Preview

Trauma Nursing Care Study B+ Paper

Best Essays
Open Document
Open Document
4493 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Trauma Nursing Care Study B+ Paper
Introduction
This paper presents the care to a patient during one shift in the Intensive Care Unit (ICU). Tony*, a 79 year old,was admitted to ICU with suspected anoxic brain injury;post Out of Hospital Cardiac Arrest; and Head Injury. Cardiopulmonary Resuscitation was initiated by his son. When the EMTambulance arrived Tony was pulseless, cardiac monitoring showed Ventricular fibrillation – he was cardioverted twice at the scene.
Inthe Emergency Department (ED) he developed Ventricular tachycardia and required a further cardioversion. CT brain showed subdural brain haemorrhage. Therapeutic Hypothermia (TH) wascommenced in ED.As Tony was without CPR for 20-25 minutes at home, his prognosis was uncertain and his family were informed of this. He had a history of hypertension.
Day 1 nursing care and diagnosis for Tonyand 2 concepts from the Careful Nursing Model(Meehan 2012a) will be discussed.
Psycho-Spiritual Reality
Tony’s psycho-spiritual reality was assessed through touch as Tony was sedated. I sat at his bedside and introduced myself. While talking to Tony he did not display any emotional effects of distress or pain. His face was relaxed and calm.
I assessed Tony through his family, as they sat with him and spoke to me about him. They told me he was a peaceful man, and contented with life. They denied he ever had low moods or stress – although he did become animated during soccer matches! He was happily married for nearly 60 years and his wife was in good health. They had 2 sons and 1 daughter. One son lived in Australia. His other children were married and lived close by. He had 3 grandchildren which he adored. His son in Australia was making arrangements to return to Ireland.
The Therapeutic Milieu
The therapeutic milieu of the environment Tony was cared in was assessed using the five dimensions defined by Meehan, (2012a). The environment had an awareness of caritas. Caritas allows nurses to care for patients with kindness, compassion, tenderness



References: *Tony* pseudonym American Association of Neuroscience Nurses (2011) ARDSNET (2002). ‘Ventilation with lower tidal volumes in patients with the Acute Respiratory Distress Syndrome’. New England Journal of Medicine 34(18) 1301-1308 Bader, M.K., Rovzar, M., Baumgartner, L., Winokur, R., Cline, J., Schiffman, G Badjatia, N., Strongilis, E., Gordon, E., Presciutti, M., Fernandez, A., Buitrago, M., Schmidt, M., Ostapkovich, N., Mayer, S. (2008) ‘Metabolic impact of shivering during therapeutic temperature modulation: the BedsideShivering Assessment Scale’ Carpenito-Moyet, L.J. (2010) ‘Handbook of Nursing Diagnosis’ 13th ed. Wolters Kluwer. Lippincott Williams & Wilkins. Philadelphia. P:487 Clayton, T.J., Nelson, R.J Helmy A., Vizcaychipi, M., Gupta A.K., (2007) ‘Traumatic brain injury: intensive care management’.British Journal of Anaesthesia 99 (1): 32–42 Holzer, A.J., Herker, H., and Mullner, M Kress, J. P., Pohlman, R. N., O’Connor, M. F. and Hall, J. B. (2000) ‘Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation’. The New England Journal of Medicine 342(20), 1471-1477. Määttä, S.M. (2006) ‘Closeness and distance in the nurse-patient relation. The relevance of Edith Stein’s concept of empathy’. Nursing Philosophy, 7, pp. 3-10. Mavin, C. (2008) ‘Does underpinning evidence influence the frequency of neurological observations?’ British Journal of Neuroscience, Oct, 5(10), 456-458. McKiernan, M., and McCarthy, G. (2010) ‘Family members’ lived experience in the intensive care unit: A phenomological study.’ Intensive and Critical Care Nursing, 26, pp.254-261 Meehan, T.C Meehan, T.C. (2012b) ‘Spirituality and spiritual care from a Careful Nursing perspective’ Journal of Nursing Management. 20, 990-1001 McQuillan, K Pedersen, C., Rosendahl-Nielsen, M., Hjermind, J., Egerod, I. (2009) ‘Endotrachael suctioning of the adult intubated patient –What is the evidence?’Intensive and Critical Care Nursing (2009) 25, 21—30 Polderman, K.H Polderman, K.H., Herold, I. (2009). ‘Therapeutic hypothermia and controlled normothermia in theintensive care unit: Practical considerations, side effects, andcooling methods’.Critical Care Medicine. 37(3)1101-11-20 Prescuitti, M., Bader, M., Hepburn, M Stewart, S.L., Secrest, J.A., Norwood, B.R., and Zachary, R. (2003) ‘A comparison of endotrachael tube cuff pressures using estimation techniques and direct intracuff measurement.’ American Association of Nurse Anaesthetists, 71(6), 443-447. The Hypothermia after Cardiac Arrest Study Group (2002) ‘Mild hypothermia to improve the neurologic outcome after cardiac arrest’.NewEngland Journal Medicine. 346(8):549-556 The NICE-SUGAR Study Investigators

