Health Alteration

This report discusses the primary priorities of a patient suffering from health alteration, including impaired gas exchange and excess fluid. It explains the interventions for these priorities and the use of the ABCDE framework. It also covers discharge planning for the patient.

Running Head: HEALTH ALTERATION
Health Alteration
Name of the student:
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Alteration
Introduction
Mr. smith who is a 70 year old patient, suffering from multiple disorder such as,
hypertension, diabetes, myocardial infection, angina and congestive heart failure. Based on the
past medical history and the current diagnosis of the patient, the ABCDE frame work is done to
evaluate the primary priorities of the patient. In this report, the intervention and the rationale of
the identified primary priorities is explained. As the patient is suffering from acute chest pain,
shortness of breathing and high respiratory rate, impaired gas exchange is identified as the 1st
primary priorities. To treat the impairment gas exchange nursing intervention such as,
maintaining the position of the body, suction pump and oxygen therapy is provided to the patient
is discussed in detail (Azad & Lemay, 2014). Patient is suffering from congestive heart failure,
which is responsible for excess fluid into the body. To remove the excess fluid from the body,
nursing intervention such as, administration of diuretics, limiting sodium intake and heparin
device is applied to the patient (Ter Maaten et al., 2015). Discharge planning of the patient is
also discussed.
Primary priorities
ABCDE frame work helps in assessing and treatment of the disease. The ABCDE
(Airway, Breathing, Circulation, Disability, Exposure) approach is used to treat critically ill
patient in an emergency situation. Mr Smith, who is 70 years old male patient has experienced
exacerbation of congestive heart failure. He was experiencing pleuritic chest pain, shortness of
breathing, fatigue, weakness and a hacking cough associated with bilateral bibasal coarse
crackles (Azad & Lemay, 2014).

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Airway- The patient is suffering from hacking cough associated with bilateral bibasal coarse
crackles, which shows obstruction in the airway passage of the patient. If deficit of oxygenation
occur in the patient it can cause impaired gas exchange in the patient.
Breathing- Impaired gas exchange is referred to as the dilation of intrapulmonary capillary
vessel which results in the reduction of oxygen from the normal alveolus causing shortness of
breathing. In this case also, patient is suffering from shortness of breathing and his respiratory
rate is 24 (normal 12-20 beats/minutes), which is responsible for impaired gas exchange. Sp02
of the patient is 92% (normal sp02 level is 94%-100% and between 88%to 94% in patient with
chest pain and respiratory complications).
Circulation- The blood flow of the patient is decreased which is responsible for myocardial
infection associated with chest pain known as Angina, which is also one of the reason for
impaired gas exchange. As the patient is suffering from congestive heart failure. In CHF
pumping of the heart is reduced in which there is an accumulation of excess blood into the blood
vessel. It cause the fluid to be pushed out from the aleivoli and blood pressure increases and
causes excess fluid into the body.
Disability- The patient is mentally active, his GCS is 15 (best eye response, best motor response
and best verbal response) (Liu, & Eisen, 2014). The patient is experiencing fatigue and
weakness, which is common in edema (excess body fluid) and impaired gas exchange.
Exposure- For impaired gas exchange and excess bod fluid, heart rate, respiratory rate BGl,
sp02, NiBP of the patient is monitored continuously (Azad & Lemay, 2014).
Intervention
Primary priorities of the patient identified is impaired gas exchange and removal of
excess fluid.

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A. Impaired gas exchange or altered supply of oxygen (Castellan et al., 2016)
Intervention 1- Helps patient in deep breathing and coughing by different techniques
such as, position maintaining and splinting
Maintain the position of the patient such as place the head of the patient in elevated
position in a semi flower position, turning the position of the patient in regular interval of 2
hours, and to avoids slumping down in the bed (Ruland, 2017).
Rationale: As the patient is suffering from impaired gas exchange, maintaining the appropriate
position of the body is extremely important. Placing the head in elevated position (sunflower
position) in the patient suffering from altered supply of oxygen helps in increasing the lung
expansion which prevents crowding of abdominal pain. In addition, proper positioning of the
patient helps in avoiding the slumping. Slumping down in bed compress the diaphragm of the
patient and prevents the full expansion of lungs which creates pressure on the lung, hence it
should be avoided to prevent the compression of the diaphragm (Ruland, 2017). The patient is
turned in the regular interval of every two hours to prevent the complications related to
immobility but special care should be taken. As Mr. Smith have low hemoglobin in the blood
and hence, turning of either side in regular interval can cause desaturation in patient and should
be avoided. Mr. Smith is also suffering from obesity, hence Trendelenburg position is also
recommended at 45 degrees, which helps in increasing the tidal volume and decreasing the
respiratory rate. Splinting of chest helps in reducing the pain and also optimizes coughing and
breathing efforts.
Outcome: After maintaining the position of the body of the patient, the respiratory rate of the
patient is increased and Spo2 is decreased which helps in deep breathing and reduce coughing.
Intervention 2- providing of oxygen therapy.

