HLTENN011 Diploma of Nursing: Acute Health Problems Assignment

This assignment addresses the management of various acute health conditions, including Acute Kidney Injury, Acute gastrointestinal disorders, Ischemic stroke, Complex regional pain syndrome (CRPS), Asthma, Acute unconscious state, Angina Pectoris, Cellulitis, Dehydration, Hemorrhagic Shock, Concussion, Myocardial infarction, Nephrolithiasis, and Bacterial Sepsis. It explores the aetiology and clinical features of each condition. The assignment also delves into the principles of surgical nursing, outlining key aspects like aseptic technique, patient assessment, pain management, and wound care. Furthermore, it defines and explains various surgical procedures such as elective/emergency surgery, different types of anesthesia, amputation, hip replacement, craniotomy, tonsillectomy, appendectomy, laparotomy, hysterectomy, prostatectomy, and cataract extraction. The assignment concludes with a case study of a 16-year-old Maori boy with testicular torsion, emphasizing the significance of holistic nursing care, considering his age, gender, and cultural background.

Running head: MANAGEMENT OF ACUTE CONDITIONS 1
Management of Acute Conditions
Student Name
Institutional Affiliation

2
Management of Acute Conditions
Q1. Explain the aetiology and outline at least TWO (2) clinical features for each the
following acute health problems.
a) Acute Kidney Injury
It is an insidious occurrence of kidney failure that is caused by pre, post or intra-renal
complications (Rocco et al., 2018). Pre-renal causes involve factors that lead to decreased
blood flow through the kidney, and they include; toxic medications, heart or liver disease,
anaphylactic reaction, massive blood loss, burns, hypotension and sepsis. Intra-renal
causes involve problems which occur directly to the kidney, and they include; trauma to
the kidney, blockage in the renal vessels, infection in the kidney and immunological
conditions. Post-renal causes include; cancer of the bladder, obstruction of ureters and
urethra, prostatitis, compromise to bladder nerves and urinary tract infections. It presents
with oliguria, retention of fluid, nausea and confusion, among other symptoms.
b) Acute gastrointestinal disorders
This are conditions of the digestive tract that occur suddenly hence require urgent
management to prevent complications. They are caused by infections due to bacteria, thus
present with vomiting and diarrhoea due to irritated intestinal lining (Stanghellini et al.,
2016). They can also be caused by acute inflammatory conditions of the gut, such as
esophagitis that can cause dyspepsia. Direct trauma to the GIT due to ingestion of harmful
substances can GI malfunction. They Present with, GI bleeding, vomiting, diarrhoea,
abdominal pains and incontinence.

3
c) Ischemic stroke
It occurs when vessels in the brain are occluded or narrowed hence depriving tissues of
perfusion. It is caused by atherosclerosis where fat deposits build up inside blood vessels that
supply the brain tissue. It presents drooping of muscles of the face, weakness in the arm and
inability to speak words clearly.
d) Complex regional pain syndrome (CRPS)
This is chronic pain in the upper or lower limb. It is classified into type one and two
based on the cause. Type one CRPS occurs after an injury to a part of the arm that does not affect
a nerve. Class two results from damage to a particular nerve during an injury which can lead to
persistent pain more than six months even after the wound has healed.
e) Asthma
It is a condition where the airways are hypersensitive, inflamed, and there is increased
mucus production. It is a genetically inherited condition that can be exacerbated by triggers such
as infections of the respiratory tract, medications- aspirin, physical exertion, cold, pollen, animal
fur and strong emotions. It presents with an exhalation wheeze, shortness of breath, chest pains
and coughing.
f) Acute unconscious state
It is a state where an individual becomes unresponsive to stimuli suddenly.it can be
caused by injury to the head or chest, massive blood loss, drug overdose, alcohol intoxication,
hypoglycemia, hypotension or due to Transient ischemic attack. Individuals in an unconscious

4
state are unresponsive, decreased heart rate, where the pulse can be faint and cessation of
breathing.
g) Angina Pectoris
It is a pain in the chest due to defect to the coronary arteries that nourish the heart. It
occurs when the heart muscle is under-perfused hence undergoes anaerobic respiration where
lactic acid is produced irritating the nerves, thus the pain. Blood supply may be blocked due to
the formation of blood clots or fat deposits inside the coronary arteries. Other causes include;
hypertrophied heart muscles, stenosis of the aortic valve, pulmonary embolism and inflammation
of the heart muscle. It presents with chest pain, sweating, fatigue, nausea, pain in the neck, arms
or neck and shortness of breath.
h) Cellulitis
It is an infection of the skin that is mostly caused by bacteria. Bacteria commonly
responsible for the disease are staphylococcus or streptococcus class. The bacteria invade an area
after surgical procedure, a cut or a bite. It presents with inflammation of the infected area, pain
and tenderness, skin feeling warm on touch, fever and chills.
i) Dehydration
Is a state where the amount of fluid loss from the body exceeds the amount of intake.
Acute fluid loss can be caused by excessive episodes of vomiting and diarrhoea hence depleting
the body of water and electrolytes. Fever is another cause of dehydration since fluid evaporates
from the body. Increased micturition due to conditions such as type 2 diabetes can cause

