Assignment task:
Martha Moore is an 87-year-old woman with a history of osteoporosis and hypertension. She had an exploratory laparotomy for a small bowel obstruction 2 days ago. Mrs. Moore's hemoglobin level is 9 g and her SaO2 is 90%. Upon assessment, Martha reports her cough kept her awake last night. Vital signs are as follows: temperature, 101°F; blood pressure, 150/78 mm Hg; heart rate, 100 beats/min; and respiratory rate, 24 breaths/min. On auscultation, the nurse hears crackles in both lungs. The patient reports a sharp pain in her chest when she takes a deep breath. After the deep breath for auscultation, the patient has a productive cough, and the nurse notices the sputum is green with rust-colored tinting. Martha reports she tries not to cough because it causes abdominal pain at her incision site. The nurse recognizes that Mrs. Moore has symptoms suggesting pneumonia as a postoperative complication. The nurse knows Mrs. Moore needs to deep breathe, increase activity as tolerated, and increase fluid intake. The nurse works with Mrs. Moore to implement the plan of care. The nurse asks Mrs. Moore to use the incentive spirometer and notices she is moving only 800 mL of air. The nurse emphasizes the importance of using the incentive spirometer approximately 10 times every hour while awake to help get air into Mrs. Moore's lungs. Together, they agree on a goal of moving 1500 mL using the spirometer. The nurse also talks with Mrs. Moore about giving her pain medication to relieve the abdominal pain. To further reduce pain when coughing, the nurse recommends that Mrs. Moore hold a pillow over her incision when she coughs to splint the incision site. After receipt of pain medication, Mrs. Moore is assisted to sit on the side of the bed and then walk to a chair for her breakfast (clear liquids). The nurse encourages Mrs. Moore to drink all of the liquids to help liquefy her secretions. When the surgeon makes rounds, the nurse reports the findings from Mrs. Moore's assessment and the plan of care initiated. The surgeon orders a chest x-ray, acetaminophen (Tylenol) as needed for fever, an antibiotic, and iron tablets. After a bath, a nap, pain medication, and use of incentive spirometry with coughing, Mrs. Moore is assisted to walk in the hall. Before discharge, Mrs. Moore is taught about ways to treat her anemia with foods rich in iron and with the daily iron tablet. The outcome of this plan of care is that by discharge, Mrs. Moore will be able to move at least 1500 mL on the spirometer, have clear breath sounds bilaterally, have an SaO2 greater than 95%, be afebrile, and be able to state the plan to treat her anemia.
1. What risk factors for impaired gas exchange does Mrs. Moore have?
2. What types of gas exchange impairments are evident in this case?
3. What are two negative consequences of impaired gas exchange?