Ryan

Question 1

What did Ryan come into ED for?

Answer 1

Burn to left arm
Wheezing 
nasal flaring, intercostal and subcostal
recession, tracheal tug, respond with single word
answers

Question 2

What is Ryan’s medical history

Answer 2

1. Upper Respiratory Tract Infection (URTI)

2. Asthma/ Reactive Airways

Question 3

What is asthma

Answer 3

People with asthma have sensitive airways in their lungs which react to triggers, causing a ‘flare-up’. In a flare-up, the muscles around the airway squeeze tight, the airways swell and become narrow and there is more mucus. These things make it harder to breathe.

Question 4

What is the Paediatric Assessment triangle

Answer 4

1. Appearance 
T - Tone
I - Interactiveness
C - Consolability 
L - Look or gaze
S - speech 
2. Work of breathing 
3. Circulation to the skin

Question 5

Best way to care for superficial burns

Answer 5

• Cool water
• Non-adhesive dressing
• Anti inflammatories
• Ensure adequate nutrition

Question 6

What is salbutamol - uses and action

Answer 6

Used to treat asthma, bronco constriction and COPD

It is a short acting beta 2 agonist allowing for bronchodilation and vasodilation by making the smooth muscles relax

Question 7

Nursing considerations for salbutamol

Answer 7

• 8 rights
• allergy check
• Monitor vital signs especially HR
• Note and report any cardiac arrhythmia
• Monitor for therapeutic effectiveness

Question 8

What is Ipratropium bromide - uses and actions

Answer 8

Used for asthma and COPD - opens up medium and large airways. Ipratropium acts as an antagonist of the muscarinic acetylcholine receptor. This effect produces the inhibition of the parasympathetic nervous system in the airways and hence, inhibit their function.

Question 9

Nursing considerations for Ipratropium bromide

Answer 9

• 8 rights
• Allergy check
• 6-8L for neb on wall
• Caution with use of those with cystic fibrosis for risk of GI motility disturbance

Question 10

What is Alvesco - use and action

Answer 10

Glucocorticoid used for asthma.

Non-halogenated glucocorticosteroid acting on the lungs without significant systemic effects

Question 11

Nursing responsibilities for Alvesco

Answer 11

• 8 rights
• Allergy check
• If changing from oral to inhaled, patient should be stable
• Caution for those with active/latent tuberculosis or Resp tract infection or liver impairment

Question 12

What is Prednisolone - use and action

Answer 12

Glucocorticoid for anti inflammatory or immunosuppressant
Prednisolone reduces inflammatory reaction by limiting the capillary dilatation and permeability of the vascular structures.

Question 13

Prednisolone nursing R’s

Answer 13

• 8 rights
• Allergy check
• Monitor serum electrolytes
• Monitor blood glucose
• Increased risk of hypothrombinaemia if given with aspirin

Question 14

Oxygen - action and use

Answer 14

This treatment increases the amount of oxygen your lungs receive and deliver to your blood. We need sufficient oxygen so that it can reach our peripheries and supply the cells with necessary oxygen to keep them alive.

Question 15

Nursing R’s for oxygen

Answer 15

• 8 rights
• allergy check
• Monitor o2 especially in COPD patients

Question 16

How to evaluate the care and plan future care

Answer 16

• Symptoms decreased (work of breathing decreased)
• More cooperative
• Reassure mother he will be okay
• Include mother in care of child, keep her up to date
• Educate them on medication use, possible triggers, what to do if he starts to flare up
• Referral to GP for burns dressings