Nursing and Acute Care

This document provides study material and assignments on Nursing and Acute Care. It includes information on initial respiratory assessments, indicators of worsening condition, and immediate priorities for nurses to address shortness of breath.

Running head- NURSING AND ACUTE CARE
NURSING AND ACUTE CARE
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Table of Contents
Question 1- Initial focussed respiratory assessments of the patient................................................2
Question 2 – Patient’s assessments that is indicating that the condition of the patient is
worsening.........................................................................................................................................2
Question3 -Immediate priorities of the nurse to increase the shortness of breathe.........................3
Reference.........................................................................................................................................5

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Question 1- Initial focussed respiratory assessments of the patient.
The respiratory assessments refers the assessments of the ventilations which are done
externally like observations of patters, rate and depth of respiration (Sheldon et al., 2015). An
appropriate assessment includes recognition of the movements of the thoracic and the abdominal
regions. The given case study is about Jennifer Hoffman who is suffering from sinus tachycardia.
The disease is identified with an increase in the rate of impulses normally the rate increased to
more than 100 beats/min. If the rate of heart beat increase too high then the cardiac output can
fail as the filling time of the ventricles get reduced (Sheldon et al., 2015). In the given scenario,
the initial hear rate of the patient is 116 where the normal heart rate for an adult man is 60-100
bpm and for an adult woman the normal range is 60-90. So it is seen that the heart rate of this
patient has increased a lot. The blood pressure is slightly high than normal, only the systolic
blood pressure is slightly high. The normal value is 120 and the patient has 134. The diastolic
value is normal. The SpO2 is 78% which means the blood of the patient is carrying 78%
oxygenated blood and the rest 12% de-oxygenated blood. The value of SpO2 means peripheral
capillary oxygen saturation. The disease sinus tachycardia increases the demand of myocardial
oxygen and reduces the flow of the blood of the coronary arteries (Brembilla-Perrot et al., 2015)
Question 2 – Patient’s assessments that is indicating that the condition of the
patient is worsening.
The nursing assessments involve collection of information about the patients’ health
condition. The assessments are the first step of starting the treatment of a patient. The
assessments involve the psychological, social, physical and spiritual status of the patient. In the
present case scenario, the nurse need to assess the viral signs of the patient from time to time and
the clinical status of the patient is determined from the values of the vital signs. The vital signs
involve the measurement of the heart rate, blood pressure, rate of respiration, body temperature
and the amount of oxygen present in the blood (Patel et al., 2016). The patient of this case study
is suffering from sinus tachycardia which is clearly visible by noticing the heart rate. The nurse
has checked the values of the vital signs ten times and in all the assessments it is seen that the
value of the heart rate is either 116, 114 or 113. The SpO2 level has decreased from 78% in the
first assessment to 73% in the last assessment. So the level of oxygen in the blood has

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deteriorated a lot. This shows that the coronary artery is not functioning properly and has
worsened a lot. The rate of respiration in the first assessment was 25 and in the last assessment it
is 31. The patient is breathing fast because of low level of oxygen in the blood. The patient is
breathing fast for compensating the high oxygen demand of the blood. The body temperature of
the patient is normal in all of the assessments and the blood pressure has reduced from the first
assessment to the last one, though the change in the blood pressure is not drastic and it is not
affecting the health conditions of the patient much.
Question3 -Immediate priorities of the nurse to increase the shortness of
breathe
The patient Jennifer has developed a rapid onset of the shortness of breath. At this time
the nurse should make priorities like making the patient understand to reduce the anxiety,
provide urgent medicines against the shortness of breath and must move according to the severe
of the case. At first the nurse must decrease the anxiety of the patient (Haugdahl et al., 2015).
The nurse must prescribe anxiolytic medicines for the purpose of controlling the panic of the
patient. The nurse must suggest the patient with some relaxation techniques so that the patient
can relax. The pathology underlying the disease must be controlled by the nurse (Hendriks et al.,
2015). The patient should be given bronchodilators and also diuretics should be administered and
the balance of the balance of the fluid must be monitored repeatedly. The oxygen therapy must
be administered by nasal cannula but only if the patient can tolerate it. The patient may not
tolerate the masks. Opioids like morphine sulphate should be administered orally (Antonoff et
al., 2016). The patient’s environment should have proper flow of air otherwise the patient will
feel suffocated. If possible a portable fan can be given to the patient and so many persons will
not stand surrounding the patient only a few persons can stand by the side of the patient. All
these measures should be undertaken by the nurse to reduce the shortness of breath of the patient.

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Reference
Antonoff, M. B., Ragalie, W., Correa, A. M., Spicer, J. D., Sepesi, B., Roth, J. A., ... &
Vaporciyan, A. A. (2016). Results of postdischarge nursing telephone assessments:
persistent symptoms common among pulmonary resection patients. The Annals of
thoracic surgery, 102(1), 276-281. doi.org/10.1016/j.athoracsur.2016.01.062
Brembilla-Perrot, B., Sellal, J. M., Olivier, A., Manenti, V., Beurrier, D., De Chillou, C., ... &
Girerd, N. (2015). Recurrences of symptoms after AV node re-entrant tachycardia
ablation: a clinical arrhythmia risk score to assess putative underlying
cause. International journal of cardiology, 179, 292-296.
doi.org/10.1016/j.ijcard.2014.11.071
Haugdahl, H. S., Storli, S. L., Meland, B., Dybwik, K., Romild, U., & Klepstad, P. (2015).
Underestimation of patient breathlessness by nurses and physicians during a spontaneous
breathing trial. American journal of respiratory and critical care medicine, 192(12),
1440-1448. doi.org/10.1164/rccm.201503-0419OC
Hendriks, S. A., Smalbrugge, M., Galindo-Garre, F., Hertogh, C. M., & van der Steen, J. T.
(2015). From admission to death: prevalence and course of pain, agitation, and shortness
of breath, and treatment of these symptoms in nursing home residents with
dementia. Journal of the American Medical Directors Association, 16(6), 475-481.
doi.org/10.1016/j.jamda.2014.12.016
Patel, P. J., Borovskiy, Y., Killian, A., Verdino, R. J., Epstein, A. E., Callans, D. J., ... & Deo, R.
(2016). Optimal QT interval correction formula in sinus tachycardia for identifying
cardiovascular and mortality risk: Findings from the Penn Atrial Fibrillation Free
study. Heart Rhythm, 13(2), 527-535. doi.org/10.1016/j.hrthm.2015.11.008
Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., ... & Sutton,
R. (2015). 2015 Heart Rhythm Society expert consensus statement on the diagnosis and
treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and
vasovagal syncope. Heart rhythm, 12(6), e41-e63.doi.org/10.1016/j.hrthm.2015.03.029