Case Study Of A Patient With Respiratory Distress And Pain

Patient’s Condition And Nursing Diagnosis

  • Shortness of breath – Dyspnoea
  • Severe Pain
  • Amount of fluid imbalance/excess
  • Risk of Myocardial infarction (Impaired lungs and heart)
  • Threat of developing infectious disease
  • Urine output

The nursing diagnosis would be when the person’s optimal ventilation was not maintained by the abdominal wall excursions throughout inspiration and expiration or even both. Among the most important difficulties for nurses to address is a patient’s ineffective respiratory pattern. Changes in respiratory rate, intensity, duration, pattern, or rhythm are all considered a part of this condition (Rolfe, 2019) Case Study Of A Patient With Respiratory Distress And Pain.

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The patient, Mr. Jones is experiencing respiratory distress, tachypnoea, as well as talking in short phrases as a result of breathing issues. This may be linked to changes in breathing rate, thoracic and abdominal patterns. The first indicators of health deterioration were a rapid pace of breathing and heart rate (Rodriguez et al., 2020). Early diagnosis of Mr. Jones’s health status can prevent the substantial harmful effects which may be achieved via the use of periodic vital indicators.

The patient, Mr Jones is in excruciating agony in both his operated foot or his chest. In order to safeguard the individual, acute pain serves a protective function by alerting them to the existence of an ailment or sickness. Patients are reminded to obtain support, aid, and comfort when they are suddenly struck with extreme pain (Rodriguez et al., 2020).  Severe pain may be exacerbated by a variety of other circumstances, including the person’s cultural background, feelings, and any underlying psychological and spiritual distress (Seganfredo et al., 2017). Linked to cognitive as well as sensory-perceptual impairments, assessing pain in elderly people may be difficult (Seganfredo et al., 2017).  In this particular case scenario of Mr. Jones, it may possible that the patient had the issue of the hyperalgesia and this condition is characterized by the situation in which the patients develop the extreme sensitivity of pain. Although, there are a lot of different reasons of developing this particular situation, it is reported that the alteration in the nerve pathways can lead to this particular condition due to the overactive responses of the nerves towards the pain sensation (Lee & Neumeister, 2020). In case of the hyperalgesia condition the patient may have acute injury or in some cases damage to the nervous system related pain can also be reported (Chiang et al., 2018). In this regard, it can be reported that, as the patient had a fall followed by a ORIF surgery it may possible that Mr.Jones  had a nerve damage which caused this hyperalgesia condition Case Study Of A Patient With Respiratory Distress And Pain.

When delivering postoperative fluid therapy, it is important to consider the patient’s current health as well as the conditions that occurred during the procedure (Hassan et al., 2017). Several elements must be considered while developing a fluid management strategy, including the types of fluids to be utilised, the volume of fluid to be supplied, and the timing of fluid administration. In fluid resuscitation, one of the most important goals is to maintain adequate tissue perfusion while minimising the risk of harm to the patient (Joosten et al., 2019). The patient’s body fluid state must be considered while executing fluid management operations, and this must be taken into consideration. It is possible that fluid resuscitation will be useful for persons who are receptive to fluids, but those who are not responsive to fluids are more likely to suffer the effects of overhydration and should not be administered this treatment (Malbrain et al., 2018).  Considering the situation of the Mr. Jones, it can be reported that IVT may cause the excessive body fluid in the body of the patients as well.

Importance Of Vital Signs And Fluid Management In Treatment

Considering the situation of Mr Jones, it can be reported that the shortness of breath can lead to the lack of oxygen supply to the various parts of the body including the cardiac muscles of the body. Along with this, using of the short sentences during the communication with the nurses also indicates about the severeness of the lack of oxygen in the body of Mr. Jones. As the patients has the previous history of MI, hence it might possible that the patient might had the MI due to his hypertension condition (Mehlum et al., 2018). In case of Mr. Jones, it can be observed that the patient had the problem of SOB leading to lack of oxygen in the different parts of the body and it can cause lesser supply of oxygen to the different parts of the body. As a consequence, the chances of developing the endothelial dysfunction and prolongs an inflammatory state is also very high (Konukoglu & Uzun, 2016) Case Study Of A Patient With Respiratory Distress And Pain.

The patient’s skin integrity was already compromised as a result of the procedure, increasing the chance of infection. Whenever a person’s natural defensive systems are not up to the task, they become vulnerable to infection. Bacteria, viruses, fungi, and some other parasites enter host bodies via accidental or unavoidable damage (Seganfredo et al., 2017). There are certain cells or tissues in the body that are devoted to preventing infection. Immune system is the body’s defense mechanism (Seganfredo et al., 2017). Survival in today’s environment of potentially lethal and destructive bacteria depends on a strong immune system within humans (Maggini, Pierre & Calder, 2018). Infections may be life-threatening whenever this system is severely damaged. The thymus, marrow, lymphoid tissue, spleen, appendices, tonsils, as well as Payer’s patches are all parts of the immune response (Rodriguez et al., 2020).  Apart from that, this hyperglycaemic condition in case of Mr. Jones can also alter the wound healing process by reducing neutrophil phagocytic function, limiting bacterial clearance and increasing infection risk.

