NUR 721 i ii

ii

ACUTE CARE AND i i

MANAGEMENT
i

CASE STUDY i

BHAVNA iBHARTIKA iDEO i

S180677
GROUP iB

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i1
 BIO-DATA iOF iTHE iPATIENT

Patient’s iName: iJV

DOA: i13/08/20

Age:43

Gender: iMale

Race: iI-Taukei

Religion: iMethodist

Address: iCunningham istage iV

Occupation: iGrog iseller iat ithe imarket

Marital istatus: iMarried iwith i4 ichildren. iDaughter iis ia iknown iasthmatic

Medical icondition: iknown iasthmatic

Allergies: iNil iknown

Diagnosis: iLife-threatening iasthma i

Social ihistory: iPrevious ismoker, iquit i11 iyears iago. iConsumes ikava ioccasionally iand

inon- ialcoholic

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i2
 Introduction

This i43-year-old iI-Taukei, imale iwas ireferred ifrom iNuffield ihealth icenter ion ithe

i13/08/20 ito ithe iemergency idepartment iin iCWM ihospital iwith ithe idiagnosis iof ilife-

threatening iasthma. iHe iwas ithen iadmitted ito ithe iIntensive iCare iUnit i(ICU). iThe iclient

ipresented ihimself ito iNuffield ihealth icenter iwith ithe ichief icomplain iof iproductive icough

iand ifever ifor i3 idays iand ichest itightness iwhich icaused ihim ishortness iof ibreath ion ithat

imorning iand ihe iwas iunable ito ispeak. iHe iwas igiven isalbutamol inebulizer iat ithe ihealth

icenter. iUpon iadmission iin iICU, ihe iwas iintubated iwith i7.5 iendotracheal itube iat i22cm

ilip ilevel. iHe iwas ia icategory i5 ipatient inursed ion iventilator iwith iSIMV imode iwith

iFio2- i100%, iPEEP- i5cm iH2O, iPS- i100 iH2O, iVR-15 ib/min, iTV- i400 ib/min. iUpon

iauscultation, iextensive ibilateral iwheezes iwere iheard. iA iFoley icatheter isize i16 iwas

iinserted ifor ithe iurine ito idrain iand ia iright ifemoral icentral iline iwas iinserted. i

Overview iof ithe icondition i

Asthma iis ia ivery icommon imedical icondition iin iFiji iand iother icountries. iIt iis ia imedical

idisorder iwhich iaffects ithe iairways iwhich iis ithe ibreathing itubes iwhich itransmits iair ito

iour ilungs. iAsthma iis ifound ito ibe ia ilong-term iand ichronic idisease. iBasically, iit iis ia

icondition ithat iintermittently ierratically iinflames ithe iairways iin ithe ilungs, ithis

iinflammation ileads ito iswelling iof iairways iand ithus, inarrowing iof ithe iairways ioccur.

iPeriodically, iindividuals iwith iasthma ifind iit idifficult ito ibreathe iin iand iout, iit ican ibe

isaid ithat iit iis ilike ibreathing ifrom ia ithin istraw. iIndividuals idiagnosed iwith iasthma

imight iexperience isigns ithat ivary ifrom iminor ito isevere iand ithat imay ioccur iinfrequently

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i3
ior ievery iday. iWhen isymptoms iworsen, iit iis inamed ian iasthma iattack. iAsthma iaffects

ipersons iof iall iages iand ioften istarts iduring ichildhood. iThe iprecise icause iof iasthma iis

iunidentified, iand ithe icauses imay idiffer ifrom iperson ito iperson. iHowever, iasthma iis

ifrequently ithe ioutcome iof ia isolid ireaction iof ithe iimmune isystem ito ian iallergen iin ithe

iatmosphere. iFor iexample, iacquaintance ito ian iallergen iin ithe isetting, ilike iragweed, ican

imake iyour iairways irespond ipowerfully. iOther iindividuals iexposed ito ithe isame iallergen

imay inot ireact iat iall, ior itheir ireaction ican idiffer. iThe ipurpose ione iperson ireacts ito ian

iexposure iwhile iothers ido inot iis inot icompletely iunderstood, ithough iit imay ibe ipartially

iexplained iby igenes (Gulledge & Beard, 2015).

