Enhancing Nursing Care through Patient Assessment and Intervention

Introduction

In nursing care, the nurses are to show empathy and develop a collaborative relationship with the patients so that they can identify the root cause of health problem and explain reason behind the symptoms been raised along with ensure appropriate treatment and enhanced diagnosis of the disease. For those working on similar topics, seeking nursing dissertation help can provide valuable insights into effectively addressing such cases. In this assignment, the case of Sharon is to be focussed and health assessment is to be made for the patient by using the ABCDE assessment framework and GSF framework. Thereafter, the nursing intervention required for improving health of Sharon is to be explained. The self-care management to be followed by Sharon is to be discussed.

Assessment of health status of Sharon

The GSF (Gold Stannard Framework) is the set standards to be followed by the nurses, health practitioners and other medical staffs in delivering high quality care to the patient (GSF, 2021). The framework is to be used currently to determine the way nurses are to effective assess the health of Sharon to understand and plan intervention. The ABCDE approach is an enhanced clinical tool for the assessment and treatment of the patients at the initial stage in acute and surgical emergencies. The approach supports strong prehospital first-aid as well as in-hospital treatment for the well-being of the patient. It helps in identifying the level of seriousness of the condition and assist in prioritising initial intervention to be made for the patient’s enhanced health and well-being (Smith and Bowden, 2017). Thus, the ABCED approach is to be used for making immediate analysis of the health condition of Sharon so that immediate care required by the patients can be determined in emergency manner. According to GSF, the nurses are to be able to control the health symptoms of the patients in effective manner (GSF, 2021). Thus, to control the symptoms, initially the nurses caring for Sharon is to identify them and therefore, the use of ABCDE assessment is essential.

The ABCDE approach stands for Airway, Breathing, Circulation, Disability and Exposure (Fernández-Méndez et al., 2019). The airway and breathing assessment of Sharon is important as she is already known to asthma which is related with complication in the airways and lungs. The airway assessment is made to determine the patency of the airways and evaluate any risk of deterioration in the ability of the patient for protecting their airways. The airways are mentioned to be clear when the patients are able to talk whereas it can be considered partially obstructed when the air entry is reduced and create nose during breathing (McCauley et al., 2019). In case of Sharon, the airway assessment mentioned that her airways are partially obstructed due to which she was unable to breath properly leading to audible wheezing during breathing and was unable to complete full sentences.

The breathing assessment is aimed to determine the level of respiratory distress and hindered respiratory symptoms been faced by the patient (Vanders et al., 2019). The initial assessment for breathing is made by counting the number of breaths taken by the patient in a minute (Gibson and McDonald, 2017). The normal breathing rate is 12-20 breaths/min and increase in the rate indicates deterioration of the health condition (McGrath et al., 2017). In case of Sharon, the breathing rate is 26 breaths/min which indicates that she expresses hyper breathing activity out of breathlessness. The peripheral oxygen saturation by using pulse oximeter is to be measured to determine the level of oxygen saturated in the blood. This is because lower oxygen saturation leads to cause damage to the organ functioning that makes the person face hindered health consequence (Hudson et al., 2018). The normal oxygen saturation in room air is 94-98% (Smith and Hofmeyr, 2019). However, in case of Sharon, the oxygen saturation is found to 90% on room air. The GSF mentions that nurses are to effectively communicate with patients to determine their needs and demands regarding care as well as inform them the way to deliver care (GSF, 2021). Thus, the nurse during health assessment of Sharon tried developing communication with her, but she was found to only reply in short words and cannot form full sentences which led the nurse to face hindrance in determining her personal needs of care to some extent.

The people suffering from asthma are mentioned to be at double risk of facing cardiovascular event such as heart attack and related condition (Wang et al., 2021). Thus, the heart rate of Sharon who is suffering from asthma is assessed to identify any risk related to cardiac disorder or if the current exacerbation of asthma has led to increase the heart rate of the individual. The normal heart rate of human is 60-100 beats/min (Rexlin et al., 2020). However, the case study mentions that Sharon’s heart rate is 115 beats/min which indicate that she has an elevated heartbeat. The increased heart rate is experienced during shortness of breath because there is increased need for oxygen created within the body due to breathlessness which is required to be compensated to increased supply of oxygenated blood to the organs for their proper function (Scarano et al., 2021). Therefore, the increased heart rate in Sharon is important aspect to be focussed on for health improvement.