5
dehydration. Clinical presentation of a dehydrated individual involve; dry lips, decreased
urination, increased thirst, headaches, dry skin and dizziness.
j) Hemorrhagic Shock
This is the decrease in body fluid volume due to acute fluid loss. This leads to decreased
perfusion to body tissues and cells hence affecting cell metabolism. It can be caused due to blood
loss in cases of severe bleeding due to open injury, GI bleeding, internal bleeding due to trauma
or endometriosis and abnormal vaginal bleeding. Hemorrhagic shock can be caused by a fluid
loss in cases of diarrhoea, vomiting, and excessive perspiration or severe burns.
k) Concussion
It is a mild injury to the brain due to trauma. It can be caused by an accident or a fall
leading to shaking of brain cells inside the skull and can lead to rupture of blood vessels.
Clinically, an individual presents with headaches, confusion, nausea and vomiting, among other
symptoms.
l) Myocardial infarction
This is a condition where the heart muscle is deprived of perfusion hence leading to
damage. It is caused by blockage to the coronary artery by plaque or blood clots. The plaque is
constituted of cholesterol, mainly low-density cholesterol or saturated fats. This is termed as
atherosclerosis. Arteriosclerosis is another cause of MI where there is hardening of coronary
artery facilitating the formation of fat deposits hence blocking blood flow. It presents with
symptoms of chest tightness, shortness of breath, nausea, vomiting and sweating.

6
m) Nephrolithiasis
It is the occurrence of calculi in the urinary tract. The stones are formed when the fluid
content in urine is less compared to the substances that form crystalline or when the mechanism
of preventing crystalline formation has been compromised. Uric acid stones occur due to
insufficient fluid intake or taking a lot of proteins in the diet. Calcium stones result from
excessive ingestion of vitamin D, use of anticonvulsive drugs or due to renal tubular acidosis.
Urinary tract infections can also cause chronic kidney stones. Clinical features include;
hematuria, flank pain, nausea, vomiting and increased urgency to urinate.
n) Bacterial Sepsis
It is a condition where the body's immune system has been compromised by bacteria and
invaded the bloodstream, which can lead to organ damage. It is usually caused by conditions
such as pneumonia, gastrointestinal invasion of bacteria, urinary tract infection and direct
bloodstream infection. Presents with a high-grade fever, confusion and decreased urine output
Q2 a. List the eight (8) key principles of surgical nursing.
 Creating and maintaining aseptic field
 Patient assessment, planning of care, implementation and evaluation of the patient in
reference to evidence-based practice.
 Pain management
 Principle of infection prevention
 Monitoring fluid and electrolyte balance
 Wound management
 Anxiety and stress management

7
 Rehabilitation in cases of altered body image
b. Explain the following surgical procedures briefly using correct surgical terminology. (30-
40 words each)
a) Elective/emergency surgery
Elective surgery is an operation that is planned to be performed at a later time. It may be
conducted for medical reasons or cosmetic purposes. Elective surgeries performed due to
medical reasons are planned to be convenient for the patient and the surgeon. Emergency surgery
is performed in circumstances where the patient is likely to face severe complications if not
performed. It involves circumstances
c) General, local, epidural and spinal anaesthetic and peripheral nerve block
General anaesthesia involves a synergistic use of medications to render the patient
unconscious before beginning a surgical procedure. In includes amnesia, hypnosis and analgesic
components. Local anaesthesia provides numbness to a specific site to prevent the patient from
pain sensation during minor procedures. The patient is alert all through the process. Epidural
anaesthetic agents offer pain relief to a patient. It works by blocking impulses from the lower
spinal section. Spinal anaesthesia involves the injection of the anaesthetic agent into the
subarachnoid space. It provides analgesia and blocks the motion and sensation. A peripheral
nerve block is injected into a peripheral nerve bundle to provide analgesia during minor
procedures.
d) Amputation

8
It is the detachment if lower or upper limb as a result of trauma or surgical procedure.
Traumatic amputation occurs during accidents or as occupational hazards, whereas surgical
amputation occurs to relieve pain or to stall the progression of the disease.
e) Open reduction
Is a surgical method of repairing fractured bones by cutting through the tissues to expose
the bone particles. It is recommended in cases where there is the dislocation of the fracture,
where the bone is broken into several fragments or in an open fracture.
f) Hip replacement
It is a procedure where the surgeon surgically excises a defective hip joint and exchanges
it for an artificial one. It is performed in patients with arthritis, chronic pain or in cases of
malignancy at the joint.
g) Craniotomy
It is the surgical taking out of skull bone to view the brain tissue. It is performed to excise
tumors of the brain, treat hematomas, repair aneurysms or to relieve swelling in the brain.
h) Tonsillectomy
Is a surgical procedure performed for excision of tonsils. It is indicated when there is
recurrent inflammation and infection of the tonsils unresponsive to pharmacotherapy.
i) Appendectomy

