Question

1. You are a nurse admitting a patient to the hospital from the emergency department (ED) with shortness of breath and recent weight loss. After receiving a report from the ED nurse, you ready the patient’s room according to unit specifications and collect the necessary equipment and forms. When the patient arrives, she is using oxygen via a nasal cannula and seems to be comfortable. As you begin your admission activities and paperwork, you note that her shortness of breath slightly increases as she answers your questions. Accompanying the patient is her daughter, who comments, “This is the fourth time she’s been admitted to this hospital in the past year.” The patient and her daughter demonstrate a close, loving relationship. The daughter not only encourages her mother, but also sets boundaries regarding her mother’s anxiety.

b. How could you facilitate the best implementation of the plan of care?

c. How would you select evidence-based nursing interventions?

d. Which interventions would you expect to implement in this case? e. How would you determine the success of your interventions?

Answer 1

b) Plan of care

• As the patient is suffering from shortness of breath the nursing care will be focusing on to relieve the dyspnea ( difficulty in breathing) of the patient.
• Allow the daughter to participate in the treatment of her mother. It will increase the patient's confidence in curing the disease as well as it will create a postive feeling thereby reducing the anxiety in the mother.
• Explain each and every procedure to the client as well as to her daughter to get more cooperation from them.
• Maintain good IPR ( Interpersonal relationship ) with the patient and her daughter.
• Be approachable for the patient's needs and make sure that you satisfy them.
• Ask the client to express their emotions so that you could help them for her needs.

c) Evidence based nusing interventions

• Evidence based interventions are the nursing activities which are successful through the research. By doing research in different areas of nursing helps the nurses to adapt to a new method of patient care and update them.
• In evidence based care (EBP) there will be evidence of what is good for a particular intervention.
• For eg. Inorder to relieve dyspnea in a patient using nasal prongs, if the patient is in supine position it will again make the patient more difficult to breath but if we provide a propped up position ( or semi fowler's position ) then it could be beneficial for the patient. This is an example for an evidence based practice.

d) The needed nursing interventions are,

• Assess the severity of dyspnea by checking the respiratory rate, depth of respiration, oxygen saturation using a pulse oxymetry.
• Provide a comfortable position to the patient. Usually a fowler's or a semi fowler's position is given.
• Provide back rest to the patient for support on back and a cardiac table to support her hands so that patient feel comfortable.
• Provide chest physiotherapy for the patient to remove any clogged secretions in the lungs. Before doing physiotherapy provide steam inhalation so that the secretions could be removed easily.
• Provide warm water to drink in order to soothen the secretions.
• Provide steam inhalation or nebulization as per the doctor's order to soothen the secretions and tell the patient to cough out the sputum to a sputum mug.
• Teach deep breathing and coughing exercises.
• Provide an incentive spirometer to the patient for lung expansion.
• Administer bronchodialators like tablet Derephylline as per the doctor's order.

e) Success of your intervention can be determined by the progress in the patient's conditions such as,

• Patient's verbalization of being well.
• Improvement in breathing after a steam inhalation or a chest physiotherapy.
• Depth and rate of respiration becomes normal.
• Oxygen saturation is maintained without an external oxygen source.
• Chest X ray shows no evidence of any sputum collection.

Note: Now a days research are progressing in the field of nursing and nurses are following an evidence based care for their patients for better outcome.