ANSWER:
Potential Issues:
Sarah’s low pulse oximetry measurement of 82% on room air suggests insufficient oxygenation, which can result in tissue hypoxia and organ failure.
Respiratory Acidosis: The arterial blood gas findings show a high PaCO2 level (58 mm Hg) and a somewhat low pH (7.30), indicating respiratory acidosis due to inadequate breathing.
Complications of Pneumonia: Bilateral pneumonia can cause sepsis, respiratory failure, and aggravation of pre-existing illnesses such as heart failure and COPD.
Care on Multiple Levels:
Oxygen Therapy: Ensure that 2 L of oxygen is administered through a nasal cannula to promote oxygenation and raise Sarah’s pulse oximetry readings. Monitor the oxygen saturation and adjust the flow rate as appropriate.
Respiratory Support: As directed, administer respiratory treatments such as nebulized bronchodilators and chest physiotherapy to help improve airway clearance and reduce respiratory distress.
Drugs: Administer recommended drugs as soon as possible, including antibiotics for pneumonia, diuretics for heart failure, and bronchodilators for COPD bronchospasm.
Fluid Management: Keep a close eye on Sarah’s fluid intake and output to ensure proper hydration, especially given her history of heart failure.
Monitor Sarah’s vital signs, including blood pressure, heart rate, breathing rate, and temperature, regularly to look for abnormalities that indicate increased respiratory distress or infection.
Symptom Management: Address Sarah’s symptoms, such as shortness of breath and discomfort, with interventions such as posture, relaxation techniques, and pain relief.
Encourage early mobilization and ambulation as tolerated to avoid consequences associated with prolonged bed rest, such as pneumonia-related complications, venous thromboembolism, and deconditioning.
Education and Self-Care: Educate patients and families on how to manage chronic diseases, recognize worsening symptoms, adhere to medicine, use oxygen, and prevent infection.
Psychosocial Support: Evaluate Sarah’s emotional state and offer supportive care. Engage her family or support system to discuss concerns or provide assistance.
Collaboration with an Interprofessional Team: Collaborate with other healthcare experts, such as respiratory therapists, physical therapists, social workers, and case managers, to ensure that Sarah’s treatment is holistic and coordinated.
Other Departments’ Roles:
Respiratory therapists can help with respiratory treatments, provide knowledge in oxygen therapy, and develop techniques to improve lung function and ventilation.
The radiology department is critical in verifying the diagnosis of bilateral pneumonia by interpreting chest X-rays and providing ongoing imaging investigations to monitor Sarah’s status.
Pharmacists guarantee correct prescription orders, assess potential drug interactions, modify dosage depending on renal and hepatic function, and give experience in optimizing pharmacotherapy for Sarah’s various diseases.
Laboratory Services: Laboratory technicians do blood tests and analyze arterial blood gas samples to determine Sarah’s acid-base status, oxygenation levels, and overall metabolic performance.
Physical therapists can help Sarah enhance her functional ability and respiratory muscle strength by assisting her with mobilization, ambulation, and pulmonary rehabilitation.
Social workers assist patients and families with discharge planning, locating community resources, addressing psychosocial issues, and enabling communication among various healthcare providers.
Case Management: Throughout Sarah’s hospital stay, case managers coordinate her care, ensuring smooth transitions between levels of care, promoting interdisciplinary communication, and lobbying for appropriate resources and services.
It should be noted that the title offered is “Multidimensional Care for a Geriatric Patient with Heart Failure, COPD, and Bilateral Pneumonia.”
QUESTION:
What potential problems can occur based on the above findings? How would you provide multidimensional care for Sarah? Describe the roles of other departments in Sarah’s treatment plan.