Oxygenation

Mt. Cook, South Island New Zealand
photo copyright clinton allen

There will be no classroom session for this content. All activities will be posted on the newsgroup.

Complete reading prior to beginning the activity assigned for your clinical group. To receive credit for this work, all group postings to the Speakeasy must be completed by Wednesday 4/14/99. Individual comments on group postings must be completed by Wednesday 4/21/99

Reading Assignment : Perry and Potter, Chapter 44, p. 1198-1203, 1206-1212, 1214-1220 (omit suctioning), 1226-1227, 1232-1236, 1243-1244.

Useful Resource:
Carlson-Catalano, J. , Lunney, M. Paradiso,C et al. (1998). Clinical validation of ineffective breathing patterns, ineffective airway clearance, and impaired gas exchange. Image 30(3), 243-248.

Learning Activities:
1. Each clinical group is to complete the case assigned to that group and post responses on Speakeasy.

2. Each individual is to read the postings of all clinical groups and respond to one posting by describing EITHER how the information is or will be useful in the clinical setting or what information in the posting was most valuable and why.

3. Cite all sources using correct APA format.

CASES

Section 1:

Your client is a 60 year old female named Sharon. Sharon is the executive secretary for one of the partners in a large law firm. She is very computer literate and loves to surf the web in her spare time. She stays in touch with her children and grandchildren via email each week. She has no history of chronic illness and sees the health care provider only for her yearly female exam and mammogram. She takes estrogen and progesterone daily to prevent osteoporosis. She also takes aspirin occasionally for headache or joint aches. Both of her parents died in their early 70's of myocardial infarction. She is worried about getting cardiovascular disease and would like to decrease her risk. She walks for 30 minutes 2 times a week. Her diet is low in fat but high in calories because she consumes a lot of nonfat high calorie snacks and eats only one complete meal, dinner, each day because she is very busy. She eats red meat less than once a week and has chicken, fish or vegetables as a main dish the rest of the time. She is 25 pounds over her desired and usual weight. She smokes 5 cigarettes per day and would like to quit.

1). Identify specific changes that Sharon might make in her lifestyle to decrease her risk of cardiovascular disease. Provide scientific rationale from the literature for each change.

2.) Identify three (3) specific programs that are available in Spokane that Sharon might use to help her stop smoking. List the names of the programs, their street address and phone number, eligibility requirements, if any, and the services they provide.

3.) Identify four (4) high quality web sites that Sharon might access for useful and current information on smoking cessation. List the URL for each site. Summarize the contents of the site. Evaluate the site using the Albany criteria.

Section 2:

Marty Morris, age 76, has smoked 2 packs of cigarettes per day for the past 60 years. Yesterday he had abdominal surgery and he has a midline incision. His temperature is 99.2 F, Pulse 80, Respirations 22. His PaO₂ is 78mmHg. He is not coughing effectively and has developed coarse crackles in both lung bases that do not clear with cough. He is not using his incentive spirometer effectively. He says his pain is at a 2 on a scale of 10 except when he coughs and then it is a 7. He is receiving Morphine Sulfate 2mg per IV bolus q 10 minutes by a patient controlled infusion device (PCID).

1. Identify six (6) high priority interventions directly related to increasing Mr. Morris' oxygenation. State the rationale for prioritization and provide supporting data from both the case history and the literature.
2. Describe the rationale from the literature for each intervention and relate the rationale directly to Mr. Morris. Cite your sources using correct APA format.
3. Describe the objective evidence needed to measure the effectiveness of each intervention. Be sure to consider the physiological parameters.

Section 3:

Mary, aged 62, has chronic bronchitis. Her p0₂ is 60, pCO₂ 55. Her temperature is 97.2, pulse 110, respirations 30. Her breathing is both rapid and shallow. Her lung sounds are decreased throughout, with scattered crackles and loud expiratory wheezes. She complains of dyspnea upon moving about in bed. She is on oxygen by nasal cannula at 2L/min. The nasal cannula is often removed by her or positioned on her forehead. Her orders include Cipro (ciprofloxacin) 500mg. p.o. q 12H, Albuterol metered dose inhaler 2 inhalations q 4-6 hours and Atrovent inhaler 3 inhalations qid.

