Unit 3: Drowning

Question 1

“Drowned”

Answer 1

term meaning that the victim died as a result of drowning

Question 2

Drowning

Answer 2

• either death or survival
• survives drowning if he/she is successfully resuscitated from cardiac or respiratory distress and is D/C from hospital
• classified as witnessed or unwitnessed; witnessed when the episode is observed, unwitnessed when victim found in water

Question 3

Risk Factors for Drowning

Answer 3

• Alcohol use
• Assault
• Drug abuse
• Head trauma
• Hypothermia
• Severe weather
• Water sport accidents
• Younger age (0-5)
• Inability to swim
• Open water swimming in severe currents, riptides, waves, and cold water temperatures

Question 4

Pathophysiology of Drowning

Answer 4

• starts with submersion in water and the victim’s automatic or voluntary response of holding his/her breath
• there is a depletion of oxygen and a build up of CO2
• as the victim remains underwater, he/she starts to breathe in water w/o any gas exchange occurring, further decreasing oxygenation
• respiratory and circulatory systems collapse
• neurologically the victim suffers seizures, coma, and death

Question 5

Clinical Manifestations of the Cardiovascular System

Answer 5

• initially hypertensive and tachycardic with activation of the sympathetic nervous system
• while hypoxia, acidosis, and hypothermia worsen, victim becomes bradycardic, pulmonary hypertension develops, and there is decreased CO
• atrial fibrillation and other arrhythmias may occur, progressing to asystole

Question 6

Clinical Manifestations of Respiratory System

Answer 6

-b/c of impaired or nonexistent ventilation, hypoxia, hypercarbia, and acidemia occur

Question 7

Neurological System Clinical Manifestations

Answer 7

• development of hypoxia from drowning causes CNS dysfunction
• it begins with 5 minutes of inadequate oxygenation
• ranges from confusion and disorientation to coma, seizures, and death

Question 8

Complications of Drowning

Answer 8

• if survives, will develop acute respiratory failure; d/t aspirated fluid, increased capillary permeability, and neurogenic pulmonary edema
• decrease in lung compliance is the result of surfactant washout and dysfunction resulting in atelectasis, ventilation-perfusion mismatch, and intrapulmonary shunting

Question 9

Diagnostic and Laboratory Tests

Answer 9

• Arterial Blood Gases (ABGs) to assess respiratory status
• Chest x-ray may reveal presence of infiltrates or aspiration
• Exam should focus on respiratory, cardiovascular, and neurological systems
• Dyspnea, wheeze, and crackles suggest aspiration

Question 10

Treatment

Answer 10

• priority: restore oxygenation, ventilation, and perfusion
• ventilatory support w/ supplemental O2
• further support w/ noninvasive ventilation or intubation depending on severity of respiratory failure and LOC
• intensive care management is directed at treating hypoxia, maintaining cardiovascular stability, neuroprotection, and prevention and/or management of infection likely present d/t aspirated fluid
• hypothermia common
• medications and defibrillation not likely successful in core temperature is below 86 degrees F
• slow, active rewarming should be instituted ASAP to facilitate resuscitation priorities
• prevention of multiorgan failure

Question 11

Nursing Management: Assessment and Analysis

Answer 11

• clinical manifestations are r/t the amount of time victim has been submerged underwater
• respiratory effects range from respiratory distress to respiratory failure and apnea
• cardiovascular effects range from hypertension and tachycardia secondary to the initiation of the SNS to cardiovascular collapse secondary to lack of oxygen
• neurovascular effects may be slight confusion to no response

Question 12

Nursing Diagnoses

Answer 12

• impaired gas exchange
• hypothermia
• decreased LOC

Question 13

Nursing Assessments

Answer 13

• Vital Signs
• Arterial Blood gases
• Neurological assessments

Question 14

Nursing Actions

Answer 14

• Administer 100% nonrebreather mask
• Prepare for intubation; protect airway
• Continuous cardiac monitoring; detects for bradycardia and dysrythmias
• Insert IV; medications and fluids to support cardiovascular status
• Anticipate CPR; in severe prolonged drowning

Question 15

Teachings

Answer 15

-Water safety; observation of children, use of life preservers, limit alcohol, learn to swim

Question 16

Evaluating Care Outcomes

Answer 16

• successful intervention is possible if submersion time is minimal
• well-managed patient is one who is discharged w/ minimal to no respiratory, circulatory, or neurological sequalae
• patient understands hazards of water and takes the safety precautions
• best cure is prevention