9
It is an emergency surgical procedure performed to excise the appendix. It is the baseline
management of appendicitis, common inflammatory disorder of the pancreas, which leads to its
blockage.
j) Laparotomy
It is a surgical procedure performed under general anaesthesia and involves cutting through
the abdomen. It is indicated in a patient with severe abdominal pain or masses as an exploratory
or treatment measure.
k) Hysterectomy
It is a procedure done to take out the uterus of a woman. It is indicated to treat severe uterine
bleeding postpartum, treat uterine fibroids or in cases of uterine cancer.
l) Prostatectomy
It is a procedure performed for partial resection or complete excision of the prostate. It is
indicated for patients with symptomatic prostatitis, in prostate cancer or benign prostate
hyperplasia.
m) Cataract extraction
It is the excision of the eye lens that is defective due to cataract and in turn, replaces it with a
humanmade lens. It is indicated for patients with cataracts where they experience visual
disturbances.
n) Internal bleeding due to trauma.

10
This refers to haemorrhage into internal organs that occur due to rupture of an inner
blood vessel after trauma. It is a severe medical condition and can result in severe complications.
Q3 Too Wadadi is a 16-year-old Maori boy from New Zealand who was rushed to the
Emergency Department this morning with testicular torsion. After initial blood work, he
was shifted to the operating room. The surgical procedure completed at noon and the
patient was moved to the post-operative ICU.
 What is the significance of holistic nursing car?
Holistic nursing care is the process of taking care of a patient by considering the patient
as a whole. It involves caring for the physical, psychological, emotional, mental and social aspect
of a patient. It also encompasses the cultural beliefs and religious concerns of the patient. It
enables in the creation of healthy relationships between the patient and nurse, leading to
improved quality of care. It creates a variety of treatment options for the patient apart from the
routine medications. It enables the nurse to approach the patient individually and provide an
individualized plan of care. It puts into consideration the patients' age, race, psychological state
and mental condition. Understanding patient state of well-being improves confidentiality hence
promoting care. Holistic care enables the nurse to identify underlying issues of the patient,
including feeding problems, stress and domestic abuse on top of the presenting complaints.
Comprehensive care of patients is an evidence-based practice that promotes healing and quality
of life.
Outline the application of holistic nursing in the treatment of Too Too Wadadi considering
his age, gender and specific culture.

11
Regarding management of Wadadi, 16-year-old, holistic care should be applied to
reassure the patient. The patient is an adolescent and has issues with body image, self-esteem and
worries on fertility. The patient requires regular measuring of vital signs and interpretation.
Ensure observation of the surgical site for any bleeding. The Maori people value proper
pronunciation of their names and prefer the presence of family member during an examination. It
is required to reassure the patient to alleviate anxiety and relieve pain. Explain to the patient and
relatives that testicular torsion is a common condition since some of them believe that a disease
is a curse. Involve the family in history taking and assessment to provide comprehensive care.
Q4 Mrs Kabita Kandel, a 55-year-old female, was admitted in the female general ward. She was
diagnosed with bilateral osteoarthritis of the hip and has been posted for a Total hip replacement.
She has a family history of type 2 Diabetes Mellitus and also coronary artery disease. The
anaesthetist reviewed the blood work and after consultation with the patient, gave the clearance
for surgery. The surgery took place at 9 am the next day, and the patient was shifted to the post-
operative room at noon. The doctors have ordered to commence patient mobilization at 8 pm
today.
Name any two (2) Risk Assessments that are required to be performed to ensure the
patient's stability on feet before mobilization.
 Static balance assessment
 Dynamic balance assessment

12
Q5A Briefly outline the purpose, complications and nursing management of the following
procedures:
 I/V Intravenous fluid intake
It is a therapy administered via the intravenous route and is used to provide fluids to
individuals who cannot afford an average fluid volume by oral ingestion. It is used to correct
dehydration, fluid loss or electrolyte deficiency. Common complications include; fluid overload,
infiltration, presence of air embolism, hematoma formation and infection of the cannula site.
During fluid replacement, the nurse should monitor signs of fluid overload and stop the infusion.
The nurse should ensure there are no air bubbles in the giving set to prevent air embolism.
Aseptic technique should be applied to avoid infection of the cannula site.
 Central venous catheter (CVC)
It is placed in the neck, chest, axilla or femoral veins and is used in the administration of
fluids, medication, and dialysis, measurement of central venous pressure and determination of
oxygen saturation on the central venous circulation. Complications include pneumothorax,
sepsis, thrombosis and air embolism. The catheter should be flushed after use to avoid blockage,
and the nurse should change the dressing on the catheter regularly to prevent infection and kink it
when opening to prevent the introduction of air to the vein.
Q5B.What is Total Parenteral Nutrition?
It is the introduction of the parenteral solution via an intravenous line into the body to provide
daily energy and nutrients required without using the gastrointestinal tract.
Outline at least three (3) indications of Total Parenteral Nutrition.

