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A 24 year old female patient is reported to emergency room with complain of increased work of breathing and high temperature since last 3 days. She has a known history of asthma and her medical history also includes management of asthmatic symptoms with mild dose of salbutamol. Patient is coughing green coloured sputum and she is suffering from severe breathlessness in all positions. From the given signs and symptoms there are a few differential diagnosis identified like pneumonia, lung abscess, Lower Respiratory tract infection, Pulmonary oedema because of abscess etc. A nursing professional is required to take care of patient during the diagnosis procedure as well as treatment part and also ensure that all vital signs of patient are properly monitored. In order to ensure a safe and effective nursing care it is required by the nursing professionals that they base their practice on latest evidences of research studies and follow the protocol of treatment as recommended and prescribed by the consulting physician.
Process of information gathered from the patient and different diagnostic tests is very important in final diagnosis and treatment planning part. In this case patient is suffering from breathlessness and green coloured sputum is coughed by her. She has history of asthma. On inspection it was observed that patient is having difficulty in breathing in resting position as well and her accessory muscle movement is also observed in breathing which indicates a severe reduction in breathing capacity and it would be much easier for patient is she is assisted in her breathing through artificial respiration (McLuckie, 2009).
On palpitation it was observed that patient’s body is slightly warm and she is suffering from midline asymmetrical expansion of lungs and chest cavity as well. These signs indicate that there is an underlying cause of breathlessness.
On percussion of chest cavity dullness was noted on the lower base of the left lung and it indicates that an abscess is present at the base of the lung or there is a chance of pleural effusion in patient which is causing dullness on palpation at base of lungs. It is also experienced on palpation that a resonance note is heard on palpation of right lung. On auscultation coarse crackles are also heard on the left side of lungs while diminished sounds were heard on lower base of the lungs. From the clinical signs and symptoms this condition is having a higher probability of pleural effusion because of an abscess or lung infection. This is also known as exudative pleural effusion which is caused by infection of the lower respiratory tract, lung infection, abscess formation etc (Cunha, 2010).
Vital signs of patient are as follows BP is 130/80 which is slightly above normal systolic, pulse is radial and G + 2 Pulse and her heart beats are highly elevated to 110 beats per minute and they are irregular as well. Her oxygen saturation level is 93.2 percent in room air pressure and her body temperature is slightly elevated to 38.1 degree Celsius. All the signs indicate that patient is suffering from an underlying disorder or disease and breathlessness and other clinical symptoms are just exuberated clinical signs.
From all the information gathered about patient there is some relevant information like presence of dullness on palpation of lower left lung base. Very critical information for diagnosis was presence of green coloured sputum on coughing which indicates presence of infected region or pus in lungs and respiratory tract. Patient’s earlier history of asthma also indicates that patient might be into a high risk group. There are some information which is not very relevant for diagnosis purpose and that information if not included in consideration and development of this essay (Wong, 2009).
There are certain investigation which is needed further to confirm the diagnosis. First would be the radiograph of lungs and area which is infected or filled with pleural diffusion would be opaque in radiograph which healthy region would not have any white opaqueness. Further investigation includes a culture of the sputum and microbiological analysis of the sputum sample to confirm the type of infection in patient. An ultra sonography of the infection region can also help in establishing the boundaries of area which is affected by pleural diffusion.
Detectable clinical signs like stony dullness and difficulty in breathing even in resting position indicates that there is accumulation of more than 300 ml of fluid in patient’s lung cavity and presence of green sputum indicate that an infection is present in lungs. Both clinical signs are classical signs of pleural effusion in patient and they can be confirmed through a chest x ray. Signs and symptoms are also related with the elevated pulse rate which is often seen in patient suffering from infection and toxins released by infection in blood streams (Joseph, et al. 2001).
As a nursing professional it is very important that all the other differential diagnosis is eliminated gradually and final diagnosis is confirmed. A nursing professional should also take care of the chances of cross infection by patient as her final diagnosis is not yet confirmed. Pneumonia is still a very much possibility in this case except the fact that sharp stabbing pain which is a classical sign of pneumonia is missing. Rest of signs and symptoms do link up for pneumonia infection.
Likely picture of patient from the information gathered that patient would be prescribed a broad spectrum antibiotic while usage of oxygen can be done for artificial respiration. An intercostals drain or thoracentosis can be prescribed for draining of accumulated fluid if fluid persists even after 3 days of treatment initiation (Ware and Matthay, 2005).
In conclusion it can be said that first nursing priority now is to ensure that patient is able to breathe easily and her air way is secure and maintained. Ensuring airway maintenance can be done using respiratory masks etc. Second nursing priority is to make sure that patient should be exerting to a minimal and she should be talking as much rest as possible. It is very difficult for nurses to maintain a treatment course unless a confirmed diagnosis is present, still by the time investigations are completed a broad and general treatment and support is priority of nurses.
Cunha, B. (2010). Pneumonia essentials (3rd ed.). Sudbury, MA: Physicians’ Press. ISBN 0763772208.
