Research Korner: Nursing care plan for asthma in children

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the effect of common skin disease on the QOL of patient in the local setting” And my adviser also wants to modify the statement of the problem. Modifications are: STATEMENT OF THE PROBLEM 1.     What are the common dermatologic problems that patients seek for treatment @ Lucena Skin Center 2.     What extent does the dermatologic problem affects their life a.     performance of activities of daily living b.     relationship with people c.     how he perceives him self     3. Is there a significant difference among the 3 factors identified and the level of impairment?   Can you make those modifications for me in 7 days? Can you also limit the number of pages to 25 including the statistical computation, because of my budget limitations? Thankyou my advicer wanted our thesis change from comparative to descriptive correlational study.                                             Abstract STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to: a.     Age. b.     Gender c.     Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?   LOCALE OF THE STUDY:           This study will be conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.               RESPONDENTS: The sampling technique used was criterion sampling. Both the inclusion and exclusion criteria for patient selection were adopted form the source. Consecutive patient's, age 15 and above, whether old or new, consulting for any skin problem were included in the study. The patient's companions whose ages were also 15 and above served as control subjects (Those who do not have skin diseases). The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no apparent disability. Excluded in the study were those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   SIGNIFICANT FINDINGS:           The study was conducted among 263 respondent's patient and 47 controls (no skin disease) in Lucena Skin Center Clinic, Lucena City.           The demographic data were analyzed using descriptive statistics (N=263) for the patient and (N=47) for the controls. Majority of the patients where females, 142 (54%) and 121 (46%) were males. The respondents were aged from 15 to 78 years. 237 (90%) were aged less than 65 years where as 26 (10%) fell into the geriatric age group (age > = 65). For the control subset, 38 (81%) were female and 9 (19%) were males.           A total of 263 subjects responded to the IKPAS (Translated Dermatology Life Quality Index in Filipino). The average time to complete it was 5 minutes. Unanswered item was observed for item 9 on sexual activity. The difference of the mean score between 15-64 y/o group (mean score= 7.5) and 65-78 y/o group (mean score= 8.07) were not statistically significant however, the difference of the mean score between male (mean score= 7.4) and female (mean score= 26.19) were statistically significant. Among the diseases, the findings with the highest mean score (greatest effect on the quality of life) were seen in Atopic Dermatitis (11.5) and the lowest mean score in Viral Warts (4.5). IKPAS was also completed by 47 healthy control subjects. Reliability was measured in the translated instrument using the 's alpha Coefficient and it showed internal consistency with  alpha Coefficient of a=0.71 (acceptable is >0.7). There was a significant difference between       mean scores of patients (7.86) and healthy subjects (0.89) (p=0.000), demonstrating construct validity. Quality of life scores were higher in inflammatory skin diseases such as Atopic dermatitis, Contact dermatitis, Erythroderma and Lichen Simplex Chronicus as compared to Acne, Viral warts and Keloids.           The first null hypothesis was: "There is no difference in the Quality of Life of patients with skin disease when respondents were group according to their demographic profiles".           The researchers reject the first null hypothesis.           The second hypothesis is: "There is no difference in the quality of life of patients with skin disease and those without skin disease"           The studies second null hypothesis was also rejected by the researchers.                             CHAPTER ONE THE PROBLEM AND ITS SETTING   BACKGROUND OF THE STUDY: During our duties in clinics and hospitals, we often encounter patients with skin diseases. We have observed that these patients were irritable, restless, and shy. They were treated for their skin problems only.           The nurses were instructed by the Physician/ Dermatologist how to take care of the patient's skin lesions and rashes but their emotional and psychological problem were not taken into consideration.           We were wondering whether the stress of having the skin disease affect their quality of life.           