92445 Complex Patient Health Issues Assignment Sample

Integrated Nursing Practice - Part 1

In this report, I will address the Cardiac Case Study. Early this morning Mathew Cottrell, 56, presented a man who complained of chest squeezing and enhanced respiration loss to the Emergency Room. He was attended in the hospital by the spouse of the patient.

After a test at 7 a.m., Mathew was initially diagnosed with chest tightness and shallow breath, often light-headedness, tachycardia, elevated blood pressure and swelling in his knees. He's awake and centered. Echocardiogram, ECG and CXR have been completed. ECG exhibits ST-free left ventricular hypertrophy. Echocardiogram indicates heart failure and diminished evacuation and evidence of pulmonary hypertension. CXR indicates that the heart is expanded and the lower lobe congestion is bilateral. The Sp02 was used with 93% of the oxygen used for RA, 95% for 2L at the moment through NP.

1.1 Impaired Oxygenation:

Different diseases (e.g. atelectasis, pneumonia, lung edema, and acute respiratory distress syndrome) cause alveoli collapse or improvement in the breathing system. Other factors influencing gas distribution include high altitudes, hypoventilation and altered blood oxygen carriage capability due to lowered hemoglobin. In older adults, average pulmonary blood pressure is smaller than in young people (Li, 2018). COPD obesity and the effect on lung function of the dietary fats have left patients more vulnerable to hypoxia. In addition to smokers and patients with respiratory issues, extended immobility times, chest or upper abdominal incisions, Compromised Gas Exchange is at risk. In their oxygen and CO2 delivery processes the heart and lung are irrevocably intertwined. Normal lung impairs the heart function frequently, and normal heart dysfunction frequently affects the pulmonary system.

Exertional dyspnea is a typical symptom of persistent congestive heart failure (CHF), and ventilating effort, through usual arterial blood gases, is intensified at a specified workout workload. The improved exercise ventilation in CHF recorded in this issue of Circulation contains prognostic evidence extending beyond the mean oxygen intake (VO_2max), left ventricular expulsion or the NYHA functional classification. Data demonstrate that the ventricle left ventricular execution and NYHA classification, either alone or in accordance with V, can become a susceptible instrument in predicting event-free survival of patients with CHF, due to the steepness with which the voltage rises relative to the generation of CO2 during incremental exercise. This instrument can be useful to determine the need for heart transplantation or to track the success of corrective intervention, can be assessed at submaxim working loads and can be analyzed better than VO_{2max (MedGen, 2019)}.

1.2 Impaired Social Interaction:

1.2.1 Can be connected

Altered processes of thought, energy scarcity and encouragement, feelings of worthlessness, fear of rejection, loss of encouragement, disrupted self-concept, Interaction with relatives, friends and others is toxic. Family observations change types or contact habits. Complaints of social settings. Remain seclusion emotions, discourage contact and neglect eye touch. Eye contact.

• The patient can understand emotions related to bad social experiences.
• Patient communicates with friends / peers of the neighborhood.
• Few social events (e.g., recreational activities, community members) are taken into account.
• At the end of the day, the patient will take part in an operation.
• When you decide you need to leave, the patient addresses 2-3 options.
• Patients can recognize two-three personal conducts that may prevent others from contact.
• The patient can willingly engage in a supportive atmosphere (community or hospital) at the individual / group therapy sessions.
• Patients would say they want to communicate with others, as well as they did before becoming stressed, with their hobbies and experiences one-on-one.
• The patient will claim and show success in restarting good and family ties in one month.

1.3 Fluid Imbalance:

A common complication of heart disease is fluid and electrolyte deficiency in a patient with cardiovascular dysfunction. The number one cause of death today remains coronary conditions. Recovery from these disorders includes close analysis of conditions underlying the heart attack. Fluid and electrolyte depletion is frequently life threatening as well as preventable in the cardiac patient. In order to ensure maximum cardiac efficiency for all heart patients, ensuring a homeostatic state in terms of fluid or electrolyte equilibrium is important. Diuretics aim to extract excess fluid from the body. There are many marks in diuretics. They are also referred to as "water tablets." Any of them are shot once a day. Some citizens are taken twice a day. Thiazide is a common form of thiazide; diuril, chlorthalidone, indapamide (lozol), chlorothiazide (esidrix) and metolazone, as are the three forms common: mycrox, zaroxolyn. The three widely used ones are thiazide. Bumetanide (Bumex), Furosemide (Lasix), and Torsemide (Demadex) diuretic series. Sparing potassium: amyloids (mitamor), spironolactone’s (oldactones) and triamterene (dyrenium). Breathing, swelling and urinating the body regularly loses water. You are dehydrated if you don't take enough liquids or fluids. It can also be tough for the body to get rid of fluids. The extra fluid then expands in the body. This is known as fluid surcharge (volume surcharge). This can lead to edema (skin and tissue excess fluid). Many medical conditions will induce fluid imbalance, which normally takes a number of days following operation to hold a significant quantity of fluid and cause the body to swell. When heart failure is involved, fluid gathers into the lungs, stomach, blood vessels, and body tissue, since it is improperly pumped into the kidneys by the heart. Diarrhea, vomiting, extreme blood loss, or high fever may cause the body to lose too much food. An absence of an antidiuretic (ADH) hormone can extract too much of the liquid from the kidneys. This leads to extreme sedation and dehydration. There is often a high or low sodium or potassium level. The fluid state can also be impaired by medications. Water pills (diuretic products) are most used for the prevention of blood pressure, cardiac failure, liver or renal disease.

