Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
Gentry and Kellie Moran, LCSWA. The both share the disposition that the patient should be reevaluated in the morning. TACT will contact the patient wife, Caroline, for further information on the patient behaviors. The patient was made aware that he is under IVC and the conditions of that
So now that he was unable to get IV access, he had to obtain an intraosseous infusion (IO). Upon insertion of the IO, you could hear the drill perforate through the tibia. Through the access, Narcan was administered. The advance support provider then took over to establish an advanced airway. He was asking for certain equipment and I can remember feeling my adrenaline pump through my veins, it was really a mix of
Annette’s reason for admittance at the hospital is an overall weakness, flu-like symptoms, and difficulty with breathing (Prizio, n.d.). She is diagnosed with diabetic acidosis, left upper lobe pneumonia, and a bacterial infection (Prizio, n.d.). Unfortunately, her condition becomes worse. Annette’s right lung collapses, her heart rate is irregular, and she has an episode of unresponsiveness that leads to mechanical ventilation (Prizio, n.d.). Annette has challenges weaning off the mechanical ventilation, which resulted in the placement of a tracheostomy and percutaneous endoscopic gastrostomy tube (Prizio, n.d.).
Arterial line kit for continuous hemodynamic monitoring b. Central venous catheter for drug administration c. Ice packs d. Cooling blanket and cooling machine filled with filtered water e. Rectal temperature probe for continuous temperature monitoring f. Sedation/ Neuromuscular blockade g. Mechanical ventilator without heated humidification N5. Baseline nursing assessment6,7,8,9 a. Baseline neurological assessment, including GCS and pupil assessment b. Baseline vital signs (heart rate, blood pressure, SpO2, ETCO2, EEG and cardiac rhythm assessment) c. Baseline skin assessment d. Baseline body temperature e. Baseline blood work: Potassium, Magnesium, Phosphate, Calcium, Glucose, ABG, PTT, INR, platelets, Amylase, AST, ALT, Bilirubin, Alkaline Phosphatase N6.
The nursing staff could wean the patients’ nitroglycerin drip as well as morphine and versed (drugs used for pain management and a sedative), overnight. After his initial morning assessment by respiratory, nursing, and his physician, respiratory was given the order to assess weaning parameters and perform a spontaneous breathing trial for possible extubation. The patient was breathing over the rate with adequate volumes, with a RSBI of 52. At this time, we placed the patient on pressure support with minimal settings to see what he could do on his own, Pressure Support settings of 10/5, 21% FiO2. This patient well exceeded normal limits and the physician placed the order for extubation.
The desired outcome will be having the patient with clear lung sounds, edema free and denies dyspnea on exertion. To achieve these outcomes we need to monitor body weight daily, ? changes in bodyweight reflect changes in body fluid volume? (Methney, 2010). Mean time we need to monitor extension and location of edema?
The nurse need to make sure the tube eyelets are visible; to keep the drainage below the patient chest level. Also to report any change in condition, such as pulse oximetry less than 90%, drainage greater
In critically ill patients, several scoring systems have been developed. The Acute Physiology and Chronic Health Evaluation (APACHE) and the Simplified Acute Physiology Score (SAPS) are the most common scoring systems used in the intensive care unit (ICU).[1] They are used for risk stratification and prediction of mortality.[2] The scoring systems should be easy, quick,cheap and predict something clinically important over a wide range of clinical situations.[3] While it seems that scores using a larger number of data inputs are the best scoring systems, simpler scores are better than complex scores. The more the score complexity, the more the barrier to calculation, as it increases the probability that some data inputs may not be available.
In the beginning of the simulation, my patient was short of breath and verbalized being in extreme pain. My initial intention was to obtain vital signs for a baseline assessment. However being under pressure from the remarks of intense pain, I lost
37% of patients had at least one episode of respiratory rate below 8 breaths per minute. But most of the time it was of very brief duration, and could be reversed by verbal command, light stimulation or by decreasing the target. As the authors identified, failure of sedation was a real possibility, for this reason a controlled environment is critical and skilled
It reduced ventilator days, length of stay in ICU and decreased mortality rates and significantly success rates associated with compliance of the nursing staff and collaborative
The lab experience was great since with have the opportunity to work with physical Therapist students and learn from that experience how to communicate and interact with others health care workers. The patient was alert and in a spontaneous (SP) mode with a FIO2of 30%, CPAP of 5cmH2O, and pressure support of 10. Oxygen saturation of 93% while in SP mode and Sedation vacation began 30 minutes ago tell us that the patient was good for early mobility. My role as a RT was to manage the ETT tube, ventilator, and patients O2 saturation. As a group we decided that when the patient was not tolerating the treatment.
Assessment is a fundamental component of any nurse’s role. However, from what I observed today it seems particularly vital to the PACU nurse. While they do provide interventions, the majority of PACU nurses’ time is spent assessing their patients and documenting their findings. Patients in the PACU have undergone the significant stressor of surgery under general anesthesia and they have the potential for very serious complications. It is up to the PACU nurse to observe if the patient is declining and act quickly and appropriately.