The concept of quality of life was developed to interpret data obtained about the impact of diseases on patients well being. This was fostered by the World Health Organizations (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. It usually utilizes a patient- administered questionnaire with items evaluating the effect of a disease and its treatment on patient's symptoms, feelings and daily activities. (called domain) over a well-defined period of time. [3] The response options are arbitrary and employ a scoring system for interpretation. [4]           This study was undertaken to examine the quality of life of patients with skin disease against those who do not have skin diseases.           By studying the impact of skin diseases on the quality of life of patients with skin diseases, the researcher hope to be able to modestly contribute to the enhancement of not only the nursing profession but also the medical profession and as well as the improvement of patient care quality to uplift their quality of life.   STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to? a. Age           b. Gender           c. Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?     SIGNIFICANCE OF THE STUDY:           Research is the best way to find solutions to nursing problems and to set standards for nursing practice. The problem that we have observed during our stints in hospitals and clinics led as to conceptualize a study that will answer our curiosity. The results of this study will therefore, benefit the following sectors; NURSES- Expertise will increase as additional knowledge will be gain when educators will formulate effective psychological and emotional counseling which will be incorporated in nursing curriculum because of the output of this study. NURSING EDUCATION- Nursing schools will be able to incorporate the results of this study into their nursing psychiatry curriculum. PATIENTS or CLIENTS- there will be increased patients care quality. This in turn, will create increased patient satisfaction and will reflect a positive view of the hospital or clinic by the community. MEDICAL EDUCATION- Medical schools will be able to incorporate results of this study into their medical psychiatry curriculum. MEDICAL PROFESSION- Dermatologist will now be more aware and sensitive about their patient emotional and psychological problem brought about by their skin condition.     SCOPE AND DELIMITATION OF THE STUDY:           This study is conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.           A primary limitation of the study is posed by the source of the sample population which is from one local clinic only.   DEFINITION OF TERMS: ·        Quality of Life- it refers to the satisfaction derived by the respondents in terms of their performance in the activities of daily living namely; shopping/ marketing, the way they dress, socializing, participation in sports activities, going to work and school and performing sexual activity and cognitive functioning. ·        Cognitive functioning- In some forms of psychometrics, particularly those related to the  Type Indicator, the cognitive functions (sometimes known as mental functions) are defined as different ways of experiencing and thinking about the             world. They are defined as "thinking", "feeling", "sensing" and "intuition". ·        Demographic profile-  refers to the gender and age of the patient                                       CHAPTER TWO THEORETICAL BACKGROUND   REVIEW OF RELATED LITERATURE AND STUDIES   RELATED LITERATURE:           Quality of Life is the degree of enjoyment or satisfaction experienced in everyday life. [5] In biblical times lepers had to live outside of society. In medieval times they had to ring a bell and call "unclean" wherever they went. Catching leprosy requires living in close contact for a long time and many labeled as lepers probably had diseases like eczema or psoriasis that are not infectious. The stigmatization of lepers was not a public health measure to control the spread but a reflection on how people view those with skin disease. Simply having skin disease is bad enough but the social response of others makes it much more difficult. [6]           As early as 1985, Quality of life has been employed as a major endpoint to evaluate and compare therapies along with clinical outcome measures such as efficacy and survival. [7] In cancer therapy, for instance, the emphasis is on the side-effect and quality of life. [8]           In dermatology where most patients are seen in the ambulatory, care setting survival is not a major end point [9] and because the therapeutic modalities here have comparable efficacies, the use of quality of life became even more important. Several well-validated dermatology-specific questionnaires have been developed, the first being 's Dermatology Life Quality Index in 1983.   