Posted: September 9th, 2016

Briefly explain what changes in Jamie’s physical assessment data (excluding vital signs) would justify the nurse changing current oxygen therapy from a non-rebreather oxygen mask to nasal prongs?

Scenario
Jamie is a 29 year old male admitted to hospital 6 hours ago with severe asthma. Jamie recently started a new job in the coal mines in central Queensland (3 weeks on 1 week off) and two days ago started his days off at home in Brisbane. Last night he was out partying with mates in the Valley and became very breathless and had an acute exacerbation of asthma symptoms. He was brought in by ambulance. Apart from having asthma since childhood Jamie reports he has good health and an active lifestyle. He usually takes an inhaled preventative medication daily and a reliever (salbutamol) when he experiences asthma symptoms. He hasn’t taken his preventer medication recently as he forgot to take it with him when he went on shift at the mine.
Currently he is lying on his side flat in bed and has oxygen 6 litres a minute delivered via nasal a face mask. He looks pale and has pink lips. Peripheral capillary refill time is 3 seconds. Respirations are deep, through the mouth, slightly laboured and chest expansion is equal left and right. He had an inspiratory wheeze audible with a stethoscope. He has a frequent cough. Jamie’s skin is warm, with no evidence of central or peripheral cyanosis. Vital signs / observations are BP 130/85 mmhg, pulse 96 b/min, respiratory rate 32 r/min, temperature 36.8C and oxygen saturations 92%. On arrival in the ward for a morning clinical practice shift you are allocated to look after Jamie, supervised by your buddy nurse.

Answer the following questions referring to the above scenario of Jamie [16 marks]
Questions.
1. Consider the person and contextual information in the scenario and select two points of information that could be relevant to Jamie’s current acute asthma diagnosis and oxygenation problem. Briefly explain why you think these could be relevant. [2 marks]
2. Jamie currently has an oxygenation problem. Select three pieces of patient data related to this problem and for each briefly explain your understanding of the underlying pathophysiology of how each piece of data indicates an oxygenation deficit. [3 marks]
3. Briefly explain two advantages of delivering oxygen via a face mask as compared to the use of nasal prongs? [2 marks]
4. Briefly explain what changes in Jamie’s physical assessment data (excluding vital signs) would justify the nurse changing current oxygen therapy from a non-rebreather oxygen mask to nasal prongs? [2 marks]
5. Identify changes in vital signs that would indicate substantial deterioration in Jamie’s condition [1 mark]
6. Identify three questions you will ask Jamie about his symptoms to elicit data relevant to his current oxygenation and condition [3 marks]
7. Identify three changes Jamie would report to you that may indicate substantial deterioration in his condition. [3 marks]