Introduction
This is M. D.’s case, a 75-year-old lady with persistent respiratory issues and a nonhealing leg wound; the assessment will equally cover D.’s appropriate nursing interventions in New Zealand.
Short Summary of Clinical Information
M. D. is a 75-year-old woman who arrives at the GP clinic with a leg wound that is not healing and a chronic productive cough. On occasion, the leg with the wound feels colder and number than the other leg. She had a cold and a runny nose about two weeks ago. Now, she reports coughing up yellow mucus, experiencing chest pain when coughing, and sometimes having trouble breathing. Her vital signs indicate a temperature of 37.5°C, blood pressure of 156/78, heart rate of 84 BPM, respiration rate of 12, and oxygen saturation of 94% on room air.
A month ago, M.’s grandson contracted pneumonia, and she took care of him throughout that period. She confirms that today’s test was negative after receiving the COVID vaccination. D. testified that she currently felt no more headaches, stuffy nose, extreme heat, light-related headaches, or impaired vision.
M. stays alone in her home, which may get wet and chilly because sometimes she cannot manage to pay her heating bills. She started taking Metoprolol for her high blood pressure 2 years ago, but she discontinued it six months ago with the 47.5mg once-daily dosage. She also has a family history of heart attacks and colon cancer but is not allergic to any drug or environment.
M. affirmed that she stopped consuming sugar and is now eating more vegetables, but sometimes feels tired and becomes short of breath. D. assumed she did not need medicine anymore because she had not refilled her prescription and was feeling well. She cracked her ankle when she was 54 years old.
At the moment, M. is not taking any medication, and she has not been consistent in checking her blood pressure. She claims not to use alcohol or recreational drugs, and she has smoked for 20 years, averaging 10 cigarettes a day. Exhaustion and dyspnea have limited M., a retired accountant, in her capacity to carry out everyday tasks. M. finalizes by mentioning that she cut her toenails by herself, so she has never seen a podiatrist.
Prioritized Problem List of the Issues
- Productive Continuous Cough
- Potential respiratory infection or aggravation of a long-term illness.
- Contributing elements include residing in a cold and wet atmosphere and having a grandchild who has pneumonia.
- Persistent cough with phlegm which could be signalizing a problem in the lungs.
- Nonhealing Wound in the Leg
- Possible problems with peripheral blood circulation, particularly in light of the afflicted foot’s numbness and colder sensation.
- Decreased blood flow and inadequate podiatrist care are contributing reasons.
- Dry skin in lower limbs, specifically in the infected leg.
- Shortness of Breath
- High blood pressure.
- Tiredness and weakness.
- Feeling short of breath.
Action Plan Development for the Patient
Productive Continuous Cough
Regular Check-Up
The first intervention is to regularly check the respiratory state, especially the oxygen saturation level. In order to manage a persistent productive cough (PPC), it is essential to monitor the respiratory state, especially oxygen saturation, since this aids in determining the patient’s capacity to breathe. This regular checking cannot heal the condition; therefore, finding and treating the underlying cause of the cough is essential to treating it successfully (See, 2022). The causes might vary from respiratory infections to long-term illnesses.
Resolving a PPC requires seeing medical specialists for a precise diagnosis and individualized therapy. By tracking oxygen saturation and respiratory status, medical professionals can quickly spot any decline in the patient’s condition or the need to modify breathing assistance, resulting in the best possible treatment. See (2022) confirms that the third phase of treating acute respiratory failure is checking the patient’s pH, pulse oximetry, and discomfort level. Therefore, through regular respiratory state check-ups, the nurses will be able to identify M.’s problem for accurate treatment.
Deep Breathing
The second nursing intervention will be deep breathing activities, which should be encouraged and supported. Ibrahim et al. (2021) confirmed that, fortunately, the study group had a considerable improvement in their cough intensity during the day and night. This was after implementing the suggested nursing interventions, in contrast to the control group, whose results remained unchanged.
