Dhaliwal veerpal kaur s296744 nur250 s1 2017 assessment 1 Help Australia

NUR 250 Asses NUR250 Assessment 1 S1 2017 Assignment templatesmen t 1 S1 It is recommended you do not delete the heading and the information below.

2017 Assig Please note: As indicated in Assessment 1 information, a cover sheet, title and nme contents pages are not required nt temp late Before you begin take a minute to fill in your details in the footer to ensure your

NUR250 Nursing Care Plan

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Use the headings provided



Don’t copy from another document onto this template



Don’t delete the section breaks on the document

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Assessment 1 presentation guidelines Start to write your assignment here. Word count is calculated from this point.

Task 1: Understanding nursing problems The respiratory problem is the core issue faced by many healthcare providers in the acute care settings. According to the handover, Neville has the core issues with his health like blocked airway, malnutrition, and possibility of infection. Neville’s airway may be affected by bronchitis because the production of thick secretions is increased due to bronchitis. The bacterial growth may occur due to the accumulation of mucus in the airway which leads to respiratory infection and impairment of airway clearance (Ramos, Krahnke, & Kim, 2014). Impaired gas exchange of Neville may be due to emphysema because emphysema impairs the lung tissue which is responsible for gasses exchange in alveoli and collapse the airway. The exacerbation also causes deterioration of gas exchange (Lemone et al., 2017). Neville has a risk of impaired gas exchange due to smoking habit. Due to continue oxygen administration, CO2 retention may occur and it causes the loss of hypoxaemic respiratory drive and fatigue of 1 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

respiratory muscles and may impair the ventilation of Neville (Lemone et al., 2017).

He might have fatigue due to dyspnoea which may result in increased consumption of energy that may be unable him to take the full diet (Lemone et al., 2017). The side effect of medicines as Neville has prescribed amoxicillin antibiotic also may cause nausea, vomiting, and anorexia to him and decreased his intake (Tiziani, 2013). Due to decreased acquired immunity and chronic disease process, Neville has the risk of further infection. The malnutrition also a responsible factor to prone him at risk of infection. Moreover, the work of cilia has been decreased due to smoking and persistence secretions in airway lead to infection (Lemone et al., 2017). The acute exacerbation cause bacterial and viral infection in COPD. The hospitalization also may lead to the risk of hospital-acquired pneumonia (Müllerova et al., 2012).

Task 2: Care planning Nursing Care Plan: Neville Note: Dot points recommended in care plan. Click and type in each cell, click enter in a cell to make it longer A reminder that all information must be referenced Nursing problem: Activity intolerance Underlying cause or reason: generalized weakness and dyspnea Goal of care Nursing interventions/actions · Monitor vital signs closely immediately after any activity and note the abnormalities. · Ensure Neville performs daily activities and reduce the risk of respiratory distress. · Assist Neville to perform activities of daily living (ADL).

Rationale

· It helps to detect the early symptoms of deteriorating condit (Li et al., 2014).

· It helps to promote function dependence and prevent the loss o motion and reduce the risk of fall injuries (Zarowitz, & O’Shea, 201

· Adequate rest prevents fati and preserves energy (Lemone et 2017). · Provide proper rest to the patient between treatment and activity periods.

· It helps to promote activity exercise tolerance (Lemone et al., 2017). ·

Provide oxygen therapy as prescribed.

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· Encourage patient to perform activities by giving positive feedback.

· This may help the patient t hope for activity tolerance after c of disease (Lemone et al., 2017) · Support the patient emotionally and reassure the patient about regain of energy.

Nursing problem: Altered sleep pattern Underlying cause or reason: a persistent cough Goal of care Nursing interventions/actions

Rationale

· Monitor sleep pattern with objective and subjective information.

· Provide fowler’s or semi-Fowler's position to the patient.

· The subjective and objectiv data helps to assess accurate sleep time (Lemone et al., 2017).

· This position promotes the ventilation and decreases breathin workload (Lemone et al., 2017).

To ensure that Neville has · Administer cough expectorants and no disturbance in sleep bronchodilators as prescribed. pattern

· Advise the patient to perform relaxation activities before bed.

· These agents help to loosen spit out the mucus in the airway a make the airway clear and patent (Lemone et al., 2017).

