Identification of Patients’ Health Issue

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

1NURSING
Identification of Patients’ Health Issue
The three priority issues are poor oxygen saturation (SpO2: 88%; normal: 95 to
97% at room temperature), increased respiratory rate (36 beats per minute; normal: 12
to 22 beats per minute) and elevated blood pressure 146/92 mmHg (normal: BP: 120/80
mm Hg) (Urden, Stacy & Lough, 2019). She is also exacerbating scattered wheezes from
both the lungs. According to Ramos, Krahnke and Kim (2014), Chronic Obstructive
Pulmonary Disease (COPD) is associated with shortness of breath (SOB) along with
wheezing or generation of gasping sound coming from lungs during breathing. Airway mucus
is the part lung’s native immune that helps in trapping of the micro-organisms and
particulates and thus helping in lung clearance through ciliary transport and cough. Mucus
hyper-secretion and generation of choric productive cough are main features of COPD.
Hyper-secretion and over-production by goblet cells reduces the elimination of mucus and is
regarded as the principal mechanism of responsible for excessive mucus production and
formation of chronic bronchitis. This is reasons why Jim is experiencing wheezing of breath.
Wheezing of breath or block in the pulmonary airways is causing SOB followed by decrease
in the oxygen saturation of the body or hypoxia (Urden, Stacy & Lough, 2019). Thus poor
oxygen saturation is a major concern. Under hypoxic condition, the lungs are unable to
exchange adequate oxygen from the external environment leading to decrease in the
dissolved oxygen content in the blood. Thus the oxygen reaching to the corners of the body
reduces along with the reduction of the oxygen supply in the brain that ultimately might lead
to cyanosis and in extreme cases, development of coma. Hypoxia stimulates ventilation along
with dyspnea (SOB) and this is reason why Jim was forced to seat all the night for managing
his discomfort. Chronic alveolar hypoxia leads to the development of corpulmonate – right
ventricular hypertrophy either in the presence or absence of right ventricular failure (Vold et

2NURSING
al. 2015). However, pulmonary hypertension (increased respiratory rate) in COPD patients
increase the pulmonary atrial pressure leading to increased heart beat and blood pressure.
Under increased blood pressure, there occurs increase in the peripheral resistance leading to
atrial fibrillation and subsequent development of heart failure. Jims’ increased blood
pressure and respiratory rate thus must be taken into consideration. Slightly elevated
body temperature (by 1 degree C) is not a significant concern for Jim as it might be due to
formation of mucus and can get reduced upon airway management. The elevated heart beat
can be managed by reduction of the high blood pressure and thus can be omitted from the
priority level (Urden, Stacy & Lough, 2019).
Prioritization of patients condition
Management of oxygen saturation
The first priority of care includes administration of the external oxygen supply in
order to increase the level of oxygen saturation within the body. The recommended treatment
issued administration of oxygen. The administration of oxygen must be undertaken in high
Fowler’s position (60 to 90 degree angle). The high Fowler’s position facilitates the relaxing
of the tension of the abdominal muscles and thereby helping to increase the surface area of
the diaphragm and promoting the process of ease breathing. The administration of the oxygen
must of done through vapotherm small bore cannula with high intensity oxygen
administration. This type of nasal cannula will reduce the unwanted loss of oxygen from the
surrounding while increasing the velocity to flushing out CO2 and increasing the inflow of
oxygen. It also ensures optimal patients’ comfort along with minimal occlusion for promoting
gas egress (Fujita et al,. 2019). A nursing professional must also monitor the level of oxygen
saturation in the body through pulse oxymetry in order to regulate the external oxygen supply
(Peyton et al., 2019).