Health Assessment and Nursing Intervention for Patient Sharon

Introduction

The health assessment of the patient helps to ensure safe and effective nursing practice as it informs the nurses regarding the risk to be faced by the patient, in turn, making them take steps to implement effective medical intervention to improve the health of the patient and protect them from harm. In this assignment, the health assessment of the patient named Sharon is to be discussed by using ABCED approach to understand the way her current health status ratings on compared to normal rating is going to impact her health. The intervention provided to Sharon is to be critically discussed to determine the way they are going to be effective in ensuring her well-being. The potential needs or the future healthcare needs of Sharon are also to be explained by considering her present physical and mental health state. For students involved in similar projects, seeking healthcare dissertation help can provide valuable insights and support in addressing complex aspects of patient care and health assessments.

Recognising, responding and justifying approaches to be taken to distress or deteriorating health condition

The case study of Sharon informs that she is an asthma patient and for the past 5 days have developed respiratory tract infection. She is admitted to the Emergency Department (ED) of the hospital due to shortness of breath as a result of exacerbation of her situation. The NEWS 2 (National Early Warning Score) is the tool that is developed to routinely record the vital health signs of patients and each of the signs is put a number from 0-3 (0-most desirable, 3-least desirable) to indicate their score. The trend of total score recorded is used to determine if the patient is progressing in health or not (GOV, 2013). This tool is to be used for Sharon to develop an observation chart of progress of her vital health signs on intervention provided. The ABCED approach stands for Airway, Breathing, Circulation, Disability, Exposure approach for assessment and treatment of patient’s health. The principle of the approach is that initial health assessment of the patient is to be made and the examinations are to be reassessed regularly so that health problems of the patients are kept under control (Thim et al. 2012). This tool is to be used to examine the physical health condition of Sharon.

The Airway assessment of Sharon informs that there is an audible wheeze and she is unable to complete full sentences in a single breath. As mentioned by Mazić et al. (2015), wheezing sound during breathing occurs when the airways are narrowed. The wheezing sound during breathing is mostly seen among patients with asthma and respiratory infection as in these cases the airways are seen to be narrowed and extra mucus is produced (Nabi et al. 2019).

Thus, it informs that Sharon is suffering from breathlessness as a result of asthma and respiratory infection as well as requires immediate support to ease her breathing.

The breathing assessment of Sharon informs that she is taking 26 breaths per minute and she has 90% oxygen saturation at room air as measured through pulse oximetry. A normal person without any health disorder has 12 to 20 breaths per minute and any respiration rate above 12 or 25 breaths per minute is regarded as abnormal (Qadir and Asif, 2019). The increased breaths per minutes indicate that the person is suffering from shortness of breath due to any health disorder such as asthma, anxiety, heart failure and others (Romão et al. 2017). Thus, the value of breaths per minutes as seen in case of Sharon indicates that it is above normal and she is suffering from shortness of breath due to which she is trying to increase her number of breaths to take in more oxygen.

The oxygen saturation among normal individuals at room air is 94-99% and any individual having oxygen saturation level of 90% at room air indicates to be critical as well as required additional oxygen for breathing (O'Driscoll et al. 2017). Thus, the oxygen saturation value of Sharon indicates that she is suffering from shortness of breath as a result of respiratory infection and is at critical state to use oxygen. The oxygen saturation in the blood is to be examined as low level of saturation leads the individuals unable to transfer proper amount of oxygen to the cell to let the body function properly (Collins et al. 2015). Therefore, Sharon’s physical health regarding airway assessment is to be made and it indicates that she immediately required additional oxygen support to ensure proper breathing as well as top ensure proper amount of oxygen is delivered to the cells and organs in the body to work properly.

In Circulation assessment, the blood pressure along with heart rate is examined. The heart rate of Sharon informs after assessment is seen to be 115 beats per minute. The normal heartbeat of a person without any health disorder is 70-100 beats per minute (Grimaldi et al. 2016). It informs that as a result of breathlessness Sharon's heartbeat is also affected. This is evident as shortness of breath leads the heart to beat faster so that increased oxygenated blood is delivered to the body to meet the scarcity of oxygen. However, increased heartbeat leads the blood to be pumped improperly in the rest of the body making the organs as well as tissues devoid of oxygen (Hajsadeghi et al. 2016). This informs that heartbeat assessment of Sharon is to be made so that if it is increased proper actions can be taken to avoid damage to her body organs due to lack of proper blood supply. The blood pressure on a normal individual is 120/80mmHg (Ochiai et al. 2015). However, in case of Sharon, it is seen that she has 140/85mmHg blood pressure indicating she is suffering from high blood pressure. The increased blood pressure causes damage to the blood vessels and may lead individuals to face stroke, heart attack or another kind of diseases (Rinnström et al. 2016). Thus, heart rate, as well as blood pressure of Sharon, is to be improved so that further damage to her circulatory system can be avoided.

