NURS7066 Acute Exacerbations of Chronic Conditions Assessment One: Short Answer

NURS7066 Acute Exacerbations of Chronic Conditions Assessment One: Short Answer Questions related to a Case Study Instructions: Firstly, review the NURS7066 subject outline for assessment details. Your answers must be directly related to this specific case study. You must use at least 10 specific nursing literature sources from the past 10 years such as peer-reviewed journal articles, textbook material, or other appropriate evidence-based resources. Complete your answers for the questions in a Word document. List each question number and then your answer. Case Study & ISBAR Handover: Chronic Obstructive Pulmonary Disease (COPD) Introduction: Mr David Nice a 72-year-old man with no known allergies (NKA) Situation- David arrived in the Emergency Department at 2200 hrs. Upon assessment he was sitting in a tripod position and found to have a barrel chest. David has a fever, sore throat, cough, and dyspnoea. Findings from the chest x-ray revealed lung hyperinflation and increased bronchovascular markings and cardiomegaly. Background: David also tested positive for COVID-19 three days ago using a rapid antigen test from a local pharmacy. His wife Linda indicated his symptoms had progressively worsened with no relieving factors noted. David had similar symptoms a year ago with an acute exacerbation of chronic obstructive pulmonary disease requiring hospitalisation. David has an increasing amount of purulent mucus. He has self-medicated with a Ventolin inhaler prior to admission with little to no effect. Past Medical History: COPD, hypertension, hyperlipidaemia. Previous smoker for 40 years however he quit 10 years ago when he was diagnosed with COPD. Regular Medications taken: Ipratropium (Atrovent) via nebulizer daily, Salbutamol (Ventolin) puffer PRN, Metoprolol 50 mg BD, Atorvastatin 40mg daily. Nursing Assessment: Airway. Patent, maintain own Breathing. RR-30 min, SpO2 78% room air, increased shortness of breath (SOB) Auscultation – diminished breath sounds bilaterally, wheezing and crackles bilaterally. Using accessory muscles of respiration. Circulation. HR 134 min & regular, BP- 158/95 mmHg. Capillary Refill Time 4 sec, peripherally pale & cool Disability. GCS-14 E4, V4, M6 confused and distressed, Pupils equal + react Exposure. Febrile, skin intact, IV cannula right cubital fossa Abdo: bowel sounds present in four quadrants, abdomen non-tender & soft Fluid. IV fluids in progress Glucose. BSL- 5.8 mmol/L Imaging: Chest X-ray Image transcription text L Pathology Results: Full Blood Count Result Reference Range Haemoglobin 115 g/L 120-140 g/L White blood cells 15.0×10^9/L 4.0-11.0×10^9/L Neutrophils 11.0×10^9/L 2.0-7.5×10^9/L Platelets 200×10^9/L 150-400×10^9/L C Reactive Protein (CRP) 25 mg/L <3mg/L 2- COVID-19 PCR Test: Positive Arterial Blood Gas (ABG) on room air (at 2200hrs) Result Reference Range pH 7.30 7.35-7.45 PaO2 62 mmHg 80-100 mmHg PaCO2 56 mmHg 35-45 mmHg HCO3- 26 mmol/L 22-26 mmol/L SpO2 78% >95% BE -4 mmol/L -2 to +2 mmol/L Clinical Impression: Exacerbation of COPD secondary to bacterial infection & +ive Covid-19 Nursing Interventions: Continuous monitoring of vitals. Initiate continuous cardiac monitoring. Transfer to High Dependency Unit. COVID-19 Management: Isolate the patient in a negative pressure room, implement infection control precautions, and monitor for progression of COVID-19 symptoms. Controlled oxygen therapy -Continuous pulse oximetry, oxygen to keep O2 between 88% to 92%. Collect ABGs q4h. Administer Salbutamol puffer PRN. Administer Ipratropium via nebulizer daily. Administer Prednisolone 50 mg p.o. daily. Administer Azithromycin 500mg IV daily. Administer Nirmatrelvir 300 mg with ritonavir 100 mg taken together p.o. q12h for 5 days. Record 12- lead ECG 6th hourly Collect blood Troponin. Collect sputum culture for culture and sensitivity. Record pulmonary function tests and then spirometry when patient is stable. Question 1 (400 words limit- worth 30 marks) Explain the underlying pathophysiology specifically related to the following clinical manifestations: Sitting in a tripod position Found to have a barrel chest Lung hyperinflation Increased bronchovesicular markings Cardiomegaly Question 2 (400 words limit- worth 40 marks) Select 1 Category only, from the 3 categories listed in the table below. Provide a rationale for each of the interventions listed for the category that you have selected. You must critically analyse the available evidence-based literature to support your rationale. Then, concisely explain your rationales in your own words and citing your evidence as in-text references to support your answers. Category 1 Non-pharmacological interventions Category 2 Pharmacological interventions Category 3 Diagnostic interventions Controlled oxygen therapy to keep O2 between 88% to 92% Initiate continuous cardiac monitoring Record 12- lead ECG 6th hourly Record spirometry when patient is stable. Administration Salbutamol Ipratropium Prednisolone Administration Azithromycin Administration Nirmatrelvir Ritonavir Collect q4h ABGs Collect blood Troponin level Isolate in a negative pressure room Collect sputum culture for culture and sensitivity. Question 3: (worth 5 marks) As the registered nurse caring for this patient, you will select the 5 highest clinical priority Nursing Interventions (listed above), and now, list them in the order that you would attend to each one. Question 4: (200 words limit- worth 10 marks) Concisely, justify the rationale for collaborating with the following groups to maximise holistic nursing care for Mr David Nice. Immediate family members. Members of the multidisciplinary health care team.

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