RELATED STUDIES: The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa. (.; ) Skin diseases can greatly affect the quality of life (QoL). Little is known, however, of their impact on QoL in the developing world. This study was designed to assess the effect of skin diseases in such a setting. A questionnaire survey of patients using the Dermatology Life Quality Index (DLQI) modified to the cultural needs of the population. The adapted instrument was translated into Afrikaans and Xhosa. Six hundred and seven patients attending general dermatology clinics at  Hospital and 53 controls were recruited. Influences on QoL of clinical severity, employment, education, age, sex, and home language were examined. Participants included 313 (52%) English-speaking, 215 (35%) Afrikaans-speaking, and 79 (13%) Xhosa-speaking dermatology patients. Independent risk factors for having a high disability score were dermatologists' assessment of severity, younger age, unemployment, and language (odds ratio, 0.13; 95% confidence interval (CI) of 0.03–0.5 for Xhosa speakers compared to Afrikaans speakers). Gender was not associated with a high score, but females were more likely to report effects of skin disease on self-esteem, clothing choice, treatment problems, and     In this multicultural setting, social class and language group, but not gender, influenced the impact of skin disease on overall QoL. Xhosa speakers were apparently less affected than other patients. This could be due to cultural differences in the experience of skin disease and in the perception of disability, or to biases in questionnaire responses. Anxiety and depression were relevant dimensions of QoL in this study and should be considered for inclusion in future research. The adapted and translated DLQI was valid and reliable. [10] Eczema impairs quality of life in children to same extent as kidney disease. Children with serious skin conditions feel their quality of life is impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes, according to research published in the July issue of British Journal of Dermatology. A team of Scottish researchers surveyed 379 five to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents. They asked the children and their parents how much the condition impaired the child’s quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.   They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group. Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.    Key findings included: ·        The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in 31 per cent impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20 per cent impairment and acne at 18 per cent impairment. ·        From the parent’s perspective, eczema was the biggest skin problem at 33 per cent, followed by urticaria at 28 per cent, psoriasis at 27 per cent and hair loss at 19 per cent. ·        When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38%. Generalized eczema and kidney disease both scored 33%t. ·        Cystic fibrosis also made the top five (32%t), followed by urticaria and asthma (28%), psoriasis (27%), epilepsy and bed wetting (24 %), diabetes, hair loss and localized eczema (19%) and acne (16%). ·        When children with psoriasis, and their parents, were asked to chose the things that affected the child’s quality of life most, parents rated bullying third and children rated bullying fourth. ·        Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.   ·        The biggest concern for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry. “Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses” says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.           “Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying. “Some skin conditions can also disturb children’s sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older. “Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives.” According to co-author Dr , Consultant Dermatologist at Ninewells Hospital, Dundee and British Skin Foundation spokesperson: Measuring quality of life can be a powerful political tool as it provides the patient’s perspective on the health impact of different diseases. “This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people’s lives as other illnesses. “Our study clearly shows the profound effect skin diseases can have on children’s quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them.”  of the British Skin Foundation agrees: “All too often, people think of skin diseases like eczema as nothing more than a mere annoyance. Sadly, this simply is not the case. “We frequently hear of children who cry all night because of their itchy, flaky skin. This in turn leads to a lack of sleep and extreme emotional upset for their parents too. “The psychological impact of visible skin diseases can be massive, with children facing bullying because of the way their skin looks. We even hear of children not wanting to swim or take part in sports because they don’t want to have to reveal their skin in the changing rooms. Of course, this can lead