Identify the problem/s

Identify ONE (1) priority nursing problem (which best relates to the patient scenario chosen) that you would address as the Registered Nurse caring for the patient.

Establish Goals And Take Action

Based on the nursing problem identified, establish your key goal and populate the table provided in the care plan template.

Within this table, you will need to provide FOUR (4) related actions (interventions) you will implement to address the goal. Your actions must include ONE(1) of the skills identified in the skill video resources for this unit. Please be mindful that some skill videos are more aligned to some scenarios than others.  The quality of your capacity to apply clinical reasoning to the scenario provided will help inform you of the skill video most likely to align with your nursing problem.

Provide a brief rationale for each action identified that draws on relevant unpinning physiology/pathophysiology.

Identify evidence-based evaluations that will assess the attainment of the goal set 

Question:

Introduction

Kobi Monterey has grown up with asthma.  Diagnosed at a very young age, he has been very diligent in knowing what triggers his asthma resulting in Kobi experiencing few episodes in recent years. Apart from his asthma, Kobi is a fit and well 25-year-old.  However, this week Kobi has not been feeling well over the past few days and his father brought him to the emergency department this morning after Kobi experienced an asthma attack whilst at work. Kobi is quite distressed and breathing rapidly with a notable wheeze on expiration. He is unable to talk to you in full sentences, states he has a tight feeling in his chest and a continuous cough. You notice that his lips are cyanosed and he appears pale and sweaty.

Review The Existing Documentation;

Social History

Kobi is a keen cyclist and rides his bike about 3 times a week with a local cycling group to which he belongs. He enjoys the social activities and has a good work-life balance. Kobi works as a carpenter with his father. He has aspirations of starting his own carpentry business and is feeling positive about his future. Kobi is often working in enclosed spaces exposed to fine wood dust particles, although he complies with all the necessary workplace health and safety regulations.

Medication Use:

Kobi indicates that he has needed to use his puffer more than usual and ceased using the preventer some time ago. When he runs out of his Ventolin puffer, he orders replacements online that are delivered to his home address for convenience. With such a busy schedule, Kobi has found it difficult to find time to schedule an appointment with his GP.

Recall:

Before you continue with this assignment you should recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be occurring.

Process information

In the following table, list the data that you consider to be normal/abnormal (not included in word count)

• Relate: cluster cues by identifying relationships between them.
•      Infer: make deductions as to why a cue, or a cluster of cues may be considered abnormal in this context. Justify by referring to appropriate anatomy, physiology and pathophysiology.

Refer To Levett-Jones (2018) Clinical Reasoning P7.

• Based on your interpretation of all the information/cues presented, form and justify an overall opinion on what may be happening

Kobi’s current health condition can be accredited to the fact that he is suffering from occupational asthma. The condition encompasses health ailment that occurs due to exposure to certain substances such as, dust, gases, or chemical fumes, to which a person is sensitive, thereby leading to immunological response or allergy (Levett-Jones 2013). An analysis of the case study suggests that Kobi had been a patient of asthma since his childhood. Presence of smaller airways in children, when compared to their adult counterparts often results in this condition that significantly attributes to tightness in the chest, coughing, wheezing and troube in breathing. These are in accordance with the subjective and objective symptoms reported by Kobi.

Wheezing sounds can be attributed to the reduction in the diameter of the airways located in the lungs, thus making them constricted or narrowed. Furthermore, presence of bluish colouration in his lips represent an absence of oxygen in the bloodstream, which in turn is indicative of presence of an abnormal type of haemoglobin.

His work as a carpenter with his father acted as an occupational trigger that led to the sudden onset of asthma attack, thereby tightening the muscles that are located around the airways, a process referred to as bronchospasm (Strong and Chang 2014). This in turn resulted in swelling or inflammation and subsequent development of thicker mucus. Hence, it can be suggested that there is an immediate need to effectively manage the asthma attack episode, in order to enhance his overall health and wellbeing.

Explain What May Happen To Your Patient If No Action Is Taken

Without any proper action, episodes of asthma attack, as the one experienced by Kobi have the probability of being potentially life-threatening. Unmanaged asthma would result in sleep deprivation in the patient over time, thus impeding his ability to conduct activities of daily living (Tarlo and Lemiere 2014). It is also associated with the onset of fatigue and permanent problems with the airways located in the lungs of the affected person. It might also result in several psychological problems such a, anxiety, stress and depression, thus increased hospital visits. If not managed immediately, the condition might also result in collapse of a portion of the lungs, and subsequent respiratory failure, thus causing death.

Identify the Problem/s

List in order of priority at least two key nursing problems (not included in word count)

• Management of asthma- This condition encompasses the unexpected deterioration of asthma symptoms triggered by the constriction of muscles located near the respiratory airways (bronchospasm). During asthma attack, linings of the airways get swollen or reddened, thereby producing mucus that is thicker and more in amount than normal. Hence, the primary goal would to be to effectively prevent and/or manage the wheezing, troubled breathing, coughing, and chest tightness (El et al. 2016).