Nursing Care Priorities for Older Adults with Chronic Healthcare Conditions

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

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Introduction
Multiple attributes influence the framing of the nursing care plans for the older adults
who are suffering from chronic healthcare conditions. For a nursing professional, the clinical
priority must be set based on the needs of the patients. This is known as prioritization of
patient care that helps to increase the effectiveness of the overall outcome of patient’s health.
The following essay aims to analyse the two care priorities care on the basis of the critical
evaluation of the case study of Mr. Smith a 70 year old man suffering from chronic chest pain
(Cruz, Carvalho & Sousa 2014). The essay will use ABCDE framework to highlight the
primary priorities of care. The generation of two care priorities will be followed by three
nursing interventions to address the care priority followed by discharge planning.
Primary Priorities
According to Grin et al. (2016), ABCDE framework deals with Airway, Breathing,
Circulation, Disability and Exposure. It is a systematic approach for immediate assessment
and treatment of critically ill patients and is applicable in the clinical emergencies.
Airway of Mr. Smith is experiencing obstruction as be is experiencing exacerbation of
his CHF (Chronic Health Failure). The airway of Mr. Smith indicates bibasal coarse crackle.
According to Pocock, Richards and Richards (2013), basal crackles are present on both side
of the lungs and are caused by "popping open" of the small airways or fluid collapsed alveoli
or lack of aeration at the time of expiration.
In breathing, it can be said that Mr. Smith has general signs of respiratory distress.
The respiratory rate of Mr. Smith is 24. Normal respiratory rate is 12 to 20 beats per minute
and rate higher than this shows visible sign of respiratory distress. This high respiratory rate
might be due to his high non-invasive blood pressure (170/90 mg/Hg) (Shier, Butler & Lewis
2015). Moreover Mr. Smith is also experiencing shortness of breath (SOB) and thus it can be
said that he is suffering from in-effective gas exchange.
Circulation is accessed by the body temperature of the patient. Body temperature is
slightly decreased. The body temperature of Mr Smith is 36.8 degree Centigrade. Normal
body temperature range for adults is 37 degree. Her heart rate is slightly increased: 105 beats
per minute (normal: 60 to 100 beats per minute) (Shier, Butler & Lewis 2015). He is also
experiencing hacking cough with bibasal course crackles. His past history indicated that she

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has oedema as she is on Frusemide medication. Thus it indicates he is suffering from excess
fluid volume.
Disability is reflected in the domain of hypoxia. Mr. Smith might be suffering from
mild hypoxia as his oxygen saturation (Sp02- 92%) (Grin et al. 2016). Normal oxygen
saturation is 98% at room temperature (Shier, Butler & Lewis 2015).
There is no significant information in the domain of Exposure.
The two main clinical priorities will be in-effective or impaired gas exchange and
excess body fluid volume. The reduction in the excess body fluid volume can be done by
restriction of sodium intake in diet and control of fluid intake. The improving in-effective or
impaired gas exchange can be done with the help of Fowler’s posture and deep breathing and
coughing technique.
Interventions
Priority 1: Management of Excess Fluid Volume
Intervention 1: Limitation of Sodium (Na) Intake
Pathophysiology
Mr. Smith is showing slightly reduced body temperature and hacking cough with
bibasal course crackles which is an indicator of excess fluid volume. According to Baird
(2015), excess fluid volume or hypervolemia is defined as increased volume of body fluid.
This increased fluid volume increases central venous pressure and this increases right atrial
pressure, right ventricular end-diastolic pressure. This is the reason why NiBP of Mr. Smith
is high. In order to compensate for impaired cardiac output, there occurs an increase in the
heart rate along with an increase in the systemic vascular resistance (SVR) (Vincent et al.
2016). As per the case study, Mr. Smith is experiencing high heart rate (105) along with high
respiratory rate (24 beats per minute) and this is the reason why Mr. Smith is experiencing
high level of fatigue. Mr. Smith is on metformin (artificial insulin). Baird (2015) stated that
excess insulin shifts the equilibrium of the metabolism towards anabolism, converting dietary
sugar and fat into stored fat and thus leading to weight gain. It leads to production of extra
cholesterol at unhealthy levels that retain kidneys to store sodium causing water retention,
high blood pressure.