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i4
Life-Threatening iAsthma

Is idefined ias iprogressive irespiratory ifailure idue ito iasthma, irefractory ito itreatment iwith

iInhaled ibronchodilators iand isystemic icorticosteroid

Risk ifactors ifor ithe iclient’s icondition i

1. Environment- ihe ilives iin ia isquatter isettlement i

2. Stress- ihe iis ithe isole ibread iwinner iand ihe isells igrog ito isupport ihis ifamily i

3. Exposure ito isecondhand ismoking

4. Previous ismoker

5. Family ihistory iof iasthma i

6. Being ioverweight- ilack iof iphysical iactivity

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i5
 Diagnostic iTests iand iResults

Diagnostic Procedure Results

iTest
A ichest ix-ray iproduces iimages iof Hyper iin iflared, i
Chest iX-ray ithe iheart, ilungs, iairways, iblood nil isupine iconsolidation, i
Rt isided ishallow ichanges-
ivessels iand ithe ibones iof ithe ispine icardiac iborder ion iRt inot
ivery iclear
iand ichest. iAn ix-ray i(radiograph) iis

ia inoninvasive imedical itest ithat

ihelps iphysicians idiagnose iand itreat

imedical iconditions.

ABGs An iarterial iblood igas i(ABG) itest Respiratory iAcidosis

(Arterial imeasures ithe iacidity i(pH) iand ithe PH-7.31
iblood igases)
iNormal irange- i[7.350-7.450]
ilevels iof ioxygen iand icarbon
PCO2- i46 i
idioxide iin ithe iblood ifrom ian
Normal irange- i[35.0-45.0]
iartery. iThis itest iis iused ito icheck SPO2- i98 i
ihow iwell ithe ilungs iare iable ito Normal irange i[80 ito i100mmhg]

imove ioxygen iinto ithe iblood iand HCO3- i23

Normal irange i[22-26mEq/L]
iremove icarbon idioxide ifrom ithe

iblood.

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i6
 Treatment

Drug Effects Side ieffects Contraindications

Adrenalin i Adrenalin iacts iquickly ito  breathing iproblems Adrenalin iis icontraindicated

iimprove ibreathing,  fast ior ipounding iin ipatients iwith iknown

istimulate ithe iheart, iraise ia iheartbeats ihypersensitivity ito

idropping iblood ipressure, isympathomimetic iamines,

 pale iskin, isweating
ireverse ihives, iand ireduce iangle iclosure iglaucoma,
 nausea iand
iswelling iof ithe iface, ilips, iand iin inon-anaphylactic
ivomiting
iand ithroat. ishock. iIt ishould inot ibe
 dizziness
iused itogether iwith
 weakness ior
ianaesthetic iagents isuch ias
itremors
icyclopropane ior ihalothane
 throbbing iheadache
ias ithese imay isensitize ithe
 feeling inervous,
iheart ito iarrhythmic iaction
ianxious, ior
iof isympathomimetic idrugs
ifearful.
(Fanta, Cristiano, & Haver,

2013)

Ceftriaxone Ceftriaxone iselectively iand  rash  diarrhea ifrom ian

iirreversibly iinhibits  diarrhea iinfection iwith

ibacterial icell iwall isynthesis  nausea iClostridium idifficile

iby ibinding ito  vomiting ibacteria.

itranspeptidases, ialso icalled  upset istomach

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i7
 itransamidases, iwhich iare  blood iclots  a itype iof iblood

ipenicillin-binding iproteins  dizziness idisorder iwhere ithe ired

i(PBPs) ithat icatalyze ithe  headache iblood icells iburst icalled

icross-linking iof ithe ihemolytic ianemia.

ipeptidoglycan ipolymers  liver iproblems.

iforming ithe ibacterial icell  disease iof ithe

iwall. igallbladder.

Ceftriaxone iinjection iis  severe irenal

iused ito itreat icertain iimpairment.

iinfections icaused iby  yellowing iof ithe iskin

ibacteria isuch ias igonorrhea iin ia inewborn ichild.

i(a isexually itransmitted

idisease), ipelvic

iinflammatory idisease

i(infection iof ithe ifemale

ireproductive iorgans ithat

imay icause iinfertility),

imeningitis i(infection iof ithe

imembranes ithat isurround

ithe ibrain iand ispinal icord),

iand iinfections iof ithe

ilungs, iears, iskin, iurinary

itract, iblood, ibones, ijoints,

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i8
 iand iabdomen. iCeftriaxone

iinjection iis ialso isometimes

igiven ibefore icertain itypes

iof isurgery ito iprevent

iinfections ithat imay idevelop

iafter ithe ioperation.

iCeftriaxone iinjection iis iin

ia iclass iof imedications

icalled icephalosporin

iantibiotics. iIt iworks iby

ikilling ibacteria i (Fanta,

Cristiano, & Haver, 2013).

Prednisone i Prednisone iis ia isteroid  sleep iproblems  active, iuntreated

imedication ithat itamps idown i(insomnia), imood ituberculosis.

iinflammation. iPrednisone ichanges  inactive ituberculosis.

ilowers iyour iimmune isystem's  increased iappetite,  herpes isimplex iinfection

ireaction ito iease iswelling iand igradual iweight igain iof ithe ieye.

iother iallergic-type isymptoms.  acne, iincreased  a iherpes isimplex

isweating, idry iskin, iinfection.

