Homeostasis and Pain Management in Patient with Multisystem Failure - Essay Example

?NURSING NURSING Homeostasis and Pain Management in Patient with Multisystem Failure Immediate Assessment of the patient The primary and immediate assessment of Geriatric Patient with Multisystem Failure particularly the patient’s homeostasis, oxygenation, and level of pain is to assess whether a patent airway, breathing and circulation processes are adequate. For the case of Mrs. Baker, she has dyspnea and starting the diagnosis by assessing her airway and breathing process is ideal. If in any case the airway is compromised due to obstruction or edema the patient should be intubated before taking care of any other issues (Poitout, 2004). Consequently, obtaining the blood pressure, respiration rate, pulse rate and temperature will reveal the vital symptoms of whatever ailments that the patient is suffering from. Determining the oxygenation of Mrs. Baker is extremely essential; this can be executed by the use of the pulse oximeter. Place the pulse oximeter on the index finger and observe the patient’s skin color, the beds of the finger nails, and also the skin around the lips (Poitout, 2004). The time intervals for capillary refills should be noted while also assessing the beds of the fingernails. Current level of consciousness should be determined by assessing the reactivity of pupils, orientation to person, time and place; ask the patient questions to estabish the state of the mind. Symptoms and signs of dehydration together with skin turgor, decreased blood pressure, lethargy, sunken eyes, confusion, dizziness, and dry mucous membranes must be investigated (Poitout, 2004). The pain levels of the patient can be assessed successfully when the patient is in a conscious state and when he/she can still speak; for instance, the pain of the patient can be rated on a scale of 1 to 10. In this regard, 1 will represent zero pain while 10 indicate extreme pain that a patient has ever felt (Gelinas, et al., 2004). However, on arrival, if the patient is unable to speak, the nurses and attending physicians should be vigil in observing any clues of how the patient is experiencing pain by looking for signs like agitation, moaning, facial grimacing and restlessness. Given the case of Mrs. Baker; she is currently suffering from diabetes; for this matter, her blood sugar levels must be examined using the glucose meter. Furthermore, there is a standard standing order for intravenous medication in such situations, in this regard it important and a must to start an IV. The lab personnel must be ordered to be drawn off of the IV. Technological tools used, why they are used, and importance of the tools in determining the patient’s status Tools and technology to be used in the diagnosis include, pulse oximeter, stethoscope, glucose meter, Sphygmomanometer, Laryngoscopes, Stylets, and tracheal tubes The pulse oximeter is a medical device essential for measuring or monitoring indirectly the patient’s blood oxygen saturation, and blood volume changes in the skin. The pulse oximeter is also useful as it displays the patient’s pulse rate (Niles, 2010). The pulse oximeter is a vital tool especially in the event where patient’s oxygenation is unstable or compromised like in the intensive care unit, operating, emergency and in ward settings. As already mentioned, the tool helps in assessing the patient’s need for oxygen and determining if there is any need for supplemental oxygen (Niles, 2010). The oxygenation levels of Mrs. Baker will be evaluated and recorded by the pulse oximeter. A stethoscope is an acoustic device used in hospitals for listening to sounds produced from within a human body or animal (Niles, 2010). In this regard, the instrument is indispensable in listening to sounds produced by lungs, heart, intestines together with blood flow in the veins and arteries. In this case scenario, the stethoscope will be used to determine the heartbeat rate, and the pulse rate of Mrs. Baker. The sphygmomanometer is vital in measuring the blood pressure by tying it around the upper arm of the patient (Niles, 2010). The brachial artery; the major artery in the upper arm is most used in this diagnosis. The blood pressure of Mrs. Baker will be measured by the sphygmomanometer. The Laryngoscope handles together with Miller blades, Stylets, and Tracheal tubes are the main tools used in intubating particularly when the patient has a blocked airway. The Laryngoscopes are either curved or straight (Niles, 2010). They also consist of a handle containing batteries for power light together with a set of interchangeable blades. A stylet is a malleable metal wire that is inserted into the endotracheal tube to ensure that the tube is in line with the upper airway anatomy of the patient. Tracheal tube is basically a catheter which is inserted into the trachea in order to establish a patent airway. In general anesthesia, tracheal tubes are used for airway management (Niles, 2010). If Mrs. Baker is found to have breathing difficulties due