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CASE STUDY 3: Mr. JOHN WONG
Whilst in the patient is in PACU, identify and discuss airway management (and rationales) for your chosen patient. (400 words).
Airway management post-operative main goal is to maintain patent airway and therefore reduce the risk of hypoxaemia, hypercapnia or hypoventilation. (Farrell & Dempsey, 2007 – chapter 15). A comprehensive assessment as described by Lambie (2010) “where airways, breathing, circulation, disability (dysfunction of central nervous system) and exposure are examined”. Therefore observations of pallor, sweating, general unease must be documented in the patient chart. Furthermore, respiratory function is variable and influenced by factors including: Pain, pulmonary oedema, respiratory depression due to morphine, airway obstruction (Lambie, 2010).
In addition, airway management would include to monitor patient if fever appears, diminished breath sounds, crackles in the lungs, sputum production, increased respiratory rate and decreased oxygen saturation. Furthermore, assessing every 4 hours patient respiratory rate, depth, breath sounds, and oxygen saturation to check for signs of atelectasis (Lambie, 2010) and therefore may indicate presence of a mucous lung or other major airway obstructions. Oxygen saturations and oxygen requirements are assessed, documented, and closely monitored to intervene promptly if needed and therefore reduce risk of further complications. Not always movement of the thorax and the diaphragm will indicates that the patient is actually breathing, therefore by placing the nursing hand to the patient nose and mouth and feel the exhaled breath will confirm patient is breathing (Farrell & Dempsey, 2007 – chapter 15).
To facilitate lung expansion and decrease diaphragm, is necessary to elevate head of the bed 30 degrees or higher (Lambie, 2010), this position will enhance lung expansion and improve air exchange (Gulanick and Myers, 2007). Also, check patient comfort and repositioning in a lateral or semi-prone position unless is contraindicated by his surgery will ease pain exacerbation and allow entry of air into and out of the lungs. This position also reduces the risk of aspiration should the patient vomit or have excessive mucous secretions. Also, oxygen therapy is normally administered following surgery (or as prescribed) to maintain oxygen saturation above 95% in order to sustain satisfactory levels of oxygenation and to prevent hypoxia/hypoxaemia (Lambie, 2010).
Moreover, monitor any ordered medication closely to observe effectiveness of side effects. Also, for patients with reduced energy, is important to educate them to maintain rest and promote energy conservation techniques (Gulanick and Myers, 2007). Pain assessment would involve using the Abbey pain scale 0 to 10 if patient is able to talk and if not observe behavior change, body movement ,to ascertain the severity of his pain, so providing adequate pain relievers will decrease pain and therefore, diminish level of anxiety and breathing exacerbation (Gulanick & Myers, 2007). Normally patients will experience high level of pain and discomfort to coughing and deep breathing (Farrell & Dempsey, 2007 – chapter 15).
Question 2: In order of priority, using evidence literature, identify and discuss the nursing interventions (and rationales) required to care for your chosen patient in the first s24 hours upon returning to the ward. Nursing intervention/care presented needs to be accurate, relevant and specific to the chosen case study (800 words).
Nursing interventions are focused on management and prevention of complications. The first 24 hours post-operative surgery is to assess any problem that might happen following the discharge from PACU. After the patient returns to the inpatient nursing unit the first 24 hours are crucial to assess patient after recovering from the effect of the anesthesia and therefore being able to identify any possibly complication (Wicker & O’Neill, 2010).
Moreover, in the first 24 hours airway, breathing and cardiovascular assessment should be perform constantly.
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