NP CASE STUDY Essay Assignment Paper
NP CASE STUDY
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Three areas to discuss when undertaking any kind of procedure
The three main areas to analyze before any procedure are; competency of the patient/surrogate to make a vital decision, disclosure of details/information and voluntary nature of decisions.
NP CASE STUDY
The groups of nosebleeds and which is most common?
There are two kinds of nosebleeds namely posterior and anterior, an anterior nose bleeding occurs when one’s the vessels at the front of the nose breaks hence bleeding while posterior occurs at the deepest or back part of one’s nose causing blood to flow down the throat. The common type of nosebleed is anterior nosebleed (Jain & T Deshmukh, 2021).
Indications for involvement by a provider for a nosebleed.
1. If the patient has anemic symptoms like shortness of breath, heart palpitations and pale complexion.
2. If the patient is taking any type of blood-thinning medications like warfarin or have a hemophilia.
3. If the patient is a kid below 2 years and as a nosebleed.
4. Lastly, if the patient has regular nosebleeds.
Horizontal or vertical way of using nasal speculum and why
The nasal speculum ought to be placed vertically. This is done to avoid further bleeding and eradicate traumas. Also, do not assume unilateral nasal discharge in a kid.
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Ways of delivering vasoconstrictive solution
Intranasal administration is an alternative for systematic and local delivery of therapeutic agents. This method is noninvasive and painless and is suitable for kids, application can be undertaken by physicians or patients in emergency setups. Intranasal drug delivery results to quick therapeutic impacts. hepatic first- pass metabolism and Nasal application circumvents gastrointestinal degradation of the medication. Nasal drops could also be used.
How long should you apply pressure with the stick?
Two minutes would be enough but the mode of treatment will depend on the case. The period that the tip touches the tissue concludes the extent of the subsequent action. Sliver nitrate sticks are utilized for cauterization and it is important to use pressure during the treatment (Sekito et al., 2022).
NP CASE STUDY
Why it is it significant not to use the silver nitrate for over that time frame?
This is because the silver nitrate stick gets activated when it comes into contact with moisture and when used in wounds it delivers silver ions on the body’s tissue hence forming an eschar as they lead to binding of tissues and obstructing of vessels in the body.
After hemostasis is obtained, what are three types of treatment methods that can be used to protect the cauterization site?
The bleeding can be controlled using silver nitrate cauterization. Managing the vessels leading to the site prior to tackling the bleeding site. Evade forceful and random cautery and cauterization.
Electro cauterization using an insulated sunction cautery unit is a technique for serious bleeding. The efficiency of these two techniques can be made effective by utilizing rigid endoscopy more so in the instance of posteriorly in the bleeding areas.
After managing the bleeding, it would be vital to recommend use of antibiotic ointment and saline spray and to evade vigorous activities for about 7-10 days. NSAIDs such as ibuprofen and manipulation of the nose should also be avoided.
If that had not stopped the bleeding and you had to make the decision to use a nasal sponge or nasal tampon, what should the sponge/tampon be coated in and how long should it be left in place?
Should be coated in antibiotics and afterwards left for about 48 hours.
After putting in the nasal sponge/tampon, approximately 2 ml of ________ or _______ should be dripped onto the tip to help the sponge expand.
Water or blood
After placing the nasal sponge/tampon, the patient should be closely monitored for 3-5 minutes. Why is that?
This is done to ensure hemostasis.
How long should the patient be kept in observation status?
About 10-30 minutes.
If a sponge/tampon is used, is it necessary to use antibiotics?
Systematic prophylactic antibiotics are not necessary in most epistaxis patients who have nasal packs (Baugh & Chang, 2018). Using topical antibiotics may be cost friendly, suitable and efficient. Using this mode of treatment algorithm will aid in standardizing use of systematic antibiotic in patients with epistaxis with nasal packing and ought to minimize expenses linked with pointless utilization of such kind of medication (Womack et al., 2018).
If it is necessary to pack the nose, it may be advisable to give the patient a narcotic or sedative medication (unless a contraindication exists). Why?
After surgery, gauze is put high up in a patients nose to allow soaking of fluids like blood and water. The gauze can be changed or left for some days. In the emergency department, nasal packing for anterior epistaxis is for unresolved bleeding after direct pressure, cautery and vasoconstructive medications are used. Other clues for anterior nasal packing are oral maxillofacial surgery, surgical processes by otolaryngology and minor procedures (Kravchik et al., 2021). In most cases in the emergency department the nasal packing for anterior epistaxis is mainly contraindicated in scenarios like;
• Basilar skull fracture
• Nasal and facial bone fractures
• Hemodynamic instability.