· Relaxation therapies help t divert mind and beat the sleeping problems (Volpato, Banfi, Rogers Pagnini, 2015).

· Some medication may distu the sleeping pattern (Lemone et a 2017). · Check the prescribed medication of patient and if there is any drug at bedtime that interferes with sleep then consult the doctor.

Nursing problem: Deficit fluid volume Underlying cause or reason: less oral intake and nausea and vomiting possible side effects of medicines 3 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

Goal of care

Nursing interventions/actions

· Maintain intake and output chart of the patient. ·

Check weight daily.

· Check vital sign regularly- pulse rate, To maintain adequate temperature, and respiration rate. hydration of the patient. · Check oral mucosa and skin turgor for dryness. · Assess the orientation level of the patient with Glasgow coma scale.

Rationale

· It may help to assess the bo requirements of fluid (Lemone et 2017).

· Tachypnoea, hypotension a tachycardia indicate the risk of dehydration (McGloin, 2015).

· Dryness of oral mucosa and decreased skin turgor are signs of dehydration (McGloin, 2015).

· Electrolytes imbalance may to disorientation.

Nursing problem: Risk of constipation Underlying cause or reason: imbalanced diet and limited fluid intake Goal of care Nursing interventions/actions Rationale

· Check the stool for consistency and frequency.

· This will help to know abo normal condition for the patient (Lemone et al., 2017).

· This helps to promote to na elimination (Lemone et al., 2017) · Encourage the patient to drink a glass of warm water in morning.

Ensure Neville get relief · Monitor dietary habits of patient and from discomfort during advise taking the nutritious diet. defecation.

· Administer stool softener or bulk laxatives as prescribed.

· Irregular and less food inta may lead to constipation (Sun et a 2013)

· Laxatives relieve constipat and maintain normal elimination (Lemone et al., 2017).

· Increased fluid intake softe the stool consistency and improve intestinal movements (Lemone et · Consult the nutritionist for the diet chart 2017). as required. zEncourage patient to increase fluid intake.

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Nursing problem: self-care deficit Underlying cause or reason: fatigue secondary to dyspnoea.

Goal of care Nursing interventions/actions · Assess the ability of the patient to perform activities. · If a patient wants to walk, provide support or walker.

Rationale

· Assessment helps to plan interventions to meet particular n (Lemone et al., 2017).

To enable the patient to perform self-care · Assist the patient in activities that need an · Minimum assistance may activities- bathing, eating, assistant. encourage the patient for self-care defecating and more on.

(Lemone et al., 2017). · Provide an atmosphere that permits the patient to perform daily care independently such as clean teeth or feeding.

· This may improve self-este · Encourage the patient to perform ADL’s and increase independence (Lemo according to his ability. al., 2017). · Allow the family members to help the patient.

Task 3: Medication management Eosinophils the main cause of the COPD to exist are targeted by prednisone as a corticosteroid (Akdis, 2012). The use of prednisone must be monitored along with the check that patient doesn’t have any fungal infection. Also, the steroid medication weakens the immune system. Neville must be briefed with the complications arising due to the use of steroids with the smoking (Tiziani, 2013). The prime responsibility of nurse during medication administration is that nurse should follow the six rights (right dose, right route, right patient, right documentation, right drug and right time) of medication administration to avoid the medication errors (Ferguson, Delaney & Hardy, 2014). Another drug Ipratropium bromide is used for the treatment of lung obstruction as it anticholinergic agent and act as a bronchodilator by reducing the airborne passages (Tiziani, 2013). Before providing the nursing intervention with the Ipratropium bromide is its contraindications to cause hypersensitivity. The possible side effects of this are tachycardia, acute angle-closure glaucoma, nausea, palpitations, and headache. The nurse should provide sips of water to the patient to avoid dryness of the mouth (Lemone et al., 2017). The excessive use through nebulizer would cause the prostatic hypertrophy in Neville. The use is required on a regular basis for the situation like that of Neville (Stephenson et al., 2011).

Antibiotics are recommended to a patient with COPD to relieve breathlessness by alleviating the increased purulent sputum production and cough (Bailey et al., 2012).

Oral corticosteroids are prescribed with a combination of broad-spectrum antibiotics to cure a bacterial infection. Oral amoxicillin is given to Neville in addition to prednisone for controlling the possible infection spread in lungs and to treat the bacterial 5 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

infections (Brusse-Keizer, VanderValk, Hendrix, Kerstjens & van der Palen, 2014).

