

Rationale development exercise

In approximately 400 words respond to each of the following statements with supporting rationale.

Mr Parietal Pleura who was admitted with a pneumothorax has a chest tube inserted attached to an UWSD.

The S/S of a pneumothorax, namely chest pain, shortness of breath, absent or diminished breath sounds, are all that is required to confirm a diagnosis of pneumothorax.

1. When a patient has a chest tube attached to a UWSD the only assessment required is swinging, bubbling, draining, TPR and BP.

2. Chest tubes should only be clamped during patient transfer.

3. If the water in the chest tube was—swinging but not bubbling or draining it means the air has been removed from the pleural space but that the pneumothorax has not resolved. When bubbling initially stops this should be further assessed by instructing the patient to cough.

4. Clamping a chest drain tube has the potential to cause a tension pneumothorax and circulatory collapse.

Rationale development exercise 2

Prepare a response as instructed in the introduction in module 10.

In approximately 400 words respond to the following statements with appropriate rationale.

The management of Mr Cushing, who is at risk for IICP (Increased Intracranial pressure), includes:

1. Pts at risk of IICP should usually have the head of bed (60º) elevated with head midline. The 60 degree position needs to be increased or decreased depending on patient response and need to maintain CPP. In addition hypotension should be prevented.

2. Pts at risk of IICP must be provided with supplemental oxygen to keep O2 saturations above 92% & CO2 must be kept within normal limits. Pts may also be administered H2 antagonists to decrease risk of GI ulcers.

3. Pts at risk of IICP should be kept hypovolaemic and serum electrolytes monitored every 2 days.

4. In severe head injury polyuria and low urine osmolality could indicate hypothalamus dysfunction and can cause neurogenic fever and/or Diabetes Insipidus (DI).

Rationale development exercise 3

Prepare a response as instructed in the introduction in module 10.

In approximately 400 words respond to the following statement and support your response with appropriate rationale.

Mr T Chemotaxis, involved in a MVA suffered head injuries, pneumothorax and multiple fractured bones. His treatment throughout admission included the insertion of chest tubes, IVT, IDC and Burr holes. His condition was considered stable by Day 3. His multiple injuries and treatment modalities have however increased his risk for Septic Shock and SIRS.

1. When the temperature is above 38°C appropriate cultures should be obtained following the commencement of antibiotics. These may include blood cultures, wounds, IV sites, blood, urine, and sputum. Oral Panadol must be given to ensure the temperature does not continue to increase.

2. An increase in platelets followed by a decrease in platelets could signify a risk for Disseminate Intravascular Coagulation and characterised by widespread micro-thrombi and excessive bleeding.

3. Sepsis is associated with an increased systematic capillary permeability and therefore the retention of fluid in interstitial spaces leading to hypovolaemia and acute cardiogenic pulmonary oedema.

4. You are to administer Mr Chemotaxis, who has an infusion of normal saline in progress, an IV antibiotic. It is essential prior to administering this IV antibiotic to ensure patency by administering a Normal saline flush.

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