1. Identify six (6) high priority nursing interventions directly related to increasing Mary's oxygenation. At least three of these must be independent nursing interventions. State the rationale for prioritization and provide supporting data from both the case history and the literature.
2. Descibe the rationale from the literature for each intervention and relate the rationale directly to Mary.
3. Describe the objective evidence needed to measure the effectiveness of each intervention. Be sure to consider the physiological parameters.

Section 4

Jake is a 55 year old man who is 5 days post-myocardial infarction. He has come to the subacute unit at Memory Palms Nursing Home for rehabilitation. He is on Digoxin 0.25 mg daily, Lasix 40 mg daily, KCL extended release tablets 20 meq. Bid, glipizide 10mg daily, aspirin 300mg daily, and atenolol 50 mg daily. His blood pressure is 140/80, resting pulse 65, respirations 18. His physician has written an order for "progressive ambulation. He becomes dyspneic, his pulse increases to 110-120, and his respirations increase to 35 after he walks 20 feet.

1. Write two (2) complete nursing diagnoses based on this data. For each diagnosis identify the objective and subjective data supporting the diagnosis.
2. Identify (3) high priority nursing interventions for each diagnosis. Describe the rationale from the literature for each intervention and relate the rationale directly to Jake.
3. Describe the objective evidence needed to measure the effectiveness of each intervention. Be sure to include physiologic parameters.

Section 5:

You are caring for John at home. John is on continuous O₂ because he has end-stage Chronic Obstructive Lung disease. His oxygen is provided by a room-air concentrator. He lives alone in a duplex. He has a personal aide who comes each morning to help him dress and bathe. His lunch is brought to him by Meals on Wheels. His neighbor comes over when ever he calls her for help. Despite many previous attempt to teach him the dangers of smoking in the presence of oxygen, he continues to smoke with his O₂ in place. He says he likes smoking and will continue until he dies. He must have his oxygen to survive.

a). Describe as many of the possible consequences as you can think of, if John continues to smoke with his oxygen in place? Support with scientific rationale from the literature.

b). Brainstorm and list as many approaches as you can think of that can be used to increase his safety but allow him to continue to smoke and to use his oxygen.

c). Select the four (4) approaches you think will be most effective. State rationale from the literature to support your conclusions and relate directly to this situation.

Yakima:

Case: Mr.Lee, a Chinese immigrant, aged 64, was admitted last evening for severe shortness of breath. He is a 3 pack a day smoker and has smoked for 35 years. He worked in a foundry for 20 years where he was exposed to many volatile chemicals. No respiratory protection was provided on the job. He also lived for 20 years in Beijing which is very dusty and has high levels of air pollution. He was diagnosed with Chronic Obstructive Pulmonary Disease 5 years ago. This morning when you assess him he is so short of breath he can only say two to three words then he needs to stop and breathe. He is pale and diaphoretic. He says he had two episodes of chest pain during the night but he didn't tell anyone because "they weren't very bad and I didn't want to bother the nurses". His pulse is 120, Respirations - 36, B/P - 90/60. His skin is cool and clammy. He is on oxygen at 2L/min per nasal cannula, Albuterol 2 inhalations q 4 hours, Atrovent 2 inhalations qid, and Cipro 500 mg q 12 hours.

a). Identify at least six (6) immediate nursing interventions. Describe the rationale from the literature for each intervention and relate the rationale directly to Mr Lee.

b). Describe the objective evidence needed to measure the effectiveness of each intervention. Be sure to include physiologic parameters.

c). Describe common norms in Chinese culture that may affect his willingness to seek help or to express distress. Support with data from the literature. Based on this information, identify 3-4 possible approaches to Mr. Lee's reluctance to "bother the nurses.
Other useful sources re: Chinese culture:
Purnell, L. & Paulanka, B. (1998). Transcultural health care. Philadelphia, F. A. Davis Co.
Giger, J. & Davidhazar, R. (1995). Transcultural nursing. 2nd edition. St. Louis, Mosby Co.

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