There is a chance that Neville could be allergic to such medication so the alternative must be given in such cases. The nurse should aware of possible side effects of amoxicillin. The main side effect of it is diarrhea. Diarrhea results in the nutrition loss which must be treated otherwise situation could be worsened as Neville is already malnourished (Tiziani, 2013). Neville has prescribed oral medications because the oral route of medication administration is convenient and safe and it is the ideal route to achieve desired curative outcomes (Cyriac & James, 2014).

Task 4: Patient teaching (Khdour, Hawwa, Kidney, Smyth & McElnay, 2012). Quitting smoking improves the COPD conditions. The nicotine replacement therapy or medication program could be used to help the patient recover from vulnerable smoking habits. Counseling session and group discussions must be arranged for the patients with other smokers so they can share their experiences (Hoogendoorn, Feenstra, Hoogenveen & Rutten-van MĂślken, 2010). The effect of passive smoking must also be avoided as it is more deteriorating than active smoking (Cao, Yang, Gan, & Lu, 2015). The information must be given to Neville that smoking is chief reason behind just not cancer, but also the reason for many other diseases like diabetes, cataracts, rheumatoid arthritis, and other coronary diseases (Jha & Peto, 2014). Patient-centred care is required in such cases to help him come up with the rehabilitation process and make it easy for them.

Proper care and monitoring could help the rehabilitation and hence the symptoms of COPD would vanish, which helps in respiratory breathing problems (Lemone et al., 2017).

Task 5: Clinical judgment and handover As per the recognition of the fact, Neville has been prescribed with salbutamol nebulizer. As a nurse, one would attend the patient and assess the situation. Seeing the condition Neville was restless, dyspnoeic, and another parameter like high oxygen saturation, heartbeat, and depressed respiration, it has been diagnosed with hypoxia.

Such situation must be considered as an emergency and patients must be elevated by 45° during supine. Ventilation must be provided, and the patient must be checked every 2 hours, to avoid complications. Hydrated oxygen must be given during the COPD condition as excessive oxygen can cause apnoea. Medication must be given to prevent any infection and monitored if granted to Neville. Slow breathing must be introduced via spirometer to improve the oxygenation I am Veerpal Kaur, a student nurse from the medical surgical ward. I am concerned about patient Neville who is 62 years old man admitted to hospital with complaints of dyspnoea, cough and increased purulent sputum. He is known case of COPD and history of smoking. He has tachycardia and slightly increased blood pressure. Oxygen is continued @2L/min as medically advised. On return to the ward, he became restless and anxious. His skin has flushed and diaphoretic. On examination, he has tachycardia and heart rate was 110 beats/minute and respiratory rate has declined to 8-10 breaths/minute. According to the condition, Neville is restless, having tachycardia and bradypnea. These are the sign and symptoms of hypoxia. All required nursing care is provided to the patient. Salbutamol nebuliser is given and nasal prong oxygen @ 6 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

2L/min continue. Medications are administered and to continue as prescribed. Intake and output chart is maintained. The close monitoring of the patient is required as per condition of the patient. The doctor's team has checked the patient and advised to transfer the patient to the High Dependency Unit to provide BIPAP support.

Veerpal Kaur Dhaliwal STUDENT NURSE. Nurse Veerpal I can see you put in a lot of time and effort to research and write your assignment. You had some of your better work in Task 2 Care Plan.

You have some more relevant points in some tasks, but have struggled in others. You need to work on your explanations to demonstrate better understanding of the connections between Neville’s condition, underlying pathophysiology, prescribed treatments and nursing interventions. In some sections the explanation may have not been clear due to grammar problems. Even so there could be an easy improvement in your work if you had attention to paragraphing and headings so that your work could be followed s much more easily.

Try to write the answers in the terms of the question, and in an order that either follows the question, or discusses each component of the question before moving onto the next. This ensures that the reader can follow your responses, and for yourself you can see that you have answered all components of the question.

You do have a good number of journal articles. There are a number of journals from medicine and other disciplines. Using these tends to deflect focus from nursing and makes it difficult to respond with nursing actions and explanations.

