Introduction
Mr Brian May is a 62-year-old man who was admitted to the emergency department following an automobile accident. Mr. May just lost his wife to pancreatic cancer six months ago, leaving him a widower. He is presently a lone resident in the little village of Wudinna. He informed the ambulance drivers and medical staff that he was non-compliance with his medication, which caused his type 2 diabetes mellitus to be in an unstable state. The prior medical history of Mr. May includes Type 2 diabetes mellitus, hypercholesterolemia, depression, and hypertension.
Identity of the patient was Mr. Brian May, 62 years 62-year-old man, admitted to the emergency department, his situation was a restless night, sleeping for short periods, and at times disoriented. The level of concern is high, patient is unstable. His background was recorded to be Type 2 diabetes mellitus, Hypercholesterolaemia, Depression, Hypertension, a current smoker of 25 cigarettes a day, and a recent weight gain of 15 kg in the last 3 months. BMI is now 30. It is believed that Mr. May suffered a medical emergency that led to him losing control of his vehicle. His assessment and action were in the accident, Mr. May sustained the following injuries, left pneumothorax and blunt chest injuries, fractured left fibula, and left-sided laceration of his forehead. ETOH 50 g daily.
Thus, it was recommended that a plaster cast be applied to the fractured left fibula – Patient-controlled analgesia commenced for pain relief. Fentanyl 500 microg in 50 mL of Normal Saline at 2 mL per bolus dose. Oxygen therapy at 2 L. min administered via nasal specs. An underwater seal drain (UWSD) was inserted in the Emergency Department by the trauma registrar. Dressing to his head laceration. Admission to the High Dependency Unit (HDU). PCR testing for COVID-19. Response & Rationale for the assessment were restless night, sleeping for short periods, and at times disoriented. He tested COVID-19 positive which enhanced the respiratory precautions.
The assignment would discuss a case study of a patient who has been admitted to the hospital. The assignment has been a subsection that includes a description of the reason for admission, identification of two separate nursing problems, nursing management of the two identified nursing problems and discharge planning for the patient. The final section of the assignment contains a summary of the main points that have been addressed in this work.
Primary admission
Mr Brian May is a 62-year-old man who was admitted to the emergency department following an automobile accident involving a tree that happened at 5.30 a.m. on Old Stump Road in Wudinna earlier today. It is believed that Mr. May suffered a medical emergency that led to him losing control of his vehicle. Witnesses said the automobile was traveling at 50 km. hr at the moment. He suffered from Left pneumothorax and blunt chest injuries, a fracture in the left fibula, and a left-sided laceration of his forehead.
The medical word for a collapsed lung is pneumothorax. A pneumothorax can be caused by a piercing or traumatic chest wound, certain surgical procedures, or damage from underlying lung disease or it can take place seemingly out of nowhere. Common symptoms include acute chest pain and shortness of breath. Sometimes, a collapsing lung might endanger life (Xu et al. 2020). A break in the fibula bone is referred to as a fibula fracture. A fracture can be brought on by a strong impact, such as landing after a high jump or any contact to the outside of the leg. The most common reasons for lacerations to the forehead, peri-orbital, and peri-oral areas were falls and attacks. With a mean length of 2.4 cm, lacerations were mostly linear, and nearly 75% of them were caused by blunt trauma.
Identification of two nursing problems
The two nursing problems that must be prioritized in this case are COVID-19 positive which is increasing respiratory distress and disorientation due to the left side laceration of the forehead of the patient. The patient complained of pain during inspiration and the breathing process is still labored. His partial pressure of oxygen has been reported to be 68 mmHg which should be 80-100 mmHg. He might have developed acute respiratory distress syndrome or ARDS. Due to both direct and indirect lung insults, acute respiratory distress syndrome (ARDS) is a severe inflammatory lung condition (Gibson et al. 2020). Reduced lung compliance, tachypnoea, and severe hypoxemia are symptoms of ARDS, which are characterized by increased vascular permeability, protein-rich edema, diffuse alveolar infiltration, and loss of aerated lung tissue. Since it first appeared, COVID-19 has typically been linked to ARDS and has grown in significance. Despite advancements in mechanical ventilation, the death rate among patients with ARDS caused by COVID-19 is shockingly high (Hasan et al. 2020).