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Supplemental oxygen is provided to the patient. Oxygen therapy is treatment that
provides extra oxygen in the body. It is provided in patient suffering from lateral oxygen supply,
who are unable to take appropriate amount of oxygen from the surrounding. Oxygen therapy is
provided in patient having Sp02 less than or equals to 92 %. Sp02 of the patient is 92%, which is
low than the normal level (94% - 100%) (Hofmann et al., 2017).
Rationale: Oxygen administration helps in relieving hypoxia by providing the appropriate
amount of oxygen to the tissues and vital organs of the body for proper functioning. It increases
the level of oxygen in the blood of the patient and along with that it help in decreasing the
resistance of blood flow. In addition, oxygen therapy also helps in preventing the accumulation
execs Co2 in to the body. The respiratory rate of the patient is 24, which is higher than the
normal respiratory rate (12-20 Beats per minute), hence oxygen therapy also helps in reducing
the respiratory rate of the patient (Hofmann et al., 2017).
Hence in order to treat the oxygen alteration in patient, supplementary oxygen is provided
in the patient by the help of face masks, High flow nasal prong therapy, mechanic ventilation and
mask-BiPaP.
Outcome: respiratory rate is reduced.
Intervention 3- Endotracheal suction is provided
Mr. Smith is suffering from hacking cough associated with bilateral bibsal coarse
crackles, which is also one of the reason which causes impaired gas exchange. If the secretion is
not cleared, it causes the blockage of airway passage of the patient. Suction is a common method
used in patient care (Liu, & Eisen, 2014)

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Rationale: It is referred as the suctioning of the respiratory secretion which is responsible for the
air passage blockage. In addition it helps in optimizing the gas exchange. Suction helps in
clearing the air passage by removing the respiratory secretion (Liu, & Eisen, 2014).
Outcome: After the suction has been provided, the average amount of yellow secretion has been
removed and lungs sounds clear.
For the removal of excess fluid present in the body (Miller, 2016)
Intervention 1 : Administration of diuretics.
MR. Smith is suffering from congestive heart failure which is one of the reason
responsible for the excess fluid into the body known as hypervolemia. To reduce the amount of
body fluids, diuretics are prescribed by the doctor (Qavi, Kamal & Schrier, 2015).
Rationale: in case of Mr. Smith, congestive heart failure is responsible for the excess body fluid
in the body. CHF is referred to as the condition where the heart is unable to pump adequate the
amount of blood according to the need of the body. This condition of the heart leads to the
kidney impairments, where the kidney is unable to work properly. Due to the kidney impairment
appropriate amount of urine does not get excreted from the body. When the diuretics is
administered to the patient, urine output of the patient is increased which helps in the removal of
the excess fluid from the body. Diuretics inhibits the reabsorption of the Na into the different
segments of the kidney which improves diuresis (Qavi, Kamal & Schrier, 2015).
Outcomes: Excess fluid is removed from the body in the form of urine.
Intervention 2- limits sodium intake

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In the patient suffering from congestive heart failure, consumption of too much salt in the
body causes excess fluid into the body. Hence limiting the consumption of salt into the diet helps
in reducing the body fluid (Sterns, 2015).
Rationale: limiting the amount of sodium onto the diet helps in preventing the reabsorption of
Na into the body. Reduction of Na absorption, increase the urine output, which decreases the
body fluid. As the blood pressure of the patient is also extremely high hence, limiting the amount
of sodium into the diet also helps in reducing the load pressure of the patient to the normal range
(120/80). Limiting the amount of sodium also provide other health benefits such as, minimizes
the risk of stroke which us high in case of the patient suffering from congestive heart failure
(Sterns, 2015).
Outcome: Excess body fluid is removed from the body with the help of limiting the sodium
intake.
Intervention 3- heparin lock device is applied
In the case of patient has excess body fluid, heparin lock device is applied, which helps in
decreasing the body fluid delivered to the patient and helps reducing the body fluid (Olthof et al.,
2014).
Rationale: when the patient is provided with intravenous fluid to increases the body fluid, but is
also necessary to maintain the IV access. Heparin lock device is used to clean the intravenous
catheter and also manages the fluid flow into the body. It supplies only the appropriate amount of
fluid into the body, which helps in reducing the blood flow (Olthof et al., 2014).
Outcome: excess body fluid in the body of the patient is reduced.

