The Emergency Nursing - Infective Exacerbation of Chronic Obstructive Pulmonary Disease n Elderly, Airway Management for Pediatric Patients - Case Study Example

Journals By Student Name Course Tutor Institution Date Elderly Indigenous woman (70 years) from a remote Northern Territory community with infective exacerbation of COPD The old woman had an excessive cough that was characterized by high production of sputum, which was different from her usual variation. Her condition could have been aggravated by environmental factors since she came from a remote territory, she could have been exposed to indoor pollution emanating from smoke from the cooking fire. Her sputum was different in appearance from clear to yellow in color. She complained of a tight sensation in her chest (Sayiner, Okyay, Unsal, and Colpan, 1999). She was breathing fast and had a fast heart rate. The nurses found out that, the old woman's fever was extremely high and had increased her wheezing. The nurses administered her with a vaccination, which was meant to prevent her from pathogens like Streptococcus pneumonia and influenza. Although the patient was wheezing, the nurses were cautious not put the old woman under oxygen as this would have worsened her condition. Once a patient is administered with high oxygen flow- as opposed to titrating their oxygen, could worsen the results. In order to enhance a speedy recovery, the nurses had to administer the woman with a corticosteroids course. The old woman would be put on antibiotics (co-trimoxazole) since her exacerbation was infective. The nurses then recommended her for mechanical ventilation (Wedzicha, 2011 p.3). She was put on tracheal intubation, which would help in maintaining the airway. Intubation will also function as a conduit, a passage where some drugs could be administered. Mechanical ventilation functions as ventilation to the lungs- a process that curbs a possibility of airway obstruction. Young (20 year old) man, intoxicated –ETOH use +++, with a large head laceration from an assault The emergency nurses were faced with two tasks; the first was the large laceration on the head and the other was the intoxication. In the managing the wounds in the emergency department, the main aim was to avoid any infection, as well as, achieving aesthetically and functional pleasing scar. This is attained by reducing any contamination to the tissue, perfusion restoration in wounds that are poorly perfused and debriding tissues that are devitalized (Hollander & Singer, 1999). The young man was experiencing sudden lapses where he could go in and out of unconsciousness, shallow breath, and fever. He also had increased heart rate. The nurses' diagnosis suggested that the patients had dehydration. The increase in heart rate could have resulted from reduced blood pressure and plasma volume. The fever was caused by a decrease in sweating. The patient had to be put on a drip. The patient had bluish, pale and cold skin. This indicated that the patient was experiencing oxygen shortage. The nurses in the emergency department resulted into providing him with oxygen through the nasal cannula. The results obtained from the blood sample suggested that the patient had low blood sugar. This meant that, the patient had to be treated for hypoglycemia. The nurses used 50ml of 50% saline flush and dextrose solution due to unresponsiveness of induced ethanol hypoglycemia. In order to prevent seizure, the nurses administered the young man with thiamine. Application of hemodialysis was necessary since it lowered the patient’s blood concentration (Rault, 2001). The differences of airway management for a pediatric patient; what can the emergency nurse do to improve this child’s situation? The child brought in the emergency department was producing snoring noise, which indicated that there could be a partial obstruction of the airway since the tongue has fallen back towards the posterior oropharynx. The nurses were informed that the child had been producing gurgling sound a fact showing that the patient could be having secretions in her airway (Desai et al. 2012). When the child was presented to the emergency department, the nurses’ diagnosis indicated that, her respiratory rate was reducing significantly (Xue, Zhang, Liao, and Liu, 2009). This indicated that, she was experiencing fatigue. This made the child’s condition extremely severe because of the impending respiratory arrest. The first step practiced by the emergency nurses in airway positioning, entailed placing the head in a sniffing middle line position with her neck chin lifted and neck extended. In order to achieve this, child’s head was lifted, and the chin tilted. A rolled towel was placed below her shoulder so as to counteract the typical child’s flexion. She was then supplemented with oxygen since her condition was severe; a nonrebreather mask was utilized. Suctioning of her nose was significant as this could enhance the status of her respiration. The nurses had to suction the woman's nose since children normally breathe through their nose thus obstruction with secretions might cause severe distress in respiration. Young children possess proportionally large tongue in comparison to that of the adults. The size of the tongue is commonly the major cause of obstruction in the airway. This means that through the placement of oral or nasal airway has the ability of reversing the obstruction. Oral aiways are only applicable to patients with comatose lacking a gag reflex. In order to identify the correct size of the oral airway, the airway is held along the child’s face. The tip must reach the mandible angle and a flange placement at mouth’s corner. The nasal airway is usually placed to either semiconscious