Joseph J, Badrinath P, Basran GS, Sahn SA (2001). “Is the pleural fluid transudate or exudate? A revisit of the diagnostic criteria”. Thorax 56 (11): 867–70
McLuckie, A. (2009). Respiratory disease and its management. New York: Springer. p. 51.
Ware LB, Matthay MA (2005). “Clinical practice. Acute pulmonary edema”. N. Engl. J. Med. 353 (26): 2788–96
Wong, CL, (2009). “Does this patient have a pleural effusion?”. JAMA 301 (3): 309–17.Order Now
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Sociology of Religion
Sociology of Religion
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Throughout the life of an individual, various events takes place that may have a negative or positive effect on an individual. This changes to a great extent influence the response of the individuals surrounding towards this changes. One of such changes is the transition from childhood into adulthood. Through thus stages, various changes occur in an individual, some of this changes could be appealing while the others are greatly unappealing. For instance, the case of reaching the adolescent stage, in this, an adolescent may develop some sense of alienation from the rest considering the various changes associated with it. Such changes might include the development of breast, having pimples, gaining some weight or rather development of hips in ladies. Such changes may make an adolescent feel different from the others thus choosing to keep to herself or himself. Other than this it may also draw him/ her to a group with same peers undergoing same transitions. This is because they find a sense of belonging and feel like they are understood more.
Just like the adolescents, middle aged adults are faced with various issues regarding their changes. Transition in this stage is coupled with a lot of responsibilities, some of which include marriage, having kids and many more. In such a scenario an individual may be enthusiastic about the roles and get responsible. Alternatively, they may be faced with pressure due to the renewed duties they are facing making them overwhelmed and at times even stressed out. This is quite a challenge to adjust to.
The final stages of life transitions are aging, that is old age, and death. In this, an individual tends to review his life trying to justify some of his actions. This creates a filling of either fulfilment or despair. Take for instance a case where an old man has accomplished his life goals, such an individual has some sense of pride for his accomplishments. However, in a scenario where an individual’s life is full of unfinished duties, he or she has regrets of a life poorly lived. Their life would be full of despair and thus not able to face death courageously.
Other than this basic life stages, their are other various life changes that may impact positively on negatively on an individual. Some of this life changes include lifestyle, relationships, health, illness, disability, economic circumstances, cultural difference and many others. Such changes may affect how individuals perceive themselves and how they behave. An example is outlined in in the case study about the Alzheimer condition. Prior to illness, Terry was able to have fun moments with his family, due some duties with his wife and so on. However, due to the manner in which the illness altered his mental state, he ability was undermined. This was not only limited to his physical ability but also his mental capability to make decisions. An instance is when he makes an emergency call to know his daughter’s well being who ironically was taking care of him.
Response by others to such changes.
Throughout all these changes in an individual life, there need to have some form of positive response and support from others. However not everyone considers ones problem as a social problem some rubbish it off considering it a personal issue. In our case study however, Terry was able to pull through his Alzheimer condition majorly due to support from the family, that is his wife and daughter. They not only stood by him but also assisted in doing his abandoned roles. This positive response was quite key in keeping Terry’s condition stable. Through this he felt quite appreciated.
Impact of changes to others.
The various changes that occur in an individual may be personal but the effects and impact is felt beyond the individual level. These is due to the gap it creates and in cases such as illness costs may be incurred during treatment phases and many more. A close relation to this is revealed in the case study about Terry. During his illness phase, a lot changes occurred majorly to his family, roles that were previously shared between the two were now solely the wife’s responsibility due to the mental instability that Terry had. This built up pressure on Christine, the wife as she had to do more. Other than this, she and her step daughter were faced with responsibility of taking care of Terry. This altered the physical mobility and social life of Terry’s wife and daughter as they were supposed to be always present to care for him
Another great impact that this changes posses is the altering of family time and good moments. In our case, there were instances when Terry questioned his relationship with Christina. This is quite depressing but understanding is the key in overcoming the overwhelming sadness.
How others may provide support.
Having to go through a sudden change in life is quite challenging as you have to deviate from the norm. This thus needs help and support of those in your surrounding, for example friends, family and even acquaintances. All this support is essential in helping one adapt to the new changes in their life. Terry for example couldn’t carry out a number of roles after he fell sick. Such activities were carried out by his wife and daughter. It is through this care, concern and support that he survived the changes.
Suitability of external sources of support.
Regardless of the support from family both the afflicted individual together with those around him would need an external source of support in order to adjust to changes. This external sources would include services of a specialist, support therapies e.g. counselling, and others. These not only brings about a change of environment and relief but also offers cancelling on the way of care. Terry and his family for example took on a vacation to the southern port with the aid of Alzheimer’s society. This helped them in breaking away from the norm giving them a change of scenery and a chance to be taken care of by the professionals. There were also the necessary equipment in taking care of those suffering from Alzheimer’s disease. This greatly gave Terry’s family a break