Hypovolemic shock is an urgent condition of the patient in which he/she looses blood and fluid very severely and the heart becomes unable to push even the required blood to the patient's body. Basically, it occurs due to the lack of enough fluid in the intravascular space. And this shock ends up to the causes where many organs of the body stop functioning, (Spaniol, 2007, Page No. 152-156).
Based on the following symptoms of hypovolaemic shock we could come to the key pieces of assessment data that support a diagnosis of hypovolaemic shock:
Blood pressure is very low
Body temperature is very low
Rapid and fast pulse
Thready and very weak
Following are the four (4) key pieces of assessment data that support a diagnosis of hypovolaemic shock:
RR 35 breaths/min. Laboured breathing, speaking in single words only. States he "can't breathe." Decreased air entry on left side and asymmetrical chest wall movement. SpO2 90% on a non-rebreather mask at 15L/min.
Core temperature 35.8°C.
BP 74/40 mmHg (MAP 51 mmHg). Apical pulse 120 beats/min but no radial or brachial pulses palpable. Carotid pulse present but weak. ECG monitor shows sinus tachycardia.
GCS 14 (E4, V4, M6) on arrival. PEARL.
In Pathophysiology, we study how to change the normal physical, mechanical and biochemical functionality of a body which is caused either by a disease or caused from an unusual syndrome. We can also understand Pathophysiology in terms of medicine which takes care of any kind of problem in body functions caused by prodromal symptoms of diesease.
The process of pathophysiology of blood or fluid imbalance in a body mainly focuses on hypovolemic shock. According to the case study, Mr. Lee was admitted to the emergency department with the following problems:
RR 35 breaths/min
Core temperature 35.8°C
GCS 14 (E4, V4, M6) on arrival. PEARL.
BP 74/40 mmHg (MAP 51 mmHg).
Apical pulse 120 beats/min but no radial or brachial pulses palpable.
Carotid pulse present but weak.
Doctors could also find out the circulatory failure and infection in the body. Mr. Lee's BP was 74/40, pulse was 120 beats/min, and the core temperature was 35.8 °C. The symptoms of Hypovolaemic shock were consistent with a generalized tube leak condition.
The process of Pathophysiology starts at the very initial stage of the patient's treatment. Or we can say that the treatment process only starts with Pathophysiology. The status of blood circulation of patients suffering from Hypovolaemic shocks is normally monitored in the initial stage of emergency. And it is done with the findings of blood pressure and heart rate report.
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During the process of Pathophysiology, the main attention in the operation theater is kept upon the deficit in blood volume as it is always estimated that during the whole procedure, blood is absorbed on surgical dabs or suctioned. But such kinds of estimates unfortunately come inaccurate. Also at the same time, doctors need to keep a track on the breaths/min and core temperature of the patient. As in case of Mr. Lee, his core temperature was 35.8°C and RR 35 breaths/min. And this kind of body condition needs to get operated immediately.
Answer 2: Pathophysiology of Mr. Lee's haemopneumothorax and intercostal catheter and underwater sealed drain insertion helped in resolving his problem. In the process of insertion of an underwater sealed drain, we put a flexible void drainage tube into the chest of the patient. And with the help of this tube, we remove an excess collection of fluid or air from the pleural space which enables the lungs to increase completely, (Dutton, 2005, Page No. 1141-6).
The following are some of the common reasons for which an underwater sealed drain/chest tube is inserted.
It can also be done in any patient who is on ventilation.
Figure1: Chest tubes:
1st- angled, 2nd- straight, 3rd-Malecot catheter, 4th- assembled trocar chest tube, 5th- its tube, 6th-metallic trocar.
Following are the steps of the whole procedure:
Evaluation is done at the pre insertion period.
Need to choose the proper place of insertion.
Need to keep all the materials and instruments required.
Need to give a proper position to the patient.
Proper cleaning and dressing need to be done.
Need to give the Local anesthesia.
Finally the tube is Incised and inserted in to the chest.
Need to take care of the correct direction and the length of the chest tube
Also a proper care is required after insertion of the tube inside the chest.
Tube needs to be removed properly and at the right time.
Need to take care of all the complications and take proper preventions.
The X-ray of the chest is done after removal of the sealed drain which shows a haemo-pneumothorax and further the course to be carried out completely depends on the quantity of the pneumothorax and also the condition of the patient. This whole process helps in getting air reabsorbed and the lung starts expanding slowly, (Maltby, 2006, Page No. 138-9). The patient starts getting relief from the pain and it happens usually after 2-3 days of the operation.
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Answer 3: The main objective of this treatment is to first stabilize the patient's situation, stop the continuous bleeding, and at the same time removal of the air and blood in the pleural space. Then a chest tube is being put in through the chest wall. It is carried out to consume the blood and air, and then it is left in the same place for many days to re-expand the lung size. The main cause of the haemopneumothorax should always consider. In case of patients like Mr. Lee who is a trauma patient, required surgery is often done on the basis of severity of the injury. Based on the diagnosis done on Mr. Lee, the doctors could come to know that he needs feeding tube as well as ventilator facility to combat the low oxygen level. The application seemed quite logical and it supported the right to live with dignity, (Graham, 2005, Page no. 17-21).