If you use journals from other disciplines it needs to be appropriate to the case. You will find that its easier to get nursing responses from nursing journals, and that journals from other disciplines can provide a lot of irrelevant information which side tracks students from the valuable time they have to complete their studies. The CDU Library can help you with locating and evaluating sources, referencing and using APA. References Akdis, C. A. (2012). Therapies for allergic inflammation: refining strategies to induce tolerance. Nature medicine, 18(5), 736-749. doi: 10.1038/nm.2754 Bailey, P. H., Boyles, C. M., Cloutier, J. D., Bartlett, A., Goodridge, D., Manji, M., & Dusek, B. (2012). Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD. Journal of Nursing Education and Practice, 3(1), 108. doi: https://doi.org/10.5430/jnep.v3n1p108 Blanco, I., Gimeno, E., Munoz, P. A., Pizarro, S., Gistau, C., Rodriguez-Roisin, R., ... & BarberĂ , J. A. (2010). Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension.

American journal of respiratory and critical care medicine, 181(3), 270-278.

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doi: 10.1164/rccm.200907-0988OC Brusse-Keizer, M., VanderValk, P., Hendrix, R., Kerstjens, H., & van der Palen, J. (2014). Necessity of amoxicillin clavulanic acid in addition to prednisolone in mild-tomoderate COPD exacerbations. BMJ open respiratory research, 1(1), e000052. doi: 10.1136/bmjresp-2014-000052 Cao, S., Yang, C., Gan, Y., & Lu, Z. (2015). The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. PloS one, 10(10), e0139907. doi: http://dx.doi.org/10.1371/journal.pone.0139907 Cuquemelle, E., Pham, T., Papon, J. F., Louis, B., Danin, P. E., & Brochard, L. (2012).

Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respiratory Care, 57(10), 1571-1577. doi: https://doi.org/10.4187/respcare.01681 Cyriac, J. M., & James, E. (2014). Switch over from intravenous to oral therapy: A concise overview. Journal of Pharmacology and Pharmacotherapeutics, 5(2), 83. doi: 10.4103/0976-500X.130042 Ferguson, A., Delaney, B., & Hardy, G. (2014). Teaching medication administration through innovative simulation. Teaching and Learning in Nursing, 9(2), 64-68.

Retrieved from http://www.sciencedirect.com.ezproxy.cdu.edu.au/science/article/pii/S1557308713001 418 Hoogendoorn, M., Feenstra, T. L., Hoogenveen, R. T., & Rutten-van MĂślken, M. P. (2010). Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD. Thorax, 65(8), 711-718. doi: http://dx.doi.org/10.1136/thx.2009.131631 Jha, P., & Peto, R. (2014). Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), 60-68. doi: 10.1056/NEJMra1308383 Khdour, M. R., Hawwa, A. F., Kidney, J. C., Smyth, B. M., & McElnay, J. C. (2012).

Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD). European journal of clinical pharmacology, 68(10), 1365-1373. doi: 10.1007/s00228-012-1279-5 Lemone, P., Burke, K., Bauldoff, G., Gubrud, P., Levett-Jones, T., Hales, M., ‌ ReidSearl, K. (2017). Medical-surgical nursing, critical thinking for person-centred care.

(3rd Australian ed.). Melbourne, Victoria: Pearson Australia.

Li, J. M., Cheng, S. Z., Cai, W., Zhang, Z. H., Liu, Q. H., Xie, B. Z., & Wang, M. D. (2014). Transitional care for patients with chronic obstructive pulmonary disease. International Journal of Nursing Sciences, 1(2), 157-164. doi:

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http://doi.org/10.1016/j.ijnss.2014.05.004 McGloin, S. (2015). The ins and outs of fluid balance in the acutely ill patient. British Journal of Nursing, 24(1). doi: 10.12968/bjon.2015.24.1.14 MĂźllerova, H., Chigbo, C., Hagan, G. W., Woodhead, M. A., Miravitlles, M., Davis, K. J., & Wedzicha, J. A. (2012). The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respiratory medicine, 106(8), 11241133. doi: http://doi.org/10.1016/j.rmed.2012.04.008 Ramos, F. L., Krahnke, J. S., & Kim, V. (2014). Clinical issues of mucus accumulation in COPD. Int J Chron Obstruct Pulmon Dis, 9, 139-150. doi: http://dx.doi.org/10.2147/COPD.S38938 Stephenson, A., Seitz, D., Bell, C. M., Gruneir, A., Gershon, A. S., Austin, P. C., ... & Gill, S. S. (2011). Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study. Archives of internal medicine, 171(10), 914-920. doi: 10.1001/archinternmed.2011.170 Sun, Y., Zheng, F., Li, Y., Wu, R., Liu, Y., Liu, M., ... & Gao, K. (2013). Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease. Journal of Traditional Chinese Medicine, 33(5), 608-614. doi: https://doi.org/10.1016/S0254-6272(14)60029-7 Tiziani, A. P. (2013). Havard's nursing guide to drugs (9th ed.). Elsevier Health Sciences.

