Nursing Care for Acute Pulmonary Oedema-Free-Samples-Myassignmenthelp.

Question: Discuss about the Nursing Care for acute Pulmonary Oedema Patient. Answer: Introduction Pulmonary oedema refers to the condition of fluid accumulation in the alveoli of the lungs. Noncardiogenic and cardiogenic pulmonary oedema can occur in humans. Pulmonary oedema can be chronic (occurs slowly) or acute (onset is sudden). The latter is considered as a case of medical emergency and leads to high mortality. Hypoxia and dyspnoea after fluid accumulation in the lungs are the main symptoms (Powell et al. 2016). This fluid accumulation impairs gaseous exchange from the alveoli. This report will elaborate on the case of one such patient, Ms. Foley suffering from the disease and its pathophysiological assessment. The patient is aged 35 years and has been admitted after an accident of a car versus a tree at high speed. She has a history of cardiomyopathy and has multiple fractures in her legs. It will also focus on the nursing (involving interprofessional healthcare model) that needs to be delivered to the patient Discussion Time Oral/enteric intake IV fluids mls/ IN Program Urine/mls 12:00:00 AM NBM compound Total 1:00:00 AM sodium 200 input 100 2:00:00 AM intake 200 3:00:00 AM 1000mls 200 4:00:00 AM 200 5:00:00 AM 200 6:00:00 AM 200 7:00:00 AM 200 8:00:00 AM 200 9:00:00 AM 10:00:00 AM 11:00:00 AM 12:00:00 PM 1:00:00 PM 2:00:00 PM 3:00:00 PM 4:00:00 PM 5:00:00 PM 6:00:00 PM 7:00:00 PM 8:00:00 PM 9:00:00 PM 10:00:00 PM 11:00:00 PM 12:00:00 AM total intake 1600 total 100 output Current Balance Posiitve 1500mls Pevious Balance Positive 1900mls Cumulative Balance Positive 3400mls Table 1: Martha Foley Fluid Balance Chart (UniSA 2017) Analysis and Interpretation of data To assess the hydration status of a patient, doctors use a non-invasive tool, a fluid-balance chart. The fluids were prescribed by surgical trainees on a daily basis. An accurate analysis and interpretation of the chart affects the patients medical outcome. Ms. Foley suffered from cardiomyopathy due to a congenital heart defect. Several studies have demonstrated that small infusion of lactate acts in the form of an energy substrate for the cardiac cells. An intravenous solution of sodium lactate was administered at the rate of 200ml/hr eight times which sum up to 1600mls IV intake in total through the left distal cubical fossa with the aim to improve her cardiac performance. She had nil oral intake during charting. Previous balance based on the chart was positive 1900mls which cumulates to 3500mls intake. The chart also reveals that she gave 100ml straw coloured urine output. Finally, the outcome of the fluid balance was 3400mls positive which indicated Ms. Foley had more fluids inta ke than output. Her respiratory rate increased to 34, blood pressure was normal (100/50), pulse increased to 120bpm and oxygen saturation was around 92% on RA which indicates Ms. Foley is dyspnoeic and shortness of breath. Table 2: Martha Foley OBS Chart (UniSA 2017) Pathophysiology Acute pulmonary oedema is a common cause of patient death in critical care. It leads to cardiac arrest, hypoxia and respiratory disorders which prove fatal for the patient. The main factor that leads to this condition is fluid loss from pulmonary capillaries into the alveoli and pulmonary interstitium. When the heart fails to pump blood efficiently, there is an increase in blood pressure in the vessels (Pinto et al. 2014). This forces the fluid into the alveoli or air spaces of the lungs. The entry of this fluid reduces the movement of oxygen in the lungs. This leads to hypoxia, or shortness of breath. Thus, pulmonary oedema occurs due to congestive heart failure. This heart failure may be the result of narrowing of the aortic or mitral valves of the heart, history of cardiomyopathy and hypertension (More 2015). Pulmonary oedema is categorized into two types: cardiogenic (when the heart is unable to pump blood due to arrhythmia, left ventricular failure or renal failure) and non-card iogenic (occurs due to pressure in the chest that ruptures the capillaries, seizures, electrocution or head trauma can also be responsible). Pulmonary oedema can also result due to lung injury. The ALI-ARDS (acute lung injury- acute respiratory distress syndrome) encompasses some of the cases that result in such lung injury. It can occur due to aspiration, pulmonary contusion, inhalation of toxic gases, lung transplantation or local/systemic inflammation. Some of the most common symptoms of pulmonary oedema include: Orthopnea (breathing difficulty while lying down), coughing up bloody froth, speaking problems due to shortness of breath (Bahloul et al. 2013), wheezing or grunting sounds during breathing, reduced alertness, anxiety, swelling in legs and abdomen and pale skin Nursing care needed Improvement of oxygenation and reduction of pulmonary congestion should be the primary treatment objectives. The precipitation factors and underlying causes should be identified and rectified to prevent recurrence of the disease (Al Deeb et al. 2014). The treatment of pulmonary oedema depends on its underlying pathology. A number of interventions are available that change the fluid shifts inside the lungs. A reduction in the air-filled lung space impairs gaseous exchange in the lungs. The first step is to add or supplement the oxygen concentration by a non-rebreathing mask with a 10-15 litres/minute reservoir. The patient should be kept in upright Fowlers position. This is a standard patient position and is used as an intervention to promote oxygenation. It maximizes chest expansion and facilitates relaxation of abdominal muscles. This leads to improved breathing (Purvey Allen 2017). Pulmonary oedema causes distress in the patients and they require reassurance and support. The keys of treatment to dysponea are Morphine, Oxygen, Aminophylline, diuretic, Digitalis and Arterial blood gases (ABG)Oxygen delivery is one of the primary treatment procedures. To keep the