13
 Cases where there is an obstruction in the GIT
 In patients with severe malnutrition who may benefit from TPN
 Patients with a fistula in the bowel or post-operative procedures involving the gut.
What is the composition of a Standard TPN solution?
TPN is given as a substitute to daily diet hence contains components of a balanced diet. It
comprises of proteins, carbohydrates, water, minerals, vitamins and electrolytes.
Q6. What is the rationale for undertaking the following pre and post-anaesthetic
observations in a patient who has been admitted for surgery?
Q7 a. List two (2) functions and two (2) complications associated with peripherally inserted
central catheter (PICC).
Functions
 Long term iv antibiotic administration
 Parenteral nutrition
Complications
 Formation of hematoma
 Inflammation of the vein
b. Outline the Nursing Management of a patient prior and post PICC insertion procedure
Before PICC insertion, the nurse explains the process to the patient, the care, and the
indication to obtain consent. The nurse provides privacy for the patient, prepares the equipment
for insertion, locate the site and use aseptic technique. Post PICC insertion, the nurse should

14
check the catheter for patency and confirm its location inside a vein. The nurse should apply a
dressing over the catheter to cover the incision site and hold it in place. The nurse should then
assess the site for any sins on bleeding and ensure the patient is comfortable
Q8 Outline any three (3) strategies a Nurse can use for pain management in a patient after
surgery except using analgesics.
 Patient positioning- change in position can provide comfort hence lead to reduced pain
perception.
 Relaxation strategies- such as taking in deep breaths help alleviate anxiety and promote
comfort.
 Patient distraction- listening to music or watching TV programs can distract the patient
from perceiving pain.
Q9 A. In terms of a patient who is not regaining consciousness, how would you assess their
level of consciousness?
The patient will be assessed using the Glasgow coma scale
Eye-opening
If the patient opens eyes spontaneously, the patient scores a total of 4. In cases where the
patient opens the eyes after verbal communication from the nurse, she scores a 3. Patient scores
two in cases where patient opens eyes in response to pain stimuli which is applied after the
patient fails to open eyes to verbal communication (Ehwarieme & Anarado, 2017). In cases
where a patient does not open eyes even after pain stimulus, then she scores 1.
Best verbal response

15
A patient who responds to questions and is oriented to place, person and time is rated to
score 5. A patient who is disoriented in time, person or place but speaks coherent words is
evaluated with a four. A patient who verbalizes inappropriate words which do not correspond to
the conversation is rated with score 3. A patient who makes sounds that cannot be comprehended
to be words is rated rating 2. A patient who is unresponsive to verbal command or pain stimulus
is allocated a score of 1.
Motor response
A patient who can move part of the body in response to verbal instruction is denoted with
a score of six. A patient who does not respond to verbal command but can detect pain and
localize pain is rated with a rating of five. Patient who shows normal flexion by withdrawing
from pain is allocated a score of four. A patient who shows abnormal slower flexion from the
pain stimulus is awarded a score of three. Patients who respond by unusual extension towards
pain stimulus are rated with a rating of 2. Patients who show no motor response at all are rated
with a scale of 1 (Ehwarieme et al., 2017).
After recording the findings, the sum of each cadre is the level of consciousness of the patient.
A score of; 3-8 denotes that the patient is in a coma, a score of 9-12 indicates moderate loss of
consciousness, 13-14 means mildly impaired consciousness.
B. What signs and symptoms of deterioration you need to monitor?
 Delayed capillary refill time
 Abnormal pulse in terms of strength and frequency

16
 Unresponsiveness
 Signs of confusion and disorientation
 Slandering speech
Q10 Draw a neatly labelled diagrammatic flow chart representation of the management of
a case of pediatric Cardio Pulmonary Resuscitation for a five-year-old male in a hospital
where two certified CPR givers are available.
Pulse present
The patient is unresponsive
to verbal and physical
stimulation.
The patient is not breathing
or gasping
2nd rescuer rushes to call for
help from other staff, bring
emergency equipment and
the defibrillator
Check the carotid pulse of
the child confirming for 10
minutes.
Open the airway; kneel over
the child and Start CPR 30
compressions with two
rescue breaths till the next
rescuer returns with AED
Administer two
rescue breaths each
after 5 seconds while
checking pulse after
every 2 minutes.
When the second rescuer
arrives, continue with CPR
15 with two rescue breaths
from the second rescuer.

17
Shockable not shockable
Q11 Explain the physiology behind the progression of a respiratory arrest into a cardiac
arrest.
Respiratory arrest is the complete cessation of breathing in a patient. In this state, the
patient's heart might still be beating and supplying distant blood organs. In cardiac arrest, there is
no heartbeat hence the organs, including the brain, are deprived of oxygen, thus shut down. After
a respiratory arrest, the heart still pumps blood throughout the body, due to cessation of
breathing, there is no ventilation hence carbon iv oxide builds up in the blood that is being
supplied to the organs (Anderson et al., 2016). Carbonic acid increase in the body and the low
level of oxygen in the blood compromises heart and brain function leading to a cardiac arrest.
Q12 A. Excluding Deep Vein Thrombosis, outline at least four (4) complications associated
with bed rest.
 Pulmonary embolism that results from a clot that migrates from the deep veins into the
lungs.
 Pressure sores due to friction and humidity.
Assess for signs of shockable
rhythm such as ventricular
fibrillation and pulseless
ventricular tachycardia.
Shock the patient once
then Resume CPR 15 to
2 breaths till the patient
is asystole or achieves
normal sinus rhythm
Continue with CPR 15
compressions to 2
breaths switching
positions until the child is
asystole or regains
normal sinus rhythm

