Managing Asthma Exacerbation: Consideration Of Patient Symptoms And Prioritization Of Care

Consider the patient situation

Kobi Monterey has grown up with asthma.  Diagnosed at a very young age, he has been very diligent in knowing what triggers his asthma resulting in Kobi experiencing few episodes in recent years. Apart from his asthma, Kobi is a fit and well 25-year-old.  However, this week Kobi has not been feeling well over the past few days and his father brought him to the emergency department this morning after Kobi experienced an asthma attack whilst at work. Kobi is quite distressed and breathing rapidly with a notable wheeze on expiration. He is unable to talk to you in full sentences, states he has a tight feeling in his chest and a continuous cough. You notice that his lips are cyanosed and he appears pale and sweaty.

Collect Cues:

Review the existing documentation;

Social History

Kobi is a keen cyclist and rides his bike about 3 times a week with a local cycling group to which he belongs. He enjoys the social activities and has a good work-life balance. Kobi works as a carpenter with his father. He has aspirations of starting his own carpentry business and is feeling positive about his future. Kobi is often working in enclosed spaces exposed to fine wood dust particles, although he complies with all the necessary workplace health and safety regulations.

Medication Use:

Kobi indicates that he has needed to use his puffer more than usual and ceased using the preventer some time ago. When he runs out of his Ventolin puffer, he orders replacements online that are delivered to his home address for convenience. With such a busy schedule, Kobi has found it difficult to find time to schedule an appointment with his GP.

Recall:

The case study could not reveal much about the most of the vital signs of the patient, although, it was identified that he had very low oxygen saturation at 88% which needed immediate attention. Now it has to be mentioned in this context that he had been suffering from asthma, and he had been admitted to the facility to manage an exacerbation event after the asthma event. The reduced oxygen saturation indicates at lower oxygen availability in the body due to the inflamed airways which can lead to tissue necrosis and organ failure if not addressed adequately. Hence, the primary priority for him had been increasing the oxygen saturation.

Process information

Interpret:

In the following table, list the data that you consider to be normal/abnormal                                 

Normal (Subjective & Objective Data)

Abnormal (Subjective & Objective)

Oxygen saturation: >98%

Rate of respiration: 12 to 20 breaths per min

Skin colour: normal

No cyanosis apparent.

Oxygen saturation: <88% to 98%

Rate of respiration: 16-22 breaths per min

Skin colour: slightly pale

No cyanosis apparent.

From the above mentioned care cues that have been identified, collected and interpreted, the patient had been in distress due to the exacerbation of asthma event, which in turn must have been the contributing factor that led to the heightened breathing and ineffective breathing pattern that led to insufficient oxygen saturation in the patient (Ballestero et al. 2018).

The lack of oxygen saturation is the most prominent health issue identified from the case study and the care plan hence will have to focus entirely on addressing the low oxygen saturation. The inflamed airways due to an asthma attack leads to the oxygen flowing to the body to lessen considerably and lead to reduced oxygen availability throughout the body on room air. This in turn leads to increasing the overload of the lung functionality, which in turn leads to enhanced breathing rate to compensate the lack of oxygen availability. Hence, he would require the assistance of external oxygen therapy and medication for the lack of oxygen saturation (Loomas et al. 2015).

Predict:

The patient was observed to have less than 88% oxygen saturation and high respiratory rate which indicates that his body is not obtaining enough oxygen to carry out the normal physiological functions. The patient would need to avail external oxygen therapy to ensure that his oxygen saturation will elevate to at least 92% as soon as possible to avoid tissue necrosis and uncontrolled shortness of breath, and eventually to organ failure (Cunningham et al. 2015).

Identify the Problem/s

Nursing problems

Ineffective breathing pattern

Ineffective airway clearance

Establish Goal & Take Action

Highest priority nursing problem

Evidenced based skill assessment and reflection

Discuss in relation to the Registered Nurse Standards for Practice. 

Strength

Weakness

The nurse introduced himself properly and explained the entire process of care activity clearly to the patient. The nurse explained the exact need for providing the oxygen therapy. The nurse documented the entire procedure properly as well which can be considered a strength too. Although the most notable strength had been proper introduction and information sharing with the patient to ensure that each care activity is clearly defined by the nurse.

The lack of respectful, compassionate and sensitive care approach is the most notable weakness from the video. The nurse did not ask permission from the patient before entering the room.

There had been an evident lack of therapeutic engagement. The nurse also did not attempt at building a therapeutic relation or rapport with the patient. There had been a lack  of dedication or compassion to the patient care throughout with a more or less casual approach to care.

Reflecting on the video performance, discuss what two (2) actions you will take to address their performance in the promotion of positive health outcomes.  Reflecting on the clinical reasoning cycle, how has this reinforced your professional responsibility as a beginning level practitioner and informed your future learning? (200 words)

From the patient care scenario exhibited in the selected video, a few key or fundamental nursing concepts or components had been neglected conspicuously in the scenario. As identified ion thee above section, the lack of proper patent engagement and therapeutic connection from the nurse to the patient in question can have a significant detrimental impact on the health and welfare of the patient. In any case, the care approach of the nurse is expected to have a huge impact on the comfort level, recovery progress and communication level of the patient. Along with that, consent is a very important aspect of nursing care and in this case the nurse has not contributed to the process of informed consent either (Blomberg et al. 2016).

In this case, I would attempt to engage in a therapeutic communication with the patient and encourage her to participate in the conversation so that the patient is comfortable to share his wishes and grievances to the nurse. Similarly, the second initiative that I would be taking is to ensure taking permission from the patient before commencing with any care activity so that her respect, dignity and empowerment is addressed at all costs (Blomberg et al. 2016).