At first glance, Reea can tell Mr. Paul’s condition has changed. As she asks him how he feels, Reea notes he is short of breath. She can hear the anxiety in his voice as Mr. Paul replies that “it’s hard to catch my breath” and his “chest feels tight".
Reea knows Mr. Paul was admitted overnight with general weakness and anemia after a fall at home. There was no record of any shortness of breath or pulmonary disease in his admission history.
Elevating the head of the bed so Mr. Paul can sit upright, Reea begins her assessment. His respiratory rate has increased to 32 and he is using his accessory muscles to breathe. She notes his skin is a little clammy and cool, and his lips and fingernails are slightly cyanosed. She hears crackles throughout his chest and decreased air entry to his left lower lobe (LLL). His pulse is 110/min and regular, BP 108/60, and 02 sats are 86% on room air.
Based on her assessment, Reea draws a conclusion about Mr. Paul’s status. She diagnoses hypoxia related to decreased air entry to his LLL as the likely cause of his symptoms. Reea knows she can improve his condition temporarily by applying oxygen, stabilizing him until a physician or nurse practitioner can diagnose the underlying medical problem.
In deciding to treat, Reea considers the risks, benefits and possible outcomes. In her judgment, the outcome is reasonably predictable and the benefits outweigh risks. She has the knowledge, skill and judgment to follow her organizational protocol for treating hypoxia, including managing any intended and unintended outcomes.
Explaining her next steps to Mr. Paul, she applies oxygen by mask at 6 litres per minute. Reassuring him, she watches for Mr. Paul’s condition to change. Within a few minutes, Mr. Paul has visibly improved. His respiratory rate slows and his O2 sats increase to 90%.
Wanting to contact Mr. Paul's physician, Reea uses the call bell to alert a colleague to come. While her colleague stays to monitor him, Reea consults with his treating physician and receives orders. She updates the care team and documents her ongoing assessment, diagnosis, treatment, and communication with the physician.
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