18
 Contractures as a result of prolonged disuse
 Malnutrition due to inability to obtain food on demand.
B. Describe in brief the complex nursing management of a patient who was recently
diagnosed with DVT.
In the nursing management of DVT, the nurse begins with history taking and physical
exam of the patient. The nurse will assess the legs for signs of swelling and the extent of the pain
and tenderness. After careful assessment, the nurse should formulate a priority nursing diagnosis
based on individual needs. The typical nursing diagnoses in DVT are, ineffective tissue perfusion
related to blocked venous blood flow, acute pain associated with the inflammatory process, and
diminished physical mobility related to the disease process. After formulating a diagnosis, the
nurse should set goals expected to be achieved after implementation of management (Kaur, Saagi
& Choudhary, 2016). The nurse should provide comfort to the patient by administering
prescribed analgesics, anti-inflammatory and anticoagulant drugs. The nurse should also elevate
the affected limb to improve venous return. The nurse should offer stockings for compression for
the affected leg to increase the velocity of blood flow. After the implementation of the
interventions, the nurse should evaluate the patient condition in reference to the set goals to
confirm the need to re-plan the management.
Q13 List five (5) clinical manifestations and five (5) complex nursing interventions of Acute
Pancreatitis
Clinical manifestations
 Pain in the upper abdomen
 Tenderness on the upper abdominal quadrant

19
 Nausea and vomiting
 Fever
 Tachycardia
Nursing interventions
 Assess the level of pain in reference to pain scale, administer prescribed analgesics and
provide comfort and relaxation techniques to alleviate pain.
 Monitor blood pressure, fluid intake and out, monitor the amount and colour of vomitus
so assess to prevent dehydration
 Explain to the patient the on the condition so as to reassure him and alley anxiety.
 Maintain the patient on Nil per Oral to prevent stimulation of the pancreas.
 Educate the patient on the causative factors of the condition and explain the rehabilitation
procedures
Q14 a. List three (3) indications of tracheostomy suctioning.
 Evidence of desaturation
 Respiratory distress
 Inability to cough out secretions.
B. Briefly outline the nursing management involved in tracheostomy suctioning
In the clinical management of a patient on tracheostomy care, the nurse has to perform
suctioning from time to time to clear secretions and promote ventilation. A patient who is
coughing has respiratory distress or gurgles is an indication for suctioning. During suctioning,

20
the nurse should administer oxygen to the lungs before beginning to suction (Schreiber, 2015).
The nurse should use a sterile procedure to avoid infections. The nurse should examine the first
secretions on the colour and consistency before discarding. During suctioning the nurse should
monitor the patient for signs of complications and should not suction for more than 10 seconds.
Suction skills should be applied to avoid removal of the tracheostomy tube.
Q15. Read the scenario and outline at least four complex nursing interventions.
Scenario Nursing Diagnosis Complex Nursing Intervention
Mrs Fernando is an 83-year-
old widow who lives with her
two adult sons. Over the past
15 years, she has become
increasingly short of breath
while gardening and walking,
two favourite activities. She
also has developed a chronic
cough that is particularly bad
in the mornings. Ten years
ago, her family physician told
her that she had emphysema.
She is admitted to the hospital
with possible pneumonia and
acute exacerbation of COPD.
Mr Harris develops the
following nursing diagnoses
for Mrs Fernando:
• Ineffective airway clearance
related to pneumonia and
COPD
• Impaired gas exchange
related to acute and chronic
lung disease
• The risk for impaired
spontaneous ventilation
related to loss of hypoxemic
Encourage the patient to
cough up secretions and give
her fluids to make secretions
light hence enable easy
clearance.
Administer oxygen via a mask
to promote gaseous exchange.
Administer prescribed
bronchodilators and
decongestants to improve
ventilation hence adequate
tissue perfusion.

21
respiratory drive and
respiratory muscle fatigue
• Impaired home maintenance
related to activity intolerance
Advice the patient to limit
activity at home and provide
emotional support until the
patient recovers.
Q16 Describe in detail the nursing management of a patient with an intercostal catheter
and an underwater chest drainage tube (UWSD)?
Intercostal catheter and an underwater chest drainage tube (UWSD) are placed surgically
to enable drain fluids accumulated in the pleural cavity. In the management, the nurse should
monitor vital signs strictly after every fifteen minutes during the first day and after every two
hours in the subsequent days. Vital observations point out to the general condition of the patient
(Altree, Jersmann & Nguyen, 2018). The nurse should ensure change of dressing on the incision
site aseptically while examining the site to prevent infection. The nurse should monitor and
record the amount of fluid drained from the catheter and observes signs of blockage. The catheter
should be kept straight and should be emptied regularly to avoid backflow. During emptying, the
nurse should clump the catheter to prevent the introduction of air into the pleural cavity. Daily
patient evaluation of the patient should be performed to establish patient condition and plan the
care.
Q17 Outline the nursing management of a patient on BIPAP and CPAP

