Management of Ms Alder's Injuries

This document discusses the interventions and rationale for managing the injuries of Ms Alder, who fell from a horse. It covers topics such as pain assessment, medication, and therapies used to reduce pain, respiratory rate, pulse rate, and blood pressure. The document provides insights into the importance of immediate care, comprehensive assessments, and appropriate interventions to minimize pain and promote recovery.

Assignment 4 Template
Student name: ID:
Class number/tutor: Scenario: 3
Ms Alder who is 25 years old had fallen from a horse during a cross country event. Her pulse
rate is 105, which is higher than that of the normal pulse rate (normal pulse rate). Her blood
pressure is also increased (observed blood pressure- 170/90, normal blood pressure –
120/80). Respiratory rate of Ms Alder is 24, which is more than that of the natural
respiratory rate (12-24 beats per minute). Her body temperature and the spo2 level is
within the normal range. Glass coma scale of the patient is observed as 13, which means the
patient is not in the fully active state and seems to be slightly confused. In addition, a score
of thirteen or above is correlated with the mild injury of the brain. As she has fallen from the
horse, she has been suffering from a significant amount of pain
Interventions
1. The SA Ambulance Service or SAAS will be immediately informed for urgent care and
emergency, treatment and transport of the patient.
2. A thorough and comprehensive ABCDE assessment will be conducted in the patient
in order to to evaluate airway, breathing, circulation, disability, and exposure.
3. Comprehensive pain assessment by using the PQRST approach will be conducted.
4. The primary priorities of the multiple disciplinary teams is to minimise the pain as
soon as possible by using pain killers such as non-steroidal anti-inflammatory drugs
(NSAIDS) for reducing the pain she got because of the injury(Gupta & Bah, 2016). In
addition, nursing strategies such as deep breathing and lowering the number of
stressors as prescribed by the physiotherapist and conducted with the help of the
nurse (Ullah et al., 2016).The pain management is necessary because she is suffering
from severe pain, it must be controlled.
5. Patient will be subjected to oxygen therapy.
6. As the respiratory rate of the patient has increased to 24, it should be
decreased.The respiratory rate of the patient can reduce if she takes some
rest.Respiratory rate of the patient has been increased because of the change in the
metabolism of her body after she has fallen down from the horse.The respiratory
rate of the patient is reduced after she took rest, the staffs of the healthcare helped
her in taking rest by maintaining the position of the patient which help in the full
expansion of the lung and lowers the respiratory rate (Perlman et al., 2016). In
addition, deep breathing exercise is also suggested by the physiotherapist and
conducted with the help of a registered nurse (Gupta & Gupta, 2018).Before
suggesting the exercises for deep breathing, the patient must lay down. After taking
rest for some time she will move for exercises.
7. The pulse rate of Ms Alder is also increased to 105. Hence it should be decreased to
the normal range (60-100 beats per minute).The pulse rate is increaseddueto
thesuddenaccident that happened with her.To reduce that medicines against
hypertension can be given medication as prescribed by the doctor. In addition, an ice
pack is given by the nurse as the Sodium and fluid intake is reduced as suggested by
the nutritionist (Cook, Appel&Whelton, 2016).

8. The blood pressure of the patient increased upto 170/90. Hence, the blood pressure
has to be managed to reach the normal level by using medication such as
Angiotensin-converting enzyme (ACE) inhibitors are prescribed by the physician.
Medicines against hypertension must begiven to her.In addition, another therapy
such as low sodium containing diet is suggested by the nutritionist and meditation by
the physiotherapist and achieved by the help of healthcare staff (Messerli et al.,
2018).
Rationale
1. This Ambulance Service is affiliated under SA Health and has been recognised as a
state government agency that provides clinical care, emergency, ambulance
transport, and helps in transferring patients distributed across several square
kilometres of South Australia. Regardless of the place of residence of the patient,
accessible transport and medical assistance is provided by the service, as and when
required, thereby reducing suffering of the patients and enhancing their quality of
life (Goverment of South Australia, 2019).
2. Conducting the assessment will help in determining signs and symptoms of internal
bleeding or trauma and will involve minute monitoring of the patient. This
assessment is generally conducted upon suspecting critical injury or illness, and has
also been recommended as the initial step for preventing cardiac arrest. Efforts will
be taken to look for signs and symptoms of airway obstruction, by determining the
breathing sounds and voice. Breathing will be evaluated by measuring respiratory
rate, performing lung auscultation, chest percussion and observing chest wall
movement (Steele, Greenwood & Desai, 2017). An assessment of circulation will
involve monitoring the patient for sweating, skin colour, capillary refill time, blood
pressure, and pulse rate. In addition, the level of consciousness and whether the
patient is pain responsive, alert, or unresponsive will also be determined while
evaluating disability. Results of this assessment will help in identification of any life
threatening conditions.
3. Owing to the subjective experience that are associated with pain, self-report has
been considered as the mainstay method for accurately measuring pain severity, and
documenting it. This assessment encompasses several aspects namely, palliation
/provocation, quantity/ quality, radiation/ region, severity scale and timing. Hence,
conducting this assessment will help in outlining the pain level of the patient on a 0-
10 scale (Fink & Gallagher, 2019). It will also facilitate gaining an insight about
patient satisfaction, in relation to pain level and help in determining the underlying
factors that might have aggravated the pain.
4. To reduce pain of Ms Alder, NSAIDs is used to relieve the pain. It reduces the
inflammation, irritation and swelling (Gupta & Bah, 2016). When an individual is
injured, prostaglandins are secreted which causes inflammation (Ullah et al., 2016).
Prostaglandins are secreted within the cells of the body with the help of the
cyclooxygenase enzyme (Ullah et al., 2016). The cyclooxygenase enzyme is of two
types, cyclooxygenase 1(COX 1) and cyclooxygenase 2 (COX 2) (Ullah et al., 2016).
Both cyclooxygenase enzyme helps in inducing inflammation associated with pain
(Ullah et al., 2016). When NSAIDS is administered into the body of an individual, it
blocks the activity of the cyclooxygenase enzyme and minimises the formation of
prostaglandins which leads to the reduction in the pain (Ullah et al., 2016).

