Question

Martha Moore is an 87-year-old woman with a history of osteoporosis and hypertension. She had an exploratory laparotomy for a small bowel obstruction 2 days ago. Before assessing this patient, the nurse noticed Mrs. Moore’s hemoglobin level was 9 g and her SaO2 was 90%. During this morning’s assessment, Martha reports her cough kept her awake last night. Vital signs reveal temperature 101° F, blood pressure 150/78 mm Hg, heart rate 100 beats/min, and respiratory rate 24 breaths/min. On auscultation, the nurse hears crackles in both lungs. The patient reports a sharp pain in her chest when she took the deep breath. After the deep breath for auscultation, the patient has a productive cough and the nurse notices the sputum is green with rust-colored tinting. Martha reports she tries not to cough because it causes abdominal pain at her incision site.

The nurse recognizes that Mrs. Moore has symptoms suggesting pneumonia as a postoperative complication. The nurse knows Mrs. Moore needs to deep breathe, increase activity as tolerated, and increase fluid intake. The nurse works with Mrs. Moore to implement the plan of care. The nurse asks Mrs. Moore to use the incentive spirometer now and notices she is moving only 800 mL of air. The nurse emphasizes the importance of using the incentive spirometer about 10 times every hour while awake to help get air into Mrs. Moore’s lungs. Together they agree on a goal of moving 1500 mL using the spirometer. The nurse also talks with Mrs. Moore about giving her pain medication to relieve the abdominal pain. To further reduce pain when coughing, the nurse recommends that Mrs. Moore hold a pillow over her incision when she coughs to splint the incision site. After receipt of pain medication, Mrs. Moore is assisted to sit on the side of the bed and walk to a chair to eat the clear liquid breakfast. The nurse encourages Mrs. Moore to drink all of the liquids to help liquefy her secretions. When the surgeon makes rounds, the nurse reports the findings from Mrs. Moore’s assessment and the plan of care initiated. The surgeon orders a chest x-ray, aspirin as needed for fever, an antibiotic, and iron tablets. After a bath, a nap, pain medication, and use of incentive spirometry with coughing, Mrs. Moore is assisted to walk in the hall. Before discharge, Mrs. Moore is taught about ways to treat her anemia with foods rich in iron and with the daily iron tablet. The outcome of this plan of care is that by discharge Mrs. Moore will be able to move at least 1500 mL on the spirometer, have clear breath sounds bilaterally, have a SaO2 greater than 95%, be afebrile, and be able to state the plan to treat her anemia.

Case Analysis

This case clearly exemplifies impairment in gas exchange in a number of ways. Mrs. Moore has several classic risk factors, including her age, a recent surgical procedure, and hesitancy to cough for fear of abdominal pain. The clinical presentation of Mrs. Moore’s signs and symptoms is consistent with two types of gas exchange impairments: bacterial pneumonia, a very common exemplar of impaired gas exchange representing impairment of ventilation, and anemia, which impairs the oxygen-carrying capacity of the blood.

Questions

1 Why is Mrs. Moore encouraged to sit up in the chair?

2. What is the advantage of walking over sitting in the chair?

Answer 1

1. Answer ; The reason the Mrs. Moore is encouraged to sit up in the chair is to position her in a upright way, cause this position will enable Mrs. moore to breath comfortably and reduce the difficulty level. While she is in that position, the gravity gets increased and the pressure that suppressing the lung will be reduced, hence Mrs. Moore is encouraged to sit in a certain position.

2. Answer ; There are some advantages that are gained by Mrs. moore when she had walking over sitting in the chair. Following are some important advantages.

• Primarily this activity will reduce Mrs. moore anxiety and fear about her health condition.
• It will enable Mrs. Moore to breath comfortably and gain some O2 from the atmosphere.
• It will also prevet the complication that are related to immobility beacuse of her current situation.