or awake patients (Ondik, Kimatian, & Carr, 2007). The bevel of the airway should point away from the septum of the nose in order to reduce any bleeding risk. The nasopharyngeal width must be lesser in comparison to the nostril. In order to avoid injuring the young children’s soft tissues of the neck when placing bag- mask ventilation, the provider should exercise absolute care. In case of young children, tongue can easily be pushed to the airway, or compressed an exercise that could easily cause obstruction (Xue et al. 2011 p.699). Among the techniques that can be utilized during the bag- mask ventilation, is E-C clamp. This involves the formation of a C by the left hand’s index and thumb finger holding the mask. The remaining three fingers should form an E, which are placed on the jaw’s angle and lifts one’s jaw to the mask. The right hand is responsible of squeezing the bag in order to produce respirations. The process of squeezing should continue until there is visible chest rise. Traumatic Brain Injury (TBI) Situation Bec a 15-year-old girl was brought in the hospital after falling from her horse. She struck a tree with her head breaking her helmet into two. She was assisted by her companions who reported an initial unconsciousness, drowsiness and vomiting. Bec did not receive good pre-hospital management from her companions after the accident. Background Once Bec was stabilized, I assessed her condition through measuring reflexes and vital signs by doing a neurological examination. Her temperature, heart rate, blood pressure, and respiration rate were checked. The Glasgow Coma Scale (GCS) was utilized in trying to identify Bec’s neurological functioning and her degree of consciousness. She was also put under computerized tomography scan (CT). During the examination, Bec vomited twice. Assessment The assessment indicated that Bec had suffered from Traumatic Brain Injury (TBI). This is a form of brain injury that occurs once a sudden trauma affects the brain. The diagnosis indicated that Bec’s condition was a closed head injury. This is the injury that results once the head suddenly hits a hard surface, which does not affect the skull. Bec’s condition was severe as revealed by the GCS since her score was 8; checking the verbal response her score was 4, she scored 2 in the eye opening test and 2 in motor response test (Valente and Fisher, 2011 p866). Her respiratory rate was 24 breaths per minute and a heart rate of 62 beats per minute. It was evident that Bec’s respiratory rate had increased from the standard 12 breaths per minute to 24 breaths per minute. Her heart beat had also reduced. This indicated that Bec was experiencing the Cushing reflex. This condition is characterized by irregular respiration, increased pulse pressure and a decrease in heart rate. This condition occurs once there is an increase in pressure within the skull. The increase in Bec’s respiratory rate must have resulted from the increase in ICP (intracranial pressure). Once Bec’s head struck the tree, the cerebrospinal fluid increased ICP simultaneously increasing its own pressure (Mangat, 2012). Eventually, the fluid’s pressure exceeds the arterial blood pressure (Ghajar, 2000. p 925). Once these happens the arterioles becomes compressed reducing blood supply to the brain. Vomiting was caused by the increase in ICP (Werner and Engelhard, 2007 p.5). The utilization of CT scan helps in examining the muscles, tissue and the bone in identifying whether there is an existence of inflammation or bleeding in her brain. Recommendation The ICP should be measured by a physician in the intensive care unit. This is effectively done attaching the ICP device to a monitor, which provides reading of pressure within the skull. In case, there is an increase in pressure the physician can treat it. Bec never suffered from fractures, but it will be advisable for her to receive moderate assistance in breathing, which requires her placement on a mechanical respirator. In managing Bec’s ICP, it is advisable to elevate the bed’s head to 30˚. This enhances the outflow of jugular venous and reduces ICP. References Desai, B., Beattie, L., Ryan, M. F., and Falgiani, M. (2012). Visual diagnosis: pediatric airway emergency. Case reports in emergency medicine, 2012, pp.495363-3. Ghajar, H. (2000). Traumatic brain injury. Lacet, 356 (9233), pp. 923-929. Hollander, J. E., and Singer, A. J. (1999). Laceration management. Annals of emergency medicine, 34 (3), pp. 356-367. Mangat, H. S. (2012). Severe Traumatic brain injury. Continuum (Minneapolis, Minn), 18 (3), 532. Ondik, M. P., Kimatian, S., and Carr, M. M. (2007). Management of the difficult airway in the pediatric patient. Operative Techniques in Otalaryngology- Head and Neck Surgery, 18 (2), pp. 121-126. Rault, R. (2001). Prolonged hemodialysis for severe alcohol poisoning. ASAIO Journal, 47 (2), pp.149. Sayiner, A., Okyay, N., Unsal, I., & Colpan, N. (1999). Infective exacerbations of COPD. Chest, 115 (5), pp. 1481. Valente, S., and Fisher, D. (2011). Traumatic Brain Injury. The journal for Nurse Practitioners, 7 (10), pp. 863-870. Wedzicha, W. (2011). Systemic effect of COPD exacerbations. The Clinical Respiratory Journal, 5, 2-3. Werner, C., and Engelhard, K. (2007). Pathophysiology of traumatic brain injury. British Journal of Anaesthesia, 99 (1), 4-9. Xue, F. S., Liao, X., Liu, J. H., Yuan, Y. J., and Wang, Q. (2011). Airway management in pediatric patients with a rigid external distractor in situ. Pediatric Anesthesia, 21 (6), pp. 699-700. Xue, F. S., Zhang, Y. M., Liao, X., and Liu, J. H. (2009). Airway management for pediatric patients with difficult airways due to craniofacial abnormalities. Paediatric anaesthesia, 19 (7), pp.701. Read More