The disability assessment includes examining the pain responsiveness and blood glucose of the individuals (Thim et al. 2012). The blood glucose is required in the bloodstream in the proper amount as it supplies energy for the proper working of cells and tissues in the body (Patel et al. 2015). The blood sugar level of a non-diabetic person is 7.1mmols/l and at peak flow is 170 mg/dL (diabetes, 2019). The disability of Sharon informs that her blood glucose level is 4.8mmols/l and at peak is 240 mg/dL. This informs that she had presence of high blood sugar in the body. The presence of high blood sugar leads the blood vessels to be narrowed, ruptured or damaged as well as leads to formation of blood clots making the person suffer stroke (Poorolajal et al. 2016). Thus, blood glucose level of Sharon is to be lowered as high level would damage her blood vessels making her experience stroke.

The pain responsiveness at zero means no pain and at 4 means moderate pain (NICE, 2016a). The assessment of Sharon informs that she is perceiving pain 4 out of 10 indicating she is suffering from moderate pain due to her health condition. The Exposure assessment includes examining body temperature (Thim et al. 2012). The body temperature of a normal person is 37ºC (Wei et al. 2017). However, Sharon’s body temperature is 38.7ºC indicating she is suffering from fever. The increased body temperature informs that the person is facing a serious health issue (Wei et al. 2017). Therefore, immediate intervention for Sharon is to be executed so that her health condition can be improved.

Critically discussing the intervention to be taken for the patient

The ABCED approach informs that Sharon required immediate assistance to resolve her shortness of breath. The British Thoracic Society (BTS) guideline mentions that adults with acute asthma when experiences increased shortness of breath are to be provided supplementary oxygen that is titrated to maintain 94-98% oxygen saturation (SpO2) (BTS, 2019). The supplementary oxygen therapy during hypoxemia or shortness of breath is important as it helps the individuals to be able to draw in proper amount of oxygen in the body to maintain normal blood oxygen saturation. This is required so that effective amount of oxygen reaches the cells and tissues of the body to let them breathe and work properly (Baig et al. 2017). In the study of Franco et al. (2019), it is mentioned that when a patient who is suffering from chest pain and dyspnea or shortness of breath is provided oxygen therapy improvement in his health was seen. This is evident as he was reported to be able to breathe normally without any shortness of breath. Therefore, the evidence mentions that supplementary oxygen therapy is effective for Sharon so that she can draw in proper oxygen in the blood which she is unable to execute currently when trying to draw in oxygen from room air. This would help her to improve her breathing rate as well as resolve her shortness of breath, in turn, helping to ensure normal oxygen amount is circulated to the body.

The BTS guideline mentions that the patients are to be provided β2 agonists in high dose as first-line of agent to help the person with acute asthma breathe properly (BTS, 2019). The β2 agonists impact on the smooth muscles of the bronchial passage to make them dilated so that individuals are the airway passage are relaxed to ensure ease in breathing (Ritchie et al. 2018). Thus, Sharon is also to be provided β2 agonists in high dose to help her on an emergency basis improve her breathing rate. The British National Formulary (BNF) informs that salbutamol is to be provided as β2 agonists for treatment of wheezing and resolving shortness of breath in asthma patients. It mentions 100-200mg is to be provided at least 4 times in a single day (NICE, 2019). In the study of Kalolella (2016), it is mentioned that when the old man of 49 years with known case of bronchial asthma for the past 43 months was provided salbutamol for nearly 3 times a day then on 7th day it was seen that 7 out of 8 asthma symptoms (chest tightness, chest pain, breathing difficulty, wheezing, cough, mucus, shortness of breath, difficulty breathing) was resolved. Therefore, the evidence indicates that prescribing continued use of salbutamol to Sharon to nearly 3-4 times a day would help her to resolve her asthma symptoms on long-term basis. (Refer to Appendix 2)

The British National Formulary (BNF) along with British Hypertension Society (BHS) informs that people who are aged less than 55 years are to be provided ACE inhibitors as the first line of medication for treatment of high blood pressure (BHF, 2019). The ACE inhibitors are drugs which act on the arteries and veins of the body to relax them so that the blood pressure is normalised. They lead the body to avoid secreting Angiotensin II that is an enzyme which avoids narrowing of the blood vessels, in turn, making the heart to beat normally (Ouwerkerk et al. 2017). Therefore, Sharon is to be provided ACE inhibitors as medication to control her raised blood pressure.

The British National Formulary (BNF) along with NICE mentions that beta-blockers are effective medication to slow down increased heart rate and improve flow of blood into the body (BNF, 2019). This is because beta-blockers acts to block the binding of the norepinephrine with epinephrine thereby by binding with the beta-adrenoceptors so that the increased heart rate can be slowed with less force, in turn, controlling the raised heartbeat to normal as well as reduce blood pressure (Raimondi et al. 2016). In study of Morales et al. (2017), it is mentioned that in 95% cases of the 35,502 people identified for the study with cardiovascular disease and asthma reported increased exacerbation of asthma on use of non-selective beta-blockers. The non-selective beta-blockers are those that not only target the heart but also GI, blood vessels, lungs and others whereas selective beta-blockers act especially on the heart to control the heartbeat (Tiotiu et al. 2019). Therefore, to help Sharon control her heartbeat and her asthma to remain in control the selective beta-blockers are to be provided for her treatment.

