Ngarla Kngwarreye is a 60 year old

Ngarla Kngwarreye is a 60 year old Anmatyerre woman from Urapuntja in Central Australia. Some years ago, after a long history of cigarette smoking, she developed chronic obstructive pulmonary disease. Despite her best efforts at quitting, she has not been able to completely stop smoking. Her disease progressed, and she also has cor pulmonale. Management of her condition now includes the following: Oxygen therapy: use of an oxygen concentrator at night Pulmonary rehabilitation: attends the clinic in Alice Springs with the support of nurses from the Central Australia Health service. Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013) Medications: Inhaler: Trelegy (fluticasone fuorate (100 mcg) / umeclidinium (62.5 mcg) / vilanterol (25 mcg)) : 1 inhalation daily spironolactone 25 mg daily alendronate 70 mg weekly calcium carbonate 600 mg x 2 daily fluoxetine 20 mg daily Other interventions: Pneumococcal vaccination Yearly influenza vaccination Last week Ms Kngwarreye visited the local school and met with the children to talk about her art. A day or so later, she developed “a bit of a head cold”. Two days ago, Ms Kngwarreye’s normal cough increased, and she began producing tenacious green-coloured sputum. The nurses from the community health clinic came to visit her at home and based on her presentation organised transport to Alice Springs Hospital. At the hospital, a chest x-ray showed that her lungs were hyper-expanded, her diaphragm flattened and a large area of consolidation in her left lung was identified as pneumonia. Based on her assessment data the following management was commenced: Oxygen therapy: BiPAP – 5 cmH2O peak end expiratory pressure / 5 cmH2O pressure support / 10 cmH20 peak inspiratory pressure – FiO2 28%; 4 hours of therapy which then changed to oxygen via high flow nasal prongs delivered in heated, humidified air – 21% FiO2 / 30 L/min – titrated to maintain SpO2 88 – 92% and a respiratory rate < 24 bpm Medications: salbutamol 5mg by nebuliser with air as required ipratroprium 500mcg by nebuliser with air as required prednisolone 50mg daily x 5 days spironolactone 50 mg daily identify the AIM of this intervention by discussing the intended physiological effects or benefits specific to Ms Kngwarreye. Refer to any GUIDELINES which support this intervention. As appropriate, identify what evidence will demonstrate the EFFECTIVENESS of this therapy. 1. oxygen via high flow nasal prongs delivered in heated, humidified air 2. BiPAP therapy 3. pulmonary rehabilitation 4. pneumococcal vaccination and annual influenza vaccination as per schedule NOTE: If you choose to discuss BiPAP or High flow oxygen therapy, you do NOT need to focus on the rates or levels of the therapy. You need to consider the general principles of this therapy as they apply to Ms Kngwarreye. SCIENCE HEALTH SCIENCE NURSING CXA 133

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