NUR 104: Case Study Assignment
H.I., a 73-year-old married man and retired coal miner, visited his primary care doctor,
complaining,
... [Show More] “Whenever I try to do anything, I get so out of breath I can’t go on. I think I’m just
getting older, but my wife told me I had to come see you about it. I spent my whole life working
in the mine and now I can barely mow the yard.” His resting SpO2 is 83%. He was sent to the
local hospital for a chest x-ray examination and arterial blood gases (ABGs) after resting 20
minutes on room air. H.I. returned to the office. After evaluating the results, the physician told
H.I. he had severe emphysema and must start on continuous oxygen therapy at a 2-liter flow rate.
The physician completed a prescription for the oxygen therapy, included on the prescription were
his pulse oximetry and ABG results.
1. What is the rationale for starting H.I. on oxygen at a 2-liter flow rate?
Our book states that the purpose of oxygen therapy is to use the lowest fraction of inspired
oxygen to have an acceptable blood oxygen level without causing harmful side effects. In this
instance, 2L probably through a nasal canula would be what the patient is started on and
increased later if needed. If too much oxygen is delivered at one time, this patient could get
oxygen toxicity.
2. What criteria need to be filled for Medicare to pay for H.I.’s home oxygen therapy?
The patient must have severe hypoxemia with PaO2 less than 55 mm HG or SpO2 of less than
88% on room air at rest. (page 536)
3. Based on the most common cause of emphysema, what assessment regarding health behaviors
is needed?
If the patient smokes or is around other inhaled irritants. We know the patient is a retired coal
miner, so he had already been breathing in irritants while working in the coal mine. I would also
ask the patient if they have any hobbies that would put them around other inhaled irritants such
as paint. What type of heat they use in their home could also be a contributing factor because if
they have a fireplace of burn firewood that could be an inhaled irritant as well.
H.I. affirmed he has been a half-pack-per-day smoker for 50 years. The physician counseled H.I.
on smoking cessation and he agreed to stop smoking. The physician told H.I. his office would
have a home equipment company call him to arrange delivery of the oxygen equipment and
educate him on its’ use. As a registered nurse working for the company, you are assigned to be
H.I’s case manager.
4. How would you prepare for the initial home visit?This study source was downloaded by 100000834903101 from CourseHero.com on 12-10-2022 16:26:53 GMT -06:00
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I would review the patient’s chart and make notes on things to educate the patient about or check
on.
5. What would address with H.I. and his wife at the first visit?
I would ask the patient and his wife what they were told to do or avoid with home oxygen
therapy. I would then make sure the patient knew not to smoke with their oxygen on, not to have
the oxygen by an open flame, and how to properly store their oxygen tanks that are not in use.
6. What assessment do you need to do at each follow-up visit with H.I.?
Assess for health and safety in the home by making sure they don’t sleep with wool blankets, the
tubing isn’t too long or getting tangled up around the patient’s feet, no open flames, no smoking
with or around the oxygen, etc. I would also do a respiratory assessment on the patient to see
what his Sp02 percentage is on his current oxygen saturation, lung sounds, mental status, and
check for any signs and symptoms of oxygen toxicity or other adverse reactions.
Case Study Progress:
The next time you visit, H.I. complains of sores behind his ears. He explains, “That long oxygen
tubing seems to take on a life of its own. It twists around and gets caught under doors, chairs,
everything. It darn near rips the ears off my head.”
7. What can you tell him that could help?
He could foam ear cushions or wrap gauze pads around the tubing by his ears to reduce irritation.
For the tubing, I would suggest shorter tubing or getting a smaller, portable oxygen delivery
system do the patient doesn’t have to worry about falling or otherwise harming himself by
getting the tubing caught on anything.
8. You auscultate H.I.’s breath sounds and detect the odor of Vicks VapoRub. When you question
H.I. about the use of Vicks, he tells you that he started to apply it in and around his nose to
prevent his nose from becoming dry and sore. What specific teaching do you need to reinforce
with H.I. and his wife?
I would reinforce how easily oxygen combusts. Vicks is an oil-based product and is highly
flammable and should not be used. The patient can use water-based gels and to avoid oil-based
or petroleum-based products.
9. After you have finished, his wife seems upset and tells you the H.I. is still “smoking a couple
of ciga [Show Less]