N4455 Nursing Leadership And Management
Answers:
Post response 1
During my clinical practice, I was aware of the fact that prone positioning is one of the evidence-based practice which helps in improving the breathing pattern of the patient suffering from respiratory distress. The post highlights about the importance of the prone positioning which can be utilized as an adjunctive therapy in recovering the sign of respiratory distress syndrome (ARDS). I have experience challenge in managing the patient’s condition due to heavy patient load and in this case, proper respiratory positioning needs to be maintained by the nurses for improving the SPO2 level. The post highlights about the effectiveness of prone positioning and highlighted that the prone position on mechanical ventilation recovers the oxygenation through augmented recruitment of malformed posterior alveolar units which also helps in reducing in the V/Q mismatch (Ghelichkahni & Esmaeili, 2020). On contrary, it can be stated that the prone position is considered to be the process of turning a patient with exact precision, safe motion in the position from back in to the abdomen. This position is one of the effective and medically accepted position for improving the oxygenations and breathing process. Hence, in this case, the patient suffering from mild COVID-19 symptom can be provided with prone position exercise which will help in improving the breathing complications. Various studies are found to support the position breathing due to its easy steps which can be recommended to the patients suffering from COVID-19 even at home and preventing the chance of developing complications. Ehrmann et al., (2021) stated that the use of awake prone positioning has been reported for improving the oxygenation among the patient suffering from COVID-19. The result of the study stated that between the year 2020, April 2 till Jan 26 2021, almost 1126 patients were randomly assigned in the intervention care and standard care. The result also highlighted that the failure in treatment was evident among 40% of the patient and 46% of the patient failed in acquiring proper care in the standard care group. Hence, the study clearly addressed the fact that awake prone positioning of patient with the condition of hypoxemic respiratory failure lowers the condition of COVID-19 and it also helps in reducing treatment failure and along with the need without any harm. Hence, it can be stated that the nurses can provide the patient suffering from COVID-19 with awake prone positioning with high-flow nasal cannula. Hence proper teaching related to the steps of prone positioning breathing will help in improving the breathing patterns. However, the use of this technique can involve the risk of developing low blood pressure and dislodged breathing tube which needs proper monitoring of the vital signs by the nurses (Golestani-Eraghi & Mahmoodpoor, 2020).
Post response 2
The nasogastric tube is considered to be one of the special types of tube which helps in carrying medicines and food to the stomach through nasal route. The tube is used for feeding especially to the critical patient in providing proper calories. The healthcare providers in this case are found to confirm the position of the tube includes- conducting a chest X-ray in order to observe the area of the upper oesophagus and it is extended to below the diaphragm. The other tests include the position of the tube must be within the midline especially down the level of diaphragm. Lastly, the nasogastric tube must be bisecting the carina. However, the healthcare providers must be aware about the challenges faced by the patient with nasogastric tube-related adverse events. Motta et al., (2021) conducted the study for determining the issues associated with the adverse effect among the patient. The result of the study highlighted that the adverse effects include- respiratory complications, pharyngeal complications, esophageal complications along with that intracranial perforation which effects the patient’s health and wellbeing. Hence, in this case the nasogastric tuber increases the risk of developing respiratory harm and increases the risk of hospitalisation. I believe that a proper evidence-based guidelines related to the correct position needs to be implemented. Fan et al., (2017) stated that the insertion of tube with the help of nasal passage is one of the common procedures which is practiced for many years. The result of the study clearly determined that the method to confirm the NGT placement is affordable and accurate which can be used for the patients and it does not require gastric aspirates. However, regular interval is also missing which needs proper care and guidelines for the nurses to provide proper care by assessing the complications (Metheny et al., 2019).
References
Ehrmann, S., Li, J., Ibarra-Estrada, M., Perez, Y., Pavlov, I., McNicholas, B., … & Marzouk, M. (2021). Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: DOI:https://doi.org/10.1016/S2213-2600(21)00356-8
Fan, E. M. P., Tan, S. B., & Ang, S. Y. (2017). Nasogastric tube placement confirmation: where we are and where we should be heading. Proceedings of Singapore Healthcare, 26(3), 189-195. https://doi.org/10.1177/2010105817705141
Ghelichkhani, P., & Esmaeili, M. (2020). Prone position in management of COVID-19 patients; a commentary. Archives of academic emergency medicine, 8(1). PMID: 32309812
Golestani-Eraghi, M., & Mahmoodpoor, A. (2020). Early application of prone position for management of Covid-19 patients. Journal of clinical anesthesia, 66, 109917. doi: 10.1016/j.jclinane.2020.109917
Metheny, N. A., Krieger, M. M., Healey, F., & Meert, K. L. (2019). A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart & lung, 48(3), 226-235.
Motta, A., Rigobello, M., Silveira, R., & Gimenes, F. (2021). Nasogastric/nasoenteric tube-related adverse events: an integrative review. Revista latino-americana de enfermagem, 29, e3400. https://doi.org/10.1590/1518-8345.3355.3400
N4455 Nursing Leadership And Management
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