Introduction
This paper will discuss a case study of Pritesh, a 26 years old man who is transferred from the emergency department (ED) to the high dependency unit (HDU) with the developing of a tension pneumothorax. Initially, a general description of the patient’s chief complaint which is tension pneumothorax will be introduced, following by assessments of the patient’s need. The paper will focus on the discussion of nursing care and management for the patient, and a brief summary and evaluation of the care will be given. Lastly, a conclusion of what author has learned from this case study will be present.
Patient’s chief complaint
Pritesh has a previous medical history of asthma and has experienced right-sided haemothorax as he got hit by a hockey ball during a competition. Currently, the nurse suspects that Prithesh may be developing tension pneumothorax which is a life-threatening medical emergency (Brown & Edwards, 2012). Tension pneumothorax develops when a hole in the airway structures or the chest wall allows air to enter but not leave the thoracic cavity (Rodgers, 2008). The pressure in the intrathoracic space will continue increase until the lung collapses, place tension on the heart and the opposite lung leading to respiratory and cardiac function impairment, and eventually shock may result (Professional guide to pathophysiology, 2011; Rodgers, 2008). Tension pneumothorax usually results from a penetrating injury to the chest, blunt trauma to the chest, or during use of a mechanical ventilator (Brown & Edwards, 2012; Rodgers, 2008).
Assessments
There are a number of assessments that may need to be conducted after Pritesh being admitted in HDU. First of all, Pritesh’s health history, such as pervious health history ...
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...c should be between 60-80 mmHg, heart rate should be within acceptable range of 60-110 beats/min, and central venous pressure should drop to the range of 0-6 cmH2O (Brown & Edwards, 2012; Rodgers, 2008; Swearingen, 2012). The patient’s pain score should be below 3-4 on a 0-10 pain rating scale, or absence of pain (Swearingen, 2012). The patient should be alert with no signs of agitation, and has good understanding of tension pneumothorax and interventions required (Swearingen, 2012).
Student reflection
From this case study, the author has learned that tension pneumothorax is a medical emergency that requires interventions immediately. The author has also realised that malfunctioned drainage system and chest tubes could lead to developing of tension pneumothorax. Therefore, staff education about how to assess and maintain closed drainage system is important.
1. Nine year old Jerry stumbled into a drug store, which is usually open late with very few attendants, gasping for breath. Blood was oozing from a small hole in his chest wall. When paramedics arrived, they said that Jerry had suffered a pneumothorax and atelectasis. Just what do both these terms mean and how do you explain his respiratory distress? How will it be treated?
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
When horrific crimes occur in large cities, many of them can be chalked up to gang violence or to the larger population of that specific city. But when horrific crimes happen in small cities like Lincoln, Nebraska, people begin to ask questions like who did this and why. In 1958, a nineteen year old man named Charles Starkweather put the entire state of Nebraska and possibly the entire nation in a state of terror. With his murder spree taking only three days, Starkweather had collected a body count of ten bodies, including two teenagers and a young child. Understanding Starkweather’s past and state of mind begins to answer the second question of why.
This essay focuses on the case study of Giovanni DeBella, who is a 72-year-old male and has come into the Emergency Department (ED) at 0300 reporting that he was experiencing shortness of breath and suffocation. Giovanni has a history of Chronic Heart Failure (CHF) and is now diagnosed with acute manifestation of heart failure due to the signs and symptoms he had experienced. The signs and symptoms consist of dyspnea, swollen feet, course crackles on auscultation, and pitting oedema on his lower limbs. The key aspects discussed in this essay include the priority problem of impaired gas exchange and excess fluid volume. Nursing interventions which will help to manage these problems are positioning, breathing exercises, and use of compression
This presentation was very informative and he was able to make the presentation very interactive and interesting. There are three basic wave forms on a ventilator in which are Airway pressure/ Time, Flow/time, and Volume/Time. The parameters are displayed in waveforms showing the proximal airway pressure/Time, Inspiratory & Expiratory flow rate/Time, and Inspiratory & Expiratory Volume/Time. The loops show pressure/volume and Flow/Volume. Greg Ruiz went through various pictures and took time to explain to us the Flow/ Volume loops and how they function and are displayed. He showed us various shapes of the PV loop that can display controlled breath, assisted breath, and Spontaneous breathe. Over distention occurs when the “volume limit” of some components of the lung has been exceeded; in which causes an abrupt decrease in the lung compliance near the termination of inspiration. At the end of the PowerPoint presentation, we were given a quiz to see if we were able to tell what the issue included through the ventilator readings. Mr. Ruiz informed us that he really preferred a visual presentation such as graphing rather than numbers displayed on a ventilator. He also shared that the ventilator can show you everything that might be occurring with the patient and how you can help to resolve the
History of present illness: The patient is a 71 year old male of the Veteran Association. His past medical history includes coronary artery disease and chronic obstructive pulmonary disease. The patient was involved in a contraindication at home where he was thrown into a dresser and hit his lower back. Shortly following the incident the police were contacted. During this time the patient consequently began to develop some substernal chest pain with a radiation to the left arm; the patient also became diaphoretic and somewhat out of breath. Emergency medical services (EMS) were contacted. EMS gave the patient aspirin and nitroglycerin and started a saline lock. EMS brought the patient to the emergency department. The patient had
Airway, trachea was in the middle, tip of the endotracheal tube ends at 2.2 cm above the carina in between the second and third thoracic vertebrae; Bones, there were no broken bones; Cardiac silhouette, normal; Diaphragm, right hemi-diaphragm was higher than the left with sharp costophrenic angles; Effusion, no pleural effusion or pneumothorax; Fields, subsegmental atelectasis noted in the left upper lobe, right upper lobe and right middle lobe; Endotracheal tube (ETT), and Nasogastric tube (NG) were seen on the
...l. "[The Use Of Physical Restraints In An Acute Care Hospital]." Assistenza Infermieristica E Ricerca: AIR 23.2 (2004): 68-75. MEDLINE. Web. 22 Oct. 2013.
