Priorities in Nursing Care

Running Head: PRIORITIES IN NURSING CARE
PRIORITIES IN NURSING CASE CARE

PRIORITIES IN NURSING CARE
Introduction
Chronic conditions are becoming a great concern for healthcare systems all world over(Singer et
al, 2011). There are many factors which influence patient care in chronic conditions. Community Health
Nurse needs to provide care to clinical and as well as patient needs. Patient care and need prioritization
are important in daily nursing practice. It needs assimilating varied patient needs for maximizing care
activities for enhancing the effectiveness of nursing interventions (Pavlish, Brown‐Saltzman, Hersh,
Shirk, & Rounkle, 2011). In the current case study scenario, a patient’s condition is discussed and then
two priorities of care by using clinical reasoning have been justified. Nursing care plays a critical role in
patient recovery and in increasing the quality of healthcare provided. The World Health Organization
along with the MacColl Institute for Healthcare Innovation provides the Chronic Care Model (CCM) to be
adopted from a global perspective (Katon et al, 2010).
Description
The current case analysis scenario 1 of Peter Mitchell, who is a 52‐year‐old male having type 2
diabetes, has been discussed. He was admitted with poorly managed diabetes, sleep apnoea and obesity
ventilation syndrome, after being referred by his GP. He was presented with shakiness, increased
hunger, diaphoresis, breathing difficulty while sleeping and high BGL levels. He is a chain smoker and
had been admitted before on other complications. He is socially isolated and is unemployed living on
government benefits. He is referred to me as the community nurse for ongoing support and follows up
for management of his weight and clinical comorbidities (Seymour, Kumar, & Froggatt, 2011).
Analysis
The increasing burden of chronic illness is a direct outcome of increased life expectancy,
unhealthy lifestyles and advances in medical treatments and interventions (Grande et al, 2009). People
living with chronic health conditions need to assume greater responsibilities along with support from
healthcare services, especially nurses. Nurses possess the capability in the optimization of patient self‐
management skills (Greene, & Hibbard, 2012). Analyzing Peter's healthcare condition reveals that he has
a medical history of high obesity, hypertension, type 2 diabetes, gastro‐oesophageal disease reflux, and
sleep apnoea. His current medications include insulin Novomix 30 B D, metformin, lisinopril, nexium,
metoprolol, and pregabalin. Applying clinical reasoning in determining priorities of care, the two nursing
priorities for Peter is the management of ineffective breathing pattern and abnormal body weight.
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PRIORITIES IN NURSING CARE
In ineffective breathing pattern, inspiration and expiration hinder adequate ventilation. In the
abdominal wall excursion in inspiration or expiration, does not maintain optimum ventilation for Peter.
In an altered breathing pattern, the body does not get enough oxygen to its cells. Respiration failure is
generally correlated with variation in respiration rate, abdominal and thoracic pattern. Ineffective
breathing is thus considered to be a state in which rate, timing, depth, and rhythm or breathing pattern
is altered. Breathing pattern alteration might transpire into a number of circumstances, hence having a
clear and effective airway is crucial in patient care for Peter.
On his admission, I will place the pt on bipapa per md order, to understand the patient’s oxygen
saturation levels every 30 minutes. I will assess pt respiratory rate every 30 minutes in the first 8 hours
and then every 4 hours when the patient’s respiratory rate is 12‐20 breaths per minute during
hospitalization. I will demonstrate and verbalize 4 breathing techniques to be used during dyspneic
episodes in 6 hours of hospitalization (Morley et al, 2014). Then I will tell him the four ways on
preventing COPD exacerbation for Peter within 12 hours of hospitalization.
My nursing intervention for Peter would include placing the patient body in appropriate
alignment for maximum breathing pattern. As sitting position provides maximum chest expansion and
lung excursion. I will encourage Peter to take sustained deep breaths by use of slow inhalation, by
holding of end inspiration for few seconds and then passive exhalation. Using incentive spirometer and
requiring the patient to yawn are some other techniques that can be used. This technique will promote
deep inspiration, increasing oxygenation and thereby preventing atelectasis (Urden, Stacy, & Lough,
2019). Peter will be encouraged diaphragmatic breathing for relaxing his muscles and increasing his
oxygen levels. Later when Pater’s condition will improvise then inspiratory muscle training to improve
his conscious control of inspiratory muscle strength and respiratory muscles will be provided.
I will undertake frequent teach periods with some rest periods in between to pace activity. Extra
activities can worsen shortlessness of breath; hence rest is necessary between strenuous activities. I will
again ask Peter to consult a dietician for modification to his dietary chart and meals. I will encourage him
to take frequent meals to satisfy his increasing hunger. This will prevent crowding of the diaphragm and
ease breathing. I will spend time with him educating regarding his medication, dosage, indications,
frequency, and possible side effects. I will provide him reviewed metered dosage of inhaler and
nebulizer treatments as and when deemed to be necessary. This will provide him with safe and effective
medication administration. The above intervention will be conducted once Peter is in a stable condition.
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