prioritise and modify nursing interventions for a person with a tracheostomy in consultation with RN?

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Instruction to Students: 

·         Answer the questions below in the spaces text box provided.

·         Ensure all references are documented under each individual question.

·         Answers are to be typed or for written submissions, use black or blue ink and ensure your name is attached to the responses.

 

 

Case scenario 1:

George has come into the acute ward after his wife stated that he had some episodes of obstructive sleep apnoea. George has been placed on a continuous positive airway pressure (CPAP) machine.

 

Provide a response to the following questions based on this case scenario.

  1. Describe the potential physical and psychological impacts of obstructive sleep apnoea on a person’s health status. (Min 100 words)

 

 

Physical effects

·         Sleepiness –

·

 

 

Psychological effects

·         Poor concentration/memory

·

 

 

 

  1. List 3 risk factors for a person developing obstructive sleep apnoea and how a CPAP machine can assist with sleeping. (Min 100 words)

 

Risk factors:

  • Excessive weight
  • Family history

 

How CPAP works: 

 

 

 

 

 

  1. George does not tolerate the CPAP machine and the specialist suggest that they change to Bilevel positive airway pressure (BiPAP) machine. What is difference between CPAP and BiPAP? (Min 50 words)
 

Differentiate BIPAP and CPAP (you may do so in a table, or by paragraph)

 

 

 

 

Case Scenario 2:

Debbie is 30-year-old women admitted to the acute ward after having a spinal anaesthetic for surgical repair to a laceration of her chest cavity after a motor vehicle accident. Debbie is 30 weeks pregnant, has a right intercostal catheter and UWSD to treat a haemothorax, is on oxygen therapy and has a PICC line to maintain fluids and deliver medications.

 

  1. The changes in a woman’s physiology during pregnancy present special challenges to the trauma team, what are they?

 

Research: Changes in woman’s physiology during pregnancy and relate it to the scenario (issues to the trauma team)

 

Example:

  • Laboratory tests need be read with an understanding that values or levels will be slightly different in the 3rd trimester of a pregnant woman compared to a non-pregnant woman

 

  • If a chest tube is indicated, place tube 1–2 intercostal spaces above usual fifth intercostal space landmark due to raised diaphragm

 

 

 

 

 

  1. Describe nursing management and monitoring of a person with an intercostal catheter and underwater seal drainage system and possible complications of this treatment. (Min 200 words)

 

  • Intercostal catheter insertion site checked for signs of infection and wound dressing according to organizational policy and procedures.
  • Check the tubings…
  • Check Underwater seal drainage observe for….
  • Check for
 

Complications:

–             Prolonged clamping may cause a tension pneumothorax

–             Air leaks

–

 

 

  1. The anaesthetists used a spinal anaesthetic for Debbie during surgery; why are the following listed types of anaesthetics used for different presenting health conditions? Complete table below.

 

Anaesthetic type Why would this type of anaesthetic be used?
Sedation  

INDICATIONS

 
General  

 

 
epidural and Spinal This is a shot of anaesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly, hips, or legs. 

Commonly used in surgeries when general anaesthetic is no suitable e.g. caesarean section.

 

 
Peripheral nerve block  

 

 
local  

 

 

 

  1. What pain management strategies and nursing care actions could you use to promote Debbie’s post-operative comfort? (Min 100 words)

 

•    Assessment of pain – ways to perform this 

•    Pain relief

•    Monitor outcome/response

 

 

 

Case Scenario 3:

A patient is admitted post-operatively after a general anaesthesia to the acute ward. The patient is a little drowsy but slowing becoming more alert but is unable to communicate with you due to having a procedure for a tracheostomy.

Patient’s vital signs are: T38.9, R 16, P 85, BP 115/85; GCS 13

oxygen saturation 99%; Humidification 30%

 

  1. What are the most common postoperative complications from general anaesthesia that nurses need to be aware of? (Min 50 words)

 

  • Nausea and vomiting

 

 

(Give at least 8-10)

 

 

 

 

  1. What are some of the physiological changes that occur when a person has a tracheostomy? (Min 50 words)
    • Loss of voice
 

 

 

 

  1. What are the clinical indicators of the need for suctioning of a tracheostomy tube? (Min 20 words)
 
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