This reflection applies Johns’ reflective model with two clinical experiences reflected upon: the first, a non-obstetric incident – an emergency appendectomy on a 10 year old girl; and the second, an emergency appendectomy on a pregnant woman. Johns’ model covers five main…
l of this reflection is to re-evaluate these two clinical experiences as an anaesthetic nurse and to establish that better knowledge and skills have been gained by this nurse from these experiences.
The 9-year old girl, Cora (not her real name), was admitted due to pain in her lower abdomen, which started three hours prior to admission, with the pain radiating to her lower right abdomen by the time she was admitted. She also had a high-grade fever at 39.50C (103.10F) and vomited as soon as they arrived in the emergency room. Prior to the manifestation of her initial symptoms, she was running the tracks at a nearby park with her friends. In the emergency room, the attending ER internist physically assessed and examined Cora and determined that she had appendicitis and immediately recommended her for surgery. Her pain symptoms were escalating and were progressively becoming unbearable. Pain escalation, in this case, is attributed to peritoneal irritation (Craig 2014).
Based on the above gathered data on the patient, I planned my next actions and decisions accordingly. I prepared the essential equipment appropriate for physiology of the child, specifically a T-piece Mapleson E valveless breathing system (Ramamani, Mohanty, and Suman Gupta 2008). This is a breathing system which supports spontaneous as well as controlled breathing. This system is attached to a 0.5 litre double-ended bag, providing the least resistance during expiration (Ramamani, Mohanty, and Suman Gupta 2008).
I opted for an adjustable pressure limiting (APL) valve including a closed-ended bag or the Ayre’s T-piece to manage scavenging (Gregory and Andropoulos 2012). A paediatric circle breathing system was also set (Gregory and Andropoulos 2012). Dead space refers to the amount of alveolar gas breathed in, and the volume of such space is decreased through an infant paediatric mask used with an appropriate filter and port (Goonasekera, Goodwin, and Wang 2014. Goonasekera and colleagues (2014), ...
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