Ms Aaliyah Abimbola; a 56-year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children, ages 14, 17 and 18. You are working on the respiratory ward and have been allocated to Ms Abimbola who has been admitted with exacerbation of COPD. Ms Abimbola presented to A&E via ambulance at 8AM after experiencing acute shortness of breath while preparing breakfast this morning.
Based on the information provided in this case study, you are required to discuss your initial assessment of Ms Abimbola using Steps 1 and 2 the Levett-Jones’ (2018) Clinical Reasoning Cycle (CRC) before interpreting the information (Step 3 CRC) you have been given to identify 3 nursing care priorities (Step 4 CRC) for Ms Abimbola.
You are the RN on a morning shift on the respiratory ward of a large inner-city hospital. At 10:30 AM you receive a patient from the Emergency Department.
This is the hand-over you receive.
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I |
My name is Catriona and I am the A&E RN who has been caring for Ms Aaliyah Abimbola. Thank you so much for taking this patient so quickly. We’re so busy we haven’t time to do much for her apart from get her ready to bring up here. |
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S |
Ms Abimbola is a 56-year-old woman with a past history of COPD who was admitted to A&E via ambulance at 8am today in acute respiratory distress. She became acutely short of breath this morning while making breakfast and called an ambulance. |
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B |
I only got the chance to ask her a few admission questions before I was told to bring her up here. She was able to tell me: She saw her GP two weeks ago due to increasing shortness of breath and fatigue and he gave her ‘some breathing medication’ (inhalers). She has had to use these with increasing frequency since then. Ms Abimbola has been working at the flour mill 50 hours per week recently. This has made it tough to look after her three daughters because she’s a single parent. She has a medical past history of moderate sleep apnoea for which she uses CPAP to sleep overnight, Type 2 Diabetes and hypertension diagnosed 3 years ago. She has never smoked but has a long history of severe exposure to industrial dust. Her children are at school but the oldest one knows she’s in hospital. |
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A |
On arrival in A&E she was acutely short of breath with an expiratory and inspiratory wheeze. Her Sat’s were 93% on room air & her GCS was 15. We haven’t had time to do much for her apart from give her a couple of nebulisers. She has an interim medical diagnosis of acute exacerbation of COPD |
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R |
Medical orders:
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Your initial assessment findings on the ward for Ms Abimbola are as follows:
Medications
Metoprolol 100mg daily, Aspirin 100mg daily, Atorvastatin 20mg mane, Glibenclamide (Daonil) 5mg orally daily before breakfast, Salbutamol sulphate (Ventolin) 100mcg inhaler as required for symptom relief (1-2 puffs as required), Fluticasone propionate/salmeterol xinafoate (Seretide) 50/25 inhaler (2 puffs BD)
Current vital observations:
BP 142/96mmHg
HR 96bpm
RR 24 bpm
SpO2 93% on RA
T 36.7C
Health assessment findings:
Height 158cm, Weight 93kg,
Total cholesterol level - 5.2mmol/L
Fasting BGL - 9.6mmol/L
Inspiratory and expiratory wheeze. speaking in short phrases taking 2-3 breaths between each phrase before continuing to speak.
Alert and orientated to time, place, and person.
Further information you gather from her medical history and as part of her admission questions:
Ms Aaliyah Abimbola is a 56 year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children (ages 14, 17 and 18) living in the inner-west of Melbourne.
Ms Abimbola went to her local health care clinic 2 weeks ago complaining of increasing shortness of breath and lack of energy. She says she was given some breathing medication (inhalers) by the doctor and told to take it easy for a few days. She has been struggling to get from the ground floor living area to the upstairs bedrooms without resting half-way to catch her breath. She says sometimes the medication helps her catch her breath but she still has to rest half way even with the medication.
Ms Abimbola has been working at the local flour mill since she arrived in Melbourne from Africa 20 years ago. She has never smoked but says the dust at the flour mill often makes her cough. Her job for the first 3 years was filling bags with flour until that process became fully automated. She then got promoted to running one of the flour grinding machines. 2 years later she got another promotion to shift supervisor in the milling and packaging section. She says her clothes were always covered in white dust at the end of every shift. "I used to look like a ghost at the end on my shift. We all did!" The flour mill made it mandatory to wear a mask and other protective equipment when you're working in the factory about eight years ago. However, Ms Abimbola has been working in the office for the last 6 years and no-one wears protective equipment in the office as it's not necessary. She says there's always a fine layer of dust on the paperwork in the office because the 'flour just gets everywhere no matter how often you clean or how careful you are."