Integrated Nursing Practice - Part 2

1. Fluid Imbalance can be suggested on the priority base. As fluid and electrolyte loss in a cardiovascular disorder patient are a common complication of heart disease. Coronary diseases remain the number one source of mortality. Closely analyzed conditions of heart disease are part of the treatment from those diseases. Fluid and electrolyte deficiency in cardiac patients are often life-threatening and preventable. It is necessary to maintain a homeostatic state with regard to fluid and electrolyte balances to achieve a full cardiac efficiency for all heart patients (Binita Kane, 2013).
2. Impaired oxygenation can be a second suggestion. Various conditions such as atelectasis, pneumonia, lung edema, and acute respiratory distress syndrome contribute to a failure of alveoli, or recovery of the respiratory tract. High altitudes, hypoventilation, and the altered blood oxygen delivery capacity due to reduced hemoglobin are other contributing factors for gas dissemination. The normal blood pressure for older adults is lower than for young people. COPD obesity has made patients more vulnerable to the effect of hypoxia on their lung capacity of dietary fats. Compromised Gas Exchange is at risk, in addition to smoking and patients with breathing problems, elevated immobility, chest or belly. The heart and lung are irrevocably interwoven in their oxygen and CO2 delivery systems. Normal lung impairs the operation of the heart often and the respiratory system is impaired by normal heart dysfunction. Exertional dyspnea is a typical indicator of chronic CHF and breathing is increased at a certain exercise strain by means of certain blood gases. The enhanced CHF exercise ventilation reported in that issue of Circulation include predictive evidence extending beyond the median intake of oxygen (VO2max)(Li, 2018)
3. Impaired social interaction can be a third suggestion. Emotions connected to poor social interactions are clear to the user. The patient is in touch with community friends / pairs. Few social activities are taken into account (e.g. leisure, group members). The patient engages in a procedure at the end of the day. The patient discusses 2-3 choices as you wish to leave. Two-three personal conducts can be detected by patients, and can preclude interaction with other persons. In each and every counselling session, the patient may actively participate in a positive environment (community or hospital)(MedGen, 2019).

Integrated Nursing Practice - Part 2

The risk of experiencing fluid and electrolytic defects in ICUs along with enhanced morbidity and morbidity rates is high in critically ill patients. A nurse is a patient caregiver who helps handle medical demands, manage diseases that treat illnesses in the health sector. For this, they would track and observe the patient and document the details required to help in the decision-making of therapies. The nurse observes and behaves appropriately, in line with the patient's best interests, during the recovery process. The care of a nurse goes throughout the use of drugs and other procedures. They are responsible for integral medical care, which covers the individual's psychosocial, behavioral, cultural and moral needs. The nurse participates actively in the patient care decision-making process (Watson, 2018).

When analyzing patient symptoms and recognizing possible issues, it is crucial for them to be able to think logically, in order to make suitable decisions and interventions. As the final medical recommendations are typically taken by other health care practitioners, including clinicians and consultants, nurses should be able to share patient health knowledge efficiently. Purses know the individual patient condition on a regular basis and should work with other care staff members to facilitate best-in - class patient outcomes. They should monitor their signs and symptoms. Various causes can support fluid and electrolyte changes in patients with serious problems. The primary cause of this disparity is the clinical mechanism of chronically ill patients. Another factor that is responsible is clinical mistakes in service, such as insufficient fluid and electrical administration and drug handling mistakes (Watson, 2018). These factors interfere with electrolyte absorption and have a negative effect on the operation of the body organs to maintain a fluid-electrolyte balance. In the event of hypoxemia (low levels of arterial oxygen), supplemental oxygen is commonly assumed to alleviate dyspnea. In patients that are normoxaemic (normal arterial oxygen levels) or very slightly hypoxemic, no proof of benefits for oxygen is present. Dyspnea’s, like metabolic acidosis, anxiety and pain and oxygen therapy is not recommended in such cases, may be induced for many other causes than for cardiorespiratory disorders. The suggestion that solitude and social loneliness improve morbidity and mortality is backed by solid data and can be regarded as a risk factor for CVD.

4 References for Integrated Nursing Practice

Binita Kane, S. D. (2013). Emergency oxygen therapy: from guideline to implementation. Breathe, 246-253.

Leilah, M. A. (2019). Developing Nursing Standards for Maintaining Fluid and Electrolyte Balance for Critically Ill Patients in Intensive Care Units.

Li, N. X. (2018). Loneliness, Social Isolation, and Cardiovascular Health. Antioxid Redox Signal, 28(9), 837–851.

MedGen. (2019). Impaired social interactions. Mental or Behavioral Dysfunction.

Pascoal, L. M. (2015). Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection. Rev Lat Am Enfermagem, 23(3), 491–499.

Watson, J. E. (2018). Fluid and electrolyte disorders in cardiovascular patients. Nurs Clin North Am, 797-803.

Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care of infants and children-E-book. Elsevier Health Sciences.

Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., ... & Missed Care Study Group. (2018). The association between nurse staffing and omissions in nursing care: a systematic review. Journal of advanced nursing, 74(7), 1474-1487.

Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2017). Correlates and predictors of missed nursing care in hospitals. Journal of clinical nursing, 26(11-12), 1524-1534.

Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing open, 6(2), 535-545.

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