Assessing Blood Pressure, Infection, And Breathing For Jim

Assessment of Blood Pressure for Jim

Jim is a 58 year old homeless Indigenous male of no fixed address. He presented to the Emergency Department with dyspnea, myalgia, fatigue, malaise, rhinorrhea and headache. His symptoms began approximately 1 day ago and are continuous and steadily getting worse. On examination he was found to be febrile with a clear nasal discharge, shortness of breath and muscle soreness. He has a previous medical history of asymptomatic hypertension but is not currently prescribed antihypertensive medication as he did not take this medication when previously prescribed. He is allergic to chickens but has no known drug allergies. He states he used to smoke but not so much anymore as he cannot afford them however he does smoke up to 5 – 10 per day if he can get them.  Discuss about the Case Study.

Blood pressure, breathing and infection are the three areas in which assessment for Jim need to be carried out. Assessment for blood pressure in Jim need to be carried because his blood pressure reading indicates he is having hypertension. His blood pressure is 158/86 mmHg and normal blood pressure should be 120/80 mmHg. It indicates his blood pressure raised above normal level. Blood pressure assessment can be carried out using sphygmomanometer. Blood pressure is sensitive parameter. It can change based on the activity and sitting position. Hence, blood pressure assessment need to be carried out in varied conditions of patient to get robust assessment of hypertension in Jim. White blood cells (WBC) can increase above normal level in patients with infection. Hence, along with culturing of sputum and nasal secretion samples for influenza A virus, WBC analysis need to be carried out in Jim. Breathing pattern and breathing rate need to be assessed in Jim to assess functioning of respiratory tract. Jim is exhibiting insufficient breathing due to abnormal functioning of respiratory system. It is evident that influenza infection can affect respiratory tract (White et al., 2012).

It would be helpful to plan effective nursing intervention for Jim through assessment of blood pressure, infection and breathing. Specific antibiotic can be administered by identifying specific organism like influenza A virus because other antibiotics might not work in the infection caused by influenza A virus. Influenza A virus has potential to affect respiratory system. Hence, there might be dysfunction of the respiratory system. It produces insufficient breathing in Jim. As a result, there can be less oxygen supply to other organs. Hence, heart starts pumping at faster rate. It can produce hypertension in Jim. It indicates influenza A virus infection can lead to multiple organ dysfunction. Due to this multiple organ dysfunction, there can be deterioration of Jim. Hence, to assess deterioration of Jim, assessment of blood pressure, infection and breathing need to carried out in Jim (Shannon et al., 2013).

Assessment of Infection for Jim

Oseltamivir is an antiviral agent. Both influenza A and influenza B infections can be effectively treated with oseltamivir. It can be more effective, if it administered within 48 hours of infection. To assess effectiveness of oseltamivir, nurse should assess fever, cough, headache, fatigue, muscular weakness and sore throat. These are the symptoms of infection and these symptoms can be improved after administration of oseltamivir. After assessment, if nurse couldn’t find improvement in his condition, nurse need to consult to physician to shift to another medication. It is evident that oseltamivir can produce psychological effects. Hence, nurse need to assess psychological abnormalities by providing questionary and seeking response to the same (Skidmore-Roth, 2015).

Paracetamol can be administered in the patients with pain and fever. Handover data specify that Jim is having fever. To bring his body temperature to the normal level, Jim need be administered with paracetamol. Nurse should check his body temperature after administration of paracetamol with short intervals and assess improvements in Jim. If nurse couldn’t find any improvement Jim, nurse should consult with physician for change in the dose of paracetamol. It is evident that paracetamol should not be taken on the empty stomach, hence nurse should make sure that Jim is consuming enough diet prior to paracetamol consumption. In clinical settings, it is evident that paracetamol can produce liver toxicity, hence nurse should perform liver function test to assess liver toxicity of paracetamol (Skidmore-Roth, 2015).

Fluvax is a vaccine which has effect of influenza infection prevention. To aid improved efficacy of Fluvax, it need to be administered every year. Antibodies present in the Fluvax can exhibit its efficacy upto 6 months. Hence, nurse need to be administer it once a year. Fluvax can produce hypersensitivity to eggs and other constituents of Fluvax, hence nurse need to assess patient’s allergic reactions to these constitutes (Skidmore-Roth, 2015).

Jim need to be educated for every aspect of influenza infection. It includes types of influenza infections, types of transmissions and methods of their prevention. Influenza virus can be transmitted either through direct or indirect mode. Direct transmission can occur through coughing and sneezing without any protection. Indirect transmission can occur through hand contacts of infected patient and by utilizing article used by the infected patient. Nurse should educate Jim about importance of cleaning hands and explain him about procedures to be followed for cleaning hands with antiseptic. Nurse need to educate him to decontaminate articles used by him. Jim should be educated about the use of PPEs like mask, gloves and gown. Nurse need to explain Jim that use of these PPEs can be helpful in reducing chances of influenza A virus transmission. Jim should be educated about signs and symptoms of influenza A infection. Hence, Jim can recognize it and can inform nurse about the same. Early reporting of the infection can be helpful to plan effective intervention for Jim. Prevention of influenza virus infection not only useful for Jim but also can be useful for other also. Its prevention can be helpful in reducing risk of re-infection in Jim. In case, there is increase in the number of patients for influenza infection, it can lead to overburden for hospital and it would be difficult to provide proper care to the influenza patients including Jim. Prevention and control of influenza infection is very important in Jim because it can adversely affect multiple organs. Due to this multiple organ damage, there can be deterioration of Jim. Jim need to be kept in the isolated environment for the prevention of spread on infection (Jardins and Burton, 2015; Beachey, 2018). :