Volpato, E., Banfi, P., Rogers, S. M., & Pagnini, F. (2015). Relaxation techniques for people with chronic obstructive pulmonary disease: A systematic review and a metaanalysis. Evidence-Based Complementary and Alternative Medicine, 2015. doi: http://dx.doi.org/10.1155/2015/628365 Zarowitz, B. J., & O’Shea, T. (2012). Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. Journal of Managed Care Pharmacy, 18(8), 598-606. doi: http://dx.doi.org/10.18553/jmcp.2012.18.8.598 There is plenty of information about gas exchange in COPD- the umbrella term Collapsed airways causing oxygen to become trapped distally with less oxygen available for diffusion across alveoli. Collapsed and damaged alveoli impairing the diffusion of carbon dioxide from the blood.

Cite all authors in the first instance, then et al in subsequent citations Indicators are the measure of whether the goal has been achieved. Indicators need to include objective and, where appropriate subjective indicators and should be short/succinct specific statements.

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Goals should be short succinct statements of what you want to achieve, and be directly related to the problem. They should also be SMART – specific, measurable, attainable, relevant, time-limited. Most importantly they need to reflect the nursing problem.

The nurse would make an emergency call, stay with Neville and remove the oxygen if it was still on. Reasons for the actions would be that oxygen will worsen the hypercapnia/hypoxia, and Neville should not be left unattended while he is confused and deteriorating while awaiting urgent medical attention.

It is recommended you do not delete the heading and the information below.

Please note: As indicated in Assessment 1 information, a cover sheet, title and contents pages are not required Before you begin take a minute to fill in your details in the footer to ensure your document is identifiable. To access the footer, double click on the grey writing “Last name….” at the bottom of the page above. Once you have done that, double click here to come back to this page.

Information about the required line spacing and font size and type is in the Assessment 1 information document in the Assessment 1 folder on NUR250 Learnline. Take a minute to check that this document meets those requirements.

To avoid or minimise problems with formatting, it is recommended you   

Use the headings provided Don’t copy from another document onto this template Don’t delete the section breaks on the document

Submission of your assignment means you have read and understood the  

University policies and procedures related to academic integrity Assessment 1 presentation guidelines

Start to write your assignment here. Word count is calculated from this point.

10 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

Task 1: Understanding nursing problems The respiratory problem is the core issue faced by many healthcare providers in the acute care settings. According to the handover, Neville has the core issues with his health like blocked airway, malnutrition, and possibility of infection. Neville’s airway may be affected by bronchitis because the production of thick secretions is increased due to bronchitis. The bacterial growth may occur due to the accumulation of mucus in the airway which leads to respiratory infection and impairment of airway clearance (Ramos, Krahnke, & Kim, 2014). Impaired gas exchange of Neville may be due to emphysema because emphysema impairs the lung tissue which is responsible for gasses exchange in alveoli and collapse the airway. The exacerbation also causes deterioration of gas exchange (Lemone et al., 2017). Neville has a risk of impaired gas exchange due to smoking habit. Due to continue oxygen administration, CO2 retention may occur and it causes the loss of hypoxaemic respiratory drive and fatigue of respiratory muscles and may impair the ventilation of Neville (Lemone et al., 2017). He might have fatigue due to dyspnoea which may result in increased consumption of energy that may be unable him to take the full diet (Lemone et al., 2017). The side effect of medicines as Neville has prescribed amoxicillin antibiotic also may cause nausea, vomiting, and anorexia to him and decreased his intake (Tiziani, 2013). Due to decreased acquired immunity and chronic disease process, Neville has the risk of further infection. The malnutrition also a responsible factor to prone him at risk of infection. Moreover, the work of cilia has been decreased due to smoking and persistence secretions in airway lead to infection (Lemone et al., 2017). The acute exacerbation cause bacterial and viral infection in COPD. The hospitalization also may lead to the risk of hospitalacquired pneumonia (Mßllerova et al., 2012).

