discusion post reply

PROMPT :

Scenario

Mr. Johnson is a 70-year-old male complaining of shortness of breath for the past three weeks. Mr. Johnson is complaining that he has chest pain, and this pain increases when he coughs. He also reports thick green/yellow sputum for the past week. His current weight was stable at 100 kg from his previous visit six months ago. He admits to occasionally smoking cigarettes.

Mr. Johnsons assessment is as follows:

• Inspection upper respiratory system: Nasal and mouth mucosa is pink; no bleeding, masses, or deformities are noted in the upper respiratory system.
• Inspection lower respiratory system: The client has a respiratory rate of 20 with even and unlabored respirations.
• During the history, the client is speaking freely and does not report any shortness of breath while talking.
• The client has skin appropriate for his ethnic background, with no skin integrity issues noted during the inspection.
• Palpation: No masses, deformities, or crepitus are noted. Trachea is midline and nontender.
• The client has equal lung expansion anterior and posterior; the client reports pain that increases with inspiration.
• Percussion: Dullness over right lower lobe, otherwise hyper resonance.
• Auscultation: Fine crackles in the right lower lobe with inspiration and expiratory wheezes and diminished breath sounds noted throughout.
• Vital signs: Temperature: 100F (38C); Respiratory rate: 22; Pulse oximetry on room air: 91% to 93%; Heart rate: 90 bpm; and Blood pressure: 130/80 mm Hg

As the nurse, you have determined the priority problem is impaired gas exchange related to the mucus collection in the airways, as evidenced by fine crackles in the right lower lobe.

Instructions

Using the assessment and nursing diagnosis provided in the scenario, write 200250 words identifying goals for Mr. Johnson in your initial post. Then, respond to at least two of your peers posts.

Discussion Prompts

• Identify two measurable short-term goals for Mr. Johnson. Explain why you chose these goals.
• Consider what possible outcomes would change the priority problem.
• Define one of these possible outcomes and explain how (and why) it would change the priority problem. Then, identify at least one new measurable goal related to the newly identified problem.

My response:

Two measurable short-term goals for Mr. Johnson are:

1. Achieve oxygen saturation 95% on room air within 24 hours, measured by pulse oximetry. Mr. Johnsons current oxygen saturation level is between 91-93%, impairing gas exchange. He is not suffering from hypoxia since SpO2 is not below 90%, but it is clearly below the ideal 95% (Pesola & Sankari, 2023). Interventions like elevating his head, using incentive spirometry and nebulization can help Mr. Johnson achieve the desired goal (Ernstmeyer & Christman, 2021), confirming improved alveolar-capillary gas transfer. This goal can be measured using objective data provided by pulse oximetry.
2. Decrease fine crackles and wheezes in the right lobe within 48 hours, measured through auscultation. Crackles and wheezes indicate that mucus is obstructing Mr. Johnsons alveoli (Cleveland Clinic, 2023). Clearing secretions will reduce inflammation and help prevent progression to respiratory failure. This goal can be measured through auscultation.

Possible outcomes that would change the priority problem include:

Assuming the interventions resolve impaired gas exchange (SpO2 95%, and cleared breath sounds), then the priority should shift to addressing acute chest pain or respiratory infection. Mr. Johnson complained about chest pain and acute pain when coughing. He also reported green/yellow sputum, which may be caused by pneumonia, bronchitis or sinus infection (Altiner et al., 2009). This still needs to be confirmed (no mention to green/yellow sputum during the interaction with the nurse).

Acute pain:

Mr. Johnson is suffering from acute chest pain when coughing due to pleural inflammation. Dealing with pain is a top priority for nurses since pain is a symptom of inflammation processes and it hinders Mr. Johnsons quality of life. The new goal is to reduce pain as measured by a self-assessment through medication and supplemental oxygen. Mr. Johnson will be told to verbalize pain level on a 0-10 scale every 12 hours after pain management interventions start. The goal is to reduce pain level.

References

Altiner, A., Wilm, S., Dubener, W., Bormann, C., Pentzek, M., Abholz, H.-H., & Scherer, M. (2009). Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scandinavian Journal of Primary Health Care, 27(2), 7073.

Cleveland Clinic. (2023, August 4). Lung Sounds. Cleveland Clinic.

Ernstmeyer, K., & Christman, E. (2021). Chapter 8 Oxygenation. In Nursing Fundamentals. Chippewa Valley Technical College.

Pesola, G. R., & Sankari, A. (2023, June 11). Oxygenation Status and Pulse Oximeter Analysis. PubMed; StatPearls Publishing.

Peer#1:Hello Everyone,

Mr. Johnsons priority nursing problem is impaired gas exchange related to mucus collection in the airways. Based on his assessment findings, two measurable short-term goals are appropriate.

The first short-term goal is for Mr. Johnson to maintain oxygen saturation of at least 94% on room air within 24 to 48 hours. This goal was chosen because his current oxygen levels are slightly low, ranging from 9193%, which suggests that his lungs are not exchanging oxygen as well as they should. Improving his oxygen saturation would show that his breathing is improving and that nursing interventions such as coughing, deep breathing, and clearing mucus from the airways are helping him breathe more comfortably and effectively.

The second short-term goal is for Mr. Johnson to show improved airway clearance within 48 hours by coughing up thinner sputum and having fewer crackles heard in the right lower lobe. This goal was chosen because the buildup of thick mucus is making it harder for him to breathe. When secretions are cleared, the airways can open more fully, allowing oxygen to move in and out of the lungs more easily and helping improve his overall breathing.

A possible outcome that could change the priority problem is worsening respiratory infection, such as pneumonia, due to retained secretions. If his infection worsens, the priority problem may shift from impaired gas exchange to ineffective airway clearance or impaired breathing pattern.

If this occurs, one new measurable goal would be that Mr. Johnson will maintain a respiratory rate between 1220 breaths per minute with reduced work of breathing within 24 hours. This goal is important because controlling breathing effort can help prevent fatigue and further respiratory decline, supporting overall respiratory stability.

Reference

Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2023). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.

Peer#2:One short term measurable goal for Mr. Johnson to maintain an oxygen saturation of 94% or higher within the next 24 hours is either on room air or with prescribed supplement oxygen. This is important because oxygen saturation is a clear indicator of how well gas exchange is occurring in the lungs, and improving it shows that oxygen is reaching the bloodstream more effectively. Another short term measurable goal is for Mr. Johnson to get better airway clearance within 48 hours, improve breath sounds and the ability to cough up sputum more effectively which is important because it addresses the cause of his impaired gas exchange which is mucus collection in the airway. The possible outcomes that would change if Mr. Johnson’s airway clearance and oxygenation get better would be better ventilation, also known as reduced sputum production as well as it will cause clearer lung sounds and decreased shortness of breath. Why it is important for the airways to be cleared is because the lungs can expand more fully which will allow better oxygen exchange and reduce respiratory distress and with this the focus can be more focused on preventing respiratory issues.

Resources:

Centers for Disease Control and Prevention. (2024). Pneumonia: Symptoms and causes.

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