22
BIPAP and CPAP are non-invasive methods of ventilation that are used in the management
of sleep apnea. CPAP works by directing air into the lungs under pressure, then allows the
patient to breathe out on his own. BIPAP has two pressure modalities where it leads air into the
lungs under high pressure and exerts a negative low pressure to help the patient exhale (Harper,
Mandal, Florentine & Harper, 2019). Nursing management include;
 Regular reading and recording of vital observation on the chart, such as rate of
respiration, Pa of oxygen, heart rate, and confirm the setting on the ventilator. Patient
temperature should be taken every four hours and perform blood gas analysis as often as
the patient presents. The nurse should assess patient holistically to identify cases of fluid
imbalance, evaluate the effectiveness of the treatment prescribed.
 The nurse should ensure the airway is kept secure and managed consistently. The nurse
should provide the air applied if of the right temperature and is humidified (Harper et al.,
2019). Airway suction is another procedure that the nurse should evaluate the necessity
and perform immediately. Suctioning removes secretions from the airway that may
prevent effective breathing. The nurse should assess the amount, consistency and colour
of the secretions to determine signs of infection.
 Positioning is a major factor in ventilation. The nurse should ensure correct positioning of
the patient and avoid regular movements of the prongs as this may lead to pressure injury
due to friction.
 The nurse should constantly assess the patient for signs of complications due to
hypoventilation or hyperventilation. Hypoventilation presents with respiratory distress,
decreasing SpO2, worsening apnea and dyspnea.

23
Q18. Outline the function of each of the following equipment that is present in an acute
care environment
Item Function
Bag and Mask,
Endotracheal tube,
Laryngoscope
Used in airway management in patients with compromised airway.
Pulse oximeter Measure the saturation of oxygen in the blood
Vacuum pump and
suction catheter
A suction catheter is used to collect secretions of the upper airway such
as saliva and mucus.
Electrocardiograph Equipment used to measure electrical heart activity.
Defibrillator Uses electric current to restore the electrical condition of the heart hence
correcting ventricular tachycardia and fibrillation.
Standard IV fluids
and administration
sets
Used in the acute correction of fluid loss, hypotension and dehydration.
Infusion Pump Used to deliver a large amount of fluids to patients in a controlled
manner.
Large-bore IV
catheters
Supplies for
Thoracostomy
Used to insert a chest tube in conditions such as pleural effusion
Nasal gastric/oral
gastric tubes
Used to aspirate gastric content, gastric suction and examination of
bleeding from upper GI

24
Hard cervical collars Used to support the neck to minimize further spinal injury
Thermal control for
patients and
fluids/blood
Helps to warm the patient and the intravenous fluids for the patient
before administration to prevent hypothermia
Q19 Classify burns based on causative factors. Describe the 4 degrees of burns as a result
of fire with clinical features.
Classification according to cause
Electric burns
This are burns due to an encounter with an electric current. The injuries have a
characteristic entry and exit points. They lead to coagulation and tissue necrosis and are mostly
concealed as they cause internal damages of the heart or nervous system.
Thermal burns
They are caused by contact with objects that are hot, direct contact of heat or flame. The
extent of the injury depends on the type of heat, site of contact and the temperature of the source.
Scald burns
These are burns caused from contact with hot liquids. They normally occur in children
due to burn from hot water, tea, or cooking oil.

25
Chemical burns
These occur due to contact with chemical substances. The severity of the injury depends
on the type of chemical and duration of exposure. They usually happen in industrial areas.
Flash burns
Result from rapid ignition of flammable gases or liquids. They affect the exposed body
parts to the agent. They can produce inhalational burns.
Steam burns
These are burn injuries that occur as a result of evaporated fluid. They affect the directly
exposed body surface and can cause severe inhalational burns.
Degree of burns
First degree
They affect the epidermis layer of the skin. It is a superficial effect with minimal tissue damage.
Generally, due to sunburns, cause tissue erythematous and painful. They heal within days
without scarring.
Second degree

26
These are partial-thickness burns which affect both the epidermis and the part of the
dermis. Adnexal structures such as sweat glands and hair follicles are involved, but their
function is preserved to allow proliferation and skin repair (Thalji, Kothari, Kuo & Mosier,
2017). The burns are excruciating; they form blisters, appear bright red and blanch with pressure.
They heal after a few weeks with minimal scarring.
Third-degree burns
They are full-thickness burns where the skin is charred and translucent colour with
underneath coagulate blood vessels. They are insensate due to the damage of nerve endings, but
the patient may complain about pain due to surrounding second-degree burns (Thalji et al.,
2017). All the adnexal structures are destroyed hence take long to heal. They heal with extensive
scarring and contractures.
Fourth degree
These are full-thickness burns which involve damage to the extensive tissues and organs.
It includes the destruction of the hypodermis and the bone tissue. The injuries usually are black
and lead to loss of the part burnt. It leads to loss of body parts and alters body image.
Q20.  What is venous thromboembolism (VTE)?
VTE is a vascular condition where there is the formation of a blood clot in the blood
veins.
 Outline the types of VTE.
-Deep Vein thrombosis (DVT) which is the formations of blood clots in the deep veins,
especially veins of the lower limb.