saturation of oxygen more than 90%, it should be administered to the patient. Oxygen delivery methods include use of non-invasive pressure support ventilation, mechanical ventilation and intubation (Chioncel et al. 2015). The non-invasive method includes continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). Depending on the level of consciousness of the patient, hypoxemia or mental status of the patient, mechanical ventilation and intubation is performed. Medical treatment focuses on preload reduction (lowering the pulmonary venous return), after load reduction (lowering of systemic vascular resistance) and inotropic support (Frat et al. 2015). Oxygenation for a breathless patient without hypoxaemia masks clinical deterioration and delays treatment procedures. Different oxygen delivery devices are used for oxygen titration. They include 4l/minute via nasal cannulae, 15l/minute via non rebreather reservoir, 5-10/minute via masks. Patients who suffer from chronic obstructive pulmonary disease need target saturation of oxygen at 88-92%. Venturi masks with 28% inspired oxygen saturation are recommended for those patients. Morphine is used for treatment owing to their power of reducing dysponea. In addition to venodialation, it leads to preload reduction and venous pooling. It also reduces anxiety and distress, which is associated with dyspnoea. However, morphine has some adverse effects on the central nervous system and the respiratory system. These effects include hypotension and reduction of cardiac output. It has also been associated with intensive care admissions, increased incidence of mechanical ventilation and mortality (Ellingsrud Agewall 2016). Therefore, low doses of morphine are used to treat non invasive ventilation but the patient should be continuously monitored for sedation and blood pressure should also be measured at regular intervals. Aminophyline is a derivative of the theophylline bronchodilator. It is present in the ratio of 2:1 with ethylenediamine. It is mainly used to treat obstruction in the airway. It is used to treat pulmonary oedema owing to its role as a cardiac stimulant. It has inotropic effect (Xu 2015). Digitalis is used to treat the condition because it increases blood flow throughout the body. It increases the force of heartbeat by elevating the calcium levels in the heart. It binds to the potassium and sodium receptors in the muscles and these receptors control calcium levels in the heart. Build-up of calcium in the cells leads to production of a strong heartbeat. However, there are some adverse effects like headache, hypotension and ventricular dysrhythmia (Gable et al. 2014). The patients response to therapy, cardiac status and the lung fields should be re-evaluated. Diuretics are considered the mainstay of treatment in case of pulmonary oedema with frusemide being the widely used drug. Furosemide increases water excretion owing to its property of interfering with chloride-binding cotransport system. It inhibits chloride and sodium reabsorption in the distal renal tubule and ascending limb of the loop of Henle. Furosemide leads to preload reduction in 20-60 minutes. It contributes to preload reduction by a vasoactive mechanism. It is mainly used in patients with total body fluid overload and helps the body to get rid of excess amount of water and salts.It is available in the brand name of Lasix. It lowers blood pressure. It also leads to reduction in potassium levels. High furosemide doses can reduce thyroid levels in the blood (Katz 2016). There should be a constant check on lowering of blood pressure, increasing heart rate and reduction in urinary output. Electrolyte levels should also be measured continuously as there can be significant loss o f potassium from the blood. Arterial blood gases (ABG) monitor or measure the lung diseases and to evaluate the effectiveness of oxygen delivery methods. These blood gases are also used to test for acid-base imbalance and check the partial pressure of oxygen in a patient (Wagner 2015). This part of the report will focus on the inter-professional model of health care required for the patient. Interprofessional teams are best suited to address complicated medical issues. It includes a team comprising of professionals from different groups and disciplines who work together to provide best care facility to a particular patient (as shown in Figure 1). Many health caregivers work in collaboration and deliver quality, effective and safe care to meet the needs of the patient. Interprofessional healthcare teams include paramedic, pharmacist, physician, hospitalist, social work, nurses, and nurse practitioner (Source- Libguides.gwumc.edu 2017). When health workers from various professional backgrounds offer comprehensive services to the patients by working together with caregivers, families and communities, it results in successful collaborative practice (Bookey-Bassett et al. 2017). This is purely based upon interprofessional education, the primary aim of which is to enhance health outcomes. Interprofessional model is based on different domains: Responsibilities and roles- One should have proper knowledge about ones role and about the role of other profession and utilize it efficiently to address the needs of the patient; Ethics in Interprofessional practice- Mutual respect creates a comfortable environment for collaborative work with people from other profession; Teamwork- Team dynamics and healthy relationships help team members to deliver timely, safe, efficient and equitable patient-centered care; Process improvement- these are used to improve team-based programs, services and policies and the overall team performance (Thompson 2016). There are various strategies used to enhance interprofessional healthcare, which contribute to maximum client satisfaction and help in reducing mortality, improve disability, decrease number of admissions and create family satisfaction. The strategies are: Organizing case conferences and team meetings, collaborative