Pursed Lip Breathing Exercise (PLBE), which reduces the frequency of coughing while improving inspiratory muscle strength and diaphragm respiratory coordination, was reported to be the reason behind such improvement. PLBE involves the patient sitting in bed with his or her hand on the rib cage, inhaling deeply through the nose, and holding the breath for 2 to 3 seconds (Ibrahim et al., 2021). The next step is to gently release the breath via tightly closed lips.
Generally, it is advised that the patient perform the workout twice a day for ten minutes each. Ibrahim et al. (2021) outline smoking, allergies, and outdoor air pollution as factors that trigger Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Therefore, D. will have to stop smoking since she has been smoking around 10 cigarettes daily for 20 years, which could increase her cough.
Antibiotics
The third intervention will be to give out prescription drugs, such as antibiotics. Antibiotics can only be used to treat bacterial infections; therefore, how they are used to treat a persistently productive cough relies on the underlying reason. D.’s case can be associated with pneumonia following her grandson’s condition. Van Eyk (2019) proceeded to prove that although pneumonia is often bacterial in origin, viruses are the most prevalent cause of upper and lower respiratory tract infections.
Antibiotics are always recommended if the cough is caused by a bacterial respiratory infection, such as bronchitis or pneumonia. These medications function by concentrating on and preventing the development of germs, which reduces the illness. However, if the cough was caused by a viral infection or a non-infectious sickness, antibiotics would be ineffective, and the therapy would need to be adjusted.
Possibly, M.s’s case seems to be related to pneumonia since she was close to the grandson, who was already infected. Geller et al. (2018) give a detailed prescription report in the case of a 61-year-old man who had 5 months of PPC. Geller and colleagues propose some medications for patients without comorbidities and risk factors for resistant S. pneumoniae. Doxycycline (100 mg twice daily), Clarithromycin (500 mg twice daily or 1000 mg prolonged-release in single daily dose) (Geller et al., 2018). Geller and his team continue in prescribing the dosage: azithromycin (500 mg once daily followed by 250 mg daily for 4 days or 2 g prolonged single dose).
Treatment options for patients who have received antibiotics within the last three months include respiratory fluoroquinolones (levofloxacin or moxifloxacin) or azithromycin or Clarithromycin combined with amoxicillin and clavulanate (1 g every eight hours) (Geller et al., 2018). Levofloxacin 750 mg daily, Moxifloxacin 400 mg daily, or a combined beta-lactam antibiotic such as amoxicillin with a macrolide (azithromycin or Clarithromycin) are the possibilities in the event of comorbidities.
Patient Education
Concerning health promotion and education, as well as referrals, M. will have to be informed on a few issues. It is key to emphasize to D. the value of getting prompt medical assistance for respiratory issues since it could be a symptom of a serious sickness. According to Chung et al. (2022), when a smoker’s cough pattern changes, it may be a sign of lung cancer.
D. equally needs to be taught the essence of maintaining a dry, warm environment to avoid respiratory problems. D’Amato et al. (2018) gave a better explanation that temporarily breathing in cold air causes ciliary ultrastructural abnormalities and increased mucus discharges from the airways. M. has respiratory difficulty, and spending in colder places can further complicate her condition. If the cough proceeds even after taking all the precautions, then it will be better for D. to see a respiratory specialist.
Nonhealing Wound in the Leg
Cleansing
The first intervention will be to cleanse the wound and apply the recommended dressing. Mayo Clinic Staff (2022) elaborates that a wound can be adequately dressed by gently cleaning it with mild soap and water and using an antibiotic ointment. Thereafter, they cover it with a sterile, non-stick dressing that is fastened with a bandage or gauze wrap. Twilley et al. (2022) propose Mupirocin for nonhealing wounds: it functions by attaching itself to the bacterial isoleucyl-tRNA synthetase and preventing it from forming. Once this is done, the cellular amounts of the isoleucine-charged transfer RNA decrease, which ends the synthesis of protein and RNA in bacteria.
