Enhancing Nursing Care Assessment and Intervention for Jamie

Introduction

The delivery of effective nursing care is important for improving the physical and mental health of the patients. In this study, the nursing assessment and intervention for Jamie is to be discussed.

Physiology behind the results

Jamie is brought to the hospital due to extreme breathlessness while at work and expressed signs of distress and fear during the assessment of initial parameters such as heart rate, respiration rate, blood pressure, oxygen saturation and temperature. During distress and fear, the heart rate and blood pressure is increased because of the presence of the adrenaline which is the hormone that is released in stressful situation as a flight-or-fight response to improve the body functioning to control stress (Regnard et al., 2018). The normal heart rate is 60-100beats/min and blood pressure are 120/90 mmHg (NHS, 2020). However, the stressful situation created out of breathlessness in Jamie has led him to show increased heart rate (128 beats/min) and blood pressure (135/88 mmHg).

Jamie when brought to the hospital was mentioned to be breathing quickly than normal which was evident as the initial respiration rate recorded for him is 28 breaths/min which is higher than normal which is 20 breaths/min (Chu et al., 2019). The increased breathing rate is caused to Jamie because he is facing breathlessness which is leading the body to lack enough presence of oxygen out of lack of effective use of oxygen from the inhaled air (Nascimento-Carvalho, 2020). In this condition, quicker breathing is executed to draw in more oxygen to support the raised oxygen demand in the body and release increased amount of carbon dioxide that is unable to realised out effectively due to hindered breathing (Apigo et al., 2020). The pulse oximetry is executed to measure the level of oxygen saturation in the blood (NHS, 2021). In case of Jamie, his oxygen saturation is 93% which is slightly lower than the normal that is 95-100% (NHS, 2021). The low oxygen saturation is recorded because of the inability of Jamie’s lungs to function effectively to transfer oxygen from the inhaled air to the blood through the alveoli (Calligaro et al., 2020).

Significance of results mentioned

The further assessment of Jamie is made in which his peak expiratory flow rate is measured. The significance of measuring peak respiratory flow rate (PEFR) is that it informs the amount along with the rate of air that is forcefully exhaled by the lungs (Chen, 2019). The normal PEFR level is 650l/min (Okazaki et al., 2020). However, PEFR measured in Jamie is 150l/min recorded which indicates that he shows extreme poor functioning of lungs in exhaling air that is leading to increased carbon dioxide to remain in the body and create difficulty in breathing. Jamie is mentioned to be coughing clear yellow sputum with quicker breathing which are few of the symptoms related to pneumonia. Thus, the full blood count is examined to determine the presence of any infection in the body related to pneumonia that is causing him to face breathlessness.

The presence of any bacteria or foreign bodies in the individuals leads the white blood cells to be increased as they act to fight against the foreign agents to relive the body of them and support normal functioning (Camon et al., 2018). The full blood count measurement of Jamie indicates that he has extremely high eosinophils and basophils level in the blood. Thus, the rise in the two WBCs indicates that Jamie is suffering from pneumonia which is caused due to presence of bacteria or other infectious agents in the lungs. The significance of arterial blood gas (ABG) test is to determine the acidity and level of CO2 and O2 in the blood to understand the efficiency with which the lungs are working (Zhang et al., 2021). In case of Jamie, the ABG test values are found to be within the reference range but at a higher indicating the lung is trying to function properly at its highest ability.

Overall disease pathophysiology

In case of Jamie, it is seen that he has no history of smoking and has well-develop healthy lifestyle. However, two week ago he reported to suffer from cold and since then he has been coughing and facing breathlessness. The symptoms regarding pneumonia include presence of coughing with production of yellow or greenish sputum, shortness of breath, loss of appetite and others (Santos et al., 2019). In case of Jamie, he is considered to be suffering from pneumonia as he meets all the symptoms. The presence of COPD in Jamie can be averted as he is non-smokers and COPD are often developed in active smokers due to harmful chemicals present in the tobacco smoke that damage the inner parts of the lungs (Bai et al., 2017). The expiration rate of the lungs indicates the extent of elasticity of the lung which is the extent to which it is deflating to allow air to be removed from the airways to the outside (Zambare and Thalkari, 2019). In case of pneumonia patients, the inflammatory exudates are seen to fill up the spaces in the alveoli of the lungs at a higher rate compared to the normal functional capacity of the lungs which creates a loss of lung volume (Mizgerd, 2017). Thus, the lung functioning even being normal in case of Jamie is unable to support enhanced peak expiration rate as the volume of the lungs is reduced. This indicates that the amount of CO2 to be able to be expired by the normal lungs has reduced due to its loss of some elasticity caused by deposition of exudates.