to enormous stress for the patient’s family also. “This is why as a charity we are dedicated to raising money for research to end the diseases that blight millions of people’s lives in the UK.” [11]   THEORETICAL & CONCEPTUAL FRAMEWORK: We theorize that skin diseases affect patients' well-being and their ability to perform activities of daily living just like any other medical problem in the local setting. The concept of quality of life was developed to interpret data obtained about the impact of disease on the patient's well being. This was fostered by the World Health Organization (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. We conceptualize that quality of life can be measured by asking patients to answer a questionnaire which measures the effect of skin disease and its treatment on a patient symptoms, feelings and daily activities over a specified time.           The theoretical framework guiding this research is the concept that skin disease has an adverse impact on the quality of life of the patient.   HYPOTHESIS:           The null hypothesis that was used to guide this study was: 1.     There is no difference in the quality of life of patients with skin diseases when respondents are grouped according to their demographic profile. 2.     There is no difference in the level of the quality of life of patients with skin diseases and those without skin diseases               CHAPTER THREE METHODOLOGY RESEARCH DESIGN:           This non-experimental study uses the prospective quality of life survey and analysis.   LOCALE OF THE STUDY:             The setting of the study was at the Lucena Skin Center. A Dermatology Clinic manned by a Fellow of the Phil. Dermatological Society and a Fellow of the Phil. Leprosy Society. The clinic is situated in Lucena City.   RESPONDENT AND SAMPLING PROCEDURE:           Respondents were consecutive patients, age 15 and above, whether old or new, consulting for any skin diseases were included in the study. The patients companions whose ages were also 15 and above served as the control (those who do not have skin diseases) subjects. Both the inclusion and exclusion criteria for patient's selection were adopted from the source. As in the original, the criteria for the selection of the controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem or other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   RESEARCH INSTRUMENT:           We reviewed 3 different well validated dermatology-specific quality of life tools for possible translation. Both developed in the U.S, the Dermatology Specific Quality of Life (DS8QL) [12] had 52 items for acne and contact dermatitis cohorts while the revised SKINDEX [13] had 29 item tests for patients with any skin disease. The revised Skindex Categorized domain/scale into emotion, symptom, and functioning, and had 5 responses choices. Dermatology Life Quality Index [14] [15] [16] (DLQI), a tool developed in UK, was similar to Skindex in terms of generic coverage, domains, and responses choices but consisted only of 10 items which fit on a single sheet of paper, and was those chose for translation. Quality of Life research measures the effect of a disease and its treatment on a patient's symptoms, feelings and daily activities over a specified time. The Dermatology Life Quality Index (DLQI) questionnaire is a non-skin disease specific Quality of Life tool developed by Dr. Finlay. It consist of 10 questions and can be analyzed under the following headings: Symptoms and feelings (items 1 and 2), daily activities (items 3 and 4), leisure (items 5 and 6), work and school (item 7), personal relationships (item 8 and 9), and treatment (item 10). It is calculated by summing the score of each question (scored from 0 to 3) resulting in a maximum of 30 for the 10 items and a minimum of 0. The higher the score, the more quality of life is impaired.   TRANSLATION:           The original questionnaire was sent to 4 independent bilingual (English and Filipino) translators and their output were later "translated-back" by a bilingual lay panel consisting of 2 persons. The first item refers to the Symptoms (itchiness, pain, discomforts) while the second item on "hiya", which loosely translates in English as "embarrassments". Item 3 evaluates the effect on shopping or household chores while item 4 in the way of dressing. The fifth item is on social and leisure and the sixth item on sports and exercise. Items 7, 8, 9 and 10 concerns on work, school, relationships, Sexual difficulty, and treatment respectively. The following modifications were noted: (1) the tool was renamed IKPAS (Indeks ng Kalidad ng Pamumuhay ng may sakit sa balat), (2) the general patient data was omitted on the questionnaire except age, sex, and diagnosis to save on space, (3) a confidentiality clause was inserted on the introductory statement and includes the aim of the study. (4) 2 Filipino words ("Gaano" and "Paano") were used to encompass "How much" in the original, (5) and although the attempt was to do a literal translation without any loss of the concept, for item on household chores of house keeping, buying at the market ("Pamamalengke") was included; for item on leisure activities, watching movie ("Panunuod ng Sine") was given as an example; For the item on sports, the word "Ehersisyo" (Exercise) was incuded; "Sex" was used in the context of sexual difficulties in the original; and on the item relationship, "Asawa" (Spouse) was used for "Partner". Response choices scales were structured similar to the original and used the same scoring system: "Sobra-sobra" (score=3), "Sobra" (score=2), "Medyo/Oo" (score=1), "Wala/Hindi" (score=0), "Walang kinalaman" (score=0), and no answer (score=0). A higher score (total=30) indicated a lower unfavorable quality of life.   DATA COLLECTION:           The researchers collected the data from Lucena Skin Centers Clinic. Both the inclusion and exclusion criteria for patient selection were adopted from the source. Consecutive patients, age 15 and above, whether old or new, consulting for any skin disease were included in the study. The patients' companions whose ages were also 15 and above served as control subjects. The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem on other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.           The time needed to complete the questionnaire ranged from 1 to 36 minutes with the mean at 5.23 minutes. However, it is significant to note that 205 respondents (78%) took less than 5 minutes and another 39 (15%) took between 5 and 10 minutes to answer the questionnaire. This leaves only 19 (7%) who took more than 10 minutes to answer the questionnaire.   DATA PROCESSING AND ANALYSIS           Consecutive patients who passed the entire inclusion and exclusion criterion were politely asked to answer the IKPAS (translated questionnaire) after giving their permission.           When all the data were at hand, we computed the reliability of our translated questionnaire using the 's alpha Coefficient and then we analyze our findings on the effect of the skin disease on the quality of life of patients with skin disease and compare the findings with those without skin diseases. There was a significant difference between scores of the patients (6.89, SD: 4.55) and controls (0.89, SD: 1.8) (p=0.000), demonstrating construct validity.   RELIABILITY TEST TOOL:           When analyzing the reliability of your instrument, the best is to retest the subjects using the same instrument to see if the subjects are consistent with their answer. But researchers have devised a formula to compute the reliability of a survey instrument. The reliability test is called 's alpha coefficient. Its formula is:

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the eff...

NURSING CARE PLAN/ ESSAY

Nursing Care Plan               The patient is      , a 72 year old man who has been admitted for dyspnea or shortness of breath.  reported that he has been coughing for the past week and his coughing has accompanied sputum discharge. His past medical history includes emphysema and chronic bronchitis. He used to smoke but has stopped since a year ago for economical reasons as well as it is also bad for his asthma. His bowel movements have also been irregular since his admission. He also reported that he is feeling depressed and fearful about the future. Further examination revealed that he has crackles in his left lower lobe with diffuse expiratory wheezing throughout his chest. Chest percussion also revealed his left lower lobe to be dull.     Needs / Problems Goals Interventions Evaluation Dyspnea or shortness of breath Use the visual analog scale (VAS) to make an objective assessment of dyspnea. The VAS is a 100-mm vertical line with end points of 0 and 10. zero is equated with no dyspnea and 10 is equated with the worst brethlessness the client has experienced ( & , 2004) Dyspnea is difficult to quantify and to treat (Potter & Perry, 2004). Interventions need to be individualized for each patient, and more than one therapy is usually implemented. The underlying process that causes or worsens dyspnea must be treated and stabilized initially. Three additional therapies have to be implemented: pharmacological measures, physical techniques, and psychosocial techniques are then implemented. Evaluation of how nursing interventions in dyspnea is usually done by evaluating the underlying cause of dyspnea. Coughing up green and yellow sputum The nurse should determine if the cough is a manifestation of any underlying diseases. In addition, other diagnostic tests must be performed. Interventions can be geared towards curing the underlying cause such as chronic bronchitis. A cough is difficult to evaluate, and almost everyone has periods of coughing. Irregular bowel movement The client has only defecated