Nursing interventions for epileptics include:
Maintaining a safe environment for the patient;
Ensuring record keeping is kept up-to-date (i.e seizure charts, care plans);
Ensuring vital signs are taken 4 hourly and after a seizure (i.e should you question Neurological problems after a seizure commence patient on the Glasgow Coma Scale or your own equivalency);
Ensuring the patient takes medication as prescribed
Hope that's a good basis! Doing the assignment and looking for more! :)
Good Luck x
I'm not completely clear on your question, whether you mean in the field or in a hospital setting. Remember your ABC's: Airway, Breathing, Circulation. Typically, a nurse's job in the hospital setting is assisting with airway management, CPR, giving medications, and establishing IV access.
When a patient vomits, the most important nursing objective is to prevent aspiration. Aspiration can lead to serious complications, such as pneumonia, which can significantly worsen the patient's condition. Additionally, maintaining hydration and electrolyte balance is crucial to prevent dehydration and its associated complications. Monitoring the patient's airway and providing appropriate interventions are vital to ensure their safety during this time.
No, a nasopharyngeal airway should not be used in a patient with an endotracheal tube in place. The endotracheal tube already secures the airway and provides ventilation, making the use of a nasopharyngeal airway unnecessary and potentially harmful. Introducing a nasopharyngeal airway could cause trauma to the airway or displace the endotracheal tube.
A patent airway is unobstructed and or not closed. It is the ability to inhale and exhale freely without surgical intervention.
The priority nursing diagnosis for pneumonia is "Ineffective Airway Clearance." This diagnosis is crucial because pneumonia can lead to the accumulation of secretions in the lungs, which impairs gas exchange and can result in respiratory distress. Nurses must assess the patient's ability to clear secretions, implement interventions to promote airway clearance, and monitor respiratory status closely to prevent complications.
An ambu bag, or bag-valve-mask (BVM), is a medical apparatus used to provide positive pressure ventilation to individuals who are not breathing adequately or at all. Nursing responsibilities include ensuring the ambu bag is functioning properly, positioning the mask to create an airtight seal over the patient's face, and delivering effective breaths while monitoring the patient's chest rise and vital signs. Nurses must also be prepared to switch to advanced airway management if necessary and document the intervention accurately.
In an unconscious patient, the tongue can fall back and obstruct the airway due to loss of muscle tone and reflexes. This occurs especially when the patient is in a supine position, allowing the tongue to block the oropharynx and impede airflow. Additionally, the lack of protective reflexes increases the risk of aspiration, further complicating airway management. Proper positioning or airway adjuncts, like an airway adjunct or intubation, may be necessary to secure the airway.
Suction is used for airway management when the patient can't manage his or her own secretions.
Ineffective airway clearance related to thick secretions or blood secretions, weakness, poor cough effort, edema, tracheal / pharyngeal.Goals :After a given airway hygiene nursing actions effectively, with the result criteria:Maintain the patient's airway.Removing secretions without help.Demonstrate behaviors to improve airway clearance.Participate in treatment programs as needed.Identify potential complications and appropriate action.Read More : http://all-nurses.blogspot.com/2012/05/ineffective-airway-clearance-related-to.html
Nursing goals for ineffective airway clearance focus on improving the patient's ability to clear respiratory secretions and maintain adequate oxygenation. Specific goals may include increasing the patient's secretion clearance through effective coughing techniques, positioning, and the use of suctioning when necessary. Additionally, ensuring optimal oxygenation levels and monitoring respiratory status are crucial to prevent complications. Education on deep breathing exercises and the importance of hydration can also support these goals.
Because even though it is recommended for an unconscious patient, if the patient has sustained to severe of a trauma the nasal airway could damage the patient more than help them.
If there is no other chest or abdominal injury, and the patient is awake and conscious there is no need to worry about the airway