Directions
Sarah is a 69-year old female that presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. You notify the provider, and he orders oxygen at 2 L via nasal cannula NC. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas result are below:
pH: 7.30
PaCO2: 58 mm Hg
PaO2: 78 mm Hg
HCO3: 26 mEq/L
Sarah is admitted to a general medical floor. You are the nurse assigned to Sarah.
1. What potential problems can occur based on the above findings?
2. How would you provide multidimensional care for Sarah?
3. Describe the roles of other departments in Sarah’s treatment plan.
Refer to the scenario and direction above to Reply to the post below. Do you agree with it, and why?
What potential problems can occur based on the above findings?
The arterial blood gas depicts respiratory acidosis due to the low pH readings of 7.30 and high levels of PaCO2 of 58 mmHg. Based on the findings, Sarah can experience blurred vision, wheezing, and a blue tint on her hands and feet, mainly due to her low oxygen levels and anxiety (Patel & Sharma, 2021). Respiratory acidosis is when one experiences a ventilation failure and an accumulation of carbon dioxide (Patel & Sharma, 2021). Mainly it occurs as a result of alveolar hypoventilation. The elevated partial pressure of carbon dioxide leads to a decreased ratio of arterial bicarbonate to arterial PaCO2, thus lowering the pH levels (Patel & Sharma, 2021). Sarah’s medical history illustrates that she has comorbidities; Chronic Obstructive Pulmonary Disease (COPD), pneumonia, and heart failure. In addition, COPD obstructs the airway, which worsens Sarah’s situation considering the low levels of PaO2.
How would you provide multidimensional care for Sarah?
Multidimensional care has proven to be efficient in patients with comorbidities. Sarah’s multidimensional care entails managing COPD and heart failure, with priority care being pneumonia and hypoxia. Multidimensional care seeks to manage all patient comorbidities with priority given to the disease that affects one’s airway or the management of low oxygen saturation levels and medical treatment. I would also ensure that Sarah feeds to meet her nutritional requirements. At the time of discharge, I would provide patient education on regulating her diet by informing her on fluid regulation, consumption of low levels of sodium, and healthy lifestyle changes. Finally, I would encourage Sarah to adhere to the medication regimen for a better prognosis.
Describe the roles of other departments in Sarah’s treatment plan.
Sarah needs care from a multidisciplinary team due to her comorbidities. The other departments involved in Sarah’s treatment plan include internal medicine, nutrition, physiotherapy, and the senior department. The physicians will help manage heart failure and COPD, pneumonia, and heart failure. The nutrition department will help Sarah develop a meal plan suitable for her state of health. The physiotherapist would provide a range of motion exercises to improve physical health. Finally, being a geriatric patient, a geriatric nurse will teach Sarah ways to prevent the most prevalent falls in the geriatric population.