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Discharge planning:
Discharge planning us diner ta the time of the discharge of the patient. It is done by the
help of different discharge planning tools by considering the patient’s condition. Proper
discharge planning of the patient helps in the providing effective result. It ensures that the patient
is placed in the safe condition after the patient’s discharge. The goal of the discharge planning is
to reduce the readmission of the patient and along with that, it also helps the patient in coping
with the changes that occur in the transition between the hospitals to post-acute settings
(Gonçalves‐Brad et al, 2016).
As Mr. Smith is suffering from multiple disorder such as, shortness of breathing,
myocardial infection, diabetes, hypertension and obesity. Hence, the discharge planning involves
the consideration of patient situation. At first the past medical history and the present health
condition of the patient is considered (Gonçalves‐Brad et al, 2016).
Depending upon the patient situation, medication are prescribed which is involved in
the discharge planning of the patient. As in this case, the patient is suffering from diabetes, hence
medicine used for the diabetes such as metformin is also mentioned in the discharge planning of
the patient. The priority disease of the patient is impaired gas exchange and excess body fluid.
Hence, additional attention in provided to both of the priorities in the discharge planning. Along
with the list of medication, specific time interval on which the medicine should be consumed is
also mentioned along with the other information related to medicine consumption such as,
whether it should be taken before or after food, how many times it should be taken in a day and
time period for which the medicine is continued (Cameron, 2018).
All these information ate included in the discharge planning by the nurse taking care of
the help of a physician.

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As the patient is suffering from impaired gas exchange, has excess fluid into the body,
hypertension and obesity. Hence specific diet is suggested by the dietician. Proper diet helps in
enhancing the efficiency of the treatment as well as it also assists in avoiding the risk factor that
are responsible for the further health deterioration. As for example, patient is suffering from
obesity, hence low cholesterol diet is suggested. For diabetes, diet consisting of low sugar level
is included in the discharge planning (Cameron, 2018).
The diet is formulated by the help considering the patient situation with the help of
dietician.
In addition, the information regarding the physical exercise such as running is also
included in the discharge planning by the help of physiotherapist. Other information such as the
date of next visit to the physician is also mentioned.
Conclusion:
From the above report it can be concluded that, ABCDE frame work is beneficial in
evaluating the primary priorities of the patient. In this report, Mr. smith who is suffering from
congestive heart failure is admitted. With the help of ABCDE framework, the primary priorities
of the patient such as impaired gas exchange and presence of excess body fluid is identified. To
treat the primary priorities identified, nursing intervention and rationale is explained and the
outcome is also discussed. Nursing intervention such as, maintain the specific position of the
patient, oxygen therapy and suction pump is provided to the patient for the treatment of impaired
gas exchange. Nursing intervention such as, application of heparin lock device, administration of
diuretics and excess sodium intake is limited in the patient. Based on the identified primary
priorities discharge planning is explained. Discharge planning is formulated with the help of
multidisciplinary team which consist of physician, dietician, physiotherapist and nurse.

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References
Azad, N., & Lemay, G. (2014). Management of chronic heart failure in the older
population. Journal of geriatric cardiology: JGC, 11(4), 329.
Cameron, B. (2018). The impact of pharmacy discharge planning on continuity of care. The
Canadian journal of hospital pharmacy, 47(3).
Castellan, C., Sluga, S., Spina, E., & Sanson, G. (2016). Nursing diagnoses, outcomes and
interventions as measures of patient complexity and nursing care requirement in
Intensive Care Unit. Journal of advanced nursing, 72(6), 1273-1286.
Gonçalves‐Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S.
(2016). Discharge planning from hospital. Cochrane database of systematic
reviews, (1).
Hofmann, R., James, S. K., Jernberg, T., Lindahl, B., Erlinge, D., Witt, N., ... & Ravn-
Fischer, A. (2017). Oxygen therapy in suspected acute myocardial
infarction. New England Journal of Medicine, 377(13), 1240-1249.
Liu, L., & Eisen, H. J. (2014). Epidemiology of heart failure and scope of the
problem. Cardiology clinics, 32(1), 1-8.
Miller, W. L. (2016). Fluid volume overload and congestion in heart failure: time to
reconsider pathophysiology and how volume is assessed. Circulation: Heart
Failure, 9(8), e002922.
Olthof, E. D., Versleijen, M. W., Feuth, T., Kievit, W., & Wanten, G. J. (2014). Taurolidine
lock is superior to heparin lock in the prevention of catheter related bloodstream
infections and occlusions. PloS one, 9(11), e111216.

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Qavi, A. H., Kamal, R., & Schrier, R. W. (2015). Clinical use of diuretics in heart failure,
cirrhosis, and nephrotic syndrome. International journal of nephrology, 2015.
Ruland, R. T. (2017). U.S. Patent No. 9,610,389. Washington, DC: U.S. Patent and
Trademark Office.
Sterns, R. H. (2015). Disorders of plasma sodium—causes, consequences, and
correction. New England Journal of Medicine, 372(1), 55-65.
Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A.
(2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and
therapy. Nature Reviews Cardiology, 12(3), 184.