You May Also Find These Documents Helpful

  • Satisfactory Essays

    If a person is exposed to the cold for a prolonged period of a time and their bodily mechanisms are unable to replenish the heat which is being lost, the body’s core temperature will fall prompting characteristic symptoms such as shivering, mental confusion etc.…

    • 253 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Case Study 3

    • 322 Words
    • 2 Pages

    The primary cause of the patient’s respiratory distress comes from hypoxemia. The hypoxemia is caused by heart failure possibly from emboli and obstructions in the circulatory system, which is causing the patient to breathe harder and faster to compensate. The mild respiratory alkalosis/hypoventilation is from the hypoxemia. The emboli is causing VA/Q mismatch.…

    • 322 Words
    • 2 Pages
    Good Essays
  • Better Essays

    Malignant Hyperthermia (MH) is a rare, life threatening, pharmacogenetic disorder characterized by hypermetabolic state of skeletal muscle induced by inhalation anesthetics like halothane, sevoflurane, desflurane and the depolarizing muscle relaxant agent like succinylcholine (Rosenberg et al, 2007). Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010)…

    • 1195 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    Putul Barua

    • 440 Words
    • 2 Pages

    Dr. J.K. Mc Clain and other members of the cardiology dept consulted on the pt. they felt that his hypoxia and breathlessness wer not secondary to his cardiac status. He had super ventricular cardiac arryhtmias, including atrial fribulation and atrial flutter. The cardiology staff utilized intravenous medication that controlled the cardiac rage, adequately resolving these cardiac issues. I managed the pt ventilator in intensive care status along with my respitory theraoy team. Unfortunately the pt developed multiple infections, hospital acquired, including Klebsiella pneumonia infection and probable fungemia. Multiple eval…

    • 440 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. Every day, 138 people in the United States die from injuries that include TBI. Those who survive a TBI can face effects lasting a few days to disabilities which may last…

    • 1575 Words
    • 7 Pages
    Good Essays
  • Better Essays

    Respiratory Therapy

    • 1288 Words
    • 6 Pages

    Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to the adequacy of tissue oxygenation in such patients, irrespective of PPaO2, and the emergence of "permissive hypoxemia," analogous to permissive hypercapnia, in managing them. (3)…

    • 1288 Words
    • 6 Pages
    Better Essays
  • Good Essays

    Ethr Protocol Analysis

    • 1396 Words
    • 6 Pages

    The decision to initiate ECPR depended on the provider present in the ED upon patient arrival as well as the availability of the ECPR team. Data for the study was collected from multiple registries including pre-hospital and hospital. Follow-up information was obtained via telephone or inquiry form. Neurologic status at three months after cardiac arrest was analyzed via the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories scale (CPC).…

