Essay Example: History and Nursing Assessment

Question#1: History and Nursing Assessment

From the foregoing, it becomes evident that Joan suffers from several conditions that cause much deterioration of her health status. Primarily, the clinical manifestations of hypoxia and hypertension continue to deteriorate the entire body system’s functions. Joan's medical condition needs urgent treatment. In the case of hypoxia, for instance, any failure to initiate oxygen therapy is likely to cause tremendous harm to the patient. Clinically, oxygen therapy plays a critical role in supplying oxygen in line with the target saturation rate. It also monitors the saturation rate to keep within the recommended or target range (Beachey, 2017). It is critical to note that the target range (SaO2) for normal adult patients is 92 – 98%. This is not the case with Joan as she suffers from COPD, so the target range should be 88-92%. SaO2 of 93% implies that Joan is deprived of body oxygen at the tissue level and thus must be subjected to rapid oxygen therapy. Various historical and nursing interventions are further needed on top of the available ones, receiving oxygen. It is critical to note that one major clinical manifestation of the hypoxia is hypertension. Thus, the nursing interventions and historical information related to this condition will be vital.

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Firstly, the nurses must evaluate Joan's report as well as the evidence related to the extreme fatigue, intolerance for the activity, sudden or progressive weight gain, and the progressive shortness of breath. Further, the evidence of swelling of extremities should also be clinically assessed (Beachey, 2017). The primary rationale behind this intervention is to assess the signs of poor ventricular function and the looming cardiac failure.

Secondly, it is critical to evaluate laboratory data. These will further include the assessment of the cardiac markers, complete blood cell count, the electrolytes, ABGs, blood urea nitrogen, as well as the Creatinine. The cardiac enzymes and culture assessment will also play a significant role in providing the necessary clinical information about the overall condition currently presented by the client. This nursing intervention will help to identify contributing factors.

It is also essential to assess the presence and the quality of central and peripheral pulses. Clinically, studies have shown that the bounding carotid, jugular radial, as well as the femoral pulses, should be evaluated and palpated (Denniston et al. 2002). It is important to note that the vibrations in the legs and feet may be dismissed, thus indicating the effects of vasoconstriction and venous ingestion. Finally, nurses will be required to assess the pulmonary gas exchange on the patient. Fundamentally, the pulmonary gas exchange involves the inspiration and delivery of oxygen from the external environment into the alveoli (Beachey, 2017). Primarily, this process consists of the diffusion across the alveolar-capillary membrane as well as the combination of oxygen with the Hb within the pulmonary capillaries (Houston, 2018). In this case, the gas exchange relies on various physiologic processes of alveolar ventilation and movement of gasses across the alveolar-capillary membrane, ventilation-perfusion, and pulmonary perfusion (Durrington et al. 2005).

Question#2; clinical assessment findings of the underlying physiological response

As observed in the findings of the patient’s clinical assessment, Joan presents various clinical symptoms related to the heartbeat rate, respiration rate, Blood pressure, Glasgow Coma Scale, Temperature, and the SpO2 (Netzer et al. 2017). The outcomes in the assessment are attributed to the underlying psychological responses that are caused by the significant manifestation of the illnesses that disrupts the normal functioning of the body (Durrington et al. 2005).

Joan’s blood pressure reading of 82/48 is a clear indication of the condition known as the Hypotension. Medically, this implies that the patient’s Bp is lower than the normal range of 120/80 mmHg. The blood pressure finding, in this case, is attributed to various underlying conditions, such as the Cerebrovascular accident (CVA), which is a medical term used to refer to a stroke. Joan is possibly suffering from disrupted blood flow to the parts of her brain due to the blockage of blood vessel rupture (Zarbin, 2004).

The decreased heartbeat rate (64 beats per minute in this case) is considered abnormal. From our clinical findings, it can be concluded that this abnormality is attributed to hypertension, ischaemic heart disease, and Cerebrovascular accident. Therefore, the synergistic effects of this condition contributed to a low heartbeat rate, which is clinically referred to as the sinus bradycardia (Beachey, 2017). The physiologic causes of the increased vagal tone are observed in patients with multiple respiratory ailments such as hypertension, ischaemic heart disease, and stroke. Physiologically, Joan could be suffering from a sinus syndrome, which involves a dysfunction in the ability of the sinus mode to produce or transmit an action potential to the atria. The condition may cause a functional reduction in the number of nodal cells (Houston, 2018). Some patients may, however, demonstrate the presence of the antinodal antibodies. While these, as well as other developments, are beginning to focus on the understanding of bradycardia, most cases have remained idiopathic. As in the case of Joan, the low heartbeat rate occurs when the SA node fails to excite the atria consistently. According to Murphy et al. (2011), this blockade may be associated with the abnormal intrinsic nodal function, which occurs as a failure of the SA junction.