Assessment of Breathing for Jim

It is evident that influenza infection can affect respiratory system functioning which can result in altered breathing pattern. Jim is infected with influenza virus, hence there is dysfunction of respiratory system in him. As a result, his lungs are unable to perform normally. It adversely impacts gaseous exchange at alveoli wall and capillary wall interface.  It resulted in reduced oxygen saturation level in the blood. As a result, different organs of Jim can’t receive optimum amount oxygen for their normal functioning. Heart recognise this deficiency in oxygen and initiate speedy heart pumping. It results in the augmented heart rate and blood pressure in Jim. To compensate, deficiency of oxygen lungs need to breath at faster rate. Hence, there is increased respiratory rate in Jim. Due to increased heart rate, blood pressure and respiratory rate, there is increase in the body temperature of Jim. He is also experiencing shivering (Morton and Fontaine, 2017).

To improve this condition Jim need to improve his breathing pattern. Breathing pattern an be achieved by suppling artificial oxygen to Jim. In addition to this, Jim need to be administered with medications like antihypertensive, bronchodilator and antipyretic medicines. Administration of these medicines can be helpful in improving vital signs like heart rate, blood pressure, respiratory rate and body temperature. Deviation from the normal values for these vital signs indicate dysfunction and deterioration of organs like heart and lung. Immediate intervention can be helpful in preventing deterioration of these organs in Jim.

 I am a nursing student in the medical-surgical ward.  I am taking care of patient Jim. He was suffering through influenza A infection, however after administration of medicines, there is improvement in his condition. However, today morning he was exhibiting symptoms like fever and shivering. His breathing pattern and speech was not normal. Recorded vital signs for Jim are body temperature 39.6?C, heart rate 125 bpm, respiratory rate 24 bpm, blood pressure 124/79 mm/Hg and oxygen saturation 86 %. Careful observation of Jim is required. After assessment of Jim, doctor decided to shift Jim to the High Dependency Unit to provide BIPAP.

References:

Beachey, W. (2018). Respiratory Care Anatomy and Physiology: Foundations for Clinical Practice. Elsevier Health Sciences.

Berman, A., Shirlee, J. S., Barbara, K., ….. Stanley, D. (2014). Kozier & Erb's Fundamentals of Nursing Australian Edition. Pearson Higher Education AU.

Carpenito, L. J. (2013). Nursing Care Plans: Transitional Patient & Family Centered Care. Lippincott Williams & Wilkins.

Costilla, V.C., and  Foxx-Orenstein, A.E. (2014). Constipation: understanding mechanisms and management. Clinics in Geriatric Medicine, 30(1), 107-15.

Doenges, M. E., Moorhouse, M. F., and Murr, A. C. (2016).  Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. F.A. Davis.

Gulanick, M., and Myers, J.L. (2016). Nursing Care Plans - E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences.

Jardins, D., and Burton, G. G. (2015). Clinical Manifestations & Assessment of Respiratory Disease - E-Book. Elsevier Health Sciences.

Manfredi, P., and D'Onofrio, A. (2013).  Modeling the Interplay Between Human Behavior and the Spread of Infectious Disease. Springer Science & Business Media

McGloin, S. (2015). The ins and outs of fluid balance in the acutely ill patient. British Journal of Nursing, 24(1). doi: 10.12968/bjon.2015.24.1.14

Morton, P. G. and Fontaine, D. K. (2017). Critical Care Nursing: A Holistic Approach. Lippincott Williams & Wilkins.

Lemone, P., Burke, K., Bauldoff, G., Gubrud, P., Levett-Jones, T., Hales, M., … Reid-Searl, K. (2017). Medical-surgical nursing, critical thinking for person-centred care. (3rd Australian ed.). Melbourne, Victoria: Pearson Australia.

Patel, D.B., Emmanuel, N.B., Stevanovic, M.V., Matcuk, G.R.. Jr, Gottsegen, C.J., Forrester, D.M., and White, E.A. (2014). Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options. Radiographics, 34(7), 1968-86.

Potter, P.A., Perry, A. G., Stockert, P., and  Hall, A. (2013). Fundamentals of Nursing - E-Book. Elsevier Health Sciences.

Seed, M.S., and Torkelson, D.J. (2012). Beginning the recovery journey in acute psychiatric care: using concepts from Orem's Self-Care Deficit Nursing Theory. Issues in Mental Health Nursing, 33(6), 394-8.

Shannon, S. L., Dirksen, R., and Heitkemper, M. M. (2013). Linda Bucher Medical-Surgical Nursing: Assessment and Management of Clinical  Problems.  Elsevier Health Sciences.

Skidmore-Roth, L. (2015). Mosby's Drug Guide for Nursing Students. Elsevier Health Sciences.

Tiziani, A. P. (2013). Havard’s nursing guide to drugs (9th ed.). Elsevier Health Sciences.

Ward, J. P. T., Ward, J., and John, R. (2015). The Respiratory System at a Glance.  Wiley & Sons.

White, L., Duncan, G., and Baumle, W. (2012). Medical Surgical Nursing: An Integrated Approach. Cengage Learning.

Yates, T., Davies, M.J., Edwardson, C., Bodicoat, D.H., Biddle, S.J., and Khunti, K. (2014). Adverse responses and physical activity: secondary analysis of the PREPARE trial. Medicine & Science in Sports & Exercise, 46(8), 1617-23.