According to the text by Sanders (2011), the Venturi Mask is likely to be the most appropriate assistive device in this process. Sanders indicates that this particular apparatus is "advised for patients who rely on hypoxic respiratory drive. This includes, for example, patients with COPD. The main benefit of the Venturi Mask is that it allows precise regulation of the FiO2. It also permits the paramedic to titrate oxygen for the patient with COPD so as not to exceed the patient's hypoxic drive while allowing enrichment of supplemental oxygen." (Sanders, p. 422)
In addition the Venturi Mask which can help to normalize pulmonary activity, the patient is also experiencing a productive cough with thick yellow sputum. The presence of excessive mucus is also likely contributing to Mr. Hay's airway blockages. This would be an appropriate place to use the Yankeur sucker in order to help remove fluids that might be making it more difficult for the patient to breathe independently.
Patient Problem 3: Pain
Also of critical importance once the patient's vital signs and breathing have been stabilized is the management of pain. This is especially pressing in an older patient with indicators of high blood pressure and other abnormal cardiac abnormalities. Excessive pain may stress the subject's body and lead to an intensification of other more troubling symptoms.
Two particular sources of pain require management and attention. First and foremost, the subject's chest pain must be reduced so as to improve the patient's comfort and lower the risk that this could mount into a more pressing issue of patient distress and its attendant possibility of true cardiac arrest. In this case, the recommended course of treatment...
Provided that no conflict can be determined between existing prescriptions such as the COPD antibiotic, and provided that no patient allergies exist, Sanders provides a rationale for this approach as a way of diminishing chest pain symptoms. As a valuable side-effect, the properly selected Vasodilator may also reduce the patient's demonstrated proclivity for high blood pressure. According to the text by Sanders, "in addition to their use as antihypertensives, some vasodilator drugs work to treat angina pectoris (ischemic chest pain). For example, nitrates dilate veins and arteries….the subsequent decrease in wall tension helps to reduce myocardial oxygen demand and also relieves the chest pain of myocardial ischemia." (Sanders, p. 314)
Also necessary for pain management is treatment of pressure injuries produced by the subject's fall and unconsciousness. This should include x-rays of the sited points of the hip, ankle and shoulder, proper stabilization of impacted points and the prescription of an anti-inflammatory presuming, once again, that no drug conflicts or allergies can be determined.
The three patient problems and treatment strategies outlined above should also be used to issue the patient a comprehensive plan for follow-up treatment and self-care following discharge.
Australian Nursing and Midwifery Council. (2006). National competency standards for the midwife. Retrieved from: http://www.nursingmidwiferyboard.gov.au/Codes-and-Guidelines.aspx#competencystandards
Ambulance Victoria. (2012). Ambulance Victoria clinical practice guidelines for ambulance and MICA paramedics. Retrieved from: http://www.ambulance.vic.gov.au/Paramedics/Qualified-Paramedic-Training/Clinical-Practice-Guidelines.html.
Courtney, M. (2005). Evidence for nursing practice. Marrickville NSW: Livingstone Churchill Elsevier. Page 19 of 24.
Johnson, R. & Taylor, W. (2010). Skills for midwifery practice (3rd ed.). Edinburgh: Elsevier.
Sanders, M.J. (ed.) (2011). Mosby's paramedic practice (4th ed.).St. Louis, MO: Elsevier.
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