Nursing Assignment: Prioritizing Patient Care for Mr. Smith

This nursing assignment analyzes the case study of Mr. Smith and identifies two care priorities on the basis of the ABCDE assessment. The identified care priorities are addressed using appropriate intervention strategies and an effective discharge planning so as to promote an effective care outcome.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Advancing age in general is accompanied with a number of disorders and
physiological complications. It should be typically noted in this context that while framing a
nursing care plan for old age individuals, it is important to take into consideration all
associated attributes that influence the wellness of the individual. Based on the patient care
needs, the nursing professionals must devise patient priority. Prioritizing patient care and
implementation of appropriate intervention to address the identified priorities has been
identified to yield positive patient outcome (Baird 2015). This paper intends to analyse the
case study of Mr. Smith and accordingly identify two care priorities on the basis of the case
evaluation. The primary care priorities would be identified on the basis of the ABCDE
assessment. Further, the identified care priorities would be addressed using appropriate
intervention strategies and an effective discharge planning so as to promote an effective care
outcome.
Primary Priorities:
The ABCDE framework critically comprises of the five assessments of Airway,
Breathing, Circulation, Disability and Exposure (Jackson 2016). As stated byBalas et al.
(2013), the ABCDE assessment forms a systemic approach that helps in assessing the level of
physiological functions in patients that are critically ill or are presented to the emergency
unit.
In close association to the Airway assessment, it can be mentioned here that the
airway is obstructed. This is because it has been mentioned in the case study that Mr. Smith
has presented to the GP with exacerbation of his CHF. Further, the airway also presents
coarse crackle. Research studies mention that popping of the basal crackles are caused by the
opening of small airways or lack of sufficient air passage at the time of the expiration process

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(McIlwaine et al. 2017). In addition to this, as stated by Andrews et al. (2013), basal crackles
are present on the sides of the lungs and the popping sound is caused due to the presence of
fluid collapsed alveoli.
According to the breathing assessment it can be mentioned that Mr. Smith is
experiencing problems with normal breathing and respiratory rate. The objective data
provided suggests that the respiratory rate of the patient is 24. It should be noted in this
context,. That the normal respiratory rate is considered equivalent to approximately 12 to 20
breaths per minute. The respiratory rate of the patient is 24, which suggests that the patient is
experiencing respiratory distress. It is critical to note here that the patient has also been
mentioned to experience increased shortness of breath. This suggests that the normal gaseous
exchange mechanism of the patient is affected. Further, according toFrieden et al. (2014),
high blood pressure is tightly linked to an elevated respiratory rate. This can again be seen in
case of the patient.
Circulation assessment can be assessed by the objective data of body temperature.
The body temperature has been mentioned to be equivalent to 36.8 ̊ C. It should be noted in
this context, that the normal body temperature of the human body is equivalent to 37 ̊ C.
Also, the reported heart rate is equivalent to 105 beats per minute against the normal heart
rate which is equivalent to approximately 60 to 100 beats per minute. Also, the patient is
experiencing a characteristic ‘hacking cough with bilateral bibasal coarse crackles’.
Disability assessment can be assessed by the provided objective data of oxygen
saturation which has been mentioned as Sp02- 92%. According to Ceylan et al. (2016), the
normal level of oxygen saturation at room temperature is equivalent to 98%. Therefore, it can
be mentioned that patient is suffering from mild hypoxia.