Checking Symptom
The second intervention will be to check the afflicted leg’s circulation and keep track of any infection symptoms. Medical compression treatment is not recommended for individuals with extensive diabetic neuropathy who have sensory impairment or microangiopathy and who run a danger of skin necrosis (Rabe et al., 2020). This is because nonhealing wounds might have resulted from further harm that compression treatment does to the skin and underlying tissues. Therefore, before beginning any medical compression therapy on M., it is crucial to evaluate her vascular condition.
Patient Education
The main health promotion and education will be to enlighten D. on the value of good wound care, particularly for those with diabetes or peripheral vascular disease. For leg care and education, M. should visit a podiatrist for a thorough evaluation.
A Comprehensive Examination of Nursing’s Role in Promoting Health
In New Zealand (NZ), NZ nurses are important for patients undergoing respiratory issues. Smith et al. (2022) explained that over 100 million individuals are diagnosed with sleep disorders, and 50 million individuals are receiving treatment for lung ailments related to their jobs. They likewise offer services pertaining to occupational screening to diagnosis; this means that Nurses in NZ are giving direct treatment to people with respiratory issues. Apart from giving direct treatment, screening, and diagnostic services are conducted to assist in the early detection of respiratory conditions, thus aiding in managing or preventing them from developing.
NZ nurses encourage a proactive attitude to self-care by enabling patients to identify early indicators of respiratory distress. Nurses specializing in respiratory care always provide symptom management, rehabilitation, non-invasive ventilation, psychological support, and health education (Smith et al., 2022). These NZ nurses similarly offer guidance on how to live well with a disease to improve the patient’s quality of life and health outcomes.
Together with developing tailored treatment plans that take into account social, cultural, and economic aspects influencing respiratory health, nurses work in interdisciplinary teams. By providing individualized instruction on medication management and lifestyle adjustments, nurses play a major role in health promotion for patients with respiratory difficulties, like M.. Their role is to increase public knowledge of the preventive measures against respiratory disorders, such as vaccination, quitting smoking, and having a healthy lifestyle.
Alternatively, these nurses are essential in wound management so that the patients with nonhealing wounds become better or heal. Between 46% and 95% of patients had burn wound care procedures performed in a theater (Perkins et al., 2022). This statistic means that NZ nurses are actively engaging in direct wound treatment. These nurses collaborate with relevant departments to ensure the patients with wounds are healed or get better. In D.’s case, they could be in charge of educating her about wound care management, stressing the value of following treatment regimens, and encouraging lifestyle changes that promote healing. These nurses can partner with dieticians so as to guide M. on eating a balanced diet since M. is not allergic to any food. Lifestyle would also entail urging her to avoid things that could obstruct the body’s ability to heal, like smoking.
In addition, these nurses work in conjunction with other medical specialists to develop a comprehensive care plan customized to meet the individual requirements of the patient. Other patient groups treated in outpatient clinics capable of performing cleansing and dressing under anesthesia in process rooms other than operating rooms are not registered with the BRANZ (Perkins et al., 2022). Due to the fact that there are outpatients, the NZ nurses must clarify the prescription and how to handle the wounds for faster and better healing. Therefore, the NZ nurses are performing a great task in encouraging self-care behaviors, enabling patients to take an active role in their health, and guaranteeing continuity of treatment through routine follow-ups.
Conclusion
Nurses hold critical positions in respiratory health promotion and wound treatment. A good example can be seen in M.’s case, who has a nonhealing leg wound and a persistent productive cough. Deep breathing exercises, routine respiratory checks, wound dressing, and infection monitoring were essential for treating M.’s nonhealing wound, cough, and shortness of breath. On the other hand, antibiotic therapy for the cough was part of the action plan.
The case described the variety of duties that nurses have in regard to managing complicated medical illnesses, including chronic wounds and respiratory disorders; these roles comprise patient education, support, screening, and direct treatment. When it comes to attending to patients’ and interrelated health requirements, NZ’s nurses’ comprehensive care is essential. The paper highlights the diverse duties of NZ nurses in furnishing direct medical care, screening, diagnostic assistance, education for patients, and support for the management of intricate health concerns, entailing persistent wounds and respiratory ailments. In order to address the complex and varied health requirements of patients like D. M., comprehensive nursing care remains a great need in NZ.
References
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