The incident in which Mr. May suffered an accident caused a head laceration which might have caused a traumatic head injury that might have resulted in disorientation. Traumatic brain injury (TBI), sometimes referred to as an intracranial injury, is brain damage caused by an external impact. The severity of the TBI ranges from “mild traumatic brain injury (mTBI/concussion) to severe traumatic brain injury”, the type of head injury (closed or penetrating head injury), or other characteristics such as “occurring in a specific location or over a widespread area” can all be used to classify the TBI (Jiang et al. 2019). TBI symptoms can be moderate to severe depending on the severity of the brain damage. A transient change in consciousness or mental state might be brought on by little incidents. In extreme cases, the patient can go into a coma, remain unconscious for a long time, or even perish away (laccarino et al. 2018).
Nursing management
The two incidents that were identified in the previous section require nursing management with high priority concern.
Nursing management 1
Nursing assessment
Ineffective breathing patterns can be a nursing assessment to identify respiratory distress in a patient. The nursing diagnosis is determined when the patient’s breathing is compromised due to abdominal wall excursion during inspiration, expiration, or both. It is recognized as the state in which the depth, rhythm, timing, or pattern of breathing changes (Henry and Lippi 2020). The body’s cells cannot get enough oxygen if the breathing rhythm is poor. Respiratory failure could be associated with changes in breathing rate, abdominal patterns, and thoracic patterns.
To identify any issues during nursing care and identify any potential issues that may have contributed to an ineffective breathing pattern, continuous examination is required. The nursing assessment would include measuring the breathing pattern and rate of the patient. Measuring and recording breathing depth and rate at least once every four hours. Adults typically breathe between 10 and 20 times each minute. When breathing patterns change, it’s critical to take action to spot potential respiratory system damage early on (Fan et al. 2020). A disease process or a functional problem might be indicated by unusual breathing patterns. Cheyne-Stokes respiration is a sign of metabolic issues or bilateral malfunction brought on by brain damage in the deep cerebral or diencephalon. Pneuneusis and ataxic breathing are both caused by the respiratory centers in the pons and medulla malfunctioning. In this case, since Mr. May suffered from a head injury and is also COVID-19 positive, measuring the pattern of breathing would help to analyze the distress that is present in him (Nayas-Blanco and Dudaryk 2020).
Nursing interventions
The nursing intervention that can be used to treat respiratory distress is Beta-adrenergic agonist medication. Beta-agonists sometimes referred to as beta-adrenergic agonists, are medications that relax the airway muscles to widen the airways and ease breathing. These medications, which belong to the class of sympathomimetic agents, all function by stimulating beta-adrenoceptors (Marini and Gattinoni 2020). Beta-adrenoreceptor agonist ligands mimic the effects of epinephrine and norepinephrine signaling in smooth muscle tissue, the heart, and the lungs; epinephrine exhibits a greater affinity. Pure beta-adrenergic agonists often have the opposite impact of beta blockers. The activation of 1, 2, and 3 causes the enzyme adenylate cyclase to become active. As a result, the secondary messenger cyclic adenosine monophosphate (cAMP) is activated, and cAMP then activates protein kinase A (PKA), which in turn activates target proteins to phosphorylate them and cause the smooth muscle to relax and contract in the heart tissue. The activation of the 1 receptor results in an increase in heart rate and blood pressure, ghrelin secretion from the stomach, and renin release from the kidneys, and also results in a positive inotropic and chronotropic output of the cardiac muscle. When two receptors are triggered, the smooth muscles in the lungs and countless blood arteries relax. The 2 receptors encourage myocardial vasodilation, whereas the 1 receptor is associated with an elevated heart rate and heart muscle contraction. Therefore, beta-adrenergic agonist medicine can be used for relaxing airway muscles thus improving respiratory distress in Mr. May.
Nursing management 2
Nursing assessment
The best imaging test for a patient with a TBI is a computed tomography scan (CT or CAT scan). The most important lesions to diagnose in situations of medical trauma are fractures and bleeding, and a CT scan is a great diagnostic for doing so. Some experts advise using straightforward skull X-rays to assess individuals with just minor neurological impairment (Massod et al. 2020). However, the majority of facilities in the United States have easy access to CT scanning, a more accurate diagnostic, which has led to a drop in the regular use of skull X-rays for TBI patients.