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Task 2: Care planning Nursing Care Plan: Neville Note: Dot points recommended in care plan. Click and type in each cell, click enter in a cell to make it longer A reminder that all information must be referenced Nursing problem: Activity intolerance Underlying cause or reason: generalized weakness and dyspnea

Goal of care  Ensure performs

Nursing interventions/actions  Monitor vital signs closely immediately Neville

after

daily

any

activity

and

note

Rationale  It helps to detect the early

the

symptoms

abnormalities.

of

deteriorating

condition (Li et al., 2014).



distress.

Assist Neville to perform activities of



daily living (ADL).

It helps to promote functional dependence and prevent the loss of motion and reduce the risk of fall



Provide proper rest to the patient between



injuries

(Zarowitz,

&

O’Shea, 2012) Adequate rest prevents fatigue and preserves energy (Lemone

treatment and activity periods.

et al., 2017).

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with less breathlessness or episodes of dyspnea.

activities and reduce the risk of respiratory

Indicators your plan is working  Neville is able to tolerate activities





Provide oxygen therapy as prescribed.

It helps to promote activity and exercise tolerance (Lemone et



al., 2017).

Encourage patient to perform activities by giving positive feedback.





Support the patient emotionally and

This may help the patient to hope for activity tolerance after

reassure the patient about regain of

curing of disease (Lemone et

energy.

al., 2017)

Nursing problem: Altered sleep pattern Underlying cause or reason: a persistent cough

Goal of care To ensure that Neville has

Nursing interventions/actions  Monitor sleep pattern with objective and

no disturbance in sleep pattern

Rationale  The subjective and objective data

subjective information. 

Provide fowler’s or semi-Fowler's position to



the patient.

helps to assess accurate sleeping

Neville can sleep comfortably without any

time (Lemone et al., 2017).

This position promotes

disturbance. the

ventilation and decreases breathing workload (Lemone et al., 2017).



Administer

cough

expectorants

and



bronchodilators as prescribed.

These agents help to loosen and spit out the mucus in the airway and make the airway clear and patent

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Indicators your plan is working Neville has decreased cough episodes.



Advise the patient to perform relaxation activities before bed.



(Lemone et al., 2017).

Relaxation therapies help to divert mind

and

beat

the

sleeping

problems (Volpato, Banfi, Rogers, 

Check the prescribed medication of patient



and if there is any drug at bedtime that

& Pagnini, 2015).

Some medication may disturb the sleeping pattern (Lemone et al.,

interferes with sleep then consult the doctor.

2017).

Nursing problem: Deficit fluid volume Underlying cause or reason: less oral intake and nausea and vomiting possible side effects of medicines.

Goal of care To maintain

adequate

Nursing interventions/actions  Maintain intake and output chart of the

hydration of the patient. 

Rationale  It may help to assess the body

patient.

Check weight daily.

Indicators your plan is working The intake and output of Neville are

requirements of fluid (Lemone

adequate as the requirements of the body.

et al., 2017).

There is no sign of dryness of oral mucosa and decreased skin turgor.



Check vital

sign regularly-

pulse

rate,



temperature, and respiration rate. 

Tachypnoea, hypotension and tachycardia indicate the risk of

Check oral mucosa and skin turgor for



dehydration (McGloin, 2015).

Dryness of oral mucosa and decreased skin turgor are signs

dryness.

of

dehydration

(McGloin,

2015). 

Assess the orientation level of the patient with Glasgow coma scale.



Electrolytes

imbalance

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may

lead to disorientation.

Nursing problem: Risk of constipation Underlying cause or reason: imbalanced diet and limited fluid intake

Goal of care Ensure Neville get relief

Nursing interventions/actions  Check the stool for consistency and

from discomfort during

Rationale  This will help to know about the

frequency.

defecation. 

Encourage the patient to drink a glass of





normal condition for the patient

Neville states no discomfort or pain on

(Lemone et al., 2017).

