Overview Of The Presenting Condition Nursing Essay

Overview Of The Presenting jibe Nursing EssayThis case study is intended to formulate pneumonic hydrops through Mr. Tos shtupas case. It will discuss the pathophysiology of pulmonic edema and how Mr. Tos preserveas invete come in nephritic imp portment is related to this specific groom. Also, Mr. Tos unravelerpotas ECG, aerial caudex screw up results and raceline tests result will be analysed and explained. Moreover, a breast feeding intention based on Mr. Tos bumas agree will be made.Overview of the Presenting ConditionPulmonary dropsy is a serious condition of the pulmonary system. In simple terms, it is actually excess roving in the lungs (skinner Mckinner 2011). To be to a greater extent specific, it is fluid that moves out from capillaries into the extravascular outer spaces and causes additional imperativeness to the lungs (Craft, J 2011). Pulmonary dropsy is affecting some 1% of people over the age of 65 (Johnson 2009). It is a worldwide condition and the mor tality rate is about 40% within a year of diagnosis (Parissis et al. 2010). The accumulation of the fluid female genitalia be in a s depressed process for patients with continuing renal trouble. It locoweed also occur fast for patients who suffer from myocardial infarct (McPhee Hammer 2010). There are devil types of pulmonary hydrops, unity is cardiogenic pulmonary, and the different in non-cardiogenic pulmonary dropsy (Craft, J 2011). Pulmonary oedema is specify as alveolar or interstitial oedema, and such a condition quarter be identified by chest X-ray (Johnson 2009). And frequently patients oxygen saturation is less than 90% on room air (Johnson 2009). Also loathsome respiratory distress, with crackles over the lungs and orthopnoea, is frequently associated with acute pulmonary oedema (Parissis et al. 2010). The or so super C cause of pulmonary oedema is untreated center failure (Johnson 2009). The acute respiratory distress syndrome and capillary watercraft i njury are early(a) common causes of pulmonary oedema (Craft, J et al. 2011). Its signs and symptoms often include dyspnoea, hypoxaemia and growthd work of breathing (Skinner Mckinney 2011). In severe cases of pulmonary oedema, patients often arrive up pink frothy flatness when coughing and their ampere-second dioxide take aim increases while oxygen level decreases (Craft, J et al. 2011).Pathophysiology that Underpins the Presenting ConditionAs mentioned before, pulmonary oedema is excess fluid in the extravascular space and according to McPhee Hammer (2010) the extravascular space is constituted by the interstitial space and the airspace (alveoli and airways). The excess fluid derriere be ready in one or both spaces in patients with pulmonary oedema (McPhee Hammer 2010). Moreover, both spaces have different barriers to stop fluid from debut into them (McPhee Hammer 2010). The intersitital space is protected by the pulmonary capillary endothelium, i.e. intimate layer of ca pillary and airspaces are protected by alveolar epithelium, that is to say surface of alveoli (McPhee Hammer 2010). It is regular for blood vessel to leak and about 0.01% of pulmonary blood flow will leak into interstitial space every hour (McPhee Hammer 2010). There are several factors that whitethorn influence the amount of fluid leaking into interstitial space and the most distinguished one is net pressure (transmural pressure) (McPhee Hammer 2010). The transmural pressure maintains the balance amidst the net hydrostatic pressure that moves fluid out of the capillaries, and the colloid osmotic pressure that keeps fluid inside the capillaries (McPhee Hammer 2010). Any imbalance of these pressures can take to the woods to pulmonary oedema.Pulmonary oedema can be divided into two types the cardiogenic and the noncardiogenic. The former is caused by change magnitude transural pressure (hydrostatic or osmotic) while the last mentioned is caused by increased permeability ( dama ged alveoli and/ or airways) (Copstead Banasik 2010). Increased pulmonary venous pressure, increased alveolar surface tension, or fall capillary colloid osmotic pressure can all scat to cardiogenic pulmonary oedema (Copstead Banasik 2010). Non-cardiogenic pulmonary oedema is normally caused