Question#3: Blood results and provide a physiological rationale for any abnormality

The analysis of the blood test results offers great insights regarding some of the possible abnormalities that Joan is suffering from. From the assessment, it is evident that various measures such as K, Na, Urea, Glucose, INR, and APTT are normal and found within the required range. Contrary to this, the blood level of other substances such as the Creatinine and Lactate is not within the normal range. The presence of high lactase and Creatinine in the body reflects an abnormality in the blood. The lactate blood test is mainly done to help determine if the patient has the lactic acidosis (Plant et al. 2000). This is a level of lactate that is high enough to disrupt an individual acid-base (pH) balance. This condition is mainly caused by inadequate oxygen within the cells and tissues. The presence of this condition in the body reduces the amount o the oxygen that is supplied to the cells and tissue. Thus, due to the severity of this condition, hypoxia, it is possible to conclude that Joan has congenital heart disease.

Question#4: How the physiological alterations associated with aging can potentially impact on assessment and management of the patients

The physiological changes that are associated with aging have been shown to affect the treatment of health conditions (Zarbin, 2004). In our case, the patient, Joan, suffered various conditions year back and may change the management of the current circumstances. The previous diseases such as hypertension, ischaemic heart disease, hypercholesterolemia, type 2 diabetes mellitus, and cerebrovascular accidents play a critical role in the selection of the current management practices (Van Bladel et al. 2020). One major challenge of treating the patient the geriatric patients is based on the fact that this group has a broad spectrum of ages and medical conditions (Chan & Holford, 2001). There are significant changes associated with aging that have the capability of affecting them medication. These changes can either be classified as pharmacokinetic and pharmacodynamic. Broadly, they involve what the body does to a given drug and what the medication does to the body.

Studies have shown that the potential decrease in the renal function is the most commonly considered aging-related physiological changes regarding medications (Rvachew & Brosseau-Lapré, 2016). This mostly happens for patients who have suffered diabetes. In this case, therefore, the dosing decision must take into consideration the age factor as well as medical history. It is also possible for hepatic metabolism to be affected by aging. In their study, Hallan et al. (2012) shown that aging does not influence the metabolic pathways within the liver in a similar fashion, and any drug metabolism changes greatly varied from one patient to another.

While it is evident that Joan had suffered Type 2 Diabetes in 2012, it is evident that there is the likelihood that she will incur from the reduced hepatic metabolism brought on by aging can extend its half-life in the body. In terms of the pharmacokinetics, it is evident that the older patients can demonstrate a considerable sensitivity to the impacts of medications aimed at normalizing the blood pressure, the heartbeat rate, and the respiration rate (Zarbin, 2004). In some cases, the older patients have demonstrated increased response to some medications. They tend to exhibit a reduced sympathetic nervous system response. Therefore, they may also respond at a lower rate to medication such as the ACE inhibitors and angiotensin receptor blockers (Fulton et al. 2014).

Finally, the homeostatic changes in the body significantly affect how older people can respond to drugs. Broadly, the changes in the cellular homeostatic include the changes in the cellular homeostatic mechanisms. These include temperature, blood, and extracellular fluid. The synergistic impact of these changes reduces body mass (Cameron et al. 2012). Further, the functional reserve loss may also impair the individual’s ability to adjust to external challenges such as surgery. Thus, keeping the physiological functions of an aging population is of great importance. This helps to enhance the individual well-being and social perspective, reducing the burden on the medical services and system.

Question#5: How Alterations to Normal Physiology Will Influence Tissue Oxygen Delivery

According to Arora & Tantia (2019), the oxygen transport constitutes one of the most crucial roles of the blood. Fundamentally, the mechanism of oxygen movement from the air where its partial pressure is about 150mmHg to Mitochondria. In this case, it falls to a single digit, constituting an evolutionary marvel. Studies have shown that alterations to normal physiology profoundly influence tissue oxygen delivery and how it impacts organ function (Portney, 2020). The amount of oxygen that binds to the hemoglobin, as well as the amount carried by the blood, is mainly determined by the PaO2. Within the pulmonary capillary blood, the PaO2 is often high. In this sense, the hemoglobin absorbs the oxygen that is dissolved in Plasma (Fulton et al. 2014).

Consequently, the Plasma takes more oxygen from the alveoli. At a sea level, studies have shown that the body is exposed to the pressure (Arora & Tantia, 2019). The alteration of the ambient pressure can have tremendous impacts on the blood’s ability to carry the oxygen. The sufficient delivery of oxygen and the absorption is vital for the proper functioning of the cellular, tissue, and organ levels (McLean & Le Couteur, 2004). Under these circumstances, the body can demonstrate tolerance to the insufficient oxygen for a given period. However, when the demand is exceeded, the hypoxia is likely to develop, thereby leading to the organ and cellular dysfunction, including death. In the case of Joan, alteration of the blood pressure to 78mmHg might have caused a temporary imbalance between the pressure in the body and the atmospheric pressure.