Airway Case Study Nursing

Question 1.
A. AIRWAY– Maintaining a clear airway is always considered a high priority because airway is essential for gas exchange (Ramkumar, 2011). However, the patient has a patent airway. Therefore, the nursing strategy is to conduct an airway assessment “look, listen and feel” continuously to detect any changes. This is to provide immediate respiratory care if the patient’s airway is compromised (Higginson, Jones & Davies, 2011). This is a low priority.

B. BREATHING – Respiration is altered due to left ventricular failure. The patient is tachypnoeic due to an increased pressure in the pulmonary veins that will lead to pulmonary congestion that lessens pulmonary compliance, which raises the respiratory rate. Also, increased blood flow
CIRCULATION – The contraction of heart muscle is less effective due to necrotic tissue in the myocardium. Therefore, cardiac contractility and cardiac output is impaired. There is a progressive ischaemia because the oxygenated blood is unable to impel in the myocardium due to the damaged ventricle (Wagner & Hardin-Pierce, 2014). The heart will compensate for decreased cardiac output from the failing ventricle. Therefore, tachycardia will develop as an effect of sympathetic stimulation while hypotension is due to compromised coronary flow (Bucher, Johnson & Rolley, 2015). The increased SNS stimulation creates vasoconstriction, which will prolonged the capillary refill and the extremities will be cool, clammy and mottled due to reduced tissue perfusion (Bucher et al., 2015). The increased JVP indicates fluid overload due to left ventricle failure and pulmonary oedema. Peripheral pulses are rapid and faint because of the decreased circulation and tachycardia. Bilateral ankle oedema is caused by accumulation of fluid and reduces blood flow out of the heart. The 3rd heart sounds indicates left ventricular dysfunction and the rapid filling of the ventricle. The temperature of 37.5°c is a systemic manifestation of the inflammatory process caused by myocardial cell death (Bucher et al., 2015). The nursing strategy is to assess the patient’s cardiac and hemodynamic status through monitoring the arterial line, ECG, and fluid status. Immediate detection of complications is
It has synthetic sympathomimetic amine that mimics the characteristic of the sympathetic nervous system and it stimulates the beta1-adrenergic receptors (Australian Medicine Handbook, 2016). It also has a chronotropic effect by controlling the nerves of the heart that changed the heart rate and likewise by affecting the rhythm produced by the sinoatrial node (Bryant & Knights, 2015). Due to its cardiac stimulant action it increases myocardial contractility and stroke volume, which will increase the cardiac output that will improve cardiac performance (Lehne, Moore, Crosby & Hamilton, 2012). Dobutamine’s onset of action is between 1 to 2 minutes. Since, it has a minimal beta2 and alpha-adrenergic effect, the main therapeutic effect is it will strengthen the contractions of the heart and the blood flow will increase without increasing the heart rate. Therefore, the result is it will increase myocardial oxygen consumption (Drugguide.com, 2016). In addition, further therapeutic uses are treating hypotension, arrhythmias and heart failure (Australian Medicine Handbook, 2016). In evaluating the therapeutic effect of the drug, cardiac function such as heart rate, electrocardiogram, blood pressure, and urine output should be monitored closely. Plus, monitoring the central venous pressure and pulmonary wedge pressure is