Advance Nursing Practice 1 Assignment 2: Case Study Analysis

Advance Nursing Practice 1 Assignment 2: Case Study Analysis and Care Plan

Create a holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

Paper For Above instruction

Introduction

The case study involves a 65-year-old Caucasian female with a complex medical history presenting with acute respiratory symptoms indicative of an exacerbation of her underlying respiratory condition. Her recent hospital discharge following a motor vehicle accident, coupled with her longstanding history of asthma and comorbidities such as congestive heart failure, necessitates a comprehensive and evidence-based nursing care plan. The primary objectives are to stabilize her respiratory status, prevent future exacerbations, promote health, and reduce disease-related complications. This paper provides an in-depth analysis of her case, identifies prioritized nursing diagnoses, and formulates a holistic plan of care aligned with current clinical guidelines and scholarly evidence.

Assessment and Diagnostic Findings

The patient exhibits symptoms consistent with an acute asthma exacerbation, including severe wheezing, shortness of breath, and coughing, which has increased in frequency over the past two months. Physical examination reveals bilateral expiratory wheezes, tachypnea (RR 31), tachycardia (HR 122), and elevated blood pressure (BP 171/94), with some improvement after albuterol treatment. Laboratory results show a slightly elevated WBC count, indicating possible infection or inflammation, and pulmonary function tests reveal an FEV1 of 1.8 L (60% predicted), indicating obstructive airway disease. Chest X-ray shows blunting of costophrenic angles, suggesting possible pleural effusions, common in pulmonary congestion and infection. Her peak flow readings are low (

Diagnosis and Priority Nursing Diagnoses

Based on her assessment, the following three primary diagnoses are identified and coded according to ICD-10-CM standards:

  • Asthma, moderate persistent (J45.40): Characterized by frequent attacks and airflow limitation evidenced by spirometry.
  • Congestive Heart Failure, exacerbation (I50.9): Worsening symptoms including ankle edema and hypertension, compounded by her past medical history.
  • Risk for Moistened Airway Clearance, related to airway obstruction and inflammation (Z99.89): Because of her current wheezing and respiratory distress.

Proposed interventions

Holistic Care Planning

1. Disease Management and Pharmacologic Interventions

The core of her management revolves around controlling her asthma exacerbation and stabilizing her cardiac condition. Initiating or adjusting inhaled corticosteroids (ICS) such as fluticasone or budesonide will reduce airway inflammation and prevent recurrent exacerbations. As her peak flow remains low, adding a long-acting beta-agonist (LABA) like salmeterol could be beneficial, provided she has no contraindications. Short-acting beta2-agonists (SABAs) such as albuterol will be used for immediate relief. Since her current bronchodilator use is frequent, educating her on proper inhaler technique and adherence is crucial (Bateman et al., 2018).

Furthermore, optimizing her cardiac management with diuretics and ACE inhibitors (enalapril) remains vital. Monitoring her electrolyte levels, renal function, and blood pressure are essential to ensure therapeutic efficacy and safety. Adjustments to her medications might be necessary considering her hypertensive status and fluid status, especially with ankle edema.

2. Disease Prevention and Health Promotion

Prevention strategies include patient education about avoiding environmental triggers such as allergens, irritants, and stress. Smoking cessation is not applicable as she is a nonsmoker; however, reducing caffeine intake might be advised to prevent exacerbating comorbid conditions like hypertension. Encouraging her to engage in supervised physical activity tailored to her capacity helps improve cardiovascular and respiratory health (GINA, 2021). Immunizations such as annual influenza vaccines and pneumococcal vaccination are crucial in reducing respiratory infection risks that could worsen her conditions (CDC, 2022).

3. Acute Care and Symptom Management

Immediate care involves administering nebulized bronchodilators and corticosteroids, oxygen therapy to maintain SpO2 >92%, and close monitoring of respiratory status and vital signs. Elevating the head of her bed helps improve ventilation and reduce dyspnea. Assessing her response to interventions and adjusting care accordingly are vital. The use of pulse oximetry and regular pulmonary function tests aid in tracking her progress (L EPL et al., 2019).

Addressing her fluid overload and edema involves adjusting her diuretic therapy and monitoring her weight and ankle circumference. Managing her blood pressure with medication adjustments and dietary modifications reduces cardiovascular strain. Her nutritional status should be optimized to support her immune function and overall recovery (Holland et al., 2019).

4. Patient Education and Counseling

Education plays a central role in her recovery and long-term management. Teaching her how to recognize early signs of exacerbation, proper inhaler and nebulizer use, and when to seek emergency care empower her to participate actively in her health management (Cazzola et al., 2018). Counseling on stress reduction techniques can alleviate some respiratory symptoms, and advise on avoiding allergen exposures in her environment.

5. Follow-Up and Monitoring

Scheduled follow-up appointments should focus on assessing her respiratory function, medication adherence, and treatment efficacy. Pulmonary function tests and peak flow monitoring will aid in adjusting her management plan. Coordination with her primary care provider and specialists ensures continuity of care. Telehealth options may support ongoing monitoring and patient engagement.

Conclusion

This comprehensive care plan addresses her immediate needs through pharmacologic treatment, health promotion, and patient education to prevent future exacerbations. It emphasizes evidence-based interventions aligned with current guidelines from the Global Initiative for Asthma (GINA, 2021), the CDC, and scholarly recent studies. Recognizing the interconnectedness of her respiratory and cardiac conditions allows for a tailored, holistic approach that enhances her quality of life and clinical outcomes.

References

  • Bateman, E. D., Hurd, S., & Barnes, P. J. (2018). Global Initiative for Asthma (GINA) Report, 2018. European Respiratory Journal, 51(2), 1800160.
  • Cazzola, M., Rogliani, P., & Matera, M. G. (2018). New pharmacological approaches to asthma management. Pulmonary Pharmacology & Therapeutics, 48, 107-117.
  • Centers for Disease Control and Prevention (CDC). (2022). Recommendations for Pneumococcal Vaccination. CDC.gov.
  • Gina, A. (2021). Global Strategy for Asthma Management and Prevention. https://ginasthma.org/gina-reports/
  • Holland, A. E., et al. (2019). Pulmonary rehabilitation for COPD. The Cochrane Library.
  • L EPL, J., et al. (2019). Use of pulse oximetry in outpatient management of COPD exacerbations. Respiratory Care, 64(7), 815-822.
  • World Health Organization (WHO). (2020). Management of Chronic Diseases. https://www.who.int
  • National Heart, Lung, and Blood Institute (NHLBI). (2020). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
  • American Thoracic Society. (2019). Standards for the Diagnosis and Management of COPD. Am J Respir Crit Care Med, 200(4), e42-e55.
  • Smith, J., & Lee, A. (2020). Integration of holistic approaches in respiratory care. Journal of Nursing Scholarship, 52(4), 369-377.

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