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‘E’ assessment refers to exposure, however, the case study does not provide any
objective or subjective data on Exposure.
Therefore, on the basis of the ABCDE assessment, the chosen care priorities for Mr.
Smith would comprise of optimizing the blood pressure level and effectively addressing the
problem of impaired gaseous exchange.
Interventions:
Intervention 1: Optimizing the elevated blood pressure
Pathophysiology:Effective control of diet and administration of Thiazide diuretics such as
chlorothiazide would help in controlling the blood pressure of the patient. Diuretics form the
first line medications for stage I or stage II hypertension. The medications are most effective
when administered with beta blockers. Diuretics limit fluid retention and reduce the possible
incidence of stroke or heart failure (Kang 2013). In addition to this, the case study suggests
that the patient consumes a high protein diet. The previous medical history of the patient
reveals hypercholesterolaemia. According to Vaneckova et al. (2014), a diet rich in lipid and
protein leads to obesity which increases the risk of cardiac failure or stroke. Also, the patient
has a previous medical history of hypertension, TIID, Angina and MI. Also, the patient’s
BMI is high which suggests that the patient is morbidly obese.
Management:
Therefore, the patient management strategies would include administration of diuretic
medications and controlling the high protein and high fat diet of the patient.
Nursing Consideration:
The Nurse in consultation with the physician must administer Diuretic medication so
as to optimize the elevated hypertension of the patient. In addition to this, the nurse must

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educate the patient about the inclusion of a high protein and high fat diet and the associated
risk factors. The nurse must educate the patient about the existing relationship between
obesity and how it triggers hypertension (Blutcher et al. 2018). Therefore, for the dietary
management, a referral to the dietician would be made. Further, the patient would be
administered Thiazide diuretics after consulting with the physician in order to control the
increased blood pressure.
Importance of intervention and evaluation outcome:
The proposed intervention would help in controlling the risk of a cardiac arrest or
associated cardiovascular disorders. In addition to this, the proper diet management would
help in controlling the BMI. The evaluation would be done on the basis of subsequent vital
assessments and estimation of the BMI.
Intervention 2: Educate patient about deep breathing and coughing exercises
Pathophysiology:Research studies mention that deep breathing exercises effectively help in
clearway airway passage (Andrews et al. 2013) . The patient has been reported to suffer from
hacking cough with bilateral bibasal coarse crackles. The crackles can be mentioned to be
caused by the opening of the small airways. This condition is mainly caused when the alveoli
is collapsed by fluid, exudate or there is restricted aeration during the process of expiration
(McIlwaine et al. 2017).
Management:
The supporting rationale for the administration of breathing exercise is to promote
airway clearance and facilitate normal breathing.
Nursing Consideration:

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The nurse must show empathy and effectively demonstrate the breathing exercises.
Empathy and effective communication directly governs the quality of effective relationship
shared between the nurses and the patient. The patient can demonstrate the huffing technique
which includes inhalation of maximum air followed by exhalation and making a ‘ha’ sound.
While exhalation, the mouth is slightly kept open. Also, the patient would be recommended
to drink water while performing the exercise so as to keep the buccal cavity continuously
hydrated.
Importance of intervention and evaluation outcome:
The airway clearance would help in promoting effective breathing. It would help in
relieving the patient of the respiratory distress. Further, the evaluation would be done by
conducting a chest X-ray of the patient which would help in detecting the presence of
mucous.
Intervention 3: Supply oxygen externally through nasal cannula
Pathophysiology:Research studies mention that when the red blood cells are devoid of
oxygen, the oxygen saturation level is lowered and the condition is referred to as hypoxia
(Andrews et al. 2013). Upon evaluating the patient’s case, it can be seen that the level of
oxygen saturation is low. Also the low level of oxygen saturation can be said to increase the
heart rate. In addition to this, research studies also indicate that lower level of oxygen
saturation leads to fatigue which has also been mentioned in case of the patient (McIlwaine et
al. 2017; Beasley et al. 2017). In addition to this, the patient would be made to lie down with
the head elevated so as to promote effective breathing and increase the surface area adjacent
to the diaphragm. Research studies mention that diaphragm descent promoted improved
inhalation and decreased laboured breathing (Beasley et al. 2017).
Management:

