[Answered]: Oxygenation Case StudyMr

Oxygenation Case StudyMr. Edwards, age 62, is admitted to the hospital with a 6-day history of chest pain, fatigue, and shortness of breath. The admission physical examination and chest ray confirmed that he has a community-acquired right upper lobe pneumonia with an intermittent productive cough with occasional thick, yellow sputum. Lying flat makes him more short of breath and the cough worse. John Smith, a junior nursing student, is the nurse assigned to Mr. Edwards.John uses his knowledge of the pulmonary system and the impact of certain risk factors on pulmonary functioning to plan a complete cardiopulmonary assessment for Mr. Edwards. Johns prior experience in health assessment and his clinical judgment help him to target important assessment areas without increasing Mr. Edwards respiratory distress or worsening his fatigue. Before he begins the assessment, he reviews Mr. Edwards medical record and notes that Mrs. Edwards has a smoking history.Mr. Edwards history reveals risk factors (alcohol abuse, sedentary lifestyle) in addition to a 40-year history of smoking 2 packs per day, and he still continues to smoke. John knows that the current increase in Mr. Edwards shortness of breath is due to his respiratory infection.The secretions are obstructing his alveolocapillary membrane, preventing oxygenation of blood in some parts of his lung. Mr. Edwards works as a salesman and lives with his wife. He has a history of chronic obstructive pulmonary disease (COPD) and alcohol abuse but at present is not drinking. Mrs. Edwards has also smoked 2 packs per day for more than 40 years. Mr. Edwards used to help with the housework and states that he loves to tinker in the garden; however, lately he has been unable to participate in any of these activities. His wife states, All he seems to be able to do is sit in his chair and watch TV. When John meets Mr. Edwards and performs his morning assessment, he observes Mr. Edwards breathing; his respiratory rate is 26, and every breath seems to be a struggle. He is tachycardic with a heart rate of 110 beats per minute, his oxygen saturations are 86%, and he is extremely anxious. Mr. Edwards still has chest pain on inspiration; he rates his pain 4/10. There are decreased breath sounds in his right lung and crackles on auscultation. John also notes that the lung sounds do not improve with coughing, and Mr. Edwards has a lot of difficulty managing his respiratory secretions. Mr. Edwards requested John to help him from the bed to the bedside chair.After Mr. Edwards was comfortable in the chair, he commented that getting out of bed took all my energy. Johns analysis of the nursing assessment data for Mr. Edwards identified several problem areas leading to multiple nursing diagnoses. John focused on assessment cues related to Mr. Edwards respiratory issues and identified two priority nursing diagnoses. John observed Mr. Edwards difficulty in breathing and clearing his respiratory secretions. John auscultated Mr. Edwards lungs and noted decreased breath sounds and crackles, which support the nursing diagnosis of Impaired Airway Clearance. His rapid respirations, difficulty with breathing, and reduced oxygen saturation are cues for Impaired Gas Exchange. Johns priorities of care for Mr. Edwards are to improve his airway clearance and gas exchange. John plans interventions to teach Mr. Edwards effective coughing techniques, to position him in semi-Fowlers to high Fowlers position, to maintain hydration, and to begin ambulation. As Mr. Edwards airway clearance improves, his gas exchange will improve, and his dyspnea and oxygen saturation will also improve. John knows that Mr. and Mrs. Edwards smoking history poses risks for respiratory disease, but Mr. Edwards has the greatest risk.As Mr. Edwards improves, John wants to learn Mr. and Mrs. Edwards understanding of how smoking affects Mr. Edwards health. Information about smoking cessation may be useful if they are receptive. He knows from experience that acute care issues need to be resolved before a patient can benefit from patient education. John identifies that a priority of Mr. Edwards care is airway clearance. To achieve that outcome John teaches him the huff cough technique and encourages him to expectorate secretions. John has Mr. Edwards do this type of cough at least once an hour. In addition, John explains to Mr. Edwards the benefits of sitting up and doing some walking around the hospital unit. Together they decide that a walk after hygiene care and before lunch is beneficial. Mr. Edwards states, I should quit smoking. Because of Johns experience with patient education, he knows that Mr. Edwards is showing interest in smoking cessation. He tells Mr. Edwards he would like to bring in some materials tomorrow if Mr. Edwards continues to feel better. John knows that he also needs to include Mrs. Edwards in patient education, as she is also a smoker. John knows that it is easier to quit smoking in a house in which no one else smokes.John also knows that sometimes the acute phase is not the best time to educate patients and families about smoking cessation. John knows that he will have to assess both Mr. and Mrs. Edwards to determine their readiness to receive smoking-cessation education and to stop smoking. John cares for Mr. Edwards throughout his hospital stay. Mr. Edwards is afebrile, his oxygen saturation and lab values are within normal limits, and his sputum cultures are negative on his day of discharge. His lung sounds and airways are clear, and he coughs and expectorates thin yellow sputum easily. While John is observing Mr. Edwards preparation for discharge, it is evident that Mr. Edwards is using the breathing and coughing techniques that they have worked on together. He is able to go home with improved activities of daily living. He and his wife both state that they are going to try to quit smoking. Mrs. Edwards even appears less anxious and states that she feels as though for the first time they have taken a small step to improve the quality of their lives. Questions1. Describe assessment data that would place Mr. Edwards at risk for worsening Impaired Airway Clearance during his hospitalization. (Recognize Cues 2. From the case study and nursing care plan, identify other assessment data and cues that support additional nursing diagnoses for Mr. Edwards. (Analyze Cues) .3. Consider all the assessment information in the case study and the additional nursing diagnoses you just identified for Mr. Edwards. Prioritize health care problems or nursing diagnoses. (Prioritize Diagnoses).4. Review the case study information, Mr. Edwards nursing care plan, and the concept map. Describe other nursing interventions to promote airway clearance and improve respiratory gas exchange. (Generate Solutions) .5. Prioritize appropriate nursing actions when planning and providing interventions to improve airway clearance for Mr. Edwards. (Take Action)