Question

You are a nurse working in a hospital. You are caring for a newly admitted 70-year-old man who has a diagnosis of pneumonia. He has a productive cough and decreased lung sounds in the bases of his lungs. His oxygen saturation is 92% on 3L of oxygen via NC. While completing the nursing admission history you learn he has a history of smoking one pack of cigarettes per day for 53 years; although he tries to eat well, his source of income is public assistance, so he heats primarily starches and very few proteins or fresh vegetables; he rents a room in a low income community residence shared by other senior men; he has not yet had his influenza vaccine.

1. What risk factors does this patient have for pneumonia?
2. What additional information is needed regarding his respiratory status i.e other values, assessment findings
3. How will you care for this patient in regards to his oxygen use?
4. What nursing interventions are indicated because of his diagnosis of pneumonia?
5. Describe in detail how you would teach this patient to use an incentive spirometer.
6. What teaching might be indicated for this patient in preparation for discharge?

Answer 1

Risk factors (that raise the chances of pneumonia) :

• Age — older than 65
• Cigarette smoking for 53 years

Having a weakened immune system due to illness, certain medications, and autoimmune disorders

Not yet had Influenza vaccine.

The components included are: an underlying assessment, history taking, review, palpation, percussion, auscultation and further examinations. An incite introductory assessment permits quick assessment of seriousness of sickness and fitting treatment measures may warrant induction now. Following this, a far reaching tolerant history will be inspired. Clinical examination of the patient pursues and includes assessment, palpation, percussion and auscultation. Now, thought must be given to arrangement of a light, warm, peaceful, private condition for examination and reasonable patient situating. Examination is an exhaustive visual assessment, while palpation includes utilizing contact to assemble data. The following stages are percussion and auscultation. While percussion is striking the chest to decide the condition of basic tissues, auscultation involves tuning in to and translating sound transmission through the chest divider by means of a stethoscope. At last, assist examinations might be important to affirm or nullify suspected analyses.

Attendant initiated oxygen

OXYGEN THERAPY – STANDING MEDICAL ORDERS FOR NURSES

•       Both hypoxaemia and hyperoxaemia are hurtful.

•       Oxygen treatment ought to be started or expanded to evade hypoxaemia and ought to be decreased or stopped to maintain a strategic distance from hyperoxaemia

•       For kids accepting oxygen therapy SpO2 targets will fluctuate as per the age of the tyke, clinical condition and direction of sickness.

Oxygen treatment is typically redundant except if the SpO2 is under 92%.

That is, don't give oxygen if the SpO2 is ≥ 92%.

Oxygen therapy (fixation and stream) might be fluctuated much of the time without particular medicinal requests, however therapeutic requests abrogate these standing requests.

•       Nurses can start oxygen if patients rupture expected typical parameters of oxygen immersion

•       A therapeutic survey is required inside 30 minutes

THE FOLLOWING MAY BE UNDERTAKEN BY NURSES WITHOUT MEDICAL ORDERS:

Beginning or Increase of Oxygen Therapy:

1.     Oxygen therapy ought to be started if:

- SpO2 is under 92% (PaO2 under 80mmHg in patients without cyanotic coronary illness

- SpO2 is under 70% (PaO2 under 37mmHg) in patients with cyanotic coronary illness who have had heart medical procedure

- SpO2 is under 60% (PaO2 under 32mmHg) in patients with cyanotic coronary illness who are sitting tight for heart medical procedure

- <91% in untimely and infant neonates

- Persistently < 90% for newborn children with bronchiolitis

2.     Reduction or Cessation of oxygen therapy. Oxygen therapy ought to be lessened or stopped if:

- SpO2 is ≥ 92%

- SpO2 is ≥ 90% for newborn children with bronchiolitis

- The tyke with cyanotic coronary illness achieves their pattern Sp02

This course applies to patients treated with:

•       Face veils and nasal prongs

•       High stream nasal prong therapy (HFNP)

•       Mechanical ventilation (don't modify other ventilator settings)

•       Mask-BiPaP or CPAP (don't change weight or volume settings without a medicinal request)

Patient assessment and documentation

•       Assess the aviation route and enhance aviation route position (e.g head tilt, jaw lift) as important

•       Clinical assessment and documentation including yet not restricted to: cardiovascular, respiratory and neurological frameworks ought to be done at the initiation of each move and with any adjustment in patient condition.

•       Check and report oxygen hardware set up at the initiation of each move and with any adjustment in patient condition.

•       Hourly checks ought to be made for the accompanying:

•       oxygen stream rate

•       patency of tubing

•       humidifier settings (if being utilized)

•       Hourly checks ought to be made and recorded on the patient perception diagram for the accompanying (except if generally coordinated by the treating therapeutic group):

•       heart rate

•       respiratory rate

•       respiratory trouble (expressive assessment - i.e. utilization of extra muscles/nasal flaring - see Respiratory Distress on EMR)

•       oxygen immersion

•       continuous beat oximetry is suggested for the patients who are seriously unwell, and who are probably going to have quick and clinically huge drop in oxygen immersions when the oxygen therapy is separated.

•       continuous beat oximetry may not be vital in the steady patient accepting oxygen therapy.

•       Ensure the individual MET criteria are watched paying little heed to oxygen necessities

-Do Ask if any Doubts.

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