Health Alteration

Running Head: HEALTH ALTERATION
Health Alteration
Name of the student:
Name of the university:
Author note:

1
Health
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).

2
Health
Alteration
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.

3
Health
Alteration
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.