Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away

QUESTION

Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away. She has been dieting for several months and skipping meals. Ms. Singh mentions that in addition to her full-time job as a secretary she is attending college classes two evenings a week. She has smoked one package of cigarettes per day since she was 18 years old. Chest x-ray confirms pneumonia.

Physical Examination

Height: 167.6 cm (5960)

Weight: 54.4 kg (120 lb)

Temperature: 39.4°C (103°F)

Pulse: 68 beats/min

Respirations: 24/min

Blood pressure: 118/70 mmHgSkin pale; cheeks flushed; Chills; use of accessory muscles; inspiratory crackles with diminished breath

sounds right base; expectorating thick, yellow sputum

Diagnostic Data

Chest x-ray: right lobar infiltration

WBC: 14,000

pH: 7.49

PaCO2: 33 mmHg

HCO3 -: 20 mEq/L

PaO2: 80 mmHg

O2 SAT: 88%

Applying Critical Thinking: (10 points each)

1. What factors may have led the medical staff to suspect that Ms. Singh had more than a very bad cold? Would you have come to the same conclusion? Yes

2. The care plan appropriately focuses on the acute care of this client. Once she is significantly improved, the nurse will perform discharge teaching. What areas should be included?

3. The client already has some signs of respiratory distress. What signs might indicate that her condition was deteriorating into a more emergency situation? How would you handle this?

4. It appears that the client’s sputum has not been cultured. In caring for this client, what infection control guidelines would be needed?

5. Ms. Singh’s oxygen order is for a face mask at 6 L/min. She repeatedly pulls it off and you find it lying in the sheets. How might you intervene.

ANSWER

Managing Oxygen Therapy and Ensuring Patient Compliance: Intervention Strategies for Ms. Singh

Introduction

In this scenario, Ms. Johti Singh, a 39-year-old secretary, has been admitted to the hospital with symptoms of an elevated temperature, fatigue, rapid, labored respirations, and mild dehydration. The nursing history and diagnostic data suggest that Ms. Singh has pneumonia. This essay will address the situation where Ms. Singh repeatedly pulls off her oxygen mask, lying it in the sheets. We will explore intervention strategies to ensure patient compliance and optimize the effectiveness of oxygen therapy.

Factors indicating more than a bad cold

The medical staff suspected more than a bad cold due to several factors, including the prolonged duration of symptoms, persistent fatigue, elevated temperature, and the presence of inspiratory crackles and diminished breath sounds in the lungs. Additionally, the chest x-ray confirmed right lobar infiltration. These factors collectively pointed towards a more severe respiratory condition. Coming to the same conclusion would be logical based on the patient’s symptoms and diagnostic findings.

Discharge teaching areas

Once Ms. Singh’s condition significantly improves, the nurse should focus on providing comprehensive discharge teaching. The areas to be included are: a. Education about the importance of completing the full course of prescribed antibiotics to eradicate the infection. b. Proper nutrition and the significance of regular meals to support recovery and boost the immune system. c. Stress management techniques to cope with the demands of work, college classes, and personal life, as excessive stress can compromise the immune system (Willett, 2006). d. Smoking cessation support and resources to help Ms. Singh quit smoking, as smoking can exacerbate respiratory conditions and hinder recovery. e. Emphasizing the importance of rest and adequate sleep to facilitate healing. f. Reinforcing the need for follow-up appointments and the importance of reporting any persistent or worsening symptoms promptly.

Signs of deteriorating respiratory condition and management

Signs indicating a deteriorating respiratory condition may include increased respiratory rate, worsening oxygen saturation levels, increased use of accessory muscles, severe dyspnea, and cyanosis. If Ms. Singh’s condition shows signs of an emergency situation, immediate actions should be taken: a. Inform the healthcare team, including the physician, about the change in her condition. b. Assess the need for oxygen therapy adjustment or additional respiratory support. c. Administer medications as ordered, such as bronchodilators or corticosteroids, to relieve bronchospasm and reduce inflammation. d. Maintain a calm and reassuring demeanor while closely monitoring vital signs and oxygen saturation levels. e. Prepare for potential interventions such as intubation and mechanical ventilation if the respiratory distress worsens.

Infection control guidelines

To ensure infection control while caring for Ms. Singh, the following guidelines should be followed: a. Use standard precautions, including proper hand hygiene, wearing gloves, gowns, and masks when necessary. b. Dispose of contaminated materials properly, including used tissues and disposable equipment. c. Perform proper hand hygiene before and after any contact with the patient or potentially contaminated items. d. Encourage respiratory hygiene practices, such as covering the mouth and nose when coughing or sneezing, to reduce the spread of respiratory droplets (World Health Organization, 2014). e. Implement isolation precautions, such as placing the patient in a private room or cohorting with other patients with the same respiratory condition, if required.

Intervention for Ms. Singh pulling off her oxygen mask

To address Ms. Singh’s non-compliance with the oxygen mask, several intervention strategies can be employed: a. Communicate with Ms. Singh to understand her concerns or reasons for removing the mask. Address any discomfort or issues she may be experiencing. b. Educate Ms. Singh about the importance of maintaining oxygen therapy and the potential consequences of not adhering to the prescribed treatment plan. c. Assess and address any potential barriers to compliance, such as discomfort, skin irritation, or difficulty breathing with the mask. Explore alternative oxygen delivery methods if necessary, such as nasal cannula or face tent, after consulting with the healthcare team (A New Nasal Oxygen Mask, 1983). d. Ensure that the oxygen mask is properly fitted and comfortable for Ms. Singh. Make adjustments as needed to enhance comfort and adherence. e. Provide distractions or diversional activities to keep Ms. Singh engaged, reducing the likelihood of removing the mask out of boredom or restlessness. f. Involve the patient’s family or support system in the education process, emphasizing the importance of their role in supporting Ms. Singh’s adherence to the oxygen therapy. g. Regularly assess and document the patient’s oxygen saturation levels and respiratory status to identify any potential deterioration promptly.

Conclusion

Effectively managing oxygen therapy and ensuring patient compliance are crucial for optimizing the treatment of respiratory conditions. In the case of Ms. Singh, addressing her non-compliance with the oxygen mask requires a patient-centered approach, including education, communication, and problem-solving. By implementing appropriate interventions and maintaining a supportive environment, healthcare professionals can improve patient outcomes and facilitate a smooth recovery process.

References

A new nasal oxygen mask. (1983, October 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/6639864/ 

Willett, W. C. (2006). Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK11795/ 

World Health Organization. (2014). Isolation precautions. Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK214342/