27
-Pulmonary embolism (PE) which occurs when a blood clot dislodges from the deep vein and
follows blood flow up to the lungs.
 Mention at least two (2) clinical features for each type of VTE.
DVT
 Swelling of the limb
 Limb pain
PE
 Chest pains
 Hemoptysis
Q21. a. Outline at least TWO (2) extrinsic and TWO (2) intrinsic causes of fractures.
Extrinsic
 Direct trauma such as falls or accidents which results in predictable fractures and mostly
occur in a commutated manner
 Breakage due to forces of torsion. This is where one end of the bone is held constant, and
the other part rotates forcefully mostly results in spiral fractures (Liu, Xiao, Ji, Xie &
Hao, 2015).
Intrinsic

28
 Pathological cause; this occurs as a result of underlying bone disease such as
osteoporosis that makes the bone weak, making it prone to fracture with minimal
force (Liu et al., 2015).
 Muscular contraction; it results as a result of trauma to the muscle leading to violent
contraction and shortening hence leading to a fracture.
b. What is a green stick fracture? What age group does it affect?
Greenstick fracture is caused by bending forces which leads to the focal application of a
force to the hence causing a break on the opposite side while the side of trauma remains intact. It
affects infants and children when the bone tissue is soft (Vargas & Mujika, 2017).
c. Outline three (3) clinical features of greenstick fractures.
 Pain on the fracture site due to tissue injury.
 Swelling at the fracture site due to inflammation.
 A bend at the fracture area due to the nature of the fracture.
Q22. Write the indications of use for the following emergency medications that are used in
acute situations.
Drug Indication

29
Adrenaline
(1000 microgram in 1 mL
injection equivalent to
1:1000) 1000 microgram =
1 mg
Anaphylactic shock
Severe hypotension
Atropine
(0.6 mg in 1 mL injection)
Organophosphate poisoning
Severe bradycardia
Benztropine
(2 mg in 2 mL injection)
Extrapyramidal drug side effects
Benzylpenicillin
(600 mg or 3 g powder,
dissolve in water for
injections)
Septicemia
Acute osteomyelitis
Chlorpromazine
(50 mg in 2 mL injection)
Chronic hiccups
Nausea and vomiting
Dexamethasone sodium
phosphate
(4 mg in 1 mL injection)
Allergic reactions
Diazepam
(10 mg in 2 mL injection)
Seizures
Panic attack
Dihydroergotamine
(1 mg in 1 mL injection)
Migraine headaches
Diphtheria and tetanus Cut wounds with foreign objects

30
booster vaccine
(0.5 mL pre-filled syringe)
Furosemide
(20 mg in 2 mL injection)
Hypertension with oedema
Glucagon
(injection kit containing 1
mg glucagon and 1 mL
solvent in the syringe)
Hypoglycemia
Glyceryl trinitrate
(400 micrograms per dose,
200 doses as a sublingual
spray
Angina pectoris
Haloperidol
(5 mg in 1 mL injection)
Acute psychosis
Alcohol withdrawal syndrome
Hydrocortisone sodium
succinate
(100 mg or 250 mg with
2 mL solvent for injection)
Allergic reaction
Acute asthmatic attack
Breathing problems
Lignocaine
(100 mg in 5 mL injection)
Local anaesthesia
Metoclopramide
(10 mg in 2 mL injection)
Nausea and vomiting
Gastro oesophagal reflux disease
Methoxyflurane Severe pain due to trauma

31
(3 mL plus inhaler)
Morphine sulfate
(15 mg or 30 mg in 1 mL
injection)
Severe pain
Naloxone
(2 mg in 5 mL injection)
Opioid overdose
Procaine penicillin
(1.5 g in 3.4 mL injection)
Syphilis
Pneumococcal pneumonia
Prochlorperazine
(12.5 mg in 1 mL
injection)
Anxiety
Severe nausea and vomiting
Promethazine
hydrochloride (50 mg in 2
mL injection)
Allergy
Nausea and vomiting
Salbutamol inhaler
(100 micrograms per dose,
200 doses)
Acute asthma
Salbutamol nebulizer
solution (2.5 mg or 5 mg in
2.5 mL per dose, 30 doses)
Chronic bronchospasm
Acute severe asthma
Terbutaline
(500 micrograms in 1 mL
injection)
Acute bronchospasm
Tramadol Acute pain

