ANSWER:
Potential Issues:
Sarah’s low oxygen saturation (82%), which suggests insufficient oxygenation, can result in tissue hypoxia and organ failure.
Respiratory Acidosis: Sarah’s increased PaCO2 (58 mm Hg) indicates hypoventilation, which can lead to respiratory acidosis and further deterioration of her respiratory function.
Impaired Gas Exchange: Sarah’s lower PaO2 (78 mm Hg) implies impaired oxygenation and possibly insufficient carbon dioxide elimination, resulting in ineffective gas exchange.
Worsening Pulmonary Function: Bilateral pneumonia can aggravate Sarah’s pre-existing COPD by increasing airway resistance, decreasing lung compliance, and jeopardizing her respiratory status.
Fluid Overload: Because Sarah has a history of heart failure, she is at risk for fluid overload, which can exacerbate her respiratory distress and lead to decreased oxygenation.
Approach to Multidimensional Care:
Respiratory Support: Ensure that 2 L of oxygen is administered through a nasal cannula (NC) as the clinician directs to enhance Sarah’s oxygen saturation and treat hypoxemia.
Medication Management: Administer recommended drugs, such as bronchodilators and diuretics, to Sarah to control her COPD and heart failure and to maximize respiratory function.
Pulmonary Hygiene: Encourage and help with lung expansion activities such as deep breathing exercises, incentive spirometry, and mobilization as tolerated.
Monitoring and Assessment: Monitor Sarah’s vital signs, such as oxygen saturation, respiratory rate, and exertion, regularly to detect any changes or deterioration in her condition.
Fluid Management: Keep an eye on Sarah’s fluid intake and output, as well as her daily weight, and look for indicators of fluid overload, such as edema or increasing dyspnea. Adjust diuretic medication as needed in collaboration with the healthcare team.
Implement appropriate infection control measures, such as isolation precautions and hand cleanliness, to limit infection transmission and safeguard the safety of other patients and healthcare workers.
Emotional Support: To minimize anxiety and increase adherence to therapy, provide emotional support and education to Sarah and her family about her condition, treatment plan, and self-care practices.
Other Departments’ Roles:
Respiratory Therapy: Work with respiratory therapists to adjust respiratory therapies based on Sarah’s response and clinical states, such as nebulizer treatments, chest physiotherapy, and oxygen titration.
Consult with pharmacists to ensure optimal medication selection, doses, and potential drug interactions, taking Sarah’s comorbidities and the requirement for customized therapy into account.
Follow-up imaging, such as repeat chest X-rays, should be coordinated with the radiology department to monitor the clearance of bilateral pneumonia and assess the therapy response.
Laboratory Services: Use laboratory services to monitor Sarah’s blood gas levels, electrolyte balance, and other laboratory data, ensuring quick analysis and treatment plan revisions.
Case Management/Social Services: Include case managers and social services in discharge planning, care coordination, and appropriate post-discharge support services, such as home healthcare or rehabilitation, as needed.
Physical and occupational therapists should work together to encourage early mobilization, improve respiratory function, and increase Sarah’s overall functional ability during her hospital stay.
Nutritional Services: Work with dietitians to ensure Sarah receives appropriate nutrition while keeping her medical conditions and potential dietary restrictions in mind to promote her healing and overall well-being.
This multifaceted care approach entails a concerted effort from multiple departments to address Sarah’s respiratory distress, manage her comorbidities, maximize gas exchange, minimize fluid overload, and give emotional support. Throughout her stay, this coordinated approach attempts to improve Sarah’s respiratory function, boost rehabilitation, and improve her general well-being.
QUESTION:
Potential problems based on the findings of Sarah