once since being admitted for four days. The client has to resume his regular bowel movements which is every two days. Fluid intake has to be encouraged, and this should include appropriate fluids, fruit juice, and water. Activity within the limits of client’s mobility should also be encouraged. Laxative and stool softeners can be provided as ordered. Privacy is also important. The client should be asked for any increased activity. The client has to state that his activity pattern has changed therefore there is an achievement of outcome. The client’s subsequent stool should be observed for characteristics such as consistency and color. Bowel movement should now be every 24 to 48 hours. Abdomen should be soft and nondistended. Crackles in the left lower lobe of the lung with diffuse expiratory wheezing The nurse has to identify what is the underlying cause of the crackles and wheezing that is revealed in the patient’s exams. Since the generation of crackles depends more on lung volume changes than on airflow, patients should be advised to take slow and deep breaths in order to minimize flow turbulence and thus reduce the intensity of normal breath sounds (, 2001). Wheezing in      could just be normal response of his asthma and therefore interventions have to be geared towards his asthma. Evaluation of nursing interventions on crackles and wheezes should be related to the evaluation of the underlying cause of such clinical manifestations. Consolidation in left lower lung  The healthcare team responsible for the care of Norm Gallagher should examine the underlying cause of the consolidated lung. Nursing interventions should be geared towards treatment of the underlying cause, like pneumonia. The participation of other healthcare professionals is usually needed, like the diagnosis of a doctor. Conventional evaluation of the lungs is based on tests of lung volume, capacities and breathing of the patient, among others.               Dyspnea means mental anguish associated with an inability to ventilate enough to satisfy the demand for air ( 2000). It is a clinical sign of hypoxia and manifests as breathlessness or shortness of breath. It is the subjective sensation of difficult or uncomfortable breathing. A common synonym for it is air hunger. Dyspnea is shortness of breath associated with exercise or excitement, but in some clients dyspnea may be present without any relation to activity or exercise. Dyspnea is associated with many conditions, such as pulmonary diseases, cardiovascular diseases, neuromuscular conditions, and anemia (, 2004). Environmental factors such as pollution, cold air, and smoking, may also cause or worsen dyspnea. In the case of       , his dyspnea is probably related to his problem of the lung.             The rationale behind performing VAS for the patient is that dyspnea is subjective and performing VAS could objectively confirm if the patient is indeed experiencing dyspnea or not. Studies have validated the use of VAS to evaluate a client’s dyspnea in the clinical setting ( 2004). The nurse can evaluate the effectiveness of nursing interventions by monitoring the client’s assessment of their dyspnea.             In the interventions for dyspnea, pharmacological agents may include bronchodilators, steroids, mucolytics, and low-dose antianxiety medications. Physical techniques, such as cardiopulmonary reconditioning through exercise, breathing techniques, and cough control, can help to reduce dyspnea. Relaxation techniques, biofeedback, and meditation are psychosocial measures that can lessen the sensation of dyspnea (, 2004).             Cough is a sudden, audible expulsion of air from the lungs. Coughing is a protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions. A cough is difficult to evaluate, and almost everyone has periods of coughing. Once the nurse determines that the client has a cough, it must be identified as productive or non-productive and its frequency must be assessed. In Norm Gallagher’s case, his cough is a productive one as it results in sputum production.             A productive cough results in sputum production, material coughed up from the lungs that may be swallowed or expectorated (, 2004). Sputum contains mucus, cellular debris, and microorganisms, and it may contain pus or blood. It is the duty of the nurse to collect data about the type and quantity of sputum.             The rationale behind the nursing interventions in bowel elimination alterations of          are pointed out in the succeeding sentences. Adequate fluid intake is necessary to prevent hard and dry stool. Activity including minimal ones such as leg lifts can increase peristalsis. The use of laxative and other medications can soften stool and prevent straining. Lastly, clients should feel relaxed when moving their bowels ( 2004).             