The blood pressure is another aspect evaluated in patients for circulation assessment. The normal blood pressure for patient is 140/90 mmHg (Hertz et al., 2020). The blood for Sharon is measured by using sphygmomanometer and it was recorded 140/85 mmHg. This indicates that Sharon blood pressure is slightly lower than normal and required intervention to normalise the condition. The disability assessment is executed to review the neurological status of the patient (Jevon, 2019). In case of Sharon, the disability assessment mentioned that she has full awareness of the condition and was conscious which is evident as responded and informed by herself regarding the problem and her health condition to nurses. The response to pain is assessed to determine the level of painful stimulus faced by the patient as a result of the current health condition (Jevon, 2019). The pain score of 0 indicates no pain, 1-3 is mild pain, 4-7 is moderate pain and 8-10 is severe pain (DeMellow et al., 2020). The pain score recorded for Sharon through APVU method is 4 out of 10 which indicates that she is suffering from moderate pain due to the current condition.

In disability assessment, the blood glucose level is measured in individual to exclude chances of hypoglycaemia in patients (Steele et al., 2017). The normal blood sugar level of patient is 7.8 mmol/L and reading more than 11.1 mmol/L is considered hypoglycaemic state and the normal peak flow is usually below 180 mg/dL (Johnston et al., 2019). In case of Sharon, her blood sugar level recorded is 4.8 mmol/L and peak flow is 240 which indicates that she is suffering from hypoglycaemic state. The body temperature recorded for Sharon is 38.7 which is slightly higher than normal which is 36.7 (Chen et al., 2021). The presence of increased body temperature or fever along with breathlessness indicates that the person is suffering from chest infection (Ito et al., 2017). Thus, the combination of assessment of symptoms through diagnosis conforms that Sharon is suffering from respiratory tract infection that is to be managed immediately.

The exposure assessment in patient is executed to determine the presence of any superficial spots or rashes or cuts on the body that may interfere with their health condition to be worsened (da Silva Moraes et al., 2019). The exposure assessment of Sharon is to be done with dignity and full willingness so that the rights and self-esteem of the patient is valued during care which is essential for delivering quality care support to patients (Mohamed et al., 2018). The exposure assessment of Sharon indicates that she has no superficial allergies ore cuts that may have interfered with her current worsened asthmatic state. The GSF mentions that nurses are to recognise the life-timing condition of the patient and assist them in planning ahead regarding the way to lead better life (GSF, 2021). This indicates that nurse assessing Sharon’s health is to inform her the care plan to followed by her in limiting her current symptoms and ensuring her better life-time management of respiratory complication current been expressed.

Nursing Intervention for Sharon

The initial problem to be resolved is reducing Sharon’s breathing rate of 26 breaths/min to 20 breaths/min and increased oxygen saturation above 95% from the current 88% at room air. The NICE guidelines mention that to increased oxygen saturation and improve the breathing ability of individuals during breathlessness out of respiratory tract infection, they are to be provided oxygen therapy (NICE, 2019). The oxygen therapy is the intervention in which supplementary oxygen is provided to the patient through venturi mask. This is because supplemented oxygen helps in delivering increased level of oxygen into the body compared to the amount accessed from normal air which helps in resolving the lack of oxygen created within the body (Guo et al., 2020). The non-invasive ventilation (NIV) is to be used in delivering supplement oxygen to the patient. This is because it helps in lowering the tidal pressure on the respiratory muscles as well as enhance tidal volume and reduce increased breathing rate by managing diaphragm working. It is executed to translate increased oxygenation and reducing hypercapnia that is essential action for shortness of breathing (Jünger et al., 2020).

The NIV is to be used for Sharon because the NIV approach is less traumatic and lowers the risk of additional infection to be passed to the respiratory tract along with reduces chances of respiratory failure (Jünger et al., 2020). The case study informs that Sharon already is suffering from respiratory tract infection and is under moderate pain. Thus, the use of NIV in this condition by the nurses to execute oxygen therapy would help in limiting pain or trauma and reduce the chances of additional infection of the respiratory tract. The oxygen saturation and pH level of the blood of Sharon is to be monitored by the nursing by executing blood gas test after 30-60 min interval (Gattinoni et al., 2018). This is to ensure that Sharon’s lungs are working effectively and the NIV intervention is effective in lowering her increased shortness of breath. The second nursing intervention to be made for Sharon is the use of drug therapy for lowering her increased respiratory tract infection. This is required to normalise her breathing efficiency and working of the airways to ensure enhanced well-being.