The white blood cell count (WBCs) is at the highest level of its reference range indicating the body is trying to produce increased WBCs to fight any foreign agents that have entered the body (Titova et al., 2018). Pneumonia is caused to the patients due to infection by Streptococcus pneumonia bacteria that causes the air sacs of the lungs to be inflamed and filled up with extra pus or fluids. It makes the oxygen transfer from the lungs to the blood to be hindered leading to lower saturation of oxygen level in the blood (Gardner et al., 2017). The eosinophils are disease-fighting white blood cells that act to be raised in parasitic reaction in site of infection to destroy the foreign bodies and support health functioning of the body (Katoh et al., 2017). The increased basophils act to avoid blood clotting so that the allergens identified are isolated and easily eliminated through enhanced blood flow in the body (Caminati et al., 2019). Since Jamie is suffering from pneumonia, the two types of WBCs are increased so that they can create fight mechanism to avoid the damage to be caused by the foreign bodies.

Pharmacological treatments

The first-line of antibiotics that are used for pharmacological intervention to manage pneumonia include macrolide such as clarithromycin or azithromycin. The azithromycin binds with the 23S rRNA of the 50S ribosomal subunit of the bacteria which results to stop formation of bacterial protein. They execute it through inhibition of the translocation step of protein synthesis and inhibiting the assembly of 50S ribosomal subunit. It is evident as the administration of the medication leads to expression of macrolides in the blood that prevent peptidyltransferase to add the growing peptide chain to the tRNA with the next amino acid leading to inhibit translation of ribosome of the bacteria to grow (Derendorf, 2020). The other antibiotic to be used for treatment of pneumonia in Jamie is amoxicillin. Amoxicillin is the beta-lactam antimicrobials that binds with the penicillin-binding proteins to create an inhibition process known as transpeptidation. It leads to activate autolytic enzymes in the cell wall of the bacteria which causes the bacteria to inhibit synthesis of cell wall mucopeptides making the cells wall of the bacteria to be weakened. The weakened cell wall makes the bacteria exposed to the WBCs of the body easily attack and destroy them to be removed from the lungs (Khan et al., 2018). The side-effects of the medications are common such as vomiting, nausea, diarrhoea and others (Chandan et al., 2018; Firth and Prathapan, 2020). The physician analysing Jamie is to determine and mention the dose and type of medication to be used by him to treat pneumonia.

Jamie mentions to cough at an increased rate which is also affecting to worsen her breathing condition. Thus, he is be provided a medication for lowering the cough for ensuring his enhanced breathing. The cough suppressants are used to loosen and allow enhanced fluid movement in the lungs to avoid coughing (Brlek and Bedek, 2020). The lowest dose of cough medication is to be provided to Jamie to be used during extreme coughing to relax. This is because coughing out sputum in pneumonia helps in clearing the lungs from the bacteria, in turn, lowering its damage (Nowicki and Murray, 2020). The other intervention to be made for Jamie in improving his pneumonia is administering intake of Proventil through oral inhaler to loosen mucus from the lungs. The Proventil acts on beta-2 adrenergic receptors for relaxing the smooth muscles of the bronchi. It also acts to inhibit the release of hypersensitivity mediators from the cells which helps in clearing the bronchial pathway for enhanced respiration (Unit, 2019). In case of Jamie, it is seen that he is experiencing low oxygen saturation which could be improved by using oxygen therapy as immediate action to lead the patient to feel relaxed and breath properly (Unit, 2019).

Conclusion

The above discussion mentions that Jamie is suffering from pneumonia which is leading him to face increased breathlessness and distress. The medications such as Proventil, clarithromycin or azithromycin are to be provided to control the condition and improve his well-being. However, cough suppressant medication is mentioned to be avoided or provided in low dose as it would avoid him to cough out the bacteria from the lungs.

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