leadership, multidisciplinary approach to staff education, self assessment using audits and care expertise, mortality rounds and morbidity Certain nurse practitioner standards should be followed to treat Ms. Foley. A nurse practitioner engages in critical and complex thinking and integrated evidence and clinical information and communicates with all people involved with the patient to provide focussed care. The nursing regulatory standards are accessible to governments, nursing practitioners, healthcare professionals and community (Matziou et al. 2014). The standard focuses on four domains, which are education, clinical, leadership and research. The knowledge that a nurse acquires in leadership, education and research are utilized in their clinical role. Figure 2- Regulatory nurse standard practices (Source- Nursingmidwiferyboard.gov.au 2017) These nursing regulatory standards help registered nurses to demonstrate competence in providing care to the patient. The different nurse practicing standards (as shown in Figure 2) are enlisted below: Diagnostic capability assessment Extensive knowledge of health assessment along with skills that help in obtaining accurate and appropriate data should be demonstrated; The complex healthcare requirements of the patient should be assessed by keeping a check on the medical history. The effects of pathology and co-morbidity impacts should also be assessed (Nursingmidwiferyboard.gov.au 2017); The nurse should demonstrate comprehensive skills in physical, mental and social examination of the patient; The medical history of the patient, physical findings and prior treatment results should be used to identify any health abnormalities; Clinical decisions should be supported by research and clinical evidence (Matziou et al. 2014); Cost, accountability and clinical efficacy of the patient must be considered while making any diagnostic decisions; Effective communication skills should be used to inform the patent and related healthcare providers about the findings of the assessment; A sound knowledge on the epidemiology, behav iour, pathophysiology, risks and demographics of the disease should be used. Care planning and engaging others Critical evaluation and integration of research findings while making healthcare decisions and ethically exploring different therapeutic options; Taking informed consent from the patient while respecting her rights and ensuring access to accurate information; Identifying needs for educating people about ongoing care facilities; Communicating individual care plan to family members and developing a partnership with the patient to determine medical goals (Nursingmidwiferyboard.gov.au 2017); Comprehensive knowledge of pharmacokinetics and pharmacology should be applied to practice. Prescribing and implementing therapeutic interventions Sharing medical knowledge with patient and contributing to health literacy; Prescribing therapeutic interventions by applying knowledge of the concurrent therapies of the patient (Purvey and Allen 2017); Demonstrating professional integrity and maintaining ethical conduct; Effectively performing invasive or non-invasive intervention procedures for clinically managing the illness; Educating and counselling the patient on the benefits, side effects and importance of the therapeutic procedures and the follow up (Nursingmidwiferyboard.gov.au 2017); Advocating for improvement in health care access and disclosing the adverse effects to the patient and related team members to mitigate any form of harm. Evaluating outcome and improving practice Evaluating the documents and interventions related to the patient and her prognosis; Considering a plan for modifying her treatment by proper consultation with the patient and the other health members (Thompson 2016); Measuring the efficacy of the services and strategies in promoting safe practice; Demonstrating leadership in evaluation of the services that are being promoted for safe healthcare and prevention of illness; Influencing health, age care policies and nursing practices through active participation and leadership at the workplace. The development of interprofessional healthcare model focuses on expanding the role of nonphysicians involved in providing healthcare. These health reforms help nonphysician providers like registered nurses, nurse specialists, nurse midwives and physician assistants to note down medical history of the patient, perform mental and physical examination and provide injury management in case of chronic illness (like the case stated in this report). Earlier, nonphysicians faced several obstacles that prevented them from being a part and sharing information linked to medical care practices (Wagner 2015). The interprofessional model helps in introduction and utilization of reforms that enables inclusion of nurse practitioners in coordinating healthcare programs and controlling the costs of treatment. Thus, the conceptual model of interprofessional healthcare services provides exemplary care to the patient in a healthy environment. It results from synergy among the team members who exhibit th eir expertise in effective functioning of the team. Conclusion From the above report it can be concluded that the patient, Ms. Foley has been diagnosed with acute pulmonary oedema and she is under medication at the healthcare centre. Her health condition is being constantly monitored after she got admitted following an accident. The illness is manifesting itself in the form of shortness of breath, a decrease in oxygen saturation and increase in respiratory rate. When the nurse made her sit in Fowlers position, the recurring problem of orthopnea disappeared. Her medical reports suggest a positive fluid balance. Her nursing reports suggest that she has been under a medication of 40mg IV frusemide for preload reduction and to increase water retention. However, some adverse effects like hypotension and tachycardia are also observed. 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