Monitoring Flashcards
- Airway
I would monitor Phil’s airway every 15 minutes and record. I would do this by talking to Phil and try to gauge a response whilst also listening to sounds of obstruction such as snoring and gurgling. This is because Phil’s current hypovolemia caused by his oesophageal variceal bleed puts him at risk of a fall in his cardiac output there reducing the amount of oxygen delivered to the brain which could suppress his conscious level further. This could also lead to Phil’s inability to maintain his own airway therefore putting him at risk of obstruction
- Respiration Rate
I would monitor and record Phil’s respiration rate every 15 minutes. I would do this by manually watching the rise and fall of his chest for a minute. This is because his RR is already high at 32bpm. If this increases further this would indicate that his hypovolemia has deteriorated further therefore reducing oxygen supply to cells therefore putting him at risk of a metabolic acidosis from lactic acid. His pH will increase the stimulus of his chemoreceptors
- Oxygen Saturation
I would monitor and record Phil’s oxygen saturations every 15 minutes. I would do this using a pulse oximeter on his finger. This is because a further decrease in Phil’s oxygen saturations would indicate that there is less haemoglobkn to bind to oxygen as a result of his hematemesis due to his oesophageal varices therefore leading to further hypoxia
- Heart Rate
I would monitor and record Phil’s heart rate every 15 minutes. I would do this by manually feeling for his radial pulse. This is because Phil’s HR is already high and a further increase would indicate that there is a further decrease is stroke volume meaning Phil could be losing circulatory volume via his oesophageal varices bleed.
- BP
I would monitor Phil’s BP every 30 minutes and record. I would do this by monitoring his BP manually. This is because his BP is already low comapared to his baseline meaning he is is progressive shock. If this deteriorates any further, he could deteriorate into the refractory stage which is irreversible if his variceal bleed gets worse. His compensatory mechanisms such as SVR and HR are already failing to maintain his BP as his circulatory volume is already decreasing due to his bleed
- CRT
I would check Phil’s CRT every 15mins and record. I would do this by putting pressure on the inside of his finger for 5 seconds and release. This is because if his CRT delays further, this would indicate a further vasoconstriction which means that his neural and hormonal compensatory mechanisms are failing to maintain his BP hence the further vasoconstriction in order to increase SVR.
- Urine Output
I would monitor Phil’s urine output every hour and record via and hourly urinary bag. Phil’s urine output is already low and a further decrease would indicate a further renal perfusion as a result of a further reduction in cardiac output based on a reduction of stroke volume due to his oesophageal varices bleed.
- Temperature
I would monitor Phil’s temperature every 15 mins and record using a tympanic probe. Phil is currently hypothermic and is at risk of infection as his liver failure means kepffer cells are less effective at destroying bacteria. His WBCC is already elevated which could indicate an underlying infection. Any small increase of temperature could be a sign of systemic infection
- Glucose
I would check Phil’s blood glucose every 30 minutes and record using a glucometer because he is at risk of a further hypoglycaemia due to his poor oral intake and depleted glycogen stores
- Conscious level
I would monitor and record Phil’s conscious levels every 15 minutes by talking to him him and observing him using the AVPU alertness scale. This is because he is at risk of his conscious levels deteriorating further due to his hypoxia as a result of reduced cardiac output