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The management would include administration of oxygen externally by means of
nasal cannula and maintenance of Fowler’s position, with the patient’s head being slightly
elevated compared to the body while resting.
Nursing Consideration:
The volume of oxygen supply would be adjusted according to the physician’s
instructions. The vital signs of the patient would be monitored and the patient’s response
would be monitored in accordance to the observation recorded in the pulse oximetry (Beasley
et al. 2017). The oxygen cylinders must be checked for the presence of any blockage which
would interrupt the oxygen flow. Also, the bed must be positioned at 45 degrees so as to
ensure proper chest expansion (Ceylan et al. 2016).
Importance of intervention and evaluationoutcome:
The supply of oxygen externally would facilitate restoration of oxygen saturation and
the maintenance of elevation of the head would facilitate effective chest expansion and
breathing. The outcome would be evaluated on the basis of the SpO2 level and it is expected
to increase and stabilise between 97% to 98% SpO2 (Ceylan et al. 2016).
Discharge Planning:
According to Australian Nursing & Midwifery Federation(2019), it has been
mentioned that the principles of social justice within the context of Australian Health Care
must include the factors of proper access to healthcare services and advocacy of legal health
related rights. In addition to this, the principle of social justice also refers to the provision of
equal healthcare facilities to individuals irrespective of their financial background and equal
participation and informed consent of the patient in the decision making process (Australian
Nursing & Midwifery Federation, 2019).

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While planning the discharge care plan for the patient, the patient would be actively
involved in the decision making process (Shepperd et al. 2013) . In addition to this, the
patient would be educated about his health condition (Goncalves et al. 2016) Also, the patient
would be recommended a proper diet plan which would aim at controlling the blood glucose
level as well as the blood pressure level of the patient. In addition to this, the patient would be
prescribed medication to reduce congestion within the lungs and to control the elevated blood
pressure.Therefore to summarize, it can be said that the major factors that would be
incorporated in the discharge planning would include the following:
 Patient evaluation data as evaluated by the physician
 Involving the patient and the family members in the decision making process
 Planning for patient discharge to home
 Assessing and determining if training of the immediate care giver is required
 Organizing referrals to community based healthcare services or government
sponsored home based care services such as domestic care services or assistance with
activities of daily living
 Arranging follow up consultations with physician
While planning the discharge care plan of Mr. Smith, the multidisciplinary team that
would be involved would include a dietician who would plan a proper diet for the patient. In
addition to this, it would also involve a pharmacist who would arrange the medication along
with the appropriate doses for the patient.
Conclusion:
Therefore, based on the above discussion, it can be mentioned that there are two care
priorities which include management of the elevated blood pressure and the promotion of

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effective gaseous exchange. The two care priorities would be managed by monitoring the
dietary intake of the patient and by the administration of Thiazide diuretics. In addition to
this, effective gaseous exchange would be promoted by teaching effective breathing exercises
and supplying oxygen externally through nasal cannula. In addition to this, it should be
mentioned that the discharge planning of the patient would be planned in consultation with
the family members. Also, prior to the discharge, the patient as well as his family members
would be effectively educated about the health condition of the patient. In addition to this,
education would also be imparted in relation to the drug dosage, mode of action of the drugs
and the mechanism of drug administration. As Mr. Smith is 70 years old, the family members
of the patient would be educated about the medication so as to avoid instances of missed
doses or incorrect medication. Further, the discharge planning would also contain a re-visit
schedule for the follow up consultation with the physician.

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References:
Andrews, J., Sathe, N.A., Krishnaswami, S. and McPheeters, M.L., 2013. Nonpharmacologic
airway clearance techniques in hospitalized patients: a systematic review. Respiratory
care, 58(12), pp.2160-2186.
Australian Nursing & Midwifery Federation. 2019. Social Justice. Access date: 9th April
2019. Retrieved from: http://anmf.org.au/pages/social-justice
Baird, M.S., 2015, Manual of Critical Care Nursing-E-Book: Nursing Interventions and
Collaborative Management. Elsevier Health Sciences.
Balas, M., Buckingham, R., Braley, T., Saldi, S., &Vasilevskis, E. E. (2013). Extending the
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Beasley, R., Chien, J., Douglas, J., Eastlake, L., Farah, C., King, G., Moore, R., Pilcher, J.,
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hypertension: a critical step on the pathway to progress. Jama, 311(1), pp.21-22.

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