Since a magnetic resonance imaging (MRI) procedure takes longer than a computed tomography (CT), it is not frequently employed for acute head injuries. The use of MRI is not practicable due to the difficulty of transferring a critically wounded patient from the emergency department to an MRI scanner (Torres et al. 2020). When a patient is stabilized, an MRI, however, could show the presence of lesions that the CT scan missed. Generally speaking, this information is more helpful for evaluating prognosis than for affecting treatment. Brain imaging may be suggested for certain individuals if they exhibit symptoms including severe headaches, seizures, frequent vomiting, or symptoms that are getting worse. Brain imaging may be able to determine the severity of the injury if there has been bleeding or swelling in the skull.
Adults frequently have a cranial computed tomography (CT) scan to assess the brain right after injury. A CT scan can provide cross-sectional images of the skull and brain by taking many X-rays (Osmond et al. 2018). Only when specific criteria are met, such as the circumstances of the occurrence or signs of a skull fracture, are CT scans used on people with suspected concussions. To shield the patient from radiation exposure, this is done.
Nursing interventions
Most individuals with significant brain injuries that result in disorientation will require therapy. It may be essential to relearn basic skills like walking and speaking. The objective is to increase their ability to do daily duties. Therapy typically begins in a hospital setting and continues there, at a residential treatment facility, an inpatient rehabilitation center, or through outpatient care. Each person will need a different form of therapy for a different amount of time, depending on the severity of the brain injury and the section of the brain that was damaged (Scotti et al. 2019). Rehabilitation specialists might be:
A rehabilitation nurse gives ongoing care and services for rehabilitation and aids with discharge planning from a hospital or rehabilitation facility. A trauma brain injury nurse specialist helps with care coordination and educates the family about the harm and recovery process (Ladak et al. 2019).
Discharge planning
A traumatic head injury increases the risk of fatality and disability. For individuals with traumatic head injury, the risk of recurrence and hospital readmission is thought to be quite high. The goal of the multidisciplinary discharge care plan is to improve Brian’s quality of life while reducing mortality from prolonged hospitalization. The patient’s discharge plan should be started as soon as they are admitted (Meo et al. 2018). This calls for a collaborative effort by medical professionals such as neurologists, neuropsychologists, neurosurgeons, general practitioners, registered nurses, pharmacists, diabetes educators, dieticians, and physiotherapists. Appropriate education and good communication with Brian help decide the best discharge care plan. As a bridge between medical professionals and as Brian’s advocate, RNs play a crucial role. Before beginning any therapeutic operations, a neurologist or other medical doctor not only diagnoses and treats the patient, but also gives a thorough explanation. The nurses need to ensure sure Brian is informed of his health status and the advantages and disadvantages of the suggested course of therapy (Gonçalves-Bradley et al. 2022). It is the responsibility of pharmacists to verify that evidence-based pharmacotherapy regimens have been recommended and to keep an eye out for medication interactions, drugs to avoid, and common adverse effects. It is important to identify the barriers that lead to poor drug compliance. The RN must emphasize the consequences of medication noncompliance and determine if Mr. May takes his medicine as directed. It is essential to tell Brian often and consistently and to provide Brian with pertinent written documents. Brian’s health beliefs and level of literacy need to be evaluated by nurses. Building trust with Brian requires a sincere and sympathetic attitude, which may also encourage him to change his unhealthy habits, such as limiting alcohol use, quitting smoking, and losing weight.
The role of the RN in the multidisciplinary discharge plan for Mr May includes, that he could need further care from another provider after receiving initial treatment at a hospital or other facility. Home care, general healthcare, physical therapy, and other treatments may be arranged for patients by a discharge planning nurse (Gonçalves-Bradley et al. 2022). Mr. May might not have had direct contact with the discharge planning nurses throughout their hospital stay. To ensure that there is a discharge plan and that everyone involved is aware of it, this nurse must collaborate closely with Mr. May’s doctors and other nurses. They must also share these plans with the patient’s family, especially if they will be involved in the patient’s further recovery
Conclusion
From the above discussion can be concluded that Mr. May might have suffered from a traumatic head injury and being COVID-19 positive is the reason for respiratory distress. Mr. Brian May, 62, was taken to the emergency room after being involved in a car accident involving a tree. Mr. May is said to have experienced a medical emergency that caused him to lose control of his car. The patient’s left side forehead laceration and increased respiratory distress caused by COVID-19 positivity are the two nursing issues that must be attended to first in this case. The event in which Mr. May had a head injury may have led to a severe brain injury that could have led to confusion. He might also suffer from respiratory distress due to COVID-19.
References
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