Giovanni Debella Case Study

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This essay focuses on the case study of Giovanni DeBella, who is a 72-year-old male and has come into the Emergency Department (ED) at 0300 reporting that he was experiencing shortness of breath and suffocation. Giovanni has a history of Chronic Heart Failure (CHF) and is now diagnosed with acute manifestation of heart failure due to the signs and symptoms he had experienced. The signs and symptoms consist of dyspnea, swollen feet, course crackles on auscultation, and pitting oedema on his lower limbs. The key aspects discussed in this essay include the priority problem of impaired gas exchange and excess fluid volume. Nursing interventions which will help to manage these problems are positioning, breathing exercises, and use of compression …show more content…

Therefore, symptoms which exacerbate CHF should be the priority problem. His vital signs at 0700 show an increased respiratory rate (RR) of 26/minute, heart rate (HR) of 115/minute, and oxygen saturation level of 94% on 2L/min of oxygen via nasal prongs. His oxygen saturation is 91% when in room air, indicating that Giovanni has impaired gas exchange, making it a priority problem. It is noted that Giovanni smokes 20 cigarettes per day. Smoking leads to the destruction of the alveolars, this causes the air sacs in the lung tissue to enlarge, making gas exchange ineffective (Craft et al., 2015, p.695). Loss of alveolar tissue means that the respiratory membranes also lose their function and the respiratory membrane is essential as it is where gasses cross between air and blood. Therefore, the loss of respiratory membrane leads to the outcome of ventilation-perfusion mismatch and hypoxaemia (Craft et al., 2015, p.695). Sousa et al. (2015, p.142) define impaired gas exchange as excess or insufficient elimination of oxygen and/or carbon dioxide in the alveolar-capillary membrane. Due to the altered function of the alveolar-capillary membrane, oxygenation throughout the body decreases. CHF also leads to weakening of the ventricles, making them unable to pump blood efficiently, thus, resulting in pulmonary congestion (Churchhouse & Thomas, 2010, p.36). These pathophysiology

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