As a respiratory therapist at a local hospital, I was called to the Emergency Department to await the arrival by ambulance of a 32 lb. (14.54 kg.), eighteen-month old male toddler with a history of coughing, congestion, fever, and runny nose for the previous five days. He is currently taking prescribed medication, by his pediatrician, consisting of acetaminophen to control fever as well as cough syrup to lessen his cough, congestion and runny nose. He has been on this medication for the past two days but suddenly, within the past hour, has developed an audible wheeze and cyanosis around his lips. This change in condition alarmed his mother and she called 911 to have an ambulance come to her home.
While in route to the hospital, the EMS reported the following vital signs: a temperature of 103.9 degrees F, heart rate of 170, respiratory rate of 48, blood pressure of 112/74, and 78% oxygen saturation on room air. The EMS team placed the patient on 100% oxygen using a non-rebreather mask and got his oxygen saturation to improve to 90%. They also administrated two 2.5 mg. Albuterol treatments. This toddler was in respiratory distress and needed additional treatment as soon as he arrived at the hospital.
To prepare for the patient’s arrival, and likely intubation due to his low oxygen saturation, I gathered the equipment required. A Servoi ventilator would be brought into the room. The monitors required are an EKG, pulse oximeter, blood pressure, end-tidal Co2, and stethoscope. The airway required is an un-cuffed size 4.5 internal diameter endotracheal tube which is recommended for a child 1-to-2 years old, as well as a size 4 and a size 5 to be sure the best size is available. The suctioning equipment would include an in-...
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...onchodilator, and Mucomyst until patient recovers sufficiently to allow a weaning trial.
Works Cited
Cairo, J. M., and Susan P. Pilbeam. Pilbeam's Mechanical Ventilation: Physiological and Clinical Applications. St. Louis, MO: Elsevier Mosby, 2012. Print.
Des Jardins, Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. Clifton Park, NY: Delmar Cengage Learning, 2013. Print.
Heuer, Albert J., Craig L. Scanlan, and Robert L. Wilkins. Wilkins' Clinical Assessment in Respiratory Care. Maryland Heights, MO: Elsevier/Mosby, 2014. Print.
Walsh, Brian K., Michael P. Czervinske, and Robert M. DiBlasi. Perinatal and Pediatric Respiratory Care. St. Louis, MO: Saunders/Elsevier, 2010. Print.
Wilkins, Robert L., James R. Dexter, and Philip M. Gold. Respiratory Disease: A Case Study Approach to Patient Care. Philadelphia: F.A. Davis, 2007. Print.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
At this point, the sepsis bundle order set will be initiated. Within one hour the physician will perform an assessment, laboratory will draw labs and blood cultures, the assigned nurse will initiate fluid resuscitation, and broad spectrum antibiotics will be administered after the cultures are collected. Figure 1 provides a detailed summary of tasks to be completed within the first hour of SIRS indicator identification. Within three hours, fluid resuscitation will be completed, lactate levels are remeasured, and the assigned nurse documents volume status. Within six hours, vasopressors are initiated if hypotension is not responding to initial fluid resuscitation, and hydrocortisone is administered if indicated. A “Gold Alert” was required for the case patient as evidenced by elevated temperature of 38.3oC and white blood cell count of 23,200
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Christopher death could have been avoided if the Doctor had been able to identify the cause of his desaturation on time. Due to lack of nursing care and many human errors from both the medical team and nurses, it leads to his death as per the inquest. Patient safety was compromised. It was found that Dr. Wooller the anesthetist and Dr. Young the surgeon who operated on Mr. Hammett didn’t investigate on the significant oxygen desaturation event that occurred in PACU while he was transferred from Operation Theater. DR. young assumed it was due to obstructed airway. As Mr. Hammett had Guedels inserted. The inquest stated that the anesthetist was supposed to review the arterial blood gas and transferred Mr. Hammett to High dependency unit due to his desaturation event for more than 20min. The nurses looking after MR. Hammett in PACU was RN Turrell and RN Proud. RN Proud notified Dr. Woller about the desaturation event for which doctor paid the visit but didn’t physically examine Mr. Hammett and left with short conversation. If Dr. Woller had investigated the cause of desaturation event at that time probably they could have prevented the rest desaturation event but unfortunately, none of them were implemented, which lead to additional complication Following the event the deceased was administered bolus morphine for his pain, which was scored 4/10. The nurses working in PACU RN Proud notified the anesthetist about the oxygen stat
One of the common diseases in the respiratory system that many people around the world face is emphysema or also known as chronic obstructive pulmonary disease (COPD). It is a chronic lung condition where the alveoli or air sacs may be damaged or enlarged resulting in short of breath (Mayo Clinic, 2011). If emphysema is left untreated, it will worsen causing the sphere shaped air sacs to come together making holes and reduce the surface area of the lungs and the amount of oxygen that travels through the bloodstream, blocking the airways of the lungs (Karriem- Norwood, 2012). The most common ways a patient can get emphysema are by cigarette smoking or being exposed to chemicals, dust or air pollutants for a long period of time. Common physical exams reveal a temperature of 100.8 Fahrenheit, 104 beats per minute, a blood pressure of 146/92, and a respiratory rate of 36 breaths per min (Karriem- Norwood, 2012). (see appendix A.1,A.2, A.3, A.4 for complete proof.)
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
Below will be looking into the progression of the disease and effects it will have on bill and his family, also will look into the pathophisology of COPD, nursing considerations, treatment management and the community services available to Bill so he can return home safely.
On my first day of week three clinical at 0830, client W and I were on our way to the dinning room and client B asked me to put his jacket on, so I told client W that I would meet him in the dinning room. After I helped Client B, I was on my way to the dinning room and nurse A told me that client W was experiencing difficulty breathing and we needed to give him his 0900 inhalers earlier. He was having audible wheezing and rapid respiratory rate. Therefore, we had to give client W his inhalers, SalbutaMOL Sulfate, which is a bronchodilator to allow the alveoli in the lung to open so th...
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Vijayan, V. K. (2013). Chronic obstructive pulmonary disease. Indian Journal Of Medical Research, 137(2), 251-269.
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...
The treatment priorities of the registered nurse upon admission to the emergency department are as follows; within the first 10 minutes of Mr. Bronson’s arrival to the emergency department begin a 12 lead ECG. Assess Mr. Bronson’s vitals heart rate, blood pressure, respiratory rate, oxygen saturation, and administer oxygen 2-4 liters via nasal cannula (Sen, B., McNab, A., & Burdess, C., 2009, p. 19). Assess any pre hospital medications, and if he has done cocaine in the last 24 hours. At this time, the nurse should assess Mr. Bronson’s pain quality, location, duration, radiation, and intensity. Timing of onset of current episode that brought him to the emergency room, any precipitating factors, and what relieves his chest pain.
A 41-year-old manwith a history of DM was brought to emergency department (ED)due to difficulty in breathing. It was associated with fever, severe sore throat and muffled voice for 2 days duration. He visited a...