Patient #1: Vehicular Accident Patient Male, 22 Diagnosis Ineffective Airway

Patient #1: Vehicular accident patient Male, 22 DIAGNOSIS

ANALYSIS

GOAL

Ineffective airway clearance related to increased production of bronchial secretions secondary to fluid shift to extravascular compartment.

Due to trauma that has occurred over the ribs, an intense inflammatory response occurred. Exudation of plasma, leukocytes, infiltration of mast cells, growth factors and inflammatory leukocytes occurs in effect. These fluid and exudates crosses the permeable membrane of the pleurae causing it to accumulate in this membranous space. Instead of the lungs being able to function normally, these fluids inhibit the lungs to expand anteroposteriorly thus causing ineffective breathing and discomfort for the patient.

The patient will be able to have effective airway clearance after the intervention within the hours of the shift.

Cues: -The patient has a tracheostomy - the patient use to point his throat

NURSING INTERVENTIONS – Assessed respiratory rate.

RATIONALE –

Provides a basis for evaluating adequacy of ventilation.

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Use of accessory muscles of respiration may occur in response to ineffective ventilation.

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Noted chest movement; use of accessory muscles during respiration.

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Auscultated breath sounds; noted areas with presence of adventitious sounds.

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Crackles indicate accumulation of secretions and inability to clear airways.

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Documented respiratory secretions: character and amount of sputum.

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Expectorations may be different when secretions are very thick.

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Maintained patient on moderate high back rest.

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Positioning helps maximize lung expansion.

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Checked for obstructions: accumulation of

EVALUATION The patient has obtain effective airway clearance

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Drug Name

Dosage 100mg q8 IVP

Tramadol

Classification Analgesic

Suctioned patient limited to 5-sec duration.

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To maintain adequate airway patency. Duration should be limited to reduce hazard of hypoxia, damage airway mucosa and impair cilia action. Increases lumen size of the tracheobronchial tree, thus decreasing resistance to airflow and improving oxygen delivery.

Indication

Contraindication

Side Effects

Used to treat moderate to moderately severe pain and most types of neuralgia, including trigeminal neuralgia. It has been suggested that tramadol could be effective for alleviating symptoms of

Health professionals have not yet fully endorsed of its use on a large scale for these disorders, although it may be used when other treatments have failed (under the supervision of a psychiatrist).

CNS: sedation, dizziness or vertigo, head ache, confusion, dreaming , sweating, anxiety and seizures CV: Hypotension, tachycardia, bradycardia

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Nursing Responsibilities Should the check the patients name, the correct route, dosage, and frequency of the medicine that should be given

Metronidazole

500 g TIV q8

depression, anxiety, and phobias. Asymptomatic and symptomatic trichomoniasis in females and males; acute intestinal amebiasis and amebic liver abscess; preoperative prophylaxis in colorectal surgery, elective hysterectomy or vaginal repair, and emergency appendectomy. IV metronidazole is used for the treatment of serious infection caused by susceptible anaerobic bacteria in intraabdominal infections, skin infections, gynecologic infections, septicemia, and for preoperative and postoperative prophylaxis, bacterial vaginosis. Topical: Rosacea.

Blood dyscrasias; active CNS disease; 1st trimester of pregnancy (category B), lactation. CAUTIOUS USE Coexistent candidiasis; second and third trimesters of pregnancy (category B); alcoholic liver disease.

(> 1%) Body as a whole: hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, overgrowth of Candida. CNS: vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, fatigue, paresthesias, sensory neuropathy (rare). GI: nausea, vomiting, epigastric distress, diarrhea, constipation, dry mouth, proctitis, anorexia, abdominal cramps, metallic/bitter taste. Urogenital: pulyuria, dysuria, pyuria, incontinence, cystitis, decreased libido, dyspareunia, dryness of vagina and vulva, sense of pelvic pressure. Special senses: Nasal congestion. CV: ECG changes

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Discontinue therapy immediately if symptoms of CNS toxicity develop. Lab tests: obtain total and differential WBC counts before, during, and after therapy, esp. if second course is necessary. Monitor for S&S of Na retention, esp. in patients on corticosteroid therapy or with a history of CHF. Monitor patients in lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician immediately. Repeat feces exam, usually up to 3 mo, to ensure that amebae have been eliminated.

(flattening wave).

Pantoprazole

40g TIV OD

Gastric acid pump inhibitor; belongs to a class of antisecretory compounds. Gastric acid secretion is decreased by inhibiting the H+, K+-ATPase enzyme system responsible for acid production.

Short-term treatment of erosive esophagitis associated with GERD.

Hypersensitivity to pantoprazole or other PPIs; severe hepatic insufficiency, cirrhosis. CAUTIOUS USE Mild to moderate hepatic insufficiency; pregnancy (category B). lactation. Safety and effectiveness in children <18 years are not established.

of

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(>1%) GI: diarrhea, – flatulence, abdominal pain. CNS: Headache, insomnia. Skin: rash. –

Monitor for and immediately report S&S of angioedema or severe skin reaction. Lab tests: urea breath test 4-6 wks after completion of therapy.

Ceftriaxone

1g

Bactericidal:

IV

Inhibits synthesis of Bacterial cell wall, causing cell death

q12

Perioperative Prophylaxis

Contraindicated with allergy to cephalosporin or penicillins or penicillins

CNS: head ache,dizziness, lethargy,parestesia GI: nausea, vomiting, abdominal pain, flatulence, liver toxicity

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GU: nephrotoxicity Hematologic: bone marrow depression Hypersensitivity: ranging from rash, fever to anaphylaxis

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Perform skin test before administering to detect if the patient is allergic to the drug Assess for patient’s history of liver and renal depression, lactation and pregnancy Have vitamin K available in case hperprothombinem ia occurs

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Discontinue if hypersensitivity occurs Inform the patient about the side effects.

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Instruct patient to avoid alcohol while taking the drug and for 3 days because severe reactions often occur

Local: pain, inflammation at IV site