Running head: Part B- Scholarly Paper on Concept Map

Part B: Scholarly Paper on Concept Map

Student: Tenzin Lektsok
Student No: N01028436
Date Submitted: 14th March, 2016
NURS 252: Complex Issues and Patient Safety
Professor: John Stone (Eva Class)
Humber College ITAL

Part B- Scholarly Paper on Concept Map

Introduction and identifying key priority data from case study

According to the case study a 35 year old male with a medical history of kidney failure
was diagnosed with Bipolar disorder in 2007 and he lives alone. His chief complaint to his
family physician was his shortness of breath and his productive cough. During his assessment, it
was found that the patient has difficulty breathing in supine positions, and coarse crackles on
expiration on bases bilaterally. Vital signs were recorded as T: 36.0C, P90, R20, BP 150/90, O2
85% on R/A.
In the case study, there are priority information that we as nurse have to consider or
observe. Firstly, his history of kidney failure which indicates that his kidneys excrete waste
products from the blood and regulate the fluid levels of body (Vallon, Muhlbauer, & Osswald,
2006). Secondly, the patient has high blood pressure of 150/90 and low level of oxygen
saturation 85% which is putting excessive pressure on patient's heart and lungs. Furthermore, he
has arrived in physicians clinic with shortness of breath for which we can validate by his low
level of SPO2 and difficulty breathing while in supine position. During auscultation, coarse
crackles were also heard on expiration. It could be pulmonary edema related to kidney failure as
symptom of SOB or it could be heard due to fluids accumulation in the lungs because of inability
of kidney to regulate fluids in the body (Gupta, 2005).
Secondly, in patients medical history, his diagnosis of bipolar disorder in 2007 and
currently living alone are also two very important conditions to consider because mental problem
with social isolation is not only harmful for such patient's wellbeing but also to other as well.
Bipolar disorder causes severe mood swings that consist of emotional lows (depression) and high
such as mania or hypomania (Aiken, 2010). If bipolar is left untreated, it can result in

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committing suicide, social isolation, drug and alcohol abuse, poor work performance and legal
issues (Aiken, 2010).
Chosen Pathological/physiological priority
My chosen priority of the case study is shortness of breath (SOB) r/t pulmonary
edema/fluid accumulation and congestion in the lungs as indicated by difficulty breathing, low
SPO2 and high blood pressure. If SOB is not treated immediately, it will lead to increased
respiration rate, and in worse cases it can cause fatal damage like cardiac and respiratory failure
(Pryor & Ammani, 2008). It could be life threatening as it could kill the concerned patient in few
minutes if neglected. All the cells and tissues of our body parts need oxygen in-order to function
properly, particularly the brain and heart which are most important for overall function of body.
Lack of oxygen impairs functioning of one's brain, creating symptoms such as disorientation,
confusion and reduced attention span (Mellema, 2008). Furthermore, in this case study, the
patient has a history of kidney failure which might further deteriorate his conditions because
kidneys are not able to remove the excess fluids and waste products from the body (Vallon &
Osswald, 2006). As a result, the excess fluids are accumulated in the lungs and other parts of
body. In lungs, fluids overflow into the alveoli and prevent effective gas exchange of oxygen and
CO2. (Critchley, Tan, Kew & Critchley 2000). In addition, kidney is also responsible to regulate
the acid and base. Malfunction of kidney causes retaining of acidic material in blood, leading to
metabolic acidosis. This causes metabolic demand of O2 consumption and elimination of CO2 in
order to reduce the acidic level in body (Ibrahim & Curthoys, 2008).
Clinical Manifestations/Complications
According to the scenario presented, shortness of breath has been manifested by
subjective data of patient where he complained difficulty in breathing. During his assessment, his

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low level of oxygen saturation 85% was also reported. According to SPO2 level of patient, he
might be suffering from hypoxia because most common symptoms of hypoxia are shortness of
breath, coughing, adventitious breath sound, changes in skin color and rapid heart rate (Misasi, &
Keyes, 1994). It is very important to get treatment for such complications and to keep a check on
O2 level. Furthermore, patient has difficulty breathing while in supine position and coarse
crackles on expiration were heard during auscultation. The coarse crackles indicate excessive
fluids in the lungs and causes difficulty in breathing (Charleston-Villalobos, GonzlezCamarena, Chi-Lem, & Aljama-Corrales, 2007).

In addition, high blood pressure 150/60

indicates the fluid overload in the body which can also relate to shortness of breath. It also shows
that renal is not able to regulate fluid level in body that fluid starts accumulating in body and also
accumulating in the lungs (Ferrario, Moissl, Garzotto, Cruz, Clementi, Brendolan & Ronco,
2014).
Interventions
There are many means to relieve the patient from SOB and the following are the six main
interventions. Firstly, repositioning the patient in semi/high fowler position as he is having
difficulty in breathing while in supine position. Semi/high fowler position promotes the
oxygenation by increasing chest expansion and relaxing tension of the abdominal muscles
(Yeaw,1992). Secondly, we have to administer 2L of oxygen via nasal prong and get order from
physician if required more than 2L as the patient has very low level of oxygen saturation 85%
which indicates low amount of oxygenated hemoglobin in the blood. Maintaining the oxygen
above 95% is required. Low oxygen saturation may compromise functions of other organs such
as heart and brain (Challapalli, Goldhaber, Brown, & Nadel, 2004). It may lead to respiratory
and heart failure.

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Thirdly, oral suctioning of excess secretions if present in the respiratory airway. Since the
patient has productive cough, producing excess secretions might block the airways and can
prevent effective breathing. Therefore, it is very important to maintain the patent airway.
Fourthly, assessing the patient respiratory status (rate, depth, and rhythm) and vital sign is very
important for baseline data. It is essential to know the patients movement of inhalation and
exhalation, exchange of C02 and O2 at the alveolar level. Finally, giving health teaching
regarding the respiratory distress is beneficial. For instance, teaching on deep breathing exercises
and purse lip breathing. These breathing techniques will facilitates patient to control their
breathing and increase/maintain as much air as possible in lungs (Van der Schans, Cees, Postma,
Koeter, & van der Mark, 1994). It is also important to let the patient demonstrate the techniques
after the teaching to find the proper understanding and implementation of the methods.
Furthermore, Dyspnea is a frightening experience and results in increase of anxiety which causes
them to be more breathless. Nurse can provide help by talking calmly, instructing patient to
breath slow and breathe with them (Reinares, Snchez-Moreno, & Fountoulakis, 2014)..
Conclusions
Nursing comprises caring and supporting patients, and allows opportunities for trust to
develop between the patient and the nurse. Nurses play an important role in the diagnosis
process. While diagnosing the condition of the patient, nurse should be able to recognize or
identify the priority information of every patient cases. In this case, the nurse and patient
interactions are an important aspect of managing patients with dyspnea. A thorough and proper
nursing assessment and measurement of systemic observations allows the nurse to gain an
understanding of how patients are managing their breathlessness.

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6
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