3205MED Healthcare Systems

Introduction

Robert Snider is sixty-eight years old and diagnosed with "community-acquired right middle lobe pneumonia," a lung infection causing breathing problems, among other symptoms. Robert's medical records indicate that he has been diagnosed with hypertension, chronic obstructive pulmonary diseases, and an active smoker of twenty cigarettes in a day. Besides, the chronic obstructive pulmonary disease causes inflation of the lungs, obstructing air circulation. The risk factor of Robert's COPD condition is tobacco smoking which causes symptoms such as sputum production, wheezing, cough, and difficulties in breathing. The doctor assessed subjective data such as fatigue, restlessness, fear, anxiety, pale in color, and shortness of breath. Robert experiences faint crackles with 105/60 mm Hg blood pressure and a respiratory rate of 33/minute. The x-ray on the chest indicates the "consolidation right middle lobe" and a heartbeat of 102 beats per minute. SaO2: 88% Room air, and his total weight is 124kg. Robert required oxygen therapy to maintain SaO2 94% room air for intravenous antibiotics. The paper has provided a nursing care assessment and evaluation basing on promoting and facilitating enough oxygen, provision of nursing care, how hospital-acquired complications are prevented, provision of enough nutrition and hydration, psychological and emotional support, and educating him before discharge on better health care services.

Promotion and facilitation of adequate oxygenation

Promoting ventilation, facilitating oxygen perfusion throughout Robert's body, and passing gas diffusion are the critical factors to consider towards improving oxygenation in Roberti's body. Health ventilation will stimulate the circulation of clean air in the ward and the general hospital environment (Wetzig & Currey, 2015). The nurses shall measure the air quality index to ensure that the air circulating in the background is not hazardous to Robert's health. Also, nurses need to advise Robert to avoid cigarette smoking as it reduces the air quality index due to his chronic obstructive pulmonary disease condition. The nurses have to teach Robert about the hazards of cigarette smoking to his health to help him recover and prevent future infections.

Moreover, nurses should initiate breathing exercises such as diaphragmatic breathing, pursed-lip breathing, and incentive spirometry which helps Robert control his breathing, decrease anxiety as a record in the subjective data, increase activity levels and improve body ventilations. However, diaphragm breathing is recommended for adequate oxygenation in Robert's condition since it allows slow and deep breaths (Shetty et al., 2021). The quiet and deliberate breaths aided by chest and abdomen muscles slow the ventilation frequency, allowing the patient to focus. To facilitate the event, the nurse has to put the patient in a sitting potion on the bedside to enable the patient to put one hand on the chest and the other hand on the upper abdomen slightly above the umbilicus. Then, the nurse should teach the patient to inhale slowly through the nose, feeling the rise of the abdomen and chest movements. The patient is then advised to exhale through the pursed lips by the use of the abdominal muscles. It will help the patient to breathe, increasing oxygenation in the body. However, the nurse should monitor the response of the patient keenly. Other interventions the nurses employ include; chest physical therapy, secretion mobilization, maintenance of patency airways, improvement of physical morbidity, mechanical ventilation, use of closed chest drainage, coughing exercises, and oxygen therapy. After the treatments, the nurses should provide general health policies to enhance Robert's respiration, such as regular thirty-minute exercises at least four times a week, avoid smoking, and the inhalation of second-hand smoke. Ensure that adequate ventilation is available while using stoves and wood and prevent exposure to noxious fumes at home and work.

Provision of general nursing care

The general nursing care for Robert snider will be encouraging him to try as much as he can to involve in a little productive and essential personal care activities so that his health can improve and to avoid being dependent on others for everything, for instance, he should be encouraged to partake physical exercises like walking for shorter distances, joking and stretching to keep the body active, and choosing a balanced diet to help improve his immunity (Ballantyne, 2016). It is achieved through direct interaction between the patient and care provider to build confidence and trust. Those people who help take care of Robert while at home or away from the hospital should be educated about his health condition, and the management needed. For instance, nurses should educate the caregivers about the correct diet to eat to bring his blood pressure to normal and prevent pulmonary obstruction disorders. Caregivers should also educate them on keeping him busy to stop being fearful and anxious every time by sharing with him his happy moments. Proper hygiene should also be considered in the general environment and food preparations. For instance, the opening of windows and airing of his room ensures there is sufficient oxygen supply to prevent difficulty in breathing. To make work easier for the caregivers, a nurse should closely monitor the health status of Robert to identify any progress in the implemented programs to determine whether the measures put in place are working to improve his health or not (Næss et al., 2017). If the measures implemented do not show any positive change in the patient's health, alternatives mean that nurses can incorporate clinical physiotherapy to help Robert sit straight and reduce his weight.

Prevention of possible hospital-acquired complications

In a hospital setup, several complications and diseases can worsen the existing health conditions. For instance, there are patients with different types of infections e.g.

