Life Limiting Illness

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Sam (name changed to protect confidentiality) is a nine month old boy who was born at 26 weeks and diagnosed with chronic lung disease. He was sent home on 0.3 litres (L) of oxygen per minute with the view of gradually weaning this down as he grew stronger. When I joined the community nurse visiting Sam at home, he had been weaned down to 0.1L of oxygen per minute, so was now having his time on oxygen weaned down; from continuous oxygen eventually to none. The community nurses follow the trust’s nursing assessment guidelines which are based on The Twelve Activities of Daily Living (Roper et al, 1983). This model allows nurses to organise and prioritise care effectively for each individual child (McQuaid et al, 1996). As Sam was recovering from chronic lung disease, his respiratory well-being was the main priority. During the weaning process the community nurses conduct regular respiratory reviews to ensure Sam is coping with the lessening amount of oxygen. This assessment can begin as soon as the nurse enters the home. We were able to assess Sam’s work of breathing by looking at him and listening to him. He was not exhibiting any signs of respiratory distress such as nasal flaring, recession, grunting or wheezing, all of which would tell us he was making excessive respiratory effort (Huband and Trigg, 2000). It is essential to monitor oxygen saturations and vital signs in a respiratory review. The pulse oximeter is used to alert nurses to potential hypoxaemia. It does this by emitting red and infrared light from the sensor into the patient. Oxygenated and deoxygenated blood absorb different amounts of infrared light, so an average value can be calculated to show the percentage saturation (Huband and Trigg, 2000). The nurse ensured Sam’s foot was warm before attaching the probe to it, to determine if he had good peripheral perfusion. This is important for obtaining an accurate reading. The nurse informed Sam’s parents that we would be happy with Sam saturating...
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