nursing acutely ill adults, high dependency

Intracranial pressure, Respiratory system, Breathing


All nurses should possess critical care skills to enable them to impact positively on their patients care (DH 2000). The Higginson and Jones (2009) state, in BJN, that the initial assessment of the critically ill patient vary but should follow a pattern based on assessing A, B, C, D and E, in other words airway, breathing, circulation, disability and environment. This essay is concerned with the altered physiology of Jim’s (for confidentiality a pseudonym has be used, NMC 2008) respiration, due to a spontaneous, non-traumatic subarachnoid hemorrhage and the nursing care he received while in the Intensive Therapy Unit (ITU) will be discussed. The pathophysiology of the haemorrhage Jim suffered will be explored and why it caused Jim’s airway to be altered. His airway and its management will be the priority for nursing staff. In order to maintain a patent airway, suctioning of the airway will be the priority followed by oral care to prevent infection, although other nursing needs such as nutrition and pressure areas will be discussed briefly. Jim was admitted to ITU with an endotrachael tube (ETT) which had been placed in A&E after his consciousness dropped due a subarachnoid haemorrhage, see appendix one. According to Kumar et al (2005) a subarachnoid haemorrhage, which occurs in the subarachnoid space, can usually be attributed to a rupture of a saccular aneurysm, also known as a ‘berry’ aneurysm. Kumar et al (2005) continues to explain that two of the possible predisposing factors contributing to the formation of a saccular aneurysm growth are smoking and hypertension. Although Jim had no past medical history, according to the Stroke Association ‘almost a quarter of people in the UK are unknowingly suffering from undiagnosed high blood pressure.’ Hypertension is one of the single biggest risk factor for causing a stroke and therefore could have, at least...
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