Custom «Pneumothorax and the Increased Intracranial Pressure Treatment» Sample Essay
In order to diagnose pneumothorax, revealing chest pain, shortness of breath and diminished breath sounds are not enough. The diagnosis should be confirmed by the chest x-ray, which has to assume the clearance of cervical spine. If the x-ray confirms the pneumothorax then the tube thoracostomy attached to an underwater-seal drain followed by clinical examination of the chest and a chest x-ray to confirm the placement of the tube should be conducted. Chest drains are used to remove a collection of air, fluid, pus or blood from the pleural space into a collecting bottle to restore the normal respiratory expansion and function.
In this case, application of the chest tube is right (in case of confirmation of the diagnosis), because it is a safe option. In some cases, patients can be treated without the chest tube, but it is recommended when a) when the pneumothorax is unilateral and small; b) when there are signs of other injuries; c) when there is no detectable air leak, d) when there is no actual requirement for the ventilation (George et al. 2005, p. 577). Inserting a chest tube is the primary measure, which has to be applied in case of pneumothorax, and it is better to place it than not to do this, because otherwise, there exists an increased possibility of penetration of blood, water, and air into the pleural space. Such thing might result in serious negative consequences.
One of the most essential things, which must be taken into account, is the fact that in case of tube disconnection, clamping is forbidden. Clamping the chest drain may cause the tension pneumothorax or subcutaneous emphysema. It is contraindicated, as it is unsafe to clamp a chest tube for any other reason unless under the supervision of a respiratory physician. In case of accidental removal of the chest tube, the dry sterile dressing has to be applied. In case of noticing the air leak, the dressing should be tapped from the three sides to allow the air escaping and prevention of tension pneumothorax.
It is obligatory to monitor the patient and note the bubbling into the sauction-control chamber. 50 mL drainage is not beneficial in a client returning to the nursing unit from the recovery room. In case of drainage of more than 70 to 100 mL/hour is considered excessive and requires the registered nurse and health care provider notification.
The Increased Intracranial pressure is a serious disorder and without proper monitoring techniques, it turns out to be the primary cause of death in most patients, who die of stroke and traumatic brain injury. Adequate control of the intracranial pressure is one of the main therapeutic goals of managing the patient. In the injured brain, cerebral circulation auto regulation is frequently impaired, and for that reason, agitation, which is linked with blood pressure elevations, may cause intracranial pressure surges (Layon et al. 2013, p. 284). While discussing the management procedures applied to Mr. Cushing, several changes have to be mentioned.
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The first is the head position. It is a heatedly debated issue. In general, the traditional head elevation was 30 to 45 degrees above the heart, but not 60 degrees. It is definitely dangerous for the patient, as when the patient’s head is raised above 45 degrees, it negatively affects the CCP. Christopher Loftus (2007) emphasizes that according to the recent studies, the head should be elevated up to 30 degrees, because it significantly decreases the ICP without reducing the CPP. And he claims that all the discussions of the flat positioning of the patient are senseless, as when the patients are placed in horizontal position, it essentially increases the ICP, and is not beneficial for the patients’ health. So, Mr. Cushing head position should be lowered up to 25-30 degrees in order to lower the ICP.
Prescribing the oxygen saturation is a right choice, because the decreased level of oxygen (below 95%) might lead to increased ICP. However, administering H2 antagonists definitely prevent ulceration. But it may result in the development of infection with aerobic Gram-negative bacilli and yeasts.
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Monitoring the electrolytes and hypovolemia is the right decision. Monitoring for the increased or diluted urine is also necessary to get the order for the osmolality to assess Diabetes Insipidus and urine electrolytes (Hockenberry and Wison 2012, p. 937). The patient should be administered additional monitoring, which were not prescribed, which include blood sugar monitoring. It is essential to avoid hyper and hypoglycemia and the glucose level review. Another essential activity to be conducted is the seizure activity monitoring. It would be wise to prescribe anticonvulsants, like mannitol. The dose is 0.5-1,0 g/kg IV over 20 minutes. The thing is that in some cases, intracranial lesions may result in seizures, and the mentioned medication is the first-line treatment in such case.
The treatment prescribed to Mr. Chemotaxis is generally right. Chest tubes should be used in case of pneumothorax, because they assist in removing a collection of air, fluid, pus or blood from the pleural space. Indwelling catheter (IDC) is commonly applied to the patients after the surgery. However, it should be applied for 24 hours only, otherwise there exists a high risk of infection. Application of the intravenous therapy (IVT) is essential in case of brain-injured patient, as it helps maintain the cerebral perfusion pressure without exacerbating the intracranial pressure. The intravenous line should be titrated carefully, while constantly monitoring the patient. IV fluid must be restricted to minimize the cerebral edema. Burr holes were necessary to hasten decompression of the brain and avoid permanent neurologic damage.
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The septic shock and SIRS are characterized by release of mediators that include vasodilation, increase in the microvascular permeability and the capillary leakage of plazma proteins.
The septic shock after an infectious process and SIRS can result from either infectious or noninfectious etiologies. When there is a risk of septic shock, the blood cultures should be obtained. The appropriate time for performing venipuncture is not known; however, it is not necessarily when the temperature is above 38 degrees. Researchers Puri and Hollwarth (2009) in their work state that it is not recommended to take blood cultures during the spike period, because the studies confirm that blood cultures are often negative at that time (p. 72). The temperature spikes and chills are attributed to bacteremia. The blood cultures should be obtained prior to the sudden spike or chill and the second set should taken 20 minutes after the first set from a different site. There should be six sets within 24- to 48-hour period (Kovac 2012, p. 80). The antibiotics should be prescribed after the identification of the bacteria. It is a right decision to monitor the blood cultures, wounds, IV sites, blood, urine, and sputum. Moreover, it would be wise to conduct the lactate measurement to understand whether the person suffers from the septic shock.
Oral Panadol is a weak analgesics and it is generally applied for the routine use. In case sepsis shock or SIRs it would be better to prescribe Mr. Chemotaxis dihydrocodeine or pentazocine. Prescription of the IV- broad spectrum antibiotics is a right choice, in case of sepsis.
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