Communicable diseases can be transmitted from one person to the other through droplets. Robert was already having a problem with difficult breathing. It is better to attend to him in a properly ventilated room while both he and the care provider are wearing protective equipment like face masks (Warner & Alterovitz, 2016). The caregiver should also ensure a safe means of transport while coming to the hospital and careful walking to prevent him from stumbling or falling because of his instability. The service benches provided at the hospital should be installed appropriately and be strong to prevent breakage or sliding so that patients are not at risk of falling while receiving services. While at the hospital, Robert should be given Deep vein thrombosis prophylaxis to prevent swelling and paining of the legs due to too much sleeping or sitting. Nurses should plan the care provision service to take a short time to avoid long sittings. During Robert's oxygen therapy, Robert should highly consider safety measures and precautions such as fire safety and appropriate oxygen levels to prevent fire hazards during the process and oxygen toxicity, leading to seizures and lung failure.

Promotion of adequate hydration and nutrition

The promotion of adequate nutrition and hydration is vital in Robert's health. The results indicate a poor appetite due to nausea. Therefore, the proper mix of the diet should ensure that the diet doesn't affect his breathing. A recommendation of a diet with fewer carbohydrates is essential. Carbohydrates increase the metabolism rate requiring much oxygen, which Robert might be having difficulties in breathing (Kolasa & Grandjean, 2009). Therefore, a diet with more fat would help him breathe easily. His weight was 124kg. Thus, to reduce his weight, he needs to opt for fresh vegetables and fruits. He needs to reduce bread and pasta consumption.  His diet should include at least twenty to thirty grams of fibre daily with good protein sources for strong respiratory muscles e.g milk, fish, meat, poultry, nuts, etc. Robert has to use protein sources with low-fat content, mainly lean meat and low-fat dairy products. For breathing improvements, cholesterol-free unsaturated fats are liquid at room temperature, e.g., sunflower fats and corn oils are highly preferred and in low consumption. Steroids and calcium supplements are essential due to his COPD condition and breathing difficulties. Vitamin D supplements and calcium carbonates are imperative in his diet. Robert should avoid sodium as it causes oedema that increases blood pressure given that the blood pressure was already very high, 105/60 mm Hg, and if sodium is essential as recommended by the doctor, it should be consumed in a low intake.

For hydration, Robert should take plenty of water, making the mucus thin, facilitating easy removal. A recommendation of six to eight glasses would be appropriate. However, water intake should be spread out for better hydration during the day but not at once. Consumption of health caffeine-free could substitute water which substantial for his health (Oates & Price, 2017). Lastly, I recommend that Robert rest before eating and eat well in the morning and approximately eat six times a day to enable free movement of the diagram. Besides, he should avoid food that causes bloating and gas as they cause breathing difficulties.

Provision of emotional and psychological support

Emotional and psychological support is critical to patients with breathing difficulties as they help them relax, enhancing their breathing. Robert recorded anxiety, restlessness, and fear and fear as a sign of emotional stress. Therefore, nurses should provide counseling such as cognitive therapy and enhance relaxation, which helps him calm down reduces blood pressure and heart rate, strengthening the respiration rate (Morelli et al., 2015). Since Robert was initially diagnosed with COPD, they are more likely to record anxiety and depression. Therefore, emotional therapy is essential in helping him to manage stressors that could increase his blood pressure. Pumar explains that living alone is one of the factors that increase depression. According to the report, Robert lives alone and probably is one reason he gets stressed (Pumar et al., 2014). Therefore, the nurses should try and find if he has a close relative to stay together to help him recover from depression and anxiety disorders. Besides, Freud explains that people are sometimes stressed and anxious due to repressed feelings and emotions in their unconscious minds (Kessler et al., 2017). It would be essential if the doctors employ psychoanalysis to find the cause of anxiety to enable the counselors to address the stress and depression to avoid future recurrence. Also, increased severity of COPD could cause depression which doctors should help assess COPD conditions and provide relevant support. Therefore, psychological and emotional support fastens the healing process due to the enhancement of relaxation, improving breathing, and reducing blood pressure.

Education and Discharge planning

Before discharging the patient, the caregiver should be educated about the problems and needs of the patient, like his shortness of breath, restlessness, feeling fearful and anxious, and fatigue, and therefore informed on how to handle him so that the problems can be minimized or avoided. For instance, the caregiver should provide sitting aids to help him sit straight and keep him busy and active so that the anxiety, fear, and restlessness do not invade him. Give the history of the patient's diagnosis, medication, and care while at the hospital to the client so that appropriate care is extended after discharge (Carroll & Dowling, 2007). For instance, Robert's history of smoking should be made aware to the caregiver so that after discharging him, they can improvise means to stop him from smoking and know the way of giving him medication while at home to prevent overdosage or under dosage. The client should also be informed of the potential problems associated with the patient's health condition, such as seizures, body swelling, shortness of breath, and advise him to seek medical assistance if these problems persist or if they notice any other strange sign in a patient. The nurse should inform the client to ensure that Robert engages in community support services like income physical exercises for the elderly, community teaching programs on the effects of smoking, and recreational activities to keep him active and busy (Palonen et al., 2015). Before the patient is released, the nurse should give an appointment schedule to the caregiver and encourage him to ensure that he attends the appointment as an indicated failure, to which a nurse should follow up with the patient either through a phone call or home visit.  Follow-up appointments help check the patient's progress and incorporate other measures to make recovery faster or efficient.

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