by an acute respiratory distress syndrome, which often results from injury, infection or inhaled toxins (Copstead Banasik). In this case study, there is no conclusion of injury of the lungs nor inhaled toxins, nor infection of any kind. Thus, Mr. Mario Toscanas condition is more likely to be cardiogenic pulmonary oedema. Although the case study does not address any cardiac problem based on his age and/ or history of chronic renal impairment, Mr. Toscana is prone to cardiac diseases.In patients with chronic renal diseases, there are damaged nephrons that cannot be regenerated (Craft, J et al. 2011). collectable to slow losings of nephrons, the remaining nephrons have to take the burden and t ry to maintain the normal function of the kidneys (Craft, J et al. 2011). However, over condemnation this compensation will increase the sacking of nephrons and the kidney will lose its normal function (Craft, J et al. 2011). This loss of normal function can result in electrolyte imbalance, which fly the coops to various conditions (Craft, J et al. 2011). Fluid over load, hyperkalemia, metabolous sharposis, congestive sprightliness failure and pulmonary oedema are all the common conditions of chronic renal diseases (Craft, J et al. 2011).Cardiovascular diseases often presents in patients with chronic renal diseases and they have a very gamey morbidity and mortality rate (McPhee Hammer 2010). hypertension can be caused by excess sodium and fluid, and vascular calcification by decreased glomerular filtration rate (Craft, J et al. 2011). Moreover, vascular diseases can lead or contribute to coronary breast disease, left ventricular hypertrophy, boldness failure and stroke. Hear t failure is defined as a manifold syndrome, which comprises of several cardiac dysfunctions and causes inadequate cardiac output (McPhee Hammer 2010). The common type of aggregate failure is the left spirit failure, also cognise as congestive heart failure (Craft, J et al. 2011). Additionally, congestive heart failure can result in both systolic and diastolic heart failures, and any of the two can cause pulmonary oedema (Craft, J et al. 2011). In systolic heart failure, the contractility of the heart decreases because of the disease and it can result in the increase of preload (Craft, J et al. 2011). Eventually, the combination will lead to decreased cardiac output and result in increased afterload (Craft, J et al. 2011). Due to the reduced cardiac output, renal perfusion diminishes and plasma volume increases (Craft, J et al. 2011). Patients with systolic heart failure often present with decreased peeing output, oedema and pulmonary oedema (Craft, J et al. 2011). And patients with diastolic heart failure can maintain a normal stroke volume and cardiac output (Craft, J et al. 2011). However, left ventricular end-diastolic pressure is still increased by the decreased compliance of the left ventricular, and the antidromic diastolic quietus (Craft, J et al. 2011). The pressure pushes fluid to go back to the lungs and causes pulmonary oedema (Craft, J et al. 2011).ECG ExaminationAn ECG can provide selective information on the electrical movement in the heart and ECG graphs sire information such as heart rate, rhythm and any abnormalcy that may involve the heart (Jevon 2010). With the method proved by Jevon (2009), Mr Toscanas heart rate can be calculated, which is 120 beats per minute. According to Jevon (2009) heart rate over 90 beats per minute is defined as tachycardia. Based on his another(prenominal) presenting conditions, Mr. Toscanas tachycardia is most likely caused by hypoxia. Hypoxia is resulted from hypoxemia, which is the decreased level of oxygen in the blood (Craft, J et al. 2011). In roam to meet the oxygen demand, the heart is trying to pump harder and faster to bring up cardiac output (Craft, J et al. 2011). On the one hand, hypoxemia can cause dilation of arterioles, capillaries and venules, in rescript to increase the blood flow through them (Copstead Banasik 2010). Therefore, peripheral blood flow is increased as salubrious as venous issuance (Copstead Banasik 2010). Venous return is a study factor that influences preload and the increased venous return authority increased preload (Copstead Banasik 2010). Preload is one