Sarah Is A 69-Year-Old Female Who Presented 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 medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%, indicating hypoxemia. The provider ordered oxygen at 2 L via nasal cannula, and a chest x-ray revealed bilateral pneumonia. Her arterial blood gas (ABG) results are pH: 7.30, PaCO2: 58 mm Hg, PaO2: 78 mm Hg, and HCO3: 26 mEq/L. She was admitted to a general medical floor. As the nurse caring for Sarah, it is essential to identify potential problems arising from these findings and to provide multidimensional care. Additionally, understanding the roles of other departments involved in her treatment plan is crucial for comprehensive management.

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Sarah's presentation with hypoxemia, hypercapnia, and acidosis necessitates a thorough understanding of her clinical condition and the potential complications that may arise during her hospitalization. Her low pulse oximetry reading indicates significant hypoxemia, which can compromise vital organ function if not adequately managed. The ABG results show a pH of 7.30, indicating acidemia; a PaCO2 of 58 mm Hg, signifying respiratory acidosis likely due to hypoventilation; and a PaO2 of 78 mm Hg, which, although elevated with supplemental oxygen, still points to impaired gas exchange, especially in the context of bilateral pneumonia and underlying COPD.

Potential problems that can occur in Sarah's case include respiratory failure, worsening hypoxemia, ventilation-perfusion mismatch, and exacerbation of her underlying COPD and heart failure. Respiratory failure is a significant concern because her elevated PaCO2 indicates hypoventilation, which could lead to further acidosis, decreased consciousness, or even respiratory arrest if not addressed promptly. Additionally, her pneumonia complicates her respiratory status, increasing the risk of sepsis and systemic inflammatory response. Her compromised cardiopulmonary system predisposes her to fluid overload, arrhythmias, and worsening heart failure symptoms, especially if fluid management is not carefully monitored.

Providing multidimensional care involves several key nursing interventions aimed at stabilizing her respiratory status, preventing complications, and supporting her overall health. First, oxygen therapy must be titrated to maintain adequate oxygenation, possibly requiring escalation if hypoxemia persists or worsens. Continuous monitoring of her oxygen saturation and ABGs is vital to assess response and prevent oxygen toxicity or hypercapnia. Non-invasive ventilation (such as BiPAP) might be considered if her hypercapnia worsens or if she develops signs of respiratory fatigue.

Nursing care also includes mobilizing and positioning Sarah to optimize lung expansion, such as semi-Fowler’s position, and encouraging coughing and deep breathing exercises to promote airway clearance. Administering prescribed medications—such as antibiotics for pneumonia, bronchodilators for COPD exacerbation, and possibly diuretics for fluid management—are crucial aspects. Monitoring her fluid status and ensuring adequate nutritional intake support recovery. Patient education on medication adherence, respiratory hygiene, and recognizing early signs of deterioration empowers her to participate actively in her care.

In addition to nursing care, multidisciplinary collaboration is essential for comprehensive treatment. Pulmonologists play a pivotal role in managing her COPD and pneumonia, possibly adjusting inhaler therapies or initiating corticosteroids to reduce airway inflammation. Infectious disease specialists can guide antibiotic therapy based on culture results and local antibiograms. Cardiologists should oversee her heart failure management, ensuring optimal use of diuretics, vasodilators, or inotropes if necessary, and monitoring for signs of fluid overload or electrolyte imbalances.

The respiratory therapists are instrumental in providing advanced airway management, including assessing the need for non-invasive ventilation or intubation if her respiratory status declines. They also assist with aerosol therapies and patient education on breathing techniques. Pharmacists ensure proper medication reconciliation, monitor for drug interactions, and provide counsel on inhaler use and adherence.

Psychosocial support and patient education are integral to her care. Anxiety and discomfort can exacerbate respiratory distress; thus, providing reassurance and explaining treatment plans help to reduce stress. Social workers and case managers coordinate discharge planning, considering her home environment, accessibility, and ongoing support needs to prevent readmission.

Long-term management of Sarah's condition involves addressing her underlying chronic illnesses, preventing future exacerbations, and promoting lifestyle modifications such as smoking cessation, nutritional adjustments, and physical activity within her limits. Regular follow-up with her primary care provider and specialists ensures continuity of care and early intervention for any deterioration.

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