Introduction
Nursing care of a patient in multisystem failure involves complex observations and decision-making. This often means a quick assessment of the patient’s level of homeostasis, oxygenation, and pain. This paper presents a review of a case scenario involving an aged patient in multisystem failure experiencing issues with fluid and electrolyte imbalance, acid-base imbalance, oxygenation imbalance, and blood glucose imbalance.
Case Study
Mrs. Eli Baker is a seventy-three-year-old female who was transferred to the emergency room after collapsing in her backyard. Just before this while, she was talking to her friend on the phone, she had seemed confused and beside herself. Upon arrival to the emergency room, she complained of some dysphonia with an increase in her respiratory rate and pulse. Her previous history included diabetes and hypertension. She had recently started a new blood pressure medication: Lisinopril. Her other medications included Metformin and Hydrochlorothiazide. The nurse was able to ask Mrs. Baker a few questions, but she then became unresponsive and had a more difficult time breathing.
Analysis
To begin with, it was vital to conduct the respiratory assessment. This was done by first positioning the patient upright for easier lung expansion and to allow access to the anterior and posterior thorax followed by undressing the patient so that proper observation could be made. The actual process of respiratory assessment involved inspection, palpation, and auscultation. The inspection involved observing the patient, listening, and smelling to compare the observations of the patient with those of a healthy person. According to Moore, Edwards, Barden & McQuay (2004), the ratio of respiration to the pulse rate of a healthy adult should be (1:4).
Other factors that were considered in the inspection were the rhythm of respiration which had irregular cycles, effort applied while breathing, skin pigmentation, consciousness, and presence of cough. Palpation involved placing the hand on the patient’s chest and assessing the movement of the chest and diaphragm. Auscultation involved assessing sounds of the breath which did not emit any sound. At the same time, the patient’s vital capacity was measured by use of a spirometer, and the vital lung capacity was found to be reduced by 40percent compared to a normal person’s vital capacity.
Consequently, the patient’s ability to breathe out the air was measured by use of a peak flow meter and it was found to be below the same time, the oxygen saturation in blood was measured by use of a pulse oximeter and it was found to be eighty percent. The patient’s sputum was too examined in the laboratory by use of a microscope and some pus cells were found (Hutchison, Hunter & Bomford, 1963).
Consequently, the patient’s homeostasis level was assessed. Here, the total serum calcium (Ca) concentration was measured and the serum ionized (Ca) level was determined by use of Mc-Hasting’s nomogram (Zaloga, 1985). According to Zaloga (1985), the normal range for serum ionized Ca concentration range is usually 4.1-5.1 mg/d.The patient was found to have the normal concentration range. This method was preferred for use since it gives more accurate results.
Moreover, there was a need to assess the level of pain felt by the patient. This was achieved by examining the history of the patient and conducting physical examination by use of pain assessment tools. The lastly administered drugs, duration of pain, and the intensity of pain were all considered while gathering the pain-related history. Pain assessment involved palpation, testing of the painful area, and observation. To support the physical examination and pain-related history, laboratory and radiographic tests were conducted.
Some of the tools that were used for pain assessment included the visual analog scale. This scale contains a line labeled from “no pain” to “worst pain”. The patient role was to indicate her level of pain as per the scale. Other factors like the time-length of pain and intensity of pain were other issues that needed to be determined. This was achieved by using the short form of the McGill Pain Questionnaire (SF-MPQ), which uses a visual analog scale to assess pain intensity (Kunkel, Daniel, Monti, Elisabeth & Kunkel, 1998). The patient had described the extent of pain she felt before she became unconscious. This scale benefits the elderly who have poor communication skills a lot. Visitors who do not know the native language and the visually impaired have specialized pain assessment scales prepared for them.
If the geriatric patient was unconscious there would be a difference in the way of assessment as compared to a conscious patient. To start with, one would have to search for pain history from secondary sources only, unlike in an alert patient, where the pain-related history can be obtained both from the patient herself and from secondary sources.
