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Within the nursing process, use of the stated framework has been demonstrated to be effective as a contextualised framework relevant to emergency conditions. This framework consists of 5 steps of history taking, potential red flags, clinical examination, investigations, and nursing interventions (Curtis, Murphy, Hoy, &. Lewis, 2009).
The inspection of his chest revealed intercostal muscle recession, and auscultation revealed diminished air entry at both bases of the lungs with crackles audible in the right base. The respiratory rate was higher than the baseline at 28 per min with deep and laboured breathing. His SpO2 was 89% on Hudson mask at 6 L of oxygen with elevation of PaCO2 to 54. All these information indicate that he was in acute respiratory failure (Delerme &. Ray, 2008).
The clinical picture indicates that this alteration in respiratory function has occurred over a short period of time. This patient was at baseline hypoxaemic indicated by his need for supplemental oxygen to maintain his oxygen saturations above 95%. Given his age and potential blood loss due to fractured neck of right femur this is expected, although the history does not suggest any chronic respiratory disease at the baseline (Calverley, 2003). This is an important part of history since quite frequently such patients develop acute respiratory failure superimposed on a chronic pulmonary condition such as chronic obstructive pulmonary disease, which is common in elderly men of his age (O’Malley, Marcantonio, Murkofsky, Caudry, &. Buchanan, 2007).
While initially 3 L of oxygen per min via nasal prongs ensured a 99% of SpO2 of 99%, postoperatively in 2 days’ time, his condition deteriorated. The assessment while trying to reach a diagnosis must include an attempt to determine causes for such changes. Although high temperature of 38.5 degrees Celsius may contribute to higher rate of breathing, the laboured breathing and findings at auscultation strongly suggests respiratory failure, which is further confirmed by rise of PaCO2 to above 50 (El Solh &. Ramadan, 2006). While a fall of PaO2 to below 50 is expected, given his oxygen supplementation, this may not occur always unless there is severe respiratory failure. As expected the pH is 7.30 which is less than 7.35 indicating respiratory acidosis along with oxygen destaturation indicated by SaO2 of 89%, which is below normal (Antonelli, Pennisi, &. Conti, 2003). The X-ray picture confirms right sided basal consolidation and collapse, which may indicate an infective episode, which perhaps is the cause of this failure, since the other reason of overuse of PCA can be ruled out through the patient’s statement.
Q2. The doctor initially prescribed two antibiotics. The later appearance of fever and concomitant respiratory failure due to consolidation and right sided pleural effusion leading to collapse indicated that this infection has been acquired in the hospital.