Prednisone iand iother

isystemic isteroids imay ibe ithinning iskin,  an iinfection idue ito ia

ibruising ior ifungus.

iused ito itreat iasthma iattacks
idiscoloration
iand ito igive iyou ibetter
 slow iwound ihealing

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i9
 icontrol iover iyour iasthma.  headache, idizziness,  intestinal iinfection

iSteroids iare iused iwith iother ispinning isensation icaused iby ithe

iasthma imedications ito ieither  nausea, istomach ipain, iroundworm

icontrol isudden iand isevere ibloating iStrongyloides.

iasthma iattacks ior ito itreat  a icondition iwith ilow

ilong-term, ihard-to-control ithyroid ihormone ilevels.

iasthma i (Fanta, Cristiano, &  diabetes

Haver, 2013).

Cloxacillin i Cloxacillin iis ian iantibiotic Gastrointestinal: iNausea,  Allergic ito

iuseful ifor ithe itreatment iof ivomiting, idiarrhea, iCloxacillin ior iother

ia inumber iof ibacterial istomach iache iantibiotics iincluding

iinfections. iThis iincludes • i iBlood: iLow iblood ipenicillin itype

iimpetigo, icellulitis, icounts imedications i(e.g.

ipneumonia, iseptic iarthritis, • i iAllergic ireaction: iamoxicillin.

iand iotitis iexterna. iIt iis inot iItching, irash, ifever, iPenicillin,

ieffective ifor imethicillin- isevere iallergic ireactions iampicillin)

resistant iStaphylococcus ilike iangioedema iand  medical ihistory iof

iaureus i(MRSA). ianaphylaxis ikidney iproblems

• i iCardiovascular

isystem: iLow iblood

Cloxacillin iis iused ifor ito
ipressure
ithe itreatment iof iseveral

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i10
 iinfections ithat imay iinclude • i iBrain: iConfusion,

iendocarditis i(infection iof ilethargy, itwitching,

ithe iinner ilayer iof ithe iseizures

iheart), ipneumonia • i iKidneys: iLoss iof

i(infection iof ithe ilung) iand iblood ior iprotein iin ithe

iother irespiratory itract iurine, ikidney idamage

iinfections, ibone iand ijoint • i iLiver: iIncreased iliver

iinfections, isepsis i(blood ienzymes, iliver idamage

iinfection), iskin iand isoft • i iSuperinfection:

itissue iinfections iand iInfection iof ithe idigestive

iurinary itract iinfection i itract iwith icertain ibacteria

(Fanta, Cristiano, & Haver, ilike iClostridium idifficile

2013). iand ifungi imay ioccur iif

icloxacillin iis

iadministered ifor ia

iprolonged iduration.

Ventolin inebs Ventolin iNebules iare  nervousness

 overactive ithyroid
iindicated ifor iuse iin ithe  shaking i(tremor)
igland
iroutine imanagement iof  palpitations
 diabetes
ichronic ibronchospasm  headache

iunresponsive ito  a imetabolic icondition

iconventional itherapy, iand iwhere ithe ibody

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i11
 iin ithe itreatment iof iacute  mouth/throat icannot iadequately

isevere iasthma idryness ior iuse isugars icalled

iirritation iketoacidosis
(Fanta, Cristiano, & Haver,
 cough
2013).  excess ibody iacid
 hoarseness
 low iamount iof
 sore ithroat
ipotassium iin ithe

iblood

 high iblood ipressure

 diminished iblood

iflow ithrough iarteries

iof ithe iheart

 a ilow isupply iof

ioxygen irich iblood

ito ithe iheart

 prolonged iQT

iinterval ion iEKG

 abnormal iheart

irhythm

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i12
  abnormal iEKG iwith

iQT ichanges ifrom

ibirth

 seizures

Heparin i Heparin iis iused ito iprevent  bruising imore ieasily.  hypersensitivity, ipast ior

iblood iclots ifrom iforming  bleeding ithat itakes ipresent iheparin-induced

iin ipeople iwho ihave icertain ilonger ito istop. ithrombocytopenia iand

imedical iconditions ior iwho  irritation, ipain, iactive ibleeding.

iare iundergoing icertain iredness, ior isores iat

imedical iprocedures ithat ithe iinjection isite.

iincrease ithe ichance ithat  allergic ireactions, isuch

iclots iwill iform i (Fanta, ias ihives, ichills, iand

Cristiano, & Haver, 2013). ifever.

 increased iliver

ienzymes ion iliver

ifunction itest iresults.