Before the treatment starts, taking care of the patient's confidentiality is one of the main interventions which is need to be considered in a proper manner. And today information technology is playing an important role in taking care of this intervention. One of the major ethical challenges in public health is the inevitable increase in the vulnerability of patients' privacy and confidentiality. As day by day, the healthcare industry is increasingly driven by economic considerations, we are going to see an increase in utilization of information technology to acquire, store and disseminate healthcare information in a cost effective manner. Therefore there is a need to re-examine the appropriate balance between the competing values of personal privacy and the free flow of personal and sensitive information related to health care. In spite of the long existence of these confidentiality issues before the arrival of the computer and the internet, the use of information technology that is quite capable of transmitting large amounts of data in very short time intervals, and of bypassing the conventional physical barriers and safeguards, certainly heightens public anxiety. If the remunerations of information technology in medicine are deemed too good to sacrifice, then one of the effective approaches would be to manage the utilization of information technology for public health which should be through the use of legislative and regulatory measures. Looking into legal reforms, a famous researcher Hodge and his colleagues suggests enhancing the privacy of health information, e.g., empowering patients with rights to consent to disclosure, laws to limit disclosure when consent is absent, incorporating industry-wide security protections and establishing a national data protection authority.
With accordance to that, there should also be minimal privacy standards which can protect individual autonomy yet take into account public health concerns should be established to guide the electronic collection and accessibility of personal healthcare information, Lagrand, (2008, Page No. 161-170).
Policy of public health and interventions has always been the topic of controversy, and often remain surrounded by controversy as they are implemented. Generally in public health, scientific considerations i.e., use of information technology has blended with political and ethical conflicts, and questions of autonomy, individual rights, coercion, justice, community, the common good, the norms of research, and multi-cultural values are central. Today in public health care system, there are several different types of political and moral theory are which overlap over time, converge, and contend with one another, including libertarian liberalism, egalitarian liberalism, utilitarianism, human rights frameworks, and communitarianism. This prospectus has explored the "application" of ethics to a broad range of contemporary public health issues. It is proposed for use both in pre-service educational programs at the undergraduate and graduate level, and for in-service continuing professional education settings in public health agencies and related organizations.
There are so many issues that related to the public health practitioner and policymaker, and issues that lend themselves to an in-depth discussion of the often-conflicting values and ethical dilemmas raised by current public health knowledge and its applications.
Ethical issues are not at all neat, tidy, or cut-and dried. The questions which arise out of genetics, researches based on international and community, the control of infectious disease, and others that have been selected for this program are particularly difficult. They literally pose ethical "dilemmas" rather than black and white questions based on moral. They involve dilemma about which well-informed persons of good will can reasonably disagree.
Hence, there are not clear-cut answers to many of the ethical issues raised. The best and most important and responsible thing an educational program can do in the face of these moral and social dilemmas is to provide public health practitioners with many perspectives on the issues, and to guide their own reasoning processes toward conclusions with which not everyone will necessarily agree, but which can stand up under close scrutiny and open dialogue with others, (Tarrant, 2008, Page No. 252-257).
An international research has been done on patients' failure to follow medical instructions correctly'" and also a study has been done to understand nurses' failure to follow operative NPO instructions correctly indicated similar reasons for the failure, such as not understanding the instructions, conflicting instructions given by more than one source, and not remembering the instructions. Patients are misinformed by well-meaning friends or reports in newspapers, magazines, or television. Generally, patients and the nurses do not understand the significance of NPO status. All staffs that are going to be involved in the insertion process of chest tubes should be effectively trained and supervised. The training of all the operators should be adequate and they all should complete the training process appropriately. In all other situations, the surgery process should be supervised by a proper trainer. With this kind of sufficient instruction, the risk of problems and patient pain and nervousness can be reduced. Based on current evidences, many nurses in the hospital we have come to know that high levels of stress and that counselling and other support services should be made available to them in order to meet each nurse's skills and ability to care and become professionals eventually. Nurses are majorly affected part of this.
It may also happen that the nurse is not efficient in drug calculations. In one of the cases, a nurse had problems with maths. And this problem leads to a bad situation. The nurses should also be efficient on various elements like technical knowledge. A nurse should be able to use all of the technological resources to provide an optimum environment for healing or maintaining health. A nurse should also have a good understanding of the structure and physiology of the human body, its response to disease, and the mechanisms of disease. In any kind of situation, the nurse must undertake her tasks not as mundane work, but as a calling to care for others. So, the proper training should be given to all the staffs involved in the surgery, (Maier RV, 2008, chapter 264).
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