Drowning: Nursing Care and Interventions (Nursing)

00:00 When you care for a drowning client, there's some very specific nursing care and interventions you need to be aware of.

00:07 Let's start with airway and breathing.

00:09 You're going to continually assess their respiratory status.

00:12 Make sure you position them so you optimize oxygenation.

00:15 Remember that's usually with the head of the bed elevated 30 to 45 degrees.

00:20 And that's good advice for anyone who's having trouble breathing.

00:24 Finally, the oxygen administration and titration your goal is to keep their set greater than 94%. Now remember these are guidelines.

00:33 You may have more specific orders from your health care provider.

00:36 But when it comes to airway and breathing, continuously assess them.

00:40 Position them so they can breathe well with the head of the bed up and make sure you keep an eye on their stats.

00:45 Keep them greater than 94%.

00:47 Now, sometimes the patient's airway feels just kind of junky.

00:50 They've got a lot of secretions.

00:52 So you're going to have to suction the patient as needed to make sure you keep that airway patent and open.

00:58 If they're on a ventilator, it's much easier to suction.

01:02 If they're on a ventilator, you're also going to have other monitoring that you do the same for as you do for all intubated patients.

01:08 And finally, just to note VAP or ventilator associated pneumonia. This is a risk for anyone that's on a ventilator.

01:16 So make sure you implement the bundle.

01:18 That's a group of orders that are listed out in your hospital that are specific to prevent the things that can cause VAP.

01:26 So, think of things like you're going to do very frequent oral care.

01:30 Lots of tips and strategies you'll be doing to prevent that type of pneumonia.

01:34 Now that's the lungs depending on where your patient is.

01:37 Now let's talk about cardiovascular support.

01:40 If they're admitted they'll likely be on continuous cardiac monitoring.

01:44 You're going to do their vital signs regularly and you're going to watch their fluid volume very closely.

01:50 So you're going to pay careful attention to how much they take in and how much they put out. And finally, if they're in that intensive care setting, you might have to give, administer and titrate vasoactive medication.

02:03 Now with the neurological management, the nurse is going to do very frequent neuro assessments. Right. Going to make sure that you do what it takes to monitor them for any signs of seizures. And you're going to take seizure precautions to protect them from harming themselves if they have a seizure.

02:19 We talked about ICP monitoring, and that's something you'll do, but that's only with a really significant or severe neurological damage.

02:28 Our goal with that is we want to maintain adequate cerebral perfusion pressure or CPP. Now we talked about if at the scene, if we thought they might have some spinal cord trauma, you would immobilize them.

02:38 But as far as neurological management in the hospital, you'll take spinal precautions if they're ordered by the healthcare provider when trauma is suspected. Now, managing their temperature can be kind of difficult, and you'll get orders from the healthcare provider on exactly how this should be done. Sometimes we use rewarding techniques for hypothermia.

02:58 Sometimes we use therapeutic hypothermia if a post cardiac arrest.

03:02 So you'll work with your healthcare provider to know exactly what the best plan is for this patient. You're going to monitor their temperature either way, right. You're going to keep a close eye on their temperature and you're going to have a target. The healthcare provider is going to tell you exactly the range of temperature they want that patient kept out.

03:21 Now, fluid, electrolyte and nutritional support are not super glamorous, but they're actually really important.

03:28 Where they talked about, I ain't know, but I'm going to bring it up again. You really need to watch very strict intake and output monitoring so you know exactly what's going in and exactly what's coming out. That gives you a good and early indication that things might be deteriorating. Make sure you try and do daily weights.

03:47 I know sometimes they can be not as accurate, but we can look at them as a trend.

03:51 You replace electrolytes as needed, so watch your patient for any signs of electrolytes that are too low or too high, and immediately report those to your health care provider. Now you can collaborate with someone.

04:04 Do a nutritional assessment with a dietitian and get support from them.

04:07 And if you need to, you're going to start enteral feeding if the patient is stable and still unable to eat. Now, if they have any skin or wound care problems, you make sure you do a a thorough skin assessment.

04:18 Make sure you prevent any risk of a pressure injury.

04:22 So make sure you're doing what you need to do to prevent that.

04:26 Reposition them frequently and then manage any of the other associated trauma moons that may have happened when the patient was experiencing drowning.

04:35 Now, the last one, I think this one is the hardest of all because.

04:40 It's psychological support.

04:41 It's emotional support for the patient and the family.

04:46 These have been some of the toughest cases I've ever been on, is when we had a young client who experienced drowning.

04:53 So difficult for the patient and the family, especially when outside, they look perfect. But we know that they've suffered such severe brain damage they likely aren't going to make it.

05:04 If your patient is awake and alert and can understand things, make sure that as you're explaining things with both your explanations, your teaching, and your comfort measures, make sure they are age-appropriate.

05:17 And don't be surprised if the client needs a referral to mental health services.

05:22 This is a phenomenally stressful experience to go through, and both the patient or the family may need that type of support.