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Sarah is a 69-year-old female presenting to the emergency department with shortness of breath, a common but serious symptom often associated with various underlying conditions. Her medical history includes heart failure and chronic obstructive pulmonary disease (COPD), both of which can significantly influence her current clinical presentation and complicate her management. Her initial assessment reveals an oxygen saturation of 82% on room air, indicating hypoxemia, which necessitated supplemental oxygen at 2 liters per minute via nasal cannula, according to medical protocols for hypoxemic patients (Kumar & Clark, 2020). The chest X-ray revealed bilateral pneumonia, an infection that can exacerbate existing respiratory issues and requires prompt intervention. Arterial blood gas (ABG) analysis further clarifies her respiratory status: a low pH of 7.30 indicates acidemia; a PaCO₂ of 58 mm Hg signifies hypercapnia; a PaO₂ of 78 mm Hg shows hypoxemia; and a bicarbonate level of 26 mEq/L suggests normal metabolic compensation, pointing toward a primary respiratory acidosis (Potter & Perry, 2021).

Potential Problems Based on Findings

The ABG results combined with her clinical presentation reveal multiple potential complications. The low pH signifies acidemia, which in this context is primarily due to respiratory acidosis caused by hypoventilation from her COPD and pneumonia. The elevated PaCO₂ (58 mm Hg) confirms hypoventilation and impaired gas exchange, which can lead to worsening acidosis if unresolved (Kumar & Clark, 2020). The coexistence of pneumonia adds an infectious component that can further impair oxygenation, leading to hypoxemic respiratory failure—a concern given her baseline oxygen saturation levels (Lanken et al., 2020). Additionally, her heart failure complicates the picture since hypoxia and hypercapnia increase myocardial workload, potentially precipitating cardiac decompensation (Yancy et al., 2017). If not addressed promptly, these issues can progress to respiratory failure, necessitating mechanical ventilation, and may induce multi-organ dysfunction due to hypoxia and acidosis (Lanken et al., 2020).

Multidimensional Care Approach

A comprehensive, multidimensional care plan for Sarah involves addressing her respiratory, infectious, cardiovascular, and psychosocial needs. First, optimizing oxygen therapy is crucial; her oxygen should be titrated to maintain SpO₂ levels above 92%, which can be achieved with adjusted oxygen delivery devices such as a Venturi mask or high-flow nasal cannula for better oxygenation control (Lanken et al., 2020). Monitoring ABGs regularly will help evaluate her response to therapy and guide adjustments. Pharmacological management includes administering antibiotics for pneumonia and bronchodilators, corticosteroids, and possibly diuretics if her heart failure exacerbates (Yancy et al., 2017). Ventilatory support, such as non-invasive ventilation (NIV), may be indicated if she develops worsening hypercapnia, to reduce the work of breathing and correct acid-base disturbances (Kumar & Clark, 2020).

Aside from respiratory management, addressing her emotional and psychological well-being is essential, as hospitalization and respiratory difficulties can cause anxiety and fear (Gerrish & Lacey, 2019). Education on her condition, medication adherence, and recognizing early signs of deterioration empower her to participate actively in her care. Nutrition support tailored to her needs should also be considered to promote healing and strength (Potter & Perry, 2021).

Roles of Other Departments in Treatment Plan

The collaboration of multidisciplinary teams is vital for optimal outcomes in Sarah's care. Respiratory therapists play a key role in managing oxygen therapy, performing pulmonary hygiene, and providing ventilatory support (Lanken et al., 2020). Pharmacists ensure proper medication management, checking for interactions, contraindications, and proper dosing—especially important given her comorbidities (Yancy et al., 2017). The infectious disease team can guide antibiotic stewardship to effectively treat pneumonia and prevent resistance. Physical therapists support early mobilization, which is crucial for preventing deconditioning and promoting lung expansion (Gerrish & Lacey, 2019). Dietitians develop nutritional strategies tailored to her condition, supporting immune function and overall recovery. The social worker or case manager can assist with discharge planning, ensuring she has adequate home support and follow-up care to prevent readmission (Gerrish & Lacey, 2019)."

Conclusion

In conclusion, Sarah's complex presentation requires an integrated approach that addresses the immediate respiratory needs, manages underlying infections, supports her cardiac health, and considers her psychosocial well-being. Her ABG results and clinical features indicate potential for respiratory failure if not promptly managed. A multidisciplinary team, involving nursing, respiratory therapy, pharmacy, nutrition, and social services, is essential in providing comprehensive care. Regular monitoring, patient education, and proactive interventions are key components that can significantly improve her prognosis and quality of life (Yancy et al., 2017; Lanken et al., 2020).

References

• Gerrish, K., & Lacey, A. (2019). The research process in nursing (7th ed.). Wiley-Blackwell.
• Kumar, P., & Clark, M. (2020). Kumar and Clark's clinical medicine (10th ed.). Elsevier.
• Lanken, N. N., et al. (2020). Management of pneumonia in adults. American Journal of Respiratory and Critical Care Medicine, 201(10), 1260-1272.
• O'Connell, Z. (2018). Multidisciplinary approach to respiratory failure. Journal of Advanced Nursing, 74(1), 3-4.
• Potter, P., & Perry, A. (2021). Fundamentals of nursing (10th ed.). Elsevier.
• Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation, 136(6), e137-e161.
• Gerrish, K., & Lacey, A. (2019). The research process in nursing (7th ed.). Wiley-Blackwell.