Sarah Is A 69-Year-Old Female Presenting To The Emergency

Sarah Is A 69 Year Old Female That Presented To the Emergency Departme

Sarah is a 69-year-old female who presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. The provider ordered oxygen at 2 L via nasal cannula. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas results are as follows: pH 7.30, PaCO2 58 mm Hg, PaO2 78 mm Hg, and HCO3 26 mEq/L. She is admitted to a general medical floor. The nurse is tasked with assessing potential problems and providing multidimensional care. Additionally, the roles of other departments in her treatment plan are essential for comprehensive management.

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Sarah’s presentation with shortness of breath, combined with her underlying conditions of heart failure and COPD, indicates a complex clinical scenario that requires meticulous assessment and management. The ABG results, notably a low pH of 7.30 and elevated PaCO2 of 58 mm Hg, suggest acute respiratory acidosis likely due to hypoventilation compounded by her pneumonia, which exacerbates her COPD. Her pulse oximetry of 82% signals significant hypoxemia, necessitating prompt interventions to optimize oxygenation and prevent further deterioration.

Potential problems arising from these findings include hypoxia, hypercapnia, respiratory acidosis, and possible respiratory distress or failure. The combination of pneumonia and COPD predisposes Sarah to increased airway secretion, inflammation, and compromised gas exchange. Her heart failure may contribute to pulmonary congestion, further impairing oxygen transfer. The elevated PaCO2 indicates hypoventilation and possible respiratory fatigue, which can precipitate respiratory failure if not managed effectively.

Addressing these issues necessitates a multidimensional approach. Pharmacological management includes bronchodilators such as beta-agonists and anticholinergics to improve airway patency, corticosteroids to reduce inflammation, and antibiotics to treat pneumonia. Oxygen therapy should be titrated carefully to avoid worsened carbon dioxide retention, especially in COPD patients, by monitoring ABGs frequently. Non-invasive ventilation (NIV) such as bilevel positive airway pressure (BiPAP) may be indicated if the patient exhibits signs of impending respiratory failure or if hypoventilation persists despite oxygen therapy.

Non-pharmacological interventions involve positioning the patient to maximize lung expansion—typically sitting upright—and pulmonary hygiene practices such as chest physiotherapy, suctioning if necessary, and encouraging effective coughing to clear secretions. Ensuring adequate hydration helps thin mucus, facilitating easier clearance. Nutritional support and energy conservation techniques are vital to prevent fatigue and optimize respiratory muscle function.

Monitoring is critical; continuous assessment of respiratory status, oxygen saturation, ABGs, and hemodynamics guides ongoing treatment modifications. The nursing role is integral in recognizing early signs of deterioration, administering medications, maintaining airway patency, and providing patient education regarding breathing exercises, medication adherence, and smoking cessation if applicable.

Involving multidisciplinary teams enhances holistic care. The respiratory therapy department plays a crucial role by titrating oxygen and administering inhaled medications or NIV. The pulmonology team assists with advanced management options, including possible escalation to ventilatory support if needed. The infectious disease specialists guide antimicrobial therapy for pneumonia. The cardiology team monitors her heart failure status, optimizing diuretics and other heart failure medications to reduce pulmonary congestion. Physical therapists assist with mobilization and breathing exercises to improve lung function and prevent deconditioning.

Psychosocial support is also essential, addressing anxieties related to breathing difficulty or hospitalization. Social workers may assist with discharge planning, ensuring home environments are suitable for ongoing respiratory support or home oxygen therapy. Education about disease management, medication compliance, and recognizing early signs of exacerbation empowers Sarah to participate actively in her care.

In summary, managing Sarah’s complex presentation involves a comprehensive, multidisciplinary approach that addresses acute respiratory dysfunction, underlying chronic conditions, infection control, and patient-centered education. Collaboration across departments ensures tailored interventions aimed at stabilizing her current condition, preventing complications, and promoting recovery and quality of life.

References

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