Dorothea Orem (1971) defined nursing with emphasis on client’s self-care needs. Self-care, according to the theory, is a learned, goal-oriented activity directed towards the self in the interest of maintaining life, health, development and well-being. Accordingly, care is needed when the client is unable to fulfill biological, psychological, developmental or social needs and the health care professionals determines by duty why a client is unable to meet the needs or what must be done to enable the client to meet them (Patricia, 2005).
“The collaborative model is a model” which shows a radical shift from the past. In such a model, the health care organizational structure is decentralized and the nurses and physicians function collaborately to make clinical decisions. A joint practice committee, with equal representations functions at the organizational level to monitor and support these professionals. The clinical records are integrated with joint patient care record views to foster collaboration (Patricia, 2005).
COLLABORATIVE PRACTICE- THE CASE STUDY The patient in this case was admitted in the ICU for an acute exacerbation of COPD with the complications Atelectasis, Anxiety and Cor pulmonale. Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), is a term used to describe progressive lung diseases, which include emphysema, chronic bronchitis and chronic asthma. The common symptoms of COPD are progressive limitations of the airflow into and out of the lungs and shortness of breath.
Intensive Care or Critical care nursing is challenging due to the nature of life-threatening health situations in the ICU, which demands complex assessments, high-intensity therapies and interventions and continuous vigilance. The primary treatment for acute massive Atelectasis is removal of the underlying cause by surgery by a surgeon. If the blockage cannot be removed by coughing or by suctioning the airways then it should be removed by bronchoscopy and involves a pulmonologist.
Antibiotics are to be given for any detected infection as in chronic Atelectasis, when infection is almost inevitable and requires a Physician and Microbiologist. A low salt diet as recommended by a dietician is given . Diuretics can be given to remove excess fluid from the body under the supervision of a urologist. An anxiolytic, buspirone, as recommended by a psychiatrist have been found to be safe in reducing anxiety in COPD patients instead of benzodiazepines which affect lung function. My role as an ICU nurse includes respiratory assessment and interventions.
Respiratory assessment of the patient includes level of dyspnea measured using a quantitative scale such as a visual analogue or numeric rating scale. Usual dyspnea is measured using a quantitative scale such as the Medical Research Council (MRC) Dyspnea Scale. The other assessments include Vital signs, Pulse oximetry , chest auscultation ,chest wall movement and shape/abnormalities, presence of peripheral edema, accessory muscle use , presence of cough and/or sputum, ability to complete a full sentence and the level of consciousness.
By doing so, nurses can detect stable and unstable dyspnea and acute respiratory failure. Nursing interventions for all levels of dyspnea including acute episodes of respiratory distress which includes acceptance of patients’ self-report of present level of dyspnea(Wunderink, 1992), Medications ,Controlled oxygen therapy ,Secretion clearance strategies,Non-invasive and invasive ventilation modalities,Energy conserving strategies ,Relaxation techniques,Nutritional strategies and Breathing retraining strategies.
It is important for the nurses to remain with patients during episodes of acute respiratory distress. Medications include Bronchodilators,Beta 2 Agonists ,Anticholinergics and Methylxanthines,Corticosteroids ,Antibiotics ,Psychotropics and Opioids (www. guidelines. gov). Patients have to be assessed for hypoxemia/hypoxia and administered appropriate oxygen therapy. Continuous Positive Airway Pressure Oxygen therapy is part of any ICU and requires absolute attention.
Patient safety checks includes circuit leaks; maintenance of positive pressure; adequate inspiratory air flow and not leaving the patient alone. Managing the therapy involves maintenance of the desired FIO2; level of positive airway pressure and time period for CPAP therapy, attaching CPAP machine medical air and oxygen gas lines to wall sources, preparation of humidification source, selection of prescribed FIO2 on oxygen blender, turning flow on to level above 25 litres / min.
, positioning of rubber securing band behind the patient’s head (Wunderink, 1992), centred on occiput, positioning of face mask over the patient, adjusting the level of positive expiratory pressure to prescribed level, adjusting inspiratory gas flow so that minimal fluctuations are present on pressure gauge, Observing and documenting respiratory rate; work of breathing and SpO2, increasing inspiratory flow if respiratory work is excessive or the patient complains of continuing dyspnoea, Maintaining continuous SpO2 monitoring with alarm function in place and maintaining humidification temperature at 36 degree C or at temperature tolerated by the patient.