Salbutamol  Relief iof isevere  headache.  Patient iwith ihistory iof

ipuffs i ibronchospasm ihypersensitivity iof iany

icomponents

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i13
  Hyperkalemia i  feeling inervous,  hypertension

irestless, iexcitable

iand/or ishaky.

 fast, islow ior iuneven

iheartbeat.

 bad itaste iin ithe

imouth.

 dry imouth.

 sore ithroat iand icough.

 inability ito isleep

Pantoprazole i Used ito itreat icertain  Headache i  Diarrhea ifrom ian

istomach iand iesophagus  Diarrhea i iinfection iwith

iproblems i(such ias iacid  Nausea i iClostridium idifficile

ireflux). iIt iworks iby ibacteria.

idecreasing ithe iamount iof  Inadequate ivitamin

iacid istomach imakes. iThis iB12

imedication irelieves  Low iamount iof

isymptoms isuch ias imagnesium iin ithe

iheartburn, idifficulty iblood

iswallowing iand ipersistent  A itype iof ikidney

icough. iIt ihelps iheal iacid iinflammation

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i14
 idamage ito ithe istomach icalled iinterstitial

iand iesophagus, ihelps inephritis

iprevent iulcers, iand imay  Subacute icutaneous

ihelp iprevent icancer iof ithe ilupus ierythematosus

iesophagus. iPantoprazole  An iautoimmune

ibelongs ito ia iclass iof idisease i

idrugs iknown ias iproton

ipump iinhibitors i(PPIs)

(Fanta, Cristiano, & Haver,

2013).

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i15
 Nursing iCare iPlan

Assessment Nursing i Planning i Intervention i Evaluation i

Diagnosis i

Subjective iData Ineffective Patient iwill 1. Monitor At ithe iend iof

 Productive ibreathing iattain ioptimal ipatient’s ithe inursing

icough i ipattern irelated ibreathing ivital iintervention

 Fever ito iswelling ipattern isigns i ithe ipatient

 Shortness iand ispasm iof 2. Monitor ihad

iof ibreath ithe ibronchial irespiratory iestablished

 Chest itubes iin irate, ioptimal

itightness iresponse ito idepth iand ibreathing

i iinhaled irhythm. ipattern, ias

iirritants, 3. Auscultate ievidenced iby

i
iinfection. i ilung irelaxed
Objective iData
ifields iand ibreathing iand
BP-222/116
iassess inormal
imm/hg
ibreath irespiratory
P-127 ib/min
isounds i irate. i
Tempt-38C
4. Assess ifor
RR- i25b/min
ithe iuse
SPO2- i87%
iof
CBG- i7.7mol/l
iaccessory

imuscles

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i16
 iand isigns

iof inasal

iflaring

5. Monitor

ioxygen

isaturation

ii

6. Monitor

iarterial

iblood

igasses

ivalues

7. Maintain

ihead iof

ithe ibed

ielevated i

8. Encourage

iclient ito

iuse

ipursed-lip

ibreathing

ifor

iexhalation

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i17
Discharge iPlan iand iFollow iup iCare i
The iclient iwas idiagnosed iwith ilife-threatening iasthma. iAnd ithe iclient iwas itrans-out ito

iacute imedical iward iafter iday i5 iof iICU icare, ihowever iupon idischarge:

 Client iwill ibe iadvised iwell ion imedication icompliance, iwhat ithe imedications ido,

ihow i(route) ito itake ithe imedications iand iwhen i(time) itake imedications.

 Client iwould ibe ieducated ion idiet iand inutrition, iaccording ito ihis icondition.

 Client iwould ibe ieducated ion ihome icare iand isimple iactivities ifor idaily iexcises ito

ihelp iMr. iJV icope iwith ihis icondition.

 The iclient iwill ibe iadvised ito ipresent ihimself ito ithe inearest ihealth ifacility iif ihe

iexperience iany iunusual isymptoms ior ichanges iin ihis icondition iand ialso ipresent

ithe idischarge isummary.

 Client iwill ibe ibooked ifor idischarge iclinic iand iwill ibe igiven ithe iclinic idate iand

iadvised ion ithe iimportance iof iattending ihis iclinics. i

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i18
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Fanta, iC. iH., iCristiano, iM. iL., i& iHaver, iE. iK. i(2013). iThe iharvard imedical ischool

iguide ito itaking icontrol iof iasthma. iNew iYork: iFree ipress.Pg ino. i121-125

Gulledge, iJ., i& iBeard, iS. i(2015). iAsthma iManagement; iClinical ipathways, iGuidelines

iand iPatient iEducation. iUnited iStates iof iAmerica: iAspen iPublication.Pg ino.132,

i217-129

BHAVNA iBHARTIKA iDEO i i i i i i i i i i i i i i i i i i i iS180677 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i

i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i pg. i19