From the case study, it was reported that in spite of the infusion of IVT bag of Normal Saline at 80mls/hr, he had not voided after the surgery process and this might cause dysfunction of the platelet of the body which can cause further complications related to blood coagulation. In this regard, it can be reported that the lower urinary output can lead to chronic kidney disease which eventually enhances the risks of thromboembolic. Along with this, risk of bleeding inside the body is also increased in such cases (Cheung et al., 2017). This also enhances the risk of arterial fibrilization and MI as well.

  • Vitals Signs – Check and record the depth as well as rate of respiration at least four times an hour and keep track of vital signs.
  • Neurovascular Assessments/observations and Pain management – Palpate the tibia, ankle, foot, especially sacrum for signs of edema.
  • Fluid Management.
  • Management of MI
  • Infection Management
  • Urine output management

Vitals Signs – The rate of respiration should be checked continuously so that the health care professionals can take adequate actions adequately. Adults typically take 16–20 breaths at an average per minute. To identify early indicators of respiratory systems deterioration, it seems critical to take measures when respiratory patterns change (Seganfredo et al., 2017). Early signs include sinus, tachycardia as well as elevated blood pressure (Share et al., 2019). Observe for crackles inside the lungs that indicates about the presence of obstacles during the process of breathing, abnormalities in breathing patterns, difficulty breathing, or orthopnea as such symptoms have been occurring due to fluid’s accumulation within lungs (Tadday Rodrigues et al., 2019). Breathing patterns may be maximized with optimal positioning of the Mr Jones because it is easiest to get the most out of the lungs and chest while an individual is sitting down. Pain, poikilothermia, paresthesia, paralysis, pulselessness, and pallor are the six P’s in a neurovascular evaluation. The pain must be felt at the site of injury during the evaluation process. Poikilothermia refers to ability to control the core temperature of the body and it is recommended that the affected area should have the same temperature with the other parts of the body. Paresthesias, or the feeling of tingling and numbness can take place followed by a surgery if the nerve is damaged during the process of the surgery. Paralysis testing refers to the process of checking the ability of extending the foot and hands of the individuals. Pulselessness refers to the absence of the dorsalis pedis, radial, and posterior tibialis pulses, or the pulses on the top of the foot, wrist and back of the foot respectively (Holleran, 2018)Case Study Of A Patient With Respiratory Distress And Pain.

Assessing Skin Integrity In Patients With Respiratory Distress And Pain

This assessment is a standardised procedure used by health professional to evaluate neurovascular impairment, reduced blood flow to the limbs, and peripheral nerve injury (Guo, 2022). Oedema happens whenever fluid builds up outside of the blood vessels. After pressing one’s finger above a region that seems to be oedematous this situation which is left behind is known as pitting oedema. Oedema may also be measured by using a gauging tape on an extremity. An effective nurse pain management strategy (PQRST technique) used to be used to identify the perception of pain, its intensity, location, duration, and description, as well as the impact on activity and the factors that may affect the experience of pain and to be used as the PRN opioid analgesics (Youngcharoen, Vincent & Park, 2017). Opioids and Nonsteroidal anti-inflammatory drug, as well as co-analgesic medications are all used in pain treatment by pharmacological approaches (Seganfredo et al., 2017). Relate this information to your assessment of Mr Jones.

In addition to re-establishing and maintaining tissue fluid and electrolyte balance, intravenous fluids are intended to keep the fluid balance of the body at a stable condition and avoid excessive intake of salt and consumption of water (Guest, 2019). It is stressed in many perioperative guidelines and procedures that adequate IV fluid administration must be obtained to get the greatest potential perioperative results. IV fluids must be administered in strict compliance with established procedures and in response to patient requirements, just as they are with other types of drugs (Allegranzi et al., 2016).

Wound Care – Conduct frequent wound inspections to determine the wound’s features and integrity.

It is recommended to change the initial dressing of the patient by a registered nurse to avoid the further chances of wound infection (Rodriguez et al., 2020). Aseptic procedures should be followed. Conduct frequent wound inspections to determine the wound’s features and integrity. Patient (Mr. Jones) should be cautioned not to scratch the wound. The patient who is experiencing discomfort is perhaps the most dependable information source concerning their suffering (Rodriguez et al., 2020). As a result, interviewing the patient helps the nurses create the most effective pain management strategy (Beck et al., 2019). Patients with certain conditions (such as COPD, anaemia, obesity and malnutrition, diabetes mellitus, haematoma development, vomiting, Ethanol (alcohol) withdrawal, usage of steroids, or older age) have a higher risk of prolonged healing (Rodriguez et al., 2020) as Mr. Jones has the issue of diabetes mellitus so he had the risk of prolonged healing as well. A more severe issue may be averted if a delayed healing as well as developing problems is caught early enough (Rodriguez et al., 2020). Patients with comorbidities or the elderly, whose diminished cardiac output affects capillary blood circulation, may take longer to heal wounds (Seganfredo et al., 2017). It also emphasises the importance of the interprofessional team in the evaluation and management of patients with postoperative wound infections and in this regard, it can be reported that the inclusion of the interprofessional team in the process of wound management can help in the monitoring process of the wound which eventually helps to improve the treatment outcomes as well (Gunter et al., 2018).  Apart from that, the health care professionals also can use the modern technology for treating the wound of Mr.Jones. In this context, the study findings of Berthet et al. (2017) can be mentioned as in this particular study the researchers reported about the nanoparticle based wound dressing process which is considered as the future of wound management.