These secondary sources could include friends, relatives, and previous medical records. In a conscious patient, one uses the visual analog scale and the short form of the McGill Pain Questionnaire (SF-MPQ) to assess pain while in an unconscious patient, one uses the Alert responds to Verbal Stimulus, responds to Painful Stimulus or Unresponsive (AVPU) scale or by use of the Glasgow Coma Scale(Hutchison,1929). In both cases of assessing pain in a conscious and an unconscious patient, laboratory or radiographic tests are important to support physical methods of pain assessment.
Discussion
Collecting data from patients should be well organized. This is because the patient may become unconscious at any time, thus there is a need to ask the most important things first from the patient. In this case, data collection was in this order: patient’s age, immediate circumstance, the intensity of pain, and prior medication.
The technological tools that were used included a spirometer, a peak flow meter, a microscope, and a pulse oximeter.
A spirometer determines one’s lung capacity as well as the capacity residual volume. The sick person is expected to breathe in air and breathe it out to the spirometer. The spirometer was used to measure the vital capacity of the patient. A pulse oximeter is a tool that monitors oxygen in the blood by displaying the percentage of hemoglobin in arteries (How does a pulse oximeter work).
The peak flow meter is a small handheld tool that is used to monitor a patient’s ability to breathe out air. The readings are usually high when the patient is well and low when the patient is unwell. A microscope is a tool that is used to observe macro and microorganisms to determine the type of organisms responsible for the ailment. A pulse oximeter is a blood-oxygen monitor that displays the percentage of arterial hemoglobin in the oxyhemoglobin configuration. Normal reading ranges from ninety-five percent to one hundred percent (Hutchison et al., 1963).
There are several reasons as to why each of the above technological tools was used. The spirometer was used to determine the vital capacity of the geriatric patient. The peak flow meter was useful in determining the patient’s flow of air. The microscope was used to observe microorganisms present in the sputum and finally, the pulse oximeter was used to monitor the oxygen saturation of a patient’s blood and changes in volume in the skin (Hutchison et al., 1963).
To manage pain in a geriatric patient with multisystem failure, showing signs of pain but not alert, you need to use laboratory or radiographic tests to determine the kind of pain being experienced, followed by administration of non-steroidal anti-inflammatory drugs (NSAIDs) if the pain is nociceptive and administration of anticonvulsants and tricyclic depressants if the pain is neurogenic (Kunkel et al., 1998). Transcutaneous electrical nerve stimulation can also be used to manage pain in this patient (Kunkel et al., 1998).
On assessing the geriatric patient, I learned that she experienced mild musculoskeletal pain. The doctor prescribed 500 mg acetaminophen by mouth or morphine 0.05mg/kg/v or morphine 0.1mg/Kg 1M. Acetaminophen and Morphine are used for the treatment of mild and moderate musculoskeletal pain. The effect of these drugs is felt after weeks, so one has to wait for some time before one can determine whether the drug was effective or not.
The collaborative team members in this scenario were the emergency room nurses, the medical doctor, the patient, and her nephew who escorted her to the hospital. When the patients became unconscious and distress in respiration increased, the emergency room’s nurses put the patient in an oxygen mask.
Conclusion
Multisystem failure is a common phenomenon among the elderly. Some several instruments and tools can be used to assess these conditions. Knowledge of assessing the geriatric patient’s homeostasis, oxygenation, and level of pain is important since it improves the capability of pain management for geriatric patients.
References
H ow does a pulse oximeter work? (n.d). Web.
Hutchison, R., Hunter, D., & Bomford , R.R. (1963). Clinical methods: A guide to the practical study of medicine. London: Lippincott.
Kunkel, M., Daniel A., Monti, M. & Elisabeth, J. (1998). Practical Geriatrics: Management of Chronic Illness among Elderly Patients. Wales: University of Cardiff.
Moore, A., Edwards, J., Barden, J. & McQuay, H. (2004). Bandolier’s Little Book of Pan: An Evidence-Based Guide to Treatments. London: Oxford University Press.
Zaloga, G.P (1985). Assessment of Calcium Homeostasis in the Critically Ill Surgical Patient: The Diagnostic Pitfalls of the McLean-Hastings Nomogram: Indiana University.