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Acute and Enduring Health Care Needs

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Introduction

Acute and Enduring Health Care Needs Clinically Focused Essay Mrs X is 75 year old lady admitted to a respiratory ward on the 22nd May 2004, with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). COPD is a disease characterised by airflow limitation that is not fully reversible. Mrs X was bought in by ambulance after her husband found her struggling to breathe; Mrs X has been on permanent home oxygen and nebulisers for approximately one year. She lives with her husband in a house in south London, and was diagnosed with COPD one year ago, as a result of her illness the couple are waiting to be moved to a home with a bathroom on the ground floor as it is not practical for Mrs X to climb the stairs to the bathroom in her current home. Previous to this admission she had four admissions within the last year all related to her breathing. COPD is not Mrs X's only complaint she has non insulin dependent diabetes, asthma, hypertension, swollen ankles, and is overweight on admission she weighed 102kg and has Body Mass Index of 32. ...read more.

Middle

BIPAP (Bi-level positive airway pressure) is a non-invasive means of ventilation, it allows the patient to control when they inspire and expire unless programmed not to and can be set to ensure the patient takes a defined number of respirations per minute. BIPAP is ideal for COPD patients has it assists patients with inspiration and expiration and so patients can not retain carbon dioxide which could lead to hypoxia and that oxygen levels can not become high enough to risk respiratory arrest. (Smeltzer 2004) While Mrs X is on oxygen she is having her oxygen saturations monitored every hour to ensure they are at level high enough for her to function without a risk of hypoxia, a level above 90% would be acceptable. The saturations will be monitored using pulse oximetry, this is an electronic probe that fits on the finger and detects absorption of red and infrared light passing through living tissue. This gives readout of arterial blood oxygen levels, although this could be achieved more accurately by taking blood gases, this way is non-invasive and will not disturb the patient through the night (Coull 1992). ...read more.

Conclusion

By recording all outputs and inputs you can see if the patient has a positive balance where the input is larger than the output, this could be a sign of retention. A negative balance when the output is greater than the input is a sign of a patient becoming dehydrated, as is the patient complaining of thirst, having dry mucous membranes of the mouth and loss of skin turgor. As well as documenting the volumes of urine produced the electrolyte balance needs to be investigated, as the use of diuretics can result in the loss of sodium and potassium. (Whittaker 2004) The final aspect of care to be addressed by Mrs X's shortness of breath care plan was for to be weighed each day. Mrs X was weighed upon admission at approximately 17.30, when she weighed 102kg. When a patient is weighed daily it must be at the same time each day and on the same set of scales. The best time to do it is every morning before breakfast and after the patient has urinated. Keeping the extraneous variables the same e.g. time of day you can get an accurate picture of weight gain or loss. Coupled with the fluid balance chart the action of the diuretic therapy can be assessed. (Whyte 2002) ...read more.

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