Ms Abimbola is currently averaging 50 hours/week which means she needs to work on most weekends. Since the Covid 19 lockdown the factory has increased production to 24 hours a day 7 days a week. That means the office is also extremely busy. Ms Abimbola has always accepted any overtime on offer to help pay the rent for their house and cover the school fees for the Catholic school her children attend. She is adamant that she wants them to get a good education so they can make the most of the opportunities she never had in Africa. She has always been socially active within her Church community, but due to her increased working hours this has restricted her ability to attend mass and contribute to her community. She states that she needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”. She has two close friends at church who help with looking after her children when she has to work late or on weekends.
Ms Abimbola states that she tries to exercise when she has time and walks to the train station every day to get to work. It used to take 8 minutes each way but lately it takes at least 20 minutes including rest stops to catch her breath. She also does a lot of walking at the flour mill taking paperwork to the production supervisors and picking up reports for processing. However, she has had to ask one of the younger staff to get the reports and deliver the orders more and more over the last year or so as she get's too short of breath when she walks too far too quickly.
Ms Abimbola has not spoken to her husband since she and the children left him 6 years ago. She says he used to work at the flour mill but was sacked for being drunk at work eight years ago. He had a hard time finding work so drank heavily and became violent. She took the children and left him after he hit the middle child for spilling his coffee. She doesn't know where he lives and has had no contact with him for over 4 years.
Family history
Her father died from a stroke in 2005.
Based on the information provided in this case study, you are required to discuss your initial assessment of Ms Abimbola using Steps 1 and 2 the Levett-Jones’ (2018) Clinical Reasoning Cycle (CRC) before interpreting the information (Step 3 CRC) you have been given to identify 3 nursing care priorities (Step 4 CRC) for Ms Abimbola.
The key components of Assessment 1 are to:
Answer: Lovett-Johns’s clinical reasoning is a process by which nurses collect cues,process the information,come to an understanding of a patient problem or situation,plan and implement interventions,evaluate outcomes,and reflection on,and learn from the process.There are 8 steps of the clinical reasoning cycle.The first 4 steps are
Step1)Consider the patients situation
Step 2) Collect cues and information
Step 3)Process information
Step4) Identify problems and issues
Step 1 CRC : Considering the situation is important to identify the causes,Symptoms,and treatment of chronic obstructive pulmonary disease.
The patient Ms.Amibola is a 56 year old female patient a case of COPD presented in A&E by ambulance at 8am with acute shortness of breathing. She visited her GP 2weeks before due to shortness of breath and had some breathing inhaler.
She has past medical history of Type 2 DM,HT, on medications and she had a long history of exposure to industrial dust.
Presenting Symptoms
Acute short of breath with expiration and inspiratory wheeze,speaking with pause in between,
Saturation 93%on room air and GC was 15
Her Vital observations:
BP 142/96 mmHg
HR - 96 bpm
RR - 24 per minute
SpO2 93% RA
Temprature - 36.7C
Health assessment
Hight 158 cm,Weight 93kg,Total cholesterols- 5.2 mole/L,Fasting BGL- 9.6mmol/L.inspiratory and expiratory wheeze.She is alert and oriented to time,place and person
Step 2 CRC: Collection of cues and information
She is a single parent migrated from Africa 20 years. She is having 3 young daughters studying in schools currently living in the inner-west of Melbourne.She is working in a flour mill for 50 hours exposed to flour dust.
Family history of father died with stroke.
Pathophysiology of COPD: For people with COPD starts with damage to the airways and tiny air sacs in the lungs.Symptoms progress from a cough with mucus to difficulty in breathing.The damage done by COPD can’t be undone.
Step 3) Process information
She is a case of COPD with ARDS with medical history of type 2DM,H T on regular medication
3 priority nursing Issues:
Potential Impacts are increased coughing,shortness of breath,fatigue and Increased sputum production as the exacerbation symptoms that had the greatest impact on her wellbeing.
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