Once a patient’s condition has stabilized, anterior nasal packing is allowed and sedatives or narcotics can be administered incase surgery will be performed on the patient.
5 complications of the above procedures.
Septic shock
Sinusitis
Epiphora
Hemorrhagic shock
Hypoxia
Why is it important not to have him take ibuprofen?
It is important to tell the patient not to take ibuprofen because it can lead to nose bleeding.
References
Baugh, T. P., & Chang, C. D. (2018). Epidemiology and management of pediatric epistaxis. Otolaryngology–Head and Neck Surgery, 159(4), 712-716.
Jain, S., & T Deshmukh, P. (2021). A Review on Deviated Nasal Septum: Classification, Clinical Features and Management.
Kravchik, L., Jamal, Z., & Pester, J. M. (2021). Anterior epistaxis nasal pack. StatPearls [Internet].
Sekito, T., Sadahira, T., Watanabe, T., Maruyama, Y., Watanabe, T., Iwata, T., … & Watanabe, M. (2022). Medical uses for silver nitrate in the urinary tract. World Academy of Sciences Journal, 4(1), 1-6.
Womack, J. P., Kropa, J., & Stabile, M. J. (2018). Epistaxis: outpatient management. American family physician, 98(4), 240-245.
Question
Use the following case to complete a focused SOAP note. Ask questions regarding social determinants of health and include within your SOAP note and plan. Incorporate answers to the questions into your SOAP write up.
A mother brings in her 14-year-old son, Branch, into the Urgent Care because he has had a nosebleed. She is concerned about it because they have been applying pressure by pinching it and the nosebleed won’t stop. He has no history of nosebleeds. He has no significant medical history and no known allergies. He is on no medications. Mom and Branch deny trauma to the nose. He says he just woke up with a nosebleed and it won’t stop. He tells you that the left side is the side that is bleeding. With further questions you learn that they took the bus to the UC and that Branch must walk to and from school. His mother expresses concern that he must walk alone in their neighborhood. She works as a cashier in a super market near their apartment. She tells you that Branch gets really good grades in school. He studies after school until she arrives when they have dinner. Both are upset about the nosebleed worrying also because they have no insurance. They seem very close as a family.
Vital signs: BP 110/70 P 84 R 14 T 97.8 oral Pulse ox 99%
You recognize that simple pressure is not going to stop the nosebleed so you know that you will have to intervene.
Prior to any type of procedure, you have the mother sign an informed consent. What are the three major areas you must discuss when doing any type of procedure?
What are the three groups of nosebleeds and which is most common?
Name 4 indications for intervention by a provider for a nosebleed.
You place Branch on the exam table at approximately 45 degrees. You drape him appropriately. You have him blow his nose gently to remove clots. You then inspect the right side to familiarize yourself with his anatomy. You then inspect the left side using a nasal speculum. How should the nasal speculum be used and why is it important to use the nasal speculum a certain way?
You note that the bleeding is coming from an area on the septum. You know that the next step is to apply a vasoconstrictive solution to the nose. What are two ways you can deliver the vasoconstrictive solution?
You note that the area that is the source of the bleeding is about 3 mm in diameter. You make the decision to use a silver nitrate stick. How long should you apply pressure with the stick? Why it is it important not to use the silver nitrate for over that time frame?
After hemostasis is obtained, what are three types of treatment methods that can be used to protect the cauterization site?
If that had not stopped the bleeding and you had to make the decision to use a nasal sponge or nasal tampon, what should the sponge/tampon be coated in and how long should it be left in place?
After putting in the nasal sponge/tampon, approximately 2 ml of _______ or _______ should be dripped onto the tip to help the sponge expand.
After placing the nasal sponge/tampon, the patient should be closely monitored for 3-5 minutes. Why is that?
How long should the patient be kept in observation status?
If a sponge/tampon is used, is it necessary to use antibiotics?
If it is necessary to pack the nose, it may be advisable to give the patient a narcotic or sedative medication (unless a contraindication exists). Why?
Name 5 complications of the above procedures.
After the procedure, you tell the pt and his mother that he can take acetaminophen for any pain/discomfort. Why is it important not to have him take ibuprofen?
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