This helps to promote to natural

defecation.

elimination (Lemone et al., 2017).

warm water in morning.

Monitor dietary habits of patient and



Irregular and less food intake may lead to constipation (Sun et al.,

advise taking the nutritious diet.

2013) 

Administer stool softener or bulk laxatives as prescribed. zEncourage patient to increase fluid



intake.

Consult the nutritionist for the diet chart



Laxatives relieve constipation and maintain



as required.

normal

elimination

(Lemone et al., 2017).

Increased fluid intake softens the stool consistency and improves intestinal movements (Lemone et al., 2017).

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Indicators your plan is working Neville has passed soft and formed stool.

Nursing problem: self-care deficit Underlying cause or reason: fatigue secondary to dyspnoea.

Goal of care

Nursing interventions/actions  Assess the ability of the patient to perform

To enable the patient to perform

self-care



activities.

If a patient wants to walk, provide support



or walker.

Assist the patient in activities that need an



assistant.

Provide an atmosphere that permits the

activities- bathing, eating, defecating and more on.

patient

to

perform

daily

Rationale  Assessment

helps

to

plan

interventions to meet particular

assistance.

needs (Lemone et al., 2017).

Neville cares for himself and well dressed.

Neville cleans teeth and comb hair



Minimum

assistance

may

encourage the patient for selfcare (Lemone et al., 2017).

care

independently such as clean teeth or 

feeding.

Encourage the patient to perform ADL’s



according to his ability.

Allow the family members to help the



This may improve self-esteem and

increase

independence

(Lemone et al., 2017).

patient.

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Indicators your plan is working Neville performs his ADL’s with little

independently.

Task 3: Medication management The COPD flares are treated with the Five-day course of prednisone. Eosinophils the main cause of the COPD to exist are targeted by prednisone as a corticosteroid (Akdis, 2012).

The use of

prednisone must be monitored along with the check that patient doesn’t have any fungal infection.

Also, the steroid medication weakens the immune system. Neville must be briefed with the complications arising due to the use of steroids with the smoking (Tiziani, 2013). The prime responsibility of nurse during medication administration is that nurse should follow the six rights (right dose, right route, right patient, right documentation, right drug and right time) of medication administration to avoid the medication errors (Ferguson, Delaney & Hardy, 2014). Another drug Ipratropium bromide is used for the treatment of lung obstruction as it anticholinergic agent and act as a bronchodilator by reducing the airborne passages (Tiziani, 2013). Before providing the nursing intervention with the Ipratropium bromide is its contraindications to cause hypersensitivity. The possible side effects of this are tachycardia, acute angle-closure glaucoma, nausea, palpitations, and headache. The nurse should provide sips of water to the patient to avoid dryness of the mouth (Lemone et al., 2017). The excessive use through nebulizer would cause the prostatic hypertrophy in Neville. The use is required on a regular basis for the situation like that of Neville (Stephenson et al., 2011).

Antibiotics are recommended to a patient with COPD to relieve breathlessness by alleviating the increased purulent sputum production and cough (Bailey et al., 2012). Oral corticosteroids are prescribed with a combination of broad-spectrum antibiotics to cure a bacterial infection. Oral amoxicillin is given to Neville in addition to prednisone for controlling the possible infection spread in lungs and to treat the bacterial infections (Brusse-Keizer, VanderValk, Hendrix, Kerstjens & van der Palen, 2014). There is a chance that Neville could be allergic to such medication so the alternative must be given in such cases. The nurse should aware of possible side effects of amoxicillin. The main side effect of it is diarrhea. Diarrhea results in the nutrition loss which must be treated otherwise situation could be worsened as Neville is already malnourished (Tiziani, 2013). Neville has prescribed oral medications because the oral route of medication administration is convenient and safe and it is the ideal route to achieve desired curative outcomes (Cyriac & James, 2014).

Task 4: Patient teaching

Patient must be taught with the serious complications arising out of the smoking. The teaching and training must be given to Neville in dealing with the administration of inhaler based medicines like salbutamol. The smoking must be stopped by Neville as it would aggravate the criticality of the issue.

