Chest Injury Questions

QUESTIONS :
1. What is the best nursing diagnosis for Marlin’s case?

- Acute pain related to stab wound as evidence by agony of pain, shortness of breath and
subscapular pain.
2. As the student nurse assigned to Marlin, how will you manage her pain?
- Help her sit in a comfortable position, such as half sitting, leaning to the injured side
- Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the
pain she is experiencing.
-Perform a comprehensive assessment of pain. Determine the location, characteristics, onset,

duration, frequency, quality, and severity of pain via assessment.
.-Hands should be thoroughly washed before applying pressure dressing to the wound with
sterile
or petrolatum gauze.
- Administer analgesics pain medication as prescribed. Note that the patient is allergic to
ibuprofen.
3. What is the purpose of the Arterial blood gas analysis ordered by Marlin’s attending
physician? How will you prepare Marlin for this test?
- An arterial blood gases (ABG) test measures the acidity (pH) and the levels of oxygen and
carbon dioxide in the blood from an artery. This test is used to find out how well your lungs are
able to move oxygen into the blood and remove carbon dioxide from the blood. In Marlin’s case
this was ordered because during emergency situations, it helps to diagnose possible lung and
breathing problems that have risen due to her condition. To prepare Marlin for this rest the
following procedure may be implemented:
-Verify the doctor’s order and secure the informed consent form.
-Identify your patient.
-Explain the procedure and purpose if ABG. Tell the patient that the test requires a blood sample.
- Check for any contraindications to arterial blood gas sampling
-Consider the patient’s medication regimen, such as anticoagulants which may cause increased
bleeding.
- It should be noted that if she is dependent on oxygen, it should be stopped for about 20 minutes
before a blood sample is taken, and then it should be resumed.
- Subcutaneously over the intended puncture location, apply local anesthetic. Make sure to
aspirate to make sure that you are not within the blood vessel.
- Inform Marlin that she may experience pain on the puncture site-Use a heparinized blood gas
syringe to draw the sample to prevent clotting of the specimen, including temporary cramping
and throbbing pain after the effect of the anesthesia fades.
4. What are the significance of the different blood (Coagulation panel, CBC etc.) work ordered
by the doctor?
- Blood testing is necessary since the patient might require transfusions and even surgery. The
coagulation panel and CBC will serve as a baseline and be useful in determining whether
additional factors, such as plasma, may be needed. A percentage of red blood cells in the blood is
the hematocrit, as you should be aware of. When a trauma patient bleeds, full blood (including
red cells and plasma) is released; this blood has the same hematocrit as the intravascular blood.
Only when interstitial fluid is moved into the vascular space in an effort to expand the overall
volume of the odes does the hematocrit decrease due to dilution. An significant sign of blood
loss and subsequent hypoperfusion, which results in metabolic acidosis, is the arterial blood gas
(decreased bicarbonate).
5. Why is ABG is being ordered? State your reasons.
- The amount of red blood cells in the blood is known as the hematocrit. The percentage of RBC
in the body is the same with or without trauma, hence this cannot be utilized as a hemorrhage
indicator. Unusual hematocrit levels, however, only occur when interstitial fluids penetrate the
intravascular region. ABG, on the other hand, is a stronger indication of hemorrhage since it can
identify metabolic and/or acidity. For Marlin, decreased blood flow will cause tissue
hypoperfusion, which will result in metabolic acidosis. And as a defense mechanism, fluid will
transfer into the plasma to preserve blood flow to the body's essential organs. ABG is more
reliable in evaluating and monitoring patient Marlin in this scenario.6. Which of these 2
diagnostic procedures does apply to Marlin’s case? Give your reasons.
A) Open laparotomy
B) Diagnostic Laparoscopy
- Laparoscopy, in my opinion, is the most effective diagnostic procedure for Marlin's condition.
The reason is that since we can precisely locate which organ has to be examined, we may
perform a diagnostic laparoscopy without needing to undergo an open laparotomy, which is less
intrusive. In diagnostic laparoscopy, a small incision is used to check for intra-abdominal organ
injury or condition without causing major trauma to the patient. This is primarily because an
open
laparotomy would require a large incision on the abdominal cavity to examine abdominal organs,
and this is only done if we have not yet found the source of the patient's pain.7. If the knife
wound had projected inferiorly penetrate the diaphragm, there is also a likelihood of intra-
abdominal injuries. Make 3 NCPs on this. Impaired Breathing pattern – ABG result with
oxygenation, Pain with pain scale of 8/10 on the operative site, Impaired physical mobility due to
presence of CTT 1 way bottle.

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QUESTIONS :

1. What is the best nursing diagnosis for Marlin’s case?

-Perform a comprehensive assessment of pain. Determine the location, characteristics, onset,

-Identify your patient.

- Check for any contraindications to arterial blood gas sampling

5. Why is ABG is being ordered? State your reasons.

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