of the factors that determines stroke volume, and when preload increases, stroke volume increases as well (Copstead Banasik 2010). On the other hand, the cardiovascular system is controlled by medulla oblongata of the brainstem and the neurons communicate with the heart via autonomic nervous system (Craft, J et al. 2011). The Bainbridge reflex causes increased heart rate with increased ve nous return at the same time (Craft, J et al. 2011).Mr. Toscanas ECG shows elevated ST segment and tale T riffle as well. They are both signs of hyperkalaemia (Humphreys 2007). This condition can also be confirmed by his kB level. The normal range of potassium is 3.5-5mEq/L, and his potassium is 5.8mEq/L (Humphreys 2007).Interpretation of Pathology TestsMr. Toscanas Arterial Blood Gas Result shows that pH is 7.34 and the normal range is 7.35-7.45, which means his pH is lower than normal range. Hasan (2009) states that pH lower than normal range represents acidosis. According to Cowley, Owen Bion (2013) that high level of blood cytosine dioxide means respiratory acidosis, and low level of hydrogen carbonate means metabolic acidosis. The Arterial Blood Gas Result of Mr. Toscana shows blood carbon dioxide and bicarbonate is 51mmHg and 18mmol/L respectively. The normal range of blood carbon dioxide is 35-45mmHg and that for bicarbonate is 22-28mmol/L. Thus, his blood carbon dioxide l evel is higher and bicarbonate level is lower, which explains that Mr. Toscana is scurvy both respiratory and metabolic acidosis (Hasan 2009). Besides, Mr. Toscanas blood oxygen level is 70mmHg and the acceptableness range is 75-100mmHg. According to Hasan (2009) low blood oxygen level indicates hypoxia. SaO2 (saturation of hemoglobin by oxygen) is the most common way to monitor oxygen level in the remains. For a healthy person, SaO2 below 95% shows lack of oxygen in the body and can lead to hypoxia (Humphreys 2007).There are many another(prenominal) causes of metabolic acidosis, such as hyperlactataemia, ketoacidosis and renal tubular acidosis (Halperin, Kamel Goldstein 2010). In this case, based on his history of chronic renal impairment, the cause of his metabolic acidosis is more likely the renal tubular one (Halperin, Kamel Goldstein 2010). One of the functions of the kidneys is to puddle the bodys acid load (Halperin, Kamel Goldstein 2010). However, for patients with chro nic renal impairment, their kidneys are already damaged and they are losing normal renal function (Craft, J et al. 2011). Therefore, kidneys cannot remove acid out of body in an adequate rate. When the acid builds up in the body, it will neutralise with bicarbonate and generate carbon dioxide (Halperin, Kamel Goldstein 2010). Normally carbon dioxide will be died. However, in this case, because Mr. Toscana suffers from an acute pulmonary oedema, he cannot exhale carbon dioxide effectively (Craft, J et al. 2011).One of the symptoms of pulmonary oedema is hypoxemia, which is low level of blood oxygen in the body (Craft, J et al. 2011). This occurs as the excess fluid builds up in the extravascular spaces, and impairs normal gas step in in the lungs (McPhee Hammer 2010). Moreover, pulmonary oedema can cause dyspnoea, which is a difficultness of breathing and eventually it can damage alveoli (Craft, J et al. 2011). some(prenominal) dyspnoea and the damaged alveoli can worsen the ina dequate gas alter (Craft, J et al. 2011). Based on Craft, J et al. (2011) when inadequate gas convince occurs, oxygen in the alveoli cannot lower into vessels and the carbon dioxide cannot go in to alveoli to be exhaled. While carbon dioxide accumulates in the body, pH decreases and respiratory acidosis occurs (Halperin, Kamel Goldstein 2010). In this case, too the inadequate gas exchange, the chronic renal impairment also contributes to the increase of carbon dioxide in the body.The blood test results show both high level of serum creatinine and blood urea nitrogen. Based on doubting Thomas Thomas (2009) creatinine results from muscular metabolism and will be cleaned out of the body by the kidneys. Urea nitrogen is resulted from protein metabolism and it will also be cleaned out of body by the kidneys (Thomas Thomas 2009). The reason for the increase in both creatinine and urea nitrogen levels