The NICE guidelines mention that people with high level of blood sugar are offered medication known as sulfonylurea for lowering raised glucose level in the blood (NICE, 2016b). The sulfonylurea executes to lower blood sugar by making the pancreas produce increased insulin which is the hormone that breaks down sugar into simple substances to help the cells of the body produce energy (Foroutan et al. 2016). However, the study by informs that metformin is more effective compared to sulfonylurea among patients with high blood glucose level. This is evident 12.1 fewer deaths per 1000 person each year is reported to be found in the study on the administration of metformin over sulfonylurea (Marcum et al. 2018). This evidence informs that metformin is a better drug compared to sulfonylurea to be provided to Sharon so that she can produce more insulin which is going to allow her body to use increased glucose in the blood controlling the blood glucose to normal.

The NICE guidelines mention that intravenous opioids in serve pain and 300mg aspirin are to be provided to individuals with moderate pain in the chest at the earliest to resolve their distress. However, aspirin is only to be provided if the patient is not allergic to the medication (NICE, 2016a). In the study Philpott et al. (2018) it is informed that out of the 1470 participants nearly 40% of them reported self-reported allergy towards aspirin which increases their asthma. This informs that Sharon is to be provided small dose of opioid to help her relax and avoid perception of pain as well as aspirin may be provided she reports not being allergic to the medication. The NICE guidelines mention that patients with high body temperature or fever are to be kept warm and paracetamol is to be provided as medication (NICE, 2016). The paracetamol lowers fever by controlling the chemical messengers in the brain that are responsible for managing body temperature (De Martino and Chiarugi, 2015). This evidence informs that Sharon is to be provided paracetamol and is to be kept in warm place to control her body temperature to normal.

Explaining the way individual’s independence as well as self-care can be assessed in diverse situations

The person-centred care approach is the way of providing care in which the patient is regarded as centre while plan care and informed decision-making regarding care are accessed from the patient (Eaton et al. 2015). In case of Sharon, it is seen that her daughter and son was grown up who are able to take to their own care. Sharon’s husband is seen to be cooperative as it was reported that the person helped Sharon in cleaning the house. This informs that Sharon’s care can be entrusted and shared among her children and husband to ensure her well-being. The follow-up clinics are referred to as face-to-face interaction between the patient and the health professional (Athanazio et al. 2016). The husband can accompany Sharon to her follow up clinics after she is released from the hospital so that a proper check on her health condition can be ensured by the health professional to avoid further severe relapse of her asthma.

In relation to person-centred approach, the multi-disciplinary team is to be involved for Sharon where the dieticians are to inform her regarding the diets to be maintained to ensure her controlling breathing, better hearty rate and controlled blood glucose level. The respiratory nurse assists asthma patients by educating them about the breathing exercises to be performed to resolve breathlessness and chest pain (Grzeskowiak et al. 2016). Therefore, in the multi-disciplinary team respirator nurses are to be involved in providing person-centred care to Sharon where the patient is to be taught to perform breathing exercises to improve her health condition related to asthma. A separate carer is to be provided to Sharon who would help her in her daily chores so that due to increased activity further breathlessness is not faced by the individuals.

Conclusion

The above discussion informs that Sharon is an asthma patient who is presently admitted to the emergency department of the hospitals due to respiratory infection along with reports of shortness of breath. The health assessment of Sharon executed through ABCED approach informs that she has increased heart rate and blood pressure along with reduced breath per minutes, high level of blood sugar, fever and increased heartbeat. The British Thoracic Society informs uses of supplementary therapy to resolve breathlessness and NICE informs the use of selective beta-blockers to resolve increased heart rate, paracetamol to lower fever, salbutamol to control asthma and others. The multi-disciplinary team along with support from the family are seen to be present for Sharon to help her cope with her health condition.

References

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Appendices

The BTS informs that metered dose inhaler (MDI) with a spacer can be used for administering β2 agonists (salbutamol) among patients suffering from severe asthma (BTS, 2019). The MDI is the puffer and the spacer acts as the holding chamber of the β2 agonists to let the individual slowly inhale the air with the medication during increased breathlessness in asthma (BTS, 2019). In case of Sharon, it is seem that she is suffering from shortness of breath and MDI spacer is to be used to provide her salbutamol so that she is able slowly inhale the medication and feel relieved. The NICE guidelines mention that clinical blood pressure ranging from 140/90 mmHg to 159/99 mmHg present in individuals are seen to be suffering from Stage 1 Hypertension.

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