From the case study, it can be observed that the patient had not voided after the process of surgery and hence it is become evident to manage the condition as the lack of urine output can lead to the onset of thrombocytopenia. Excess bodily fluids are excreted more easily with the help of diuretics. Diuretic responses may be more accurately measured using urinary catheters (Kramer et al., 2017). In the study of Chitturi and Novak (2018) the researchers reported the use of the diuretics for the management of the poor urine output and along with this the researchers also reported the effectiveness of the diuretics for the managing the heart failure management. Therefore, use of the diuretics in case of Mr. Jones can help in the management of the heart failure related problem along with the management of the urine output. The release of the urine after the use of the diuretics can reduce the complications of the patient. The above finding was also supported by the study findings of Mullens et al. (2019) and in this study the researchers reported about the increment of effective circulating volume of the body fluids by redistributing the body fluids. As Mr. Jones is experiencing severe pain in operated leg and chest pain it may possible that he may not be able to move to the bathroom and so insertion of catheter can help the health care professionals to measure the urine output of the patient. However, it is also very important to mention that during the removal of catheter from the body of the patients, it is very important to adhere to the removal guidelines in order to enhance the recovery after the surgery as well. In this context, the study findings of Okrainec et al. (2017) can be mentioned as in this study the researchers reported to adhere to the guidelines which eventually reduces the chances of further infection in the patients’ body by lowering the chances of urinary tract infections in the body as well Case Study Of A Patient With Respiratory Distress And Pain.

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Another potential complication for the patient Mr. Jones is the onset of the MI and for managing this condition the use of the beta-adrenoreceptors can be used. The beta receptors are mainly an adrenergic Gs heterotropic G-protein coupled receptor which are located in various parts of the body. The beta receptors present in the myocardial region are primarily stimulated by the norepinephrine (noradrenaline) and sympathetic nervous system along with catecholamines epinephrine (adrenaline) as their primary endogenous agonists. Therefore, treatment with the beta blockers in case of the non-acute myocardial infarction treatment process is associated with the stoppage of the inotropic and chronotropic effects of the beta?receptor.  As a consequence, reduction of heart rate, contractility of the myocardium and blood pressure of the individuals are reported and these result in the lowering of the oxygen requirement by the heart muscles that leads to the management of the conditions as well. In the study of Chung et al. (2021) the researchers also had reported about the effectiveness of the beta-blockers in the treatment process of the myocardial infarction patients. In this study, the researchers reported that the use of this drug can provide better medical outcomes compared with conventional β-blocker therapy among the myocardial infarction patients Hence, this intervention can be used for treating Mr. Jones as well.

References:

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Beck, Steele, S. R., & Wexner, S. D. (2019). Fundamentals of Anorectal Surgery. Springer International Publishing AG.

Berthet, M., Gauthier, Y., Lacroix, C., Verrier, B., & Monge, C. (2017). Nanoparticle-based dressing: the future of wound treatment?. Trends in biotechnology, 35(8), 770-784. https://www.sciencedirect.com/science/article/pii/S0167779917301130

Cheung, K. L., Zakai, N. A., Folsom, A. R., Tamura, M. K., Peralta, C. A., Judd, S. E., … & Cushman, M. (2017). Measures of kidney disease and the risk of venous thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. American Journal of Kidney Diseases, 70(2), 182-190. https://www.sciencedirect.com/science/article/pii/S0272638616307041

Chiang, H., Chang, K. C., Kan, H. W., Wu, S. W., Tseng, M. T., Hsueh, H. W., … & Hsieh, S. T. (2018). Physiological and pathological characterization of capsaicin?induced reversible nerve degeneration and hyperalgesia. European Journal of Pain, 22(6), 1043-1056. https://onlinelibrary.wiley.com/doi/abs/10.1002/ejp.1189

Chitturi, C., & Novak, J. E. (2018). Diuretics in the management of cardiorenal syndrome. Advances in chronic kidney disease, 25(5), 425-433. https://www.sciencedirect.com/science/article/pii/S1548559518301423

Chung, J., Han, J. K., Yang, H. M., Park, K. W., Kang, H. J., Koo, B. K., … & Kim, H. S. (2021). Long-term efficacy of vasodilating β-blocker in patients with acute myocardial infarction: nationwide multicenter prospective registry. The Korean journal of internal medicine, 36(Suppl 1), S62. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8009151/

Guest, M. (2019). Understanding the principles and aims of intravenous fluid therapy. Nurs Stand, 35(2), 75-82. https://search.proquest.com/openview/f84b830ba91dd260c540471849916cb3/1?pq-origsite=gscholar&cbl=2042228 Case Study Of A Patient With Respiratory Distress And Pain