Question

Provide a short ase scenario (Client Assessment, Nursing interventions (and rational using your theory), Client Goals, Client evaluation) where the Theory of Integral Nursing (Barbara Dossey) was used.

Answer 1

A patient X came to E.R with shortness of breath. He appears to be restless. He has a history of diabetes and on medications for the past 20 years. He was recently got treated for cellulitis left lower limb.He is a chronic smoker given up 5 years ago.On examination, b.p 150/90 , afebrile, lungs - clear and no abnormal heart sounds, no pedal edema.

CLIENT ASSESSMENT IN THIS CASE:

Medical history should be checked prior to initiating any treatment. ( In this case based on the symptoms we should check for history of COPD as he is a chronic smoker and other cardiac diseases like DCM ( dilated cardiomyopathy).

To check for clubbing of hands and feet which is a characteristic feature of lung and heart diseases.

Brief history of present illness should be taken- Duration of the present symptoms and check whether it is new onset or if he is having recurrent episodes.

NURSING INTERVENTIONS:

E.C.G and A.B.G should be ordered immediately to rule out the cause for shortness of breath.

E.C.G showed sinus tachycardia, A.B.G indicated Respiratory alkalosis.

1Q) What should be done now?

2Q) Should O2 can be given to this patient?

1A) Respiratory alkalosis( PH 7.55 PCO2 22 PO2 45 HCO3 20) should be treated immediately by calming down the patient and advising him to breathe through nose rather than the mouth.

usually, panic attacks and anxiety are the most common causes of respiratory alkalosis . So, initially the patient should be reassured, help him calm down or give a sedative like lonazepam or clonazepam ( not to give more as they may cause respiratory depression).

In this case, he was given LONAZEP MD ( Lonazepam sublingual) 2 tablets with half an hour interval. He improved gradually after an hour. Nevertheless, one should check for other causes as well. In this case, eventhough he recovered it is better to refer him to cardiologist for further interventions.

2A) O2 is not recommended in this patient as A.B.G showed high O2 and less CO2 .Giving excess oxygen can lead to altered mental status, myopia .