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The smoking causes the periodic flares of the COPD. Smoking is the reason by which the air sacs are damaged, airways are cluttered, and linings are deteriorated. Such situations cause the irritation and become hard to breathe in (Khdour, Hawwa, Kidney, Smyth & McElnay, 2012). Quitting smoking improves the COPD conditions. The nicotine replacement therapy or medication program could be used to help the patient recover from vulnerable smoking habits. Counseling session and group discussions must be arranged for the patients with other smokers so they can share their experiences (Hoogendoorn, Feenstra, Hoogenveen & Rutten-van MĂślken, 2010). The effect of passive smoking must also be avoided as it is more deteriorating than active smoking (Cao, Yang, Gan, & Lu, 2015).

The information must be given to Neville that smoking is chief reason behind just not cancer, but also the reason for many other diseases like diabetes, cataracts, rheumatoid arthritis, and other coronary diseases (Jha & Peto, 2014). Patient-centred care is required in such cases to help him come up with the rehabilitation process and make it easy for them. Proper care and monitoring could help the rehabilitation and hence the symptoms of COPD would vanish, which helps in respiratory breathing problems (Lemone et al., 2017).

Task 5: Clinical judgment and handover

As per the recognition of the fact, Neville has been prescribed with salbutamol nebulizer. As a nurse, one would attend the patient and assess the situation. Seeing the condition Neville was restless, dyspnoeic, and another parameter like high oxygen saturation, heartbeat, and depressed respiration, it has been diagnosed with hypoxia. Such situation must be considered as an emergency and patients must be elevated by 45° during supine. Ventilation must be provided, and the patient must be checked every 2 hours, to avoid complications. Hydrated oxygen must be given during the COPD condition as excessive oxygen can cause apnoea. Medication must be given to prevent any infection and monitored if granted to Neville. Slow breathing must be introduced via spirometer to improve the oxygenation levels I am Veerpal Kaur, a student nurse from the medical surgical ward. I am concerned about patient Neville who is 62 years old man admitted to hospital with complaints of dyspnoea, cough and increased purulent sputum. He is known case of COPD and history of smoking. He has tachycardia and slightly increased blood pressure. Oxygen is continued @2L/min as medically advised. On return to the ward, he became restless and anxious. His skin has flushed and diaphoretic. On examination, he has tachycardia and heart rate was 110 beats/minute and respiratory rate has declined to 8-10 breaths/minute. According to the condition, Neville is restless, having tachycardia and bradypnea .

These are the sign and symptoms of hypoxia. All required nursing care is provided to the patient.

Salbutamol nebuliser is given and nasal prong oxygen @ 2L/min continue. Medications are 18 Double click here to fill in this footer Dhaliwal__Veerpal Kaur_S296744_NUR250 S1 2017 Assessment 1

administered and to continue as prescribed. Intake and output chart is maintained. The close monitoring of the patient is required as per condition of the patient. The doctor's team has checked the patient and advised to transfer the patient to the High Dependency Unit to provide BIPAP support.

Veerpal Kaur Dhaliwal STUDENT NURSE.

Nurse Veerpal I can see you put in a lot of time and effort to research and write your assignment. You had some of your better work in Task 2 Care Plan.

You have some more relevant points in some tasks, but have struggled in others.

You need to work on your explanations to demonstrate better understanding of the connections between Neville’s condition, underlying pathophysiology, prescribed treatments and nursing interventions. In some sections the explanation may have not been clear due to grammar problems. Even so there could be an easy improvement in your work if you had attention to paragraphing and headings so that your work could be followed s much more easily.

Try to write the answers in the terms of the question, and in an order that either follows the question, or discusses each component of the question before moving onto the next. This ensures that the reader can follow your responses, and for yourself you can see that you have answered all components of the question.

You do have a good number of journal articles. There are a number of journals from medicine and other disciplines. Using these tends to deflect focus from nursing and makes it difficult to respond with nursing actions and explanations.

If you use journals from other disciplines it needs to be appropriate to the case. You will find that its easier to get nursing responses from nursing journals, and that journals from other disciplines can provide a lot of irrelevant information which side tracks students from the valuable time they have to complete their studies. The CDU Library can help you with locating and evaluating sources, referencing and using APA.

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Zarowitz, B. J., & O’Shea, T. (2012). Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. Journal of Managed Care Pharmacy, 18(8), 598-606. doi: http://dx.doi.org/10.18553/jmcp.2012.18.8.598

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