Please help with Case Study Scenario!! - page 3
by cdl766 2,860 Views | 24 Comments
I would appreciate any insights and thoughts on this case study scenario! I will write my thoughts after the study, but I'm hoping for some help on this one!!! CASE STUDYYou are an ED nurse and a patient arrives via EMS... Read More
- 1May 5, '13 by NYCRN16[QUOTE=cdl766;7314742]
So, yes airway airway airway. If he is at 97% on 15L non rebreather, doesn't that mean his airway is holding up fine? QUOTE]
This is a dangerous assumption to make. This is exactly the type of patient that gets put on a stretcher in the hallway because he stinks and is drunk and when you go back in an hour to see him he is dead.
Remember, saturation is not a good indicator of resp effort. A patient can be apnec for 2 minutes before having a drop in saturation, by the time he drops its pretty late. I have seen this with my own two eyes in the PACU, the sat is fine but the patient is not breathing at all or taking breaths so shallow that he has no breath sounds because he is not moving air.
The nasal airway is in place to keep his airway open until arrival at the hospital. This patient would have to be closely watched if the doctor decided not to intubate on arrival. Depending on the doctor, you may have some that would intubate right away and others that would just watch him closely and see if he improves.
Personally, if the patient did not have active shingles I would not put him in an isolation room where I can't see him.
- 1May 7, '13 by GrnTea" became I tundras in the field"
I think that's autocorrect for "obtunded," .
The hypothermia is just about at the life-threatening level. You need orders fr active rewarming, e.g., to give heated humidified (not dry room-temp) gases to breathe and warmed (not room-temp) IV fluids, in addition to nursing measures like removing ongoing routes of heat loss (wet clothes, skin, and hair in a nice air-conditioned place) because merely instituting measures to preserve body heat (hat, warm dry clothing) will not do a thing to warm him.
When you look up hypothermia, what does it say to worry about with rewarming? What are some of the other effects of hypothermia? Hint: additive effects with other factors to increase risk of bleeding, lousy oxygenation, electrolyte imbalances, arrhythmias ...