Nursing Case Studies Essay

Nursing Diagnoses

Impaired gas exchange related to loss of lung elasticity, overproduction of secretions, bronchoconstriction, and pulmonary-venous congestion, as evidenced by tachycardia, prolonged expiration, use of accessory muscles, anxiety, dyspnea, decreased PaO2, and increased Pa CO2.

Plan of care: The nurse must continually assess Sharon’s work of breathing, lung sounds, and oxygenation on the monitor. A nasal cannula with and end-tidal CO2 connected to the monitor is a better indicator of respiratory distress than the oxygen saturation. A rate greater than 20, oxygen saturation less than 92%, PaCO2 greater than 45, and adventious lung sounds are the first warning signs that Sharon’s respiratory status is deteriorating. Altered breathing patterns such as abnormal

Next, the nurse will deliver low-flow oxygen therapy 2L/min via nasal cannula, and she will call the respiratory therapist to administer bronchodilators ordered by doctor. Upon opening the airway, wheezing should stop. In order to reduce Sharon’s airway inflammation, steroids will be appropriate to be administer by the nurse if there is an order. If not, and order for steroids and antibiotics should be obtained. Antibiotics are necessary to fight the bacteria present in the lungs, which led to COPD exacerbation. Before starting the antibiotics therapy, the nurse must make sure the serum cultures are drawn. A high white count and infiltrates on the X-ray will indicate the presence of an infections in the lungs. Because of the infection, Sharon could have a fever, monitoring her temperature and keeping the fever down will be an appropriate action for the nurse. Fever could be lowered by uncovering the patient, providing ice pack, or administered anti-pyretic prescribed by the physician. On the other hand, if crackles are auscultated throughout* lung fields and BNP is elevated, the nurse will most like administer diuretics per