The purpose of this essay will be to analyse and evaluate the nursing care given to an individual during their stay at a respiratory ward whilst using the nursing process as its foundation

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The purpose of this essay will be to analyse and evaluate the nursing care given to an individual during their stay at a respiratory ward whilst using the nursing process as its foundation (Kozier at al., 2008).

Permission was sought from the individual in question to have access to their medical and nursing notes with the intent of writing this essay. In accordance with the Data Protection Act (1998) and the NMC’s Code (2008), sensitive personal data has been anonymised and the individual gave full valid consent.

The name Cecil has been given in order to not continually refer to the subject of this essay as ‘the individual’.

At the time of writing, Cecil was 76 years old. He lived on his own in a council bungalow with no help from relatives. He had a sister, however they fell out many years previously and she lived in Chester 150 miles away. He never had children, even though he confided that he had wanted them but an unfortunate accident caused by playing football with his brother as a child made it out of the question. He had been married but had been widowed two years previously. He sincerely loved his wife and he would always talk about her, (they were both sergeants in the British Army) she was 12 years older than he and he would tell anyone that would listen how much he missed her. It was after his wife passed away that he began to suffer frequent panic attacks.

At home Cecil had carers visit twice a day to assist with cooking meals and dressing if his shortness of breath was too great. It was just before his admission to hospital that he had fallen.

Primarily Cecil was admitted to the accident and emergency department presenting shortness of breath and low oxygen saturations in his blood. His immediate concern was the panic he felt over the shortness of breath and the effort it took to breathe. His longer-term concern was how long he would be admitted for.

His physiological measurements on admission were:

  • Temperature        36.6 degrees Celsius
  • Heart rate        106bpm
  • BP                145/68mmHg
  • Respirations        24 per minute
  • O2 saturations        75% on 28% oxygen.

Cecil’s O2  saturations increased to 92% once 40% oxygen was administered, once stable Cecil was admitted to the respiratory ward. The overall assessment of his immediate actual needs by paramedics and staff at the A&E department was his shortness of breath and low O2  saturations. This was obtained from Cecil’s notes. His long-term needs included chronic obstructive pulmonary disease (COPD), type II respiratory failure, hypotension, sleep apnoea and a recent fall at home. His potential needs could have been that he would fall again, anxieties related to his fall, depression due to lack of independence, fatigue from the sleep apnoea and related social issues and mobility issues as his COPD became more severe.        

When admitted to the respiratory ward assessments were made by use of the universal NHS Waterlow Risk Assessment (pressure ulcer prevention) and MUST (Malnutrition Universal Screening Tool) put him in high-risk categories for each. Cecil had an air mattress for his bed and the MUST was repeated and documented weekly.

This essay will focus on two key areas; they are Cecil’s sleep apnoea and his increasing intolerance to mobility because of worsening COPD. These areas have been chosen because Cecil believed that they had the highest impact in his daily routine. They also prevent him from carrying out most of the twelve activities of the Roper-Tierney-Logan Activities of Daily Living Model (ADLs) (Roper et al., 1983, cited in Kozier et al., 2008). Of the twelve ADLs  Cecil has difficulties communicating due to shortness of breath. Evidently he has problems breathing which relates to finding it difficult to wash and dress which also leads on to problems with mobilising. Cecil does not do much in the way of working and playing, he is retired and his COPD prevents him from doing most activities outside of his home such as visiting shops. Finally he has problems with sleeping due to sleep apnoea which has been artificially corrected with treatment.

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Firstly, focus will begin with sleep apnoea and its assessment.  Sleep apnoea literally means not breathing whilst sleeping (McFerran et al., 2008). In this case, Cecil suffers from obstructive sleep apnoea, which is the blocking of the upper airway. This is caused by the muscles supporting the airway and tongue being too ‘slack’, these can then totally occlude the airway causing total lack of breathing and lead to a drop in oxygen saturations (Vara, 2007).  

In order to assess whether Cecil had sleep apnoea, he underwent a test called partial polysomnography. The test measures heart rate, oxygen saturations, chest ...

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