Using medication will decrease all the pressure that is caused by fluid going around the lungs and heart. Pulmonary edema may be life-threatening, especially without urgent medical treatment and professional assistance. Curing this problem may also be follow the steps of supplement oxygen and medicine. The patient should then follow a low sodium diet to prevent this from being an occurring health problem. Oxygen therapy on a three to five-day treatment will cut down on the chances of having this health condition attacking the Pulmonary system. Follow -up appointments scheduled by a patient that had been diagnosed with Pulmonary edema is critical. Just based off the studies that this wet lung disorder is a chronic build up that is to be controlled and not necessarily cured. Controlling possible risk factors such as salt intake, smoking, cholesterol consumption and taking the prescribed medications will eventually help minimize symptoms and future episodes of edema. On the other hand, it is important to understand that a lot of treatment resolutions can come from self-care which include a low sodium diet and also supportive care which consists of an oxygen therapy treatment. Nevertheless, with a low sodium diet, this a type of diet that restricts salt and other types of sodium. With the oxygen treatment, patients with pulmonary
Respiration is vital for all physiological systems to function and is especially important for patients that are recovering from disease and invasive medical procedures. Respiration is contingent on how much pressure is exerted on the internal organs and how much resistance these organs meet when trying to relieve this pressure. In this regard, posture has a great influence on how well the respiratory system functions. It has been found that standing and lying in an augmented prone position are the best postures for promotion of respiratory function, as these positions allow more room for respiratory muscles to move and decrease resistance. In these positions, patients are able to intake greater amounts of air, which allows for greater perfusion of oxygen to the tissues, in turn allowing the tissues to heal faster. These postures are found to be most beneficial in patients who suffer from respiratory distress or have similar symptoms. The position that best promotes respiratory function is not always one that is used by medical professionals, as many variables influence this decision. Practitioners must consider the complex needs of the patients when deciding how to treat them. This process often leads the professional to place the patient in positions that are less beneficial to respiratory function in order to accommodate other needs of the patient, such as medical equipment or relief of pressure sores. Further barriers to use of the evidence-based practice are the overall practicality of placing a patient in the discussed postures. It may be very difficult to place a patient in an augmented prone position if he or she is in respiratory distress, as this position seems counterintuitive to the patient. Other patients may not b...
CT scans of the chest with contrast was also done which showed right lower lobe consolidation with air bronchogram as well as region of decreased density suggesting possible pulmonary necrosis in the medial right lower lobe and moderate right-sided pleural effusion with right middle lobe atelectasis, trace pericardial effusion or thickening on the right medially, mildly enlarged mediastinal, and right hilar lymph nodes likely reactive in etiology and moderate centrilobular emphysematous changes bilaterally most prominent in both upper lobes. Then, administration of antibiotic azithromycin and Rocephin was initiated. A Pulmonologist at Mercy Folsom evaluated her and recommended to continue the broad-spectrum antibiotic and thoracentesis of the right-sided pleural effusion was done with 700 mL of fluid were removed consistent with exudate and empyema. Afterwards, antibiotic was switched to vancomycin and cefepime and was evaluated by Surgery. Chest tube placement was done on the right side drained some serosanguineous fluid discharge from the right-sided chest tube and empyema is noted. She was transferred to Mercy San Juan Hospital to be evaluated by thoracic surgeon, for possible VATS and surgical intervention for her right-sided
Ruppert, S, D., Shiao, S, K., Tolentino-DelosReyes, A. F.,(2007). Evidence- Based Practice. Use of the Ventilator Bundle to prevent Ventilator associated pneumonia (3rd ed). American Journal of Critical Care.
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
A tension pneumothorax can be caused by a blunt or penetrating trauma, in the case study provided it would be a blunt trauma. The trauma to the chest area causes damage to the plural cavity; either the visceral (lines either lung) or parietal plura (lines the thoracic wall), or can be caused by trauma to the traceobronchial tree (Daley, 2014). The trauma to the chest area causes the formation of a one-way-valve, this allows for the air to flow into the plural space on inhalation, but on exhalation cannot be expelled (Curtis, Ramsden, & Lord, 2011). As the trapped air in the lungs build up within the affected side it can cause serious complications.
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.