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Essey po angielsku Astma notatki


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This essay will discuss an episode of care of a 15-year-old patient admitted to Paediatric Intensive Care Unit (PICU) with an asthma attack and difficulty of breathing. It will focus on one aspect of the care plan which is salbutamol nebuliser and management of the patient airway. The rationale for this topic is that asthma is a condition that affects a big group of children in United Kingdom (UK) (Asthma UK, 2016). Asthma UK, states that in the UK there is still a very high rate of people with asthma disease in comparison to the rest of theEurope. This episode of care was also chosen because it helped with developing knowledge about management of the child undergoing nebulisation for asthma and it will also include an understanding of the holistic family centred approach to the patient and the family.
Asthma is a long-term chronic condition which affects the person's airway and lungs. It causes narrowing of the airway, chest tightness, shortness of breath and coughing (Nhlbi.nih.gov, 2016). Asthma treatment depended on their severity and the frequency of their symptoms and based on this it is treated in different ways. One of the commonest treatment of asthma exacerbations is salbutamol nebulization therapy. The first nebuliser was produced in 1858 by a French inventor named Dr Sales-Girons (Frea, 2012). Nebuliser ‘is a machine that changes liquid medicine into a fine mist. The medication can then be inhaled through a mask or mouthpiece.(Asthma UK, 2016). Medication such as bronchodilator is very useful in opening the airway(Fanta, Cristiano and Haver,2003). The primary goal for using salbutamol nebuliser in asthma treatment is to open up the patient airway by reducing inflammation of the bronchioles (Salbutamol.org, 2016). Nebuliser also helps to loosen mucus and improve faster and easier clearance of the secretions from the patient chest (Potter et al., n.d.) which lead to improvement of patient condition and better breathing.(Asthma.partners.org, 2016)
Because medication management is not included in the HCA scope of practice salbutamol medication was prepared by the trained nurse and placed into the nebuliser chamber and then connected to the wall oxygen. Next step is to attach the tubing it to the oxygen mask and then put on the patient face making sure that it is covering patient mouth and nose for good and sufficient nebuliser inhalation. The size of the mask should be correct for the patient age to avoid inaccurate administration of the drug and pressure sores on the patient face or head.(Shenoi, 2013) To maintain good oxygen saturation nebuliser's should be oxygen driven on the flow rate of 6 litres per minute. (Brit-thoracic.org.uk, 2014 p.93)
Day shift was started from taking the handover from the nurse who looked after the patient in the past twelve hours. All of the relevant information was passed to the day staff together with patient observation, medications and level of oxygen that the patient required. All the information was recorded, and relevant questions were asked to ensure that current patient condition was fully explained and discussed with the nurse from the previous shift.
Firstly following ABCDE approach patient physical assessment was performed looking on the patient airway, breathing, including the patient respiratory rate, oxygen saturation, circulation, capillary refill, body temperature, disability and exposure (Resus.org.uk, 2016). Disability was assessed by monitoring the patient level of consciousness using the AVPU method.
Secondly, the safety of the bed space was checked to make sure that is appropriate for the child and its condition, all in the correct quantity and working order. All of these checks are crucial because patients having an asthma attack can quickly deteriorate and life-saving equipment in the bed space is necessary to provide efficient patient care. Consequently patient vital signs were checked and recorded focusing on the respiratory effort which is important in an asthmatic child.
Following on from the patient assessment and care plan this essay will focus on nebuliser therapy. Salbutamol, nebuliser was prepared by the nursing staff according to the local protocol and patient's drug chart which stated that the nebuliser should be administered every 2 hours. The medication was then placed in the nebuliser chamber and connected to the wall oxygen. The flow was set at 6 litres of oxygen for the. Before the nebuliser was administered, the procedure was explained to the patient, and verbal consent was gained. (Gov.uk, 2009)

The role of the Healthcare Assistant (HCA) in this episode of care was crucial, and his help and knowledge were very valued. The HCA was able to help with managing the nebuliser with a minimum help of the trained nurse and within his scope of practice. Firstly he took all of the vital signs of the patient and recorded them on the system before nebuliser was started. Secondly, HCA was able to help to administer the nebuliser to the patient firstly by positioning the patient in the upright, comfortable position which allowed the patient to breath better and expanded their chest more (Sheldon, 2001). Secondly, HCA pleased the mask on the patient face making sure that is in the right place and is covering both mouth and the nose. Communication with the patient throughout was maintained which is the vital part of patient treatment because it helps with patient cooperation and understatement of the procedure (healthcarecomm.org, 2016). When the nebuliser therapy was finished HCA took off the mask from the patient face, disconnect the set and switched off the oxygen. Then he washes the nebuliser set with the soap and water and left to be air dried. (Edgepark.com, 2016) Properly washing and drying nebuliser kit is very important from the infection control and prevention point of view. Any medication which has been left in the chamber is a perfect place for bacteria to grow and spread which then can be easily transferred to the patient airway by administering another nebuliser.(Nhsdg.scot.nhs.uk, 2016) The family centred approach was very well maintained throughout the day. Every step of the patient treatment together with all the intervention was explained, and consent was gained.(Gov.uk, 2009).Family- centre approach is commonly used practice in peadiatric and is thought to be the best form to support children in hospital and is broad and helpful way of delivering care to the patient (Shields et al., 2012). That makes the patient, and the parents felt important in decision-making about the treatment and valued. Parents were able to help with their son treatment by assisting with his positioning, distracting when important and painful procedures such as cannula insertion was taking place. The patient was less stressed when parents were present. The episode of care was very well performed and the patient outcome was very good. The patient recovered from this asthma episode and it was transferred to the paediatric ward. The importance of structured, systematic, and holistic approach to the patient and its family together with the excellent communication was well presented. The main points of this essay highlighted how complex asthma treatment can be and how many different aspects of treatment have to be considered. From the morning handover throughout the day every step of the patient care need to be very well planned and performed in the best possible way to achieve the best result in the patient recovery. I have learned a lot about new skills such as full body examination of the patient looking for the important signs and symptoms of the deterioration of the patient condition. I have learned how good preparation of the bed space promotes confidence to the nurse and all the medical staff which work with the patient. Management of the nebuliser is the skill which I learned and practised. I have learned whot to preper before nebuliser is started such us oxygen flo rate. I l
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