is because of the decreased glomerular filtration rate, which is an indication of chr onic renal disease (Craft, J et al. 2011).Holistic Plan of Nursing frettingThe first nursing care for Mr. Toscana is in fact to provide a reassurance to him as he is distressed by the tightness of CPAP mask and his difficulty in breathing. There is a very high chance that he will remove the CPAP mask. If CPAP is removed, it will make it even harder for him to happen (Ducros et al. 2010). Nurses can educate Mr. Toscana on the use of CPAP and explain to him that by using CPAP, he can breathe more easily (Nehyba 2006). Nurses can also get his family involved to give reassurance to Mr. Toscana.Then, because Mr. Toscanas oxygen saturation is lower and he is presenting respiratory acidosis, nurses withdraw to keep his oxygen saturation up (Lemone slay 2011). Due to his acute pulmonary oedema, CPAP is a more effective way to utter oxygen and open up more air ways, which in return improves his gas exchange in the lungs and reduces work of breathing (Ducros, L et al. 2010). Nurses affe ct to remind themselves of a few things while looking after patients breathe with CPAP. First, CPAP mask call fors to be sealed properly and tightened to provide a positive pressure air (Ducros, L et al. 2010). Second, nurses requisite to monitor the patients fast for any change in oxygen saturation and respiratory rate (Ducros, L et al. 2010). Third, they should allow breaks in between sections of the treatment so that patients can cough, drink or eat (Nehyba 2006). Also, breaks can release the pressure caused by CPAP mask and decrease the risk of pressure ulcer. Finally, like any other medical procedure, CPAP also has its adverse effects. When a full mask is used, CPAP therapy can lead to gastric distension (Nehyba 2006). In addition, some air can go into stomach and cause discomfort, splinting of the diaphragm and reduce lung expansion. Therefore, nasogastric tube may be need at some stage (Nehyba 2006)Monitoring Mr. Toscanas fluid intake and urine output is also important, a s he has a history of chronic renal impairment and presenting pulmonary oedema (Lemone bump off 2011). A fluid balance chart can be used. If there is a negative balance, doctors need to be notified accordingly (Lemone Burke 2011). Nurses need to educate Mr. Toscana on adequate fluid intake. His vital signs also need to be monitored, especially his oxygen saturation and respiratory rate (Lemone Burke 2011). He is presenting signs of hypoxemia and respiratory acidosis, which can lead to respiratory failure (Craft, J et al. 2011). Therefore, closely monitoring his oxygen saturation and respiratory rate can pose any trend towards respiratory failure so as to intervene earlier to prevent it from happening.Cardiac monitoring is also required for Mr. Toscana because of the following reasons. First, his ECG shows heart rate of 120 which means tachycardia. Second, the most likely cause of his acute pulmonary oedema is heart failure. Third, abnormal potassium level can cause cardiac arrest (Humphreys 2007). Moreover, nurses need to check for any new arterial blood gas results and blood test results to be aware of any changing situation of the patient.Finally, as Mr. Toscana has a history of chronic renal impairment and both his arterial blood gas results and blood tests result show trend of renal failure, acute dialysis may be needed for him (Daugirdas, Blake, Ing 2012). For patients with chronic renal disease, their renal functions are impaired and some toxic wastes cannot be removed from their bodies (Craft, J et al. 2011). Dialysis is the only effective way to help them to remove these toxic wastes (Daugirdas, Blake, Ing 2012). Nurses cannot order dialysis. However, they can discuss patients conditions and tests result with doctors to arrange dialysis if necessary.SummaryPulmonary oedema is a crucial condition that can lead to respiratory failure. This condition can be caused by heart failure and worsen by chronic renal diseases. Procedures such as ECG, arterial bl ood gas test and blood tests can help nurses to understand patients conditions can identify any trend of deterioration. A detailed, holistic nursing care plan can help nurses to provide better care for patients.