Mrs. Mavis Jones Case Study: Nursing Problems, Interventions, And Outcomes

Problems

Discuss about the Case Study for Mrs. Mavis Jones Case.

I will start the process of completing this case study by undertaking a consideration of Mrs. Mavis Jones’ situation, collect cues, process them and subsequently present associated health information. I will then identify and prioritize three nursing problems anchored on the Mrs. Mavis assessment data and establish goals for priority of nursing care based on the three issues. I will then discuss Mrs. Mavis Jones’ nursing care linking it to the assessment data and history. Finally, I will undertake an evaluation of my nursing care strategies for justifying the nursing care delivered to Mrs. Mavis and reflect on her outcome. Levett-Jones’ clinical reasoning cycle will be helpful in this completing this case study especially in planning and evaluating person-centred care by giving effective framework for  the clinical decision making regarding Mrs. Mavis Jones’ shortness of breath condition (Levett, 2013).

Based on a clinical reasoning cycle, I have identified and prioritized three health problem faced by Mrs. Mavis. The first priority is temperature due to infection in Mrs. Mavis (Kushimoto et al., 2014).  My goal is temperature control. I will focus on giving Mrs Mavis drugs that will bring down her temperature to the right level. I will provide antibiotics such as acetaminophen or ibuprofen and aspirin.   This will help her get reprieve since it is inappropriate to start any intervention with this high temperature. By controlling her temperature back to the required level, it will give me an opportunity to attend effectively to Mrs Mavis (Kushimoto et al., 2014).  I will give Mrs Mavis sedative agents and neuromuscular blocking agents to control the temperature. I will also give antipyretic medication such as paracetamol and non-steroidal anti-inflammatory drugs (Rowe & Fletcher, 2008). The paracetamol will be effective since it acts by selective inhibition of the COX-3 enzyme resulting into decreased production of fever-producing prostaglandins (Rowe & Fletcher, 2008). Research has shown effectiveness of paracetamol in critical ill patients and hence its usefulness in this case (Rowe & Fletcher, 2008). Based on these studies, I will ensure that next time I give paracetamol to my patients to control temperature. However, in the future, I will also use other physical methods of cooling such as uncovering the patient whilst preserving her dignity as well as using cold towels placed across the patient or in axillae ((Kushimoto et al., 2014)).

The second priority is Shortness of breath due to difficulty to breathe properly as this patient is CO2 retainer so supplement oxygen cannot be given more than 2l via NP (Nasal Prongs) ((Kushimoto et al., 2014).This is my second priority since it facilitates the the management of SOB which may point to Mavis being asthmatic since it was detected during the handover that she had a pre-existing history of Asthma. She had even been admitted into the Intensive Care Unit five years prior without being intubated. My goal here is to maintain breathing pattern effectively through SOB management. I will give Mrs Mavis oxygen 2I via NP (Kushimoto et al., 2014). As a result of dyspnoea, Mrs. Mavis is experiencing respiratory distressed, cyanosis symptoms. I will focus on treating Asthma which has affected Mrs. Mavis for a long period of time. I will take Mrs. Mavis through intubation which has never been done to Mrs. Mavis despite a pre-existing history of Asthma (Heidenreich, 2013). This will be helping and I will closely follow her progress while in the ICU to note every change and call for any action that might be necessary. I will also seek to ensure that Mrs. Mavis respiratory distress is curtailed within the shortest time possible to speed up her recovery. It would be counteractive when she continues to have such a distress.  This will help Mrs. Mavis since it will improve her oxygen supply by eliminating the saturation of 85% thereby getting reprieve (Lunenburg, 2013). I intend to undertake intubation in the next one hour so as to examine her reaction to the intervention ((Kushimoto et al., 2014)) Mrs. Mavis asthmatic situation has improved following the intubation. The shortness breath has improved she is currently breathing normally (Lapinsky, 2012). Certain studies have shown that oxygen has caused severe problems for people. From these studies (Lapinsky, 2012). I have subsequently acknowledged the significance of oxygen and hence next time I would ensure that I give oxygen for my patient in time to manage SOB (Lapinsky, 2012) However; I will continue to keep a close eye on her since it might another intubation in the future.

Conclusion

My third priority is Anxiety due to discomfort, SOB and respiratory distress manage. It has been shown that Mrs Mavis is has peripherally cyanosed with slight diaphoretic. It was also indicated that she had oxygen saturation of 85% on room air. The triage nurse even triaged Mrs, Mavis as a category 2 resulting from her respiratory distress. My goal will be to provide comfort, reassurance and change position. To do this, I will subject Mrs. Mavis to antiperspirant that has mostly been used on a daily basis to control sweating. The antiperspirant has aluminium salts which when rolled in the skin will form a plug which blocks perspiration. I will also give the patient medical treatment such as Iontophoresis where she will sit with her hands, feet or both in a shallow tray of water for about 20 minutes allowing a low electrical current to pass through water. I will immediately identify and correct the underlying cause of cyanosis and restoring the oxygenated blood flow to the affected parts of Mrs. Mavis’ body. I will do the oxygenation as a treatment for cyanosis by doing the initial stabilization which requires oxygenation after checking the airway or the wind pipe clarity or oxygenation. I will remove any obstruction or difficulties through endotracheal tube insertion to enable me administer oxygen. I will also administer drugs to treat cyanosis to reduce the accumulation of fluids to enable the heart to pump harder. I will also warm the affected areas due to peripheral cyanosis through symptomatic treatment using gentle warming of the toes and fingers.  

Conclusion

My intervention for Mrs. Mavis proved effective based on the outcomes I noted. Mrs. Mavis temperature conditions improved within a short period of time. My decision to give Mrs. Mavis paracetamol was effective as her body temperature restored shortly after the administration. Also by giving oxygen to manage SOB was satisfactory, Mrs. Mavis’ Shortness of breath became under control effectively. She reacted well when I gave her oxygen leading to restoration of her respiratory distress.  However, from the outcomes, I have learned that I could have given more emphasis on Mrs. Mavis use of accessory muscle. I realized that this is a severe challenge that affects the Asthmatic patients based on how I witnessed it from Mrs. Mavis experience. Subsequently, when faced with this particular situation, I will ensure that I involve my fellow colleagues into the decision-making process so as to make more fruitful clinical judgment. I now understand the effectiveness of intubation and the importance of knowing the medical history of a patient (Lunenburg, 2012). Knowing that she had been taken into ICU five years prior without intubation helped me make quick decision to intubate her which greatly helped me address her severe asthmatic situation. I have also realized that I should have continued to keep an eye on Mrs. Mavis situation especially on the part of her use of accessory muscle (Thompson, 2012). I learnt that this was a severe problem that needed input of my co-workers so that we could have reach amicable and fast solution.   

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