32
(100 mg in 2 mL injection)
Verapamil
(5 mg in 2 mL injection)
Angina pectoris
Arrhythmias
Q23. a. What are the clinical manifestations of Acute Myocardial Infarction?
 Pain or tightness on the chest due to irritation of nerve cells of the heart muscle.
 Shortness of breath due to pulmonary oedema caused by the failure of the heart to pump
blood effectively.
 Fast heart rate due to the compensatory mechanism of the heart.
 Sweating due to increased sympathetic flow
b. Outline the complex steps involved in its nursing management.
Nursing assessment
The nurse should take a detailed history to do a comprehensive physical exam on the
patient to understand the nature of the symptoms and the duration. The nurse should monitor
blood pressure and check for signs of increased heart rate (de Cordova, Johansen, Martinez &
Cimiotti, 2017). The nurse should also assess the presence of nausea and vomiting and its
severity. Assess the respiratory system to check for signs of dyspnea and tachypnea.
Nursing diagnosis

33
In reference to the history collected and physical exam, the nurse should establish a
priority nursing diagnosis to aid in patient care.
Acute pain related irritation of nerve cells of the heart as evidenced by patient verbalization of
pain.
Ineffective cardiac tissue perfusion related to deficient coronary blood flow.
Expected outcome
Due to the presenting symptoms, the nurse should set patient goals to promote patient
condition. The patient should verbalize reduced pain, present normal respiratory status,
demonstrate regular heart rate and controlled symptoms of the attack. The nurse should ensure
the patient demonstrates calmness and an understanding of the prognosis of the condition.
Nursing interventions
The nurse should administer oxygen therapy to improve cardiac tissue perfusion hence
relieve symptoms. Assess the level of pain in reference to pain scale, administer prescribed
analgesics and provide comfort and relaxation techniques to alleviate pain (de Cordova et al.,
2017). The nurse should monitor blood pressure, fluid intake and out, monitor the amount and
colour of vomitus so assess to prevent dehydration. Explain to the patient the on the condition so
as to reassure him and alley anxiety. The nurse should also monitor the patient's condition to
detect deviation from usual symptoms hence prevent complications.
Patient evaluation

34
After implantation of the planned interventions, the nurse should reassess the patient to
confirm the effectiveness of the management and determine the need for a change of
management strategy. It involves assessing the pain level, the respiratory function and the
cardiac perfusion. The nurse ensures that the patient is relaxed, and impending cardiac muscle
damage is prevented.

35
References
Altree, T. J., Jersmann, H., & Nguyen, P. (2018). Persistent air leak successfully treated with
endobronchial valves and digital drainage system. Respirology case reports, 6(8),
e00368.
Andersen, L. W., Kim, W. Y., Chase, M., Mortensen, S. J., Moskowitz, A., Novack, V., ... &
Donnino, M. W. (2016). The prevalence and significance of abnormal vital signs before
in-hospital cardiac arrest. Resuscitation, 98(1), 112-117.
De Cordova, P. B., Johansen, M. L., Martinez, M. E., & Cimiotti, J. P. (2017). Emergency
department weekend presentation and mortality in patients with acute myocardial
infarction. Nursing Research, 66(1), 20-27.
Ehwarieme, T. A., & Anarado, A. N. (2017). Nurses use of Glasgow coma scale in the
neurological assessment of patients in University of Benin Teaching Hospital, Benin City
Edo State, Nigeria. Journal of Medicine and Biomedical Research, 16(1), 47-61.
Harper, J., Mandal, V. J., Florentine, V., & Harper, J. (2019). Using Respiratory Care
Practitioners to Reduce Readmissions by Managing Cardiopulmonary Patients in a
Skilled Nursing Facility. Journal of the American Medical Directors Association, 20(3),
B12.
Kaur, R., Saagi, M. K., & Choudhary, R. (2016). Evaluate the Effectiveness of Structured
Teaching Program on Knowledge Regarding Prevention and Management of Deep Vein
Thrombosis (DVT) in Patients among Nursing Staffs. International Journal of Nursing
Education, 8(1), 123-127.

36
Liu, W., Xiao, J., Ji, F., Xie, Y., & Hao, Y. (2015). Intrinsic and extrinsic risk factors for
nonunion after nonoperative treatment of midshaft clavicle fractures. Orthopaedics &
Traumatology: Surgery & Research, 101(2), 197-200.
Rocco, M. V., Sink, K. M., Lovato, L. C., Wolfgram, D. F., Wiegmann, T. B., Wall, B. M., ... &
Lewis, C. E. (2018). Effects of intensive blood pressure treatment on acute kidney injury
events in the Systolic Blood Pressure Intervention Trial (SPRINT). American Journal of
Kidney Diseases, 71(3), 352-361.
Schreiber, M. L. (2015). Tracheostomy: site care, suctioning, and readiness. Medsurg
Nursing, 24(2), 121.
Stanghellini, V., Chan, F. K., Hasler, W. L., Malagelada, J. R., Suzuki, H., Tack, J., & Talley, N.
J. (2016). Gastroduodenal disorders. Gastroenterology, 150(6), 1380-1392.
Thalji, S. Z., Kothari, A. N., Kuo, P. C., & Mosier, M. J. (2017). Acute kidney injury in burn
patients: clinically significant over the initial hospitalization and one year after injury: an
original retrospective cohort study. Annals of Surgery, 266(2), 376.
Vargas, G., & Mujika, F. (2017). Greenstick fracture in composite pultruded rods. Composites
Part B: Engineering, 110, 106-115.