems, but the problem priority should be meet the physical needs of the patient, and and so reach other levels of need. Problem of oxygen supply is spry threat to vitality may cause dysnea or brain hypoxia etc, and need to take immediate action to solve it. Besides fluid retention is a symptom of acute exacerbations of COPD and anxious is related to the dyspnoeic, so if the Gas Exchange, Impaired solve, the other problems may improve.To improve Mr. Lees condition, A shift nurse need to have some essential assessment and measures perform for him.Give general assessment including monitor vital sign and notice any abnormal reading which directly reflect metabolism, oxyg enation and circulatory functions Monitor O2 intensity level where Mr. Lee at risk for desaturation Assess skin colour and perfusion for suppuration of cyanosis Communication such as any changes in orientation and behavior. office IPPA to check lung condition i.e. use accessory muscles, lung sound, expansion of chest, noting any signs and symptoms of SOB or airway resistance, also pay attention to breathing pattern, respiration rhythm and dept can reflex lung function such as falling off lung volume and ventilation. Nurse also can use peak expiratory flow rate to measure airflow obstruction,Follow the lab report of CXR, ABGs etc and note changes. Assess the positioning of Mr. Lee to notice any physical effort on oxygenation. Also assess patients ability to cough in effect to clear airway secretions. Note the quantity, color, and consistency of sputum.After assessments, nurse need to compare with the normal standards, noted any abnormal finding which help to give suitable measures .The measures includes keep continues assessment and monitor which state on above. Positioning of patient, eating and drinking assist avoid dehydration. Medication should be given as prescription and assess any side effect appear. Also use anxiety scale to check the emotion then give psychological care to reduce the anxiety level.The expected force in the A shift for Mr. Lee is free of difficulty breathing by showed as maintains pulse oximetry90%, normal ABGs result and natty responsive, reduce anxious level. However there may occur undesirable situation such as patients condition remain unchanged even become worse. In that way, nurse need to refresh the data and limited review patients health condition to modify the aim and preventive to meet the need of patient.Important information hand over to B shift nurseA shift nurse should hand over the information of Mr. Lees health history, general survey and physical assessment, Mr. Lees condition in A shift and the nurse action done at A shift.In conclude nursing assessment is a process with planning, businesslike and systematic and run through hold nursing process of Mr. Lee. It helps nurses nail information to master health condition of patient. The assessment provides evidences to nurse analysis, judging and give proper nursing care, which increase the accuracy of nursing diagnosing and the management, fit the health needs of the patient more specifically.