What signs and symptoms of altered oxygenation does Ms. Dawson have?
Melissa Dawson is a 30-year-old Caucasian female who was diagnosed with severe persistent asthma as a young child. She presents at her pulmonologist’s office at 0900 on Thursday after calling and requesting to be worked in because she is not “getting enough air.” As the nurse working with Ms. Dawson’s pulmonologist, you conduct her client interview and initial assessment when she comes to the clinic. It takes a little time to get through the client interview; Ms. Dawson can only speak a few words at a time and appears short of breath. Ms. Dawson reports that she came down with bronchitis over the holiday weekend and went to an urgent care clinic to get an antibiotic. The P.A. at the clinic prescribed a Z-pack (azithromycin). Ms. Dawson states she has been on 40 mg prednisone since Monday for asthma symptoms and has been using her rescue inhaler 4 times daily in addition to her Flovent Diskus (fluticasone) inhaler. Ms. Dawson tells you that she woke up in the middle of the night unable to get enough air, and that her nail beds were blue. She used her rescue inhaler and her symptoms improved enough that she decided not to go the emergency department but to wait and call the office first thing this morning. You observe that Ms. Dawson is holding back tears. She is sitting on the exam table leaning forward with her hands on her knees. Her voice is hoarse. Her face is pale, and she has dark rings around her eyes. Ms. Dawson tells you her voice only gets hoarse when she is very, very sick. On taking her vitals, you note that Ms. Dawson’s blood pressure is elevated, and her respirations are 32. Her oxygen saturation (SaO2) is 91% on room air. When you auscultate her lungs, you hear decreased breath sounds. The pulmonologist puts her on 4 LPM oxygen by nasal cannula. Question 1 What signs and symptoms of altered oxygenation does Ms. Dawson have? Question 2 Why might Ms. Dawson’s blood pressure be high? Question 3 Why might Ms. Dawson be close to tears? Question 4 What is the priority nursing diagnosis for Ms. Dawson at this time? (Remember to list related to.) Question 5 What independent nursing interventions can you perform to help make Ms. Dawson more comfortable while she waits for the specialist? Question 6 What additional interventions should the nurse anticipate implementing as part of Ms. Dawson’s immediate care?