Evidence-Based Nursing Interventions for Patient Problems

QUESTION

Case Scenario: You are a student nurse working on an acute medical ward. You are working with a registered nurse and are allocated 4 patients. One of those patients is Ms. Alina Santiago. Alina was admitted to the ward overnight after presenting to the emergency department (ED) with increasing shortness of breath and a productive cough. Alina is a 27-year-old female, with a past medical history of anemia and has recently completed a course of antibiotics for an upper respiratory tract infection. Alina has been refusing oral fluids, states she is not thirsty, and is feeling fatigued. Alina has an allergy to penicillin and takes Ferro-grad C 325mg/500mg daily. Following handover, you complete a set of vital signs on Alina. You then identify the following patient problems for Alina. Patient Problems: 1. Alteration in breathing pattern. 2. Risk of fluid volume deficit. 3. Ineffective cardiac output. 4. Impaired gas exchange. BP: 100/80 mmHg HR: 132 bpm regular RR: 23 bpm, short, shallow breaths. Temperature: 38.3°C diaphoretic SpO2: 93% Room Air (RA) Pain: 2/10 (Numerical Pain Score)

A) Identify two (2) evidence-based nursing interventions for each of the four (4) patient problems identified.

B) Provide a rationale for each of the identified nursing interventions, including an explanation of the underlining physiology and/or pathophysiology.

Patient Problem: Alteration in breathing pattern

Evidence-based Nursing Intervention

1.

2.

Rationale

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2.

Problem: Ineffective cardiac output

Evidence-based Nursing Intervention

1.

2.

Rationale

1.

2.

Problem: Impaired gas exchange

Evidence-based Nursing Intervention

1.

2.

Rationale

1.

2.

Problem: Risk of fluid volume deficit

Evidence-based Nursing Intervention

1.

2.

Rationale

1.

2.

(APA) 7th edition referencing style.

With Citations.

ANSWER

Evidence-Based Nursing Interventions for Patient Problems

In the acute medical ward, providing evidence-based nursing interventions is crucial for ensuring the optimal care of patients. In the case of Ms. Alina Santiago, who presents with altered breathing pattern, risk of fluid volume deficit, ineffective cardiac output, and impaired gas exchange, it is essential to address each patient problem with appropriate interventions based on evidence. This essay outlines two evidence-based nursing interventions for each patient problem and provides a rationale for each intervention.

Alteration in Breathing Pattern

Intervention 1: Administer supplemental oxygen therapy as prescribed to maintain oxygen saturation within the desired range (e.g., 94-98%).

Rationale: Alina’s SpO2 is 93% on room air, indicating hypoxemia. Supplemental oxygen helps improve oxygen saturation and ensures adequate oxygen delivery to tissues. The underlying physiology involves enhancing the oxygen-carrying capacity of hemoglobin, thereby promoting effective tissue oxygenation.

Intervention 2: Encourage and assist Alina in practicing deep breathing exercises and effective coughing techniques.

Rationale: Promoting deep breathing exercises enhances lung expansion and improves airway clearance. This helps prevent complications such as atelectasis and pneumonia. By aiding in mobilizing secretions, this intervention supports improved gas exchange and lung function.

Ineffective Cardiac Output

Intervention 1: Administer prescribed medications, such as diuretics, to manage fluid overload and reduce cardiac workload.

Rationale: Elevated heart rate and blood pressure, along with diaphoresis, indicate increased cardiac workload. Diuretics help reduce fluid volume, alleviating strain on the heart and promoting efficient cardiac output by lowering preload.

Intervention 2: Implement strategies to promote a restful environment and relaxation techniques to reduce cardiac workload.

Rationale: Stress and anxiety increase sympathetic nervous system activity, raising heart rate and cardiac workload. A calm environment and relaxation techniques, such as deep breathing, can help lower sympathetic tone, promoting optimal cardiac function.

Impaired Gas Exchange

Intervention 1: Position Alina in a semi-Fowler’s position to improve lung expansion and facilitate adequate ventilation.

Rationale: Semi-Fowler’s position enhances lung expansion by reducing pressure on the diaphragm and optimizing ventilation-perfusion matching, which is crucial for efficient gas exchange.

Intervention 2: Administer prescribed bronchodilators to dilate bronchioles and improve airway patency.

Rationale: Alina’s shortness of breath and rapid breathing suggest airway constriction. Bronchodilators relax smooth muscles, opening airways and enhancing airflow, ultimately improving gas exchange.

Risk of Fluid Volume Deficit

Intervention 1:Monitor Alina’s intake and output closely and maintain accurate fluid balance records.

Rationale: Alina’s refusal of oral fluids and symptoms of fatigue may contribute to dehydration. Monitoring intake and output aids in assessing fluid status and ensuring that any deficits are promptly addressed.

Intervention 2:Collaborate with the dietitian to plan and provide fluid-rich foods and snacks in line with Alina’s preferences and dietary needs.

Rationale: Providing fluid-rich foods helps maintain hydration and prevents fluid volume deficits. Collaboration with the dietitian ensures a balanced approach to meeting Alina’s nutritional and fluid requirements.

In conclusion, evidence-based nursing interventions for each of Alina’s patient problems contribute to her holistic care. By addressing altered breathing pattern, ineffective cardiac output, impaired gas exchange, and risk of fluid volume deficit with appropriate interventions, healthcare providers can improve her outcomes and enhance her overall well-being.