    • 1396 Words
    • 6 Pages
    Good Essays
  • Satisfactory Essays

    © 2009 American Association of Critical-Care Nurses Published online http://www.ajcconline.org Personal use only. For copyright permission information: http://ajcc.aacnjournals.org/cgi/external_ref?link_type=PERMISSIONDIRECT…

    • 366 Words
    • 2 Pages
    Satisfactory Essays
  • Best Essays

    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.…

    • 5173 Words
    • 21 Pages
    Best Essays
  • Powerful Essays

    Developing Adult Critical Care (GM6314) Neurogenic fever management following traumatic brain injury patients Word count: The measurement of body temperature and treatment of fever have long been considered to be within the domain of nursing practice. Intensive care unit (ITU) nurses are well positioned to lead the way to best practices for fever management ' ' grounded in current evidence for their vulnerable patients with TBI. Introduction On the other hand, fever in the early stage of TBI might be of infectious cause rather than neurogenic(Thompson,2003) Progress in neuroscience over the past decade has enabled a better understanding of the neurobiological basis of fever. Apart from being a symptom, NF is also associated with neurologic complications, which are considered to be triggered mainly as a result of increased local cytokines activity which sets in motion a cascade of pathophysiological changes (inflammation, release of excitotoxic amino-acids, and production of free radicals) with delayed clinical presentation. Knowledge regarding these dynamic events is essential for a better understanding of fever management (new pharmacological avenues and non-pharmacological strategies), which are being developed to improve the outcome of this silent devastating condition. Physiology The hypothalamus and preoptic regions play a crucial role in integrating and initiating autonomic thermoregulatory mechanisms such as skin vasomotor responses, sweating, salivation, and shivering. On the other hand,there are cortical and subcortical areas that influence the activity of the hypothalamus includes: the orbito-frontal, anterior temporal, insular regions, amygdale (particularly the central nucleus), the periaqueductal gray, and the nucleus of the tractus solitarius, along with cerebellar nucleus. Damage to these areas due to the primary injury or from the secondary processes, releases the control of vegetative functions and results in disruption of overall…

    • 1781 Words
    • 5 Pages
    Powerful Essays
  • Powerful Essays

    Case Study on Pneumonia

    • 1632 Words
    • 7 Pages

    Gill, S. S., Reddy, M., & Ronchon, P. A. (2006). Preventing pressure ulcers: A systematic…

    • 1632 Words
    • 7 Pages
    Powerful Essays
  • Powerful Essays

    CBE Paper (Martin)

    • 1243 Words
    • 5 Pages

    and lowered oxygen consumption by body tissues. Although hypothermia may produce fatal cardiac arrhythmias such as ventricular fibrillation, it is also associated with bradycardia and peripheral vasoconstriction, both of which enhance oxygen supply to the…

    • 1243 Words
    • 5 Pages
    Powerful Essays
  • Powerful Essays

    This paper will explain the process of Extracorporeal Membrane Oxygenation (ECMO), its original intended purpose, new advancements in the process, and complications post ECMO. It will also examine the origin of the process and how it differs from other types of life support. The professional nurse takes ownership in the well being and safety of the client, and as such has a responsibility to become well informed in the processes, equipment, and technologies that make it possible for the client to strive. The client is always the priority and safe nursing is the measure in which the nurse aids a client through the recovery process. Patient monitoring continues to be even more critical when the bodies own processes are being intervened and replaced…

    • 1167 Words
    • 5 Pages
    Powerful Essays
  • Best Essays

    [xc] Osborne, GA, et al. Crisis management during anaesthesia: awareness and anaesthesia. Qual Saf Health Care. 2005; 14(3):e16.…

    • 7300 Words
    • 30 Pages
    Best Essays
  • Good Essays

    Case Study1

    • 1010 Words
    • 5 Pages

    Elliot, M., & Conventry, A. (2012). Critical care: the eight vital signs of patient monitoring, British Journal. 21(10), 621-625…

    • 1010 Words
    • 5 Pages
    Good Essays