to edema or blocked airway, then, intubation is the first medical procedure to be undertaken. Prioritizing Data collection The primary or initial data collected from the patient is vital in enhancing the treatment. In this regard, asking questions provided the patient is in a talking condition or alert helps in retrieving and recording relevant data. Verbal communication helps in determining the patient’s mental status (Niles, 2010). Accordingly, looking or rather observing the patient particularly when he/she is unconscious aids in getting vital symptoms. Nonetheless, using diagnostic technological tools like the stethoscope, pulse oximeter, thermometer, and sphygmomanometer are indispensable in establishing the patient’s blood pressure, pulse rates, oxygenation rates, and the temperature levels. Assessing pain in a geriatric patient in a conscious state and a geriatric patient in unconscious state Medical technology is developing and there is no valid or reliable biochemical or physiological measure of pain. However, pain associated behaviors are vital in indicating that the patient is suffering from pain. For patients that are conscious and alert they can be asked questions regarding how they feel and the examiner can establish the intensity of the pain that the patient is undergoing (Pontollo, 2000). Accordingly, the pain of the patient can be rated on a scale of 1 to 10. In this regard, 1 will represent zero pain while 10 indicate extreme pain that a patient has ever felt. However, if the patient is in unconscious state, and unable to speak, the nurses and attending physicians should be vigil in observing any clues of how the patient is experiencing pain by looking for signs like agitation, moaning, facial grimacing, restlessness, wincing, and clenching of fists (Pontollo, 2000). Managing pain in an unconscious geriatric patient The first step in pain management is pain assessment, however, pain intervention or prevention can be provided prior to the pain stimulus. Pain amplification can result into hyper-excitability that may culminate into sensitization of the central nervous system which can develop into persistent pain. Administering preemptive analgesia is extremely important to preventing pain amplification and central nervous system hyper-excitability (Gelinas, et al., 2004). Preemptive analgesia administration should and must be timed to make sure that the peak effect of the selected drug is achieved. Patient’s can be given either IV ketorolac or IV morphine. Opioid and Sedative Therapies are also key in managing pain particularly for ICU patients. For ICU patients, Opioid analgesic therapy for instance is the primary pharmacologic treatment. When acetaminophen 500mg administered orally, the patient’s pain will be elevated to the extreme and he/she will react displaying signs of feeling adverse pain like moaning, facial grimacing or clenching of fists (Gelinas, et al., 2004). Patient’s temperatures will also be elevated. However, after sometimes the pain will diminish or subside while temperatures gradually reduce. The lessons learnt from the geriatric patient with multisystem failures is that attending physicians and nurses in the emergency room have to be extra-cautious when treating them. For instance, they must be inquisitive, observant, and prompt in order to achieve optimal care. Consequently, they must understand how to investigate and manage pain for patients of this kind. Collaborative team The members of the interdisciplinary team in geriatric include: Geriatrician: diagnosing, treating and administering preventive measures to minimize the escalation of symptoms of the geriatric patient Geriatric nurses and nurse practitioners: they are tasked with eliciting a comprehensive health history of the patient including the evaluation of physiological, psychological and functional status of the geriatric patient. They also analyze data collected together with the health care team thus determining the need for consultation (Long &Wilson, 2001). Psychologist: will help determine the mental status of the patient Pharmacist: Dispensing the prescribed drugs Dietitian: Determining the types of foods and nutrients that the patient should be fed on (Long &Wilson, 2001). References Gelinas C, Fortier M, and Viens, C (2004). Pain assessment and management in critically-ill intubated patients: a retrospective study. Am J Crit Care.13(2):126-35. Long DM, and Wilson NL, (2001). Houston Geriatric Interdisciplinary Team Training Curriculum. Houston, TX: Baylor College of Medicine’s Huffington Center on Aging Poitout, D. G., (2004) Biomechanics and Biomaterials in Orthopedics. New York; Springer Puntillo, KA.( 2000) Pain Management. In: H. Schell-Chapel and K. A. Puntillo(eds.). Critical Care Nursing Secrets. Philadelphia: Hanley & Belfus Inc. Wicker, P. and O'Neill, J., (2006) Caring for the perioperative patient. Houston, TX; John Wiley & Sons (Wicker & O’Neill, 2006) Niles, N. J., (2010), Basics of the U.S. Health Care System. New York: Jones & Bartlett Learning. Read More