NR 305 Week 8 Discussion – Case Study or Share an Experience

When entering the room, I would first identify the patient as Jonah. Then I would note to see if the patient is awake and alert. As per Jarvis (2016), I would assess his facial expression, posture and position, and speech as a visual assessment. The patient is showing signs of respiratory distress, with cyanosis evident. I would call a rapid response team to the room (using the S.B.A.R. method) and call a patient care assistant for vital signs of the patient (blood pressure, oxygen saturation, pulse, respiratory rate, and temperature). My assessment would be focused on the respiratory and oral cavities since these are currently where his distress lies. I would want to inspect the patient’s oral cavity to see if there is anything visually blocking the Airway. I would also want to ask the mom if he was eating anything prior to this situation. I would want to know if he was allergic to anything. This could be either a choking situation or an allergic reaction. I would want to see if Jonah was able to speak because if he is not able to, then obstruction is evident. I would apply oxygen with a facemask to provide additional oxygen; a patient may need other means in the long run, such as intubation, depending on severity. I’d listen to his lungs and assess for audible adventitious breath sounds and note his use of accessory muscles when breathing. I would also assess skin and note discoloration, perspiration, etc. According to the New York State Department of Health, “Choking is the fourth leading cause of unintentional death in children under the age of 5” (2018). If this is a choking situation, I would consider initiating the Heimlich maneuver to try and dislodge the choking hazard.

When using the S.B.A.R. to discuss the situation with the doctor, I would include…

This is Karina from telemetry. I’m calling about the patient in room #2, Jonah. The patient’s state has changed, and he is currently breathing very loudly and using his accessory muscles. The patient is cyanotic.

Jonah is a 2-year-old boy admitted to our floor and is having difficulty breathing. I’m calling the rapid response to assess and treat. Vital signs are… (Temp, B/p, pulse, respirations, oxygen saturation)

The airway seems obstructed, could be an allergic reaction, or the patient may be choking. Asked the mother for allergies or if the patient was eating prior to this situation occurring.

The doctor needs to assess the patient’s Airway to determine if he is choking or if this is an allergic reaction. Does the patient need epinephrine administered, a Heimlich maneuver initiated? A Rapid Response team would enable all members of the hospital team at the bedside to make quicker judgment calls.

References:

Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders

New York State Department of Health. (2018). Choking prevention for children. Retrieved from https://www.health.ny.gov/prevention/injury_prevention/choking_prevention_for_children.htm

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