Week 9

Reflection

Using the Gibb’s reflective I will reflect on the ninth lab session we had for this semester. It took place on the 21^th of March.

Description: This week we performed the BVM ventilation an apneic adult patient OSCE.  Also, the oxygen administration by non-rebreather mask OSCE and I passed the two skills.

In the first OSCE I have been called to scene the patient was unconscious. I checked the response, the patient was unconscious, and at that time I called for additional EMS assistance. Then I checked the breathing along with pulse for 5 seconds but not more than 10 seconds. I felt a weak carotid pulse but the patient is not breathing. I opened the airway using head tilt – chin left. The mouth was full of secretions and vomitus. I prepared rigid suction catheter, I turn on power to suction device or retrieves manual suction device, I inserted rigid suction catheter without applying suction, I suctioned the mouth and oropharynx less than ten seconds. I have opened the airway to insert the OPA and no gag reflex was present. Then I started immediately to place mask of BVM on patient’s face and ensured a tight seal. Ventilates the patient, one breath every 5 to 6 seconds ensuring the chest rise. After 2 minutes I checked for the pulse and breathing. The patient still not breathing. I have attached the BVM to oxygen and set flow rate to 15 L/min and continuing given ventilation.

In the second OSCE, I have been called to scene the patient complaining of shortness of breath. First, I have taken appropriate body isolation precaution. The patient Spo2 was 90%. I gathered appropriate equipment, I cracked valve on the oxygen tank and I assembled the regulator to the oxygen tank. After that, I Opened the oxygen tank valve, I Checked for any leaks and checked tank pressure. Also, I have Attached non- rebreather mask to correct port of regulator, Adjusts regulator to assure oxygen flow rate of at least 10L/ min, Turns on oxygen flow to pre-fill reservoir bag, attaches mask to patient’s face and adjusts to fit snugly.

Feelings: I passed the OSCE so I felt really good, after the management of the both cases was right, because I was followed the correct sequences of OSCE sheet. I had so much fun. I felt it was the biggest impression during my lab sessions.

Evaluation: This whole was very good and there is nothing bad about it. Actually, I learned a lot.

Analysis: After I have done the lab, I understand the importance of following the correct sequence of OSCE        sheet. This helped me a lot to manage the patient condition and know what is happening to the patient.  

Conclusion: I felt my management was correct and nothing I could done better.  

Action plan: I plan to keep practice in the same way because this is the best practice that helped me to understand the patient condition and it was easy to manage.

 

Checking the response

Checking the breathing and pulse

 Measuring the OPA

Inserting the OPA

Giving ventilation

Domain knowledge

 

Enquiry and Research

I this week, I further read the respiratory changes in multiple sclerosis and Parkinson disease.

Patient with advanced multiple sclerosis associate with respiratory dysfunction and may manifest as acute or chronic respiratory failure, respiratory muscle weakness, sleep disordered breathing or neurogenic pulmonary edema. The pathophysiology is related to demyelinating plaques involving the brain stem or spinal cord. In long standing multiple sclerosis, respiratory complications are common such as aspiration, lug infections and respiratory failure. Due to appearing demyelinating plaques involving areas of brain stem, acute respiratory failure is uncommon.in fact, early recognition of multiple sclerosis patients at risk for respiratory complications lets for the timely implementation of care and measures to decrease disease associated morbidity and mortality (Tzelepis & McCool, 2015).

Moreover, Parkinson’s disease is a common neurodegenerative disorder.Clinically, Parkinson’s disease is characterised by rigidity, tremor at rest, bradykinesia, postural instability and parasympathetic hyperactivity. Patients with Parkinson's disease are at risk for pulmonary complications as a consequence of both the underlying disease pathology and the side effects of medication. Degeneration of the substantia nigra and subsequent loss of dopaminergic neurons may lead to changes in ventilatory parameters. Both Upper airway obstruction and chest wall restriction are common, and both may respond to levodopa. However, therapy for Parkinson's may also contribute to pulmonary morbidity. Overtreatment using levodopa may lead to respiratory dyskinesia which is difficult to differentiate from complications of the disease itself. Therapy with ergot derivatives may cause pleuropulmonary fibrosis. Pneumonia is significant cause of morbidity and mortality in Parkinson's patients, resulting from the respiratory complications of parkinson’s disease (Shill & Stacy, 2002).

Figure.2

Complications of Parkinson disease

(Sense for care, 2010).

References

Shill, H., & Stacy, M. (2002). Respiratory complications of Parkinson’s disease Parkinson’s disease. Seminars respiratory and critical care medicine, 23(2), 261-5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16088618

Tzelepis, G., & McCool, F. (2015). Respiratory dysfunction I multiple sclerosis. Respiratory medicine,109(6),671-9. doi: 10.1016/j.rmed.2015.01.018

Sense for care. (2010).non-motor disorder caused by Parkinson’s disease. Retrieved from http://www.sense4care.com/en/about-us/parkinson