Auscultation of lung sounds involves listening for movement of air throughout all lung fields: anterior, posterior, and lateral. Adventitious or abnormal breath sounds occur with collapse of a lung segment, fluid in a lung segment, or narrowing or obstruction of an airway. Auscultation also evaluates the client’s response to interventions for improving Norm Gallagher’s response to interventions for improving his respiratory status (, 2004).             Crackles are most commonly heard in dependent lobes: right and left lung bases. The cause is random, sudden reinflation of groups of alveoli and disruptive passage of air. Crackles (rales) are useful indicators of cardiorespiratory disease. The timing, pitch, and waveform of crackles reflect different pathophysiology in diseases, such as pneumonia, bronchiectasis, asbestosis, sarcoidosis, fibrosing alveolitis, cystic fibrosis, and pulmonary congestion due to cardiac failure (, 2001). Wheezes on the other hand can be heard all over lung fields. The cause of this is high-velocity airflow through severely narrowed bronchus. They are high-pitched, continuous musical sounds like a squeak heard continuously during inspiration or expiration. It is usually louder during expiration ( 2004). Wheezing is a common clinical finding in patients with asthma and chronic obstructive pulmonary disease (COPD) during episodes of severe airway obstruction, and can also be heard in normal subjects during forced expiratory maneuvers; however, the properties of wheezing are difficult to perceive and quantify during auscultation ( 2002). Chest percussion of         revealed that his left lower lobe is dull. A dull or flat sound may suggest atelectasis, pleural effusion, pneumothorax or asthma (, 2004).             The nurse should also take into account that         is already 72 years old. The chest is normally more resonant in the child than in the adult. Breath sounds are also much louder in children because of the thinness of the chest wall. The normal assessment finding in the pulmonary system of an aging individual is as follows: The pathophysiological changes include (1) decreased chest wall compliance and loss of elastic recoil, (2) decreased respiratory muscle mass/strength, (3) increased ventilation/perfusion mismatch, (4) decreased alveolar surface area, (5) decreased carbon dioxide diffusion capacity, (6) decreased responsiveness of central and peripheral chemoreceptors to hypoxemia and hypercapnia, (7) decreased number of cilia, (8) decreased IgA production and humoral and cellular immunity, (9) decreased respiratory drive, and (10) decreased tone of upper airway muscles (, 2004).             Key clinical findings in an aging pulmonary system includes (1) prolonged exhalation phase, (2) decreased vital capacity, (3) decreased PaO2, (4) decreased cardiac output, (5) slightly increased PaCO2, (6) increased respiratory rate, (7) decreased tidal volume, (8) decreased airway clearance, (9) diminished cough reflex, (10) increased risk of aspiration and infection, (11) increased risk of arterial oxygen desaturation, and (12) snoring, obstructive sleep apnea ( 2004).             Upon physical examination of         , it revealed that his arterial blood gases are at pH 7.36, the PaO2 is at 55 mmHg, and the PaCO2 is at 65 mmHg. PaCO2 is the partial pressure of carbon dioxide in the arterial blood and PaO2 is the partial pressure of oxygen in the arterial blood. Unlike liquids, gases expand to fill the volume available to them, and the volume occupied by a given number of gas molecules at a given temperature is ideally the same regardless of the composition of gas. This is what is called as the partial pressure. The normal values for PaCO2 and PaO2 are 40 mmHg and 100 mmHg respectively ( 2001).             The past medical history of        showed that he has emphysema and chronic bronchitis. The term pulmonary emphysema literally means excess air in the lungs. However, chronic pulmonary emphysema is a complex obstructive and destructive process of the lungs that is in most instances a consequence of long-term smoking (, 2000). Chronic bronchitis is the chronic inflammation of the bronchi which leads to thickening of mucosa and decreased bronchial diameter (, 2004). Clients with chronic bronchitis generally produce sputum all day ( 2004). This is a result of the dependent accumulation of sputum in the airways and is associated with reduced mobility.             Consolidation of the lungs – whole lobes or even the whole lung – is usually a manifestation of pneumonia. Large areas of lungs become consolidated which means that they are filled with fluid and cellular debris (, 2000). All interventions and evaluation of treatments for       has to take into account the underlying causes of his medical manifestations like crackles and wheezing.       REFERENCES

NURSING CARE PLAN/ ESSAY

Nursing Care Plan The patient is , a 72 year old man who has been admitted for dyspnea or shortness of breath. re...