Question

Clinical Scenarios, Respiration

Maureen Matthews is 84 years old. She has been living in a nursing home for the past 8 years. She is unable to move independently or complete her activities of daily living independently.Her BP is 143/76, RR- 20, HR- 98,Pulse OX - 89%. She has two children that come to visit frequently. Maureen is suffering from dementia and chronic obstructive pulmonary disease. Over the past week, Maureen has been having difficulty ambulating from her bathroom to her bed. She has always been able to ambulate with standby assist.

1.What assessment techniques can you use to assess Maureen?

2.The physician ordered oxygen for Maureen to use. What other steps can you take to help improve Maureen’s breathing and quality of air?

3.Maureen is continuing to feel short of breath at times? Her family likes to turn up the flow of oxygen when she becomes distressed. What steps should you take to ensure Maureen is on the right flow of oxygen?

Answer 1

1.physical examination

patients normally use pursed -lip breathing

check for anterior-posterior chest diameter- most COPD patients have barrel chest

sitting position -patient always sit forward to ease breathing

breath sounds-rhonchi

the colour of the sputum

2.lung function test

spirometry

3.arterial blood gases- if Sa O2 is <92 %, arterial gas should be measured

5. Blood tests -

patient may have polycythemia

anaemia,

antitrypsin level measured in all patients above 50 years

6.radiology

CT computerised tomography

• 2, Pulmonary rehabilitation to optimize the patients physical and social functioning. it teaches how to reach their maximum functional level. it improves activity tolerance and reduces disabling symptoms. Those exercise three to five times weekly, with each session lasting up to 30 to 90 minutes have better exercise capacity, decreased dyspnea and improve quality of life
• pursed lip breathing help to reduce respirations while improving expiratory phase.
• proper positioning - tripod position, in which patient leans forward while sitting or standing with the arms supported.
• energy conservation techniques- frequent rest in between activities, use assistive devices break activities into small tasks
• avoid environmental triggers of dyspnea like extreme temperature, air pollution and so on

3. In some Chronic obstructive pulmonary disease patients, excess oxygen cause increased carbon dioxide retention which may result in drowsiness, headache and death. Oxygen therapy is only prescribed to a COPD patient if their arterial blood gas level is too low. breathlessness is not a valid tool. The main aim of oxygen therapy is to raise the PaO2 without worsening acidosis.

therefore through

venturi mask -4L/minute

nasal prongs- no more than 2L/minute