The drug therapy for respiratory tract infection is to be made for Sharon because it is reasonable and safe along with ensures enhanced recovery of the patient. The NICE guidelines mention that Amoxicillin is the first choice of medication to be used by the nurse under prescription from pulmonologist to provide orally to the patient suffering from respiratory tract infection (NICE, 2019). The amoxicillin is the beta-lactam antimicrobials that act through binding with the penicillin proteins for inhibiting transpeptidation which leads to activate autolytic enzymes in the bacterial cell for it to be destroyed. It helps in lowering the infection rate and healing of the respiratory tract (Veeraraghavan et al., 2021). In case Amoxicillin is unsuitable for Sharon, the medication such as doxycycline, erythromycin and clarithromycin are to be provided (NICE, 2019). The erythromycin acts as macrolide antibiotic that works to stop the growth of the bacteria and avoid the spread of infection in the respiratory tract (Scaglione et al., 2018). The doxycycline acts by inhibiting the protein synthesis in bacteria by binding with the 30S ribosomal unit which helps in lowering intensity of infection of the respiratory tract (Rahman et al., 2020).

The nurses to determine the level of infection level of Sharon are required to test sputum sample after a week of administration of the medication to the patient. This is required to ensure the additional improvement in treatment through antibiotic is to be made to resolve the respiratory tract infection of Sharon. The hypoglycaemia is the condition in which the blood glucose level is lower than the normal and it affects to create complication such as increased palpitation, sweating, feeling of fatigue and others along with raises risk of death based on its severity (Amiel et al., 2019). In the current condition, the nurses are to provide intervention for Sharon to manage her hypoglycaemic state that may have increased heartbeat along with shortness of breath. The nursing intervention to be provided is administering 50% dextrose intravenously to the patient and in absence of intravenous delivery, the intramuscular glucagon is to be provided to the patient to resolve hypoglycaemia. This is because it would help in resolving the lack of glucose developed in the body (Villani et al., 2017).

Self-care management and future care for Sharon

The practicing of self-care management for health is important for the patients to make them feel independent and empowered to take own care (Athilingam and Jenkins, 2018). It is also essential as it helps the family have low burden of care to manage the well-being of the patient (Ausili et al., 2017). The initial self-manage strategy to be adopted by Sharon is ensuring wearing of mask in polluted areas and places where there is increased dust practices or probability of presence of macrobacteria that may cause infection of the airways. This is because it would help the patient to protect entry of unwanted bacteria or particles that may cause irritation or infection of the airways that leads to breathlessness and increased execration of asthmatic state (Kähler and Hain, 2020). Thus, Sharon is to be ensure that is further redecoration of her room, she is ensure wearing face mask to protect herself from infection. The other self-management to be adopted by Sharon is ensuring presence of well-ventilated rooms with air filters that are to be cleaned and changed properly after certain interval of time. This is because enhanced ventilation leads increased air to be present for the asthmatic patients to breath and the air filters assist in trapping microorganisms and dust particles, in turn, helping to avoid triggering of betrothing problem in asthmatic patients like Sharon (Zhu et al., 2020).

Sharon is required to ensure keeping her inhaler always handy to be used in emergency situation of breathlessness. She is to learn regarding the breathing exercise such as pursed lip breathing and others so that she can use them to enhance her breathing efficiency. Sharon required to increased fluid intake as self-care strategy to cope with respiratory tract infection and asthma. This is because it helps in keeping the mucus thinner which aids in enhanced breathing without feeling of blockage of the respiratory tract due to deposition of mucus (Dickey, 2018). In order to manage hypoglycaemia, Sharon is required to ensure effective intake of food as self-care activity. For this purpose, she is required to visit a dietician and develop a diet chart to be followed as per her health condition. This is because dieticians are professionals with expert knowledge regarding the nutrient content present in each food that to be provided to patients based on their health condition to ensure their well-being and good health (Suhl et al., 2017). The self-care to be adopted by Sharon is that she is involved in physical activity with the help from physical trainer. This is because enhanced physical activity helps in enhancing lung capacity along with reduce inflammation that helps in improving overall respiratory system of patients with asthma (Yang, 2019). Moreover, effective physical exercise helps in keeping the blood sugar under control which reduces chances of hypoglycaemia or hyperglycaemic state in patients (Area, 2017).

Conclusion

The above discussion informs that Sharon is an asthmatic patient who currently facing breathlessness and has been admitted to the hospital with detection of respiratory tract infection. The ABCDE assessment indicates that Sharon is suffering from respiratory infection of the airways and has breathing problem. Her heartbeat has increased with slightly low blood pressure. She is seen to be effectively conscious but has pain perception of 4 out of 10 and has hypoglycaemia. The nursing intervention for respiratory infection for Sharon includes administering oral medication like amoxicillin and erythromycin and others if amoxicillin is unsuitable for her. She is to be provided non-invasive oxygen therapy to reduce her breathlessness and enhance her oxygen saturation level. The use of effective diet, clean and airy rooms, pollution mask and others are to be used as self-care strategies by Sharon to manage her hypoglycaemic state and respiratory complications.

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