5. Commencement of oxygen therapy will prevent the onset of breathlessness, and
thereby reduce the likelihood of the patient of suffering from respiratory or cardiac
failure. Oxygen therapy is widely used in the domain of emergency medical services
in case of major trauma or resuscitation, in order to restore the physiological
parameters of acutely ill patient (Jin & Guan, 2016).
6. The normal respiratory rate of an individual should be between 12 to 20 beats per
minute, but the respiratory rate of Ms Alder is 24 which means her respiratory rate is
increased (Trangmar et al., 2014). The high respiratory rate may lead to occurrence
of any lung disease in future.To maintain the normal respiratory rate of an individual,
full expansion of the lungs is required. The changes in the homeostatic conditions
result in increasedrespiratory rate. Hence, maintaining the position of the patient is
extremely necessary as it helps in the full expansion of the lungs. The patient is
maintained in the semi-Fowler's position. Through the help of semi-fowler position,
the chest is expanded fully which helps in promoting the oxygenation into the body
by increasing the thoracic capacity (Trangmar et al., 2014). Slumping position of the
patient is also avoided as the slumped position compresses the abdomen and the
diaphragm of the individual which reduces the capacity of the lung and thus limits
the expansion of the lung. The patient is turned in every two hours because Turning
in regular interval decreases the cardiac output of the patient (Trangmar et al.,
2014).
7. The pulse rate of the patient is also increased to 105, which should be reduced to the
normal range (60-100 beats per minute) (Mitchell, Graff & Simons, 2016). If the pulse
rate is not reduced to the normal level, it can lead to much more complications ad
increase in rate of pulse is not a good sign, it is a symptom of fever and intestinal
diseases.To reduce the pulse rate of the individual, antidysrhythmic medication is
prescribed by the doctor (Mitchell, Graff & Simons, 2016).These class of drugs slower
the electrical conduction in the heart(Long &Koyfman, 2017). When administered, it
blocks the impulses of the heart which are responsible for the irregular heartbeat
and interferes the hormonal influences (Long &Koyfman, 2017). By blocking the
impulses and interfering the hormonal action blood pressure of the patient is
decreased, which eventually decreases the heart rate and pulse rate (Long
&Koyfman, 2017). By limiting the sodium intake in the body, the blood pressure of
the patient is decreased which decreases the heart rate of the patient, though it
seldom happens so early, but in this case, the heart rate has decreased.Along with
that, providing ice packs also helps in reducing the pain that the patient has suffered.
(Westerdahl, 2015).
8. The blood pressure of the patient is also increased (170/90), which is to be reduced
to the normal range (120/80). To reduce the blood pressure of the individual,
Angiotensin-converting enzyme inhibitors are prescribed by the doctors. The doctors
have prescribed this medicine by checking all medical conditions of the
patientAngiotensin-converting enzyme inhibitors help in reducing blood pressure
(Molokhia et al., 2019). ACE inhibitors reduce the activity of an enzyme in the body
which is responsible for the secretion of angiotensin II. Angiotensin II is responsible
for narrowing the blood vessel. (Drawz et al., 2017).Narrowing of the blood vessel
increases the secretion of a hormone which helps in increasing the blood pressure
and lead to an increase of the heart rate. (Drawz et al., 2017).Hence after the
administration of ACE inhibitors, blood pressure is decreased (Messerli et al., 2018).

Low sodium diet is also suggested by the nutritionist to Ms Alde, as it is also assisting
in reducing the blood pressure of the individual (Drawz et al., 2017).

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