Clinical Observations and Investigations in SimMan

1) List the physiological parameters measured on SimMan during the practical

During the experiment, physiological parameters such as body temperature, the heart rate, respiratory rate, oxygen saturation, level of consciousness and the current blood pressure (Kelly, 2018). These parameters should be measure every 12 hours unless directed otherwise by the doctor. On admission, these vitals should be taken and clearly documented and considered as part of the whole patient admission of a patient. A written plan should outline which observations should be recorded and at what frequency.

2) Explain the physiology behind the results obtained from the above measurements.

The results obtained in measuring the physical parameters in SimMan’s experiments form part of the early warning system (Dougherty & Lister, 2015). The patient’s treatment and medication is based on this assessment. It is important to take record of these vitals for a patient who has presented themselves with a respiratory problem. This information provides a baseline and determines the patient usual range, which aids in determining whether the patient has exhibited changes that could improve or worsen the situation, determining the exact level of care that is required.

However Poor monitoring of patients continues to be an issue of concern (NICE, 2007). In an attempt to improve the deteriorating patients early identification system NICE suggested that hospitals with acute patients should adopt the physiological systems that trigger or give warning scores for their patients. Taking the vitals of a patient is a core skill in nursing care. Research shows that in a positive operative study of 211 patients, only 15 % of the records were undocumented on the vitals (Mok et al, 2015). Inadequate recording and assumptions in physiological results is an issue in patient care. When results are recorded poorly or in cases of escalated vital signs there is always a resultant impact on the patient’s outcome. I n early stages of deterioration, patients may appear to be normal but later increases as oxygen levels decrease and may lead to death if action is not immediately taken.

3) a). What investigations were performed on SimMan during the practical?

On the practical exercise, the Hemoglobin level, White cells count, Neutrophilis, Lymphocytes, Monocytes and Eosiniphilils. The hemoglobin test is used to measure red blood cells in the body. It is a protein stored in rebloods cells and is produced by the born marrow. The test on the white blood cells in Simpsons practical was to determine the body’s ability to fight diseases in the human body. Neutrophilis were examined to determine the ability of the body to repair the damaged tissues and help cure the infection.

b). Comment on the significance of these results in comparison to the reference ranges provided.

The hemoglobin range in the table shows that the red blood cells count in the human body are within the normal range. Hence hemoglobin was ruled out as a factor that could have caused shortage of breath to the patient (Li et al., 2021). The patients red blood cells were still in a proper shape and the hemoglobin levels could still ensure that the enough oxygen reached the blood cells. The while blood cells count was within the normal range. The neutrophils and the white blood cells levels were also within the average range for a human body and the body’s ability to fight pathogens is still in proper condition. The Neutrophils level increase in response to infection injuries or stress, and in severe chronic infections and injuries, they decrease drastically. The Monocytes, Basophils, Lymphotes results obtained from the practical were within the normal range when compared to the reference range. The results obtained from Eosinophils were not in range with the reference point.

c). Relate these results to the overall disease pathophysiology.

The Eosinophil test count in the above results shows that SimMans’s body contains them in large numbers that were above the normal range. This type of white blood cells, help to fight pathogen infections in the human body (Ramanavičiūtė, Burbaitė and Adamonienė, 2021). Their exact role in the human body is not known, but they are usually associated with the allergic diseases that may result into infections if not treated well. These elements of white cells are made in the bone marrow and later dispatched to different tissues in the body. Eosinophils perform two important tasks in the human immune system as they curb infections and boost the inflammation which helps to fight diseases that may attack the human body. When they are two many Eosinophils in the lungs, patients exhibit breathing challenge leading to a condition known as Eosinophilic lung condition.

The study results showed that hemoglobin levels were normal in SimMan’s by hence anemia could not be the causal condition for breathing difficulty. Hence the body’s ability to exchange gases in the lungs was not hindered by the Red blood cells count (Ramanavičiūtė, Burbaitė and Adamonienė , 2021). The Neutrophils in SimMan’s experiment were in the normal range, meaning that the were able to play a role in response to immunity by releasing enough oxygen that enhances effectiveness in the respiratory system. However excess Neutrophils in the human body produce excessive oxygen that may cause cells to burst which may cause brain injury and atherosclerosis.

Lymphocytes play a role the development of asthma like conditions, when a balance is lost between two types of lymphocytes (Th1 and Th2), which results in airway inflammation. The Th1 cells produces the interleukin which is very important cellular defense, contrary, Th2 produces a family of cytokines which can mediate allergic reactions in the body. However the results from the SimMan’ test suggest that the lymphocytes were within the normal range hence could not have cause respiratory disorder. Monocytes test showed that this type of white blood cells were in normal body range, they play an important role in maintaining a balance in inflammation diseases by destroying and repairing of damaged tissues. The Basophils in the test results were also at normal level, these cells are involved in the pathogenesis of diseases such as allergic reactions, asthma, pneumonitis and contact dermatitis.

4). justify the choice of pharmacological treatments that were administered to the patient (comment of the observed effects of these treatments on SimMan).

The Eosinophils were above the normal range, suggests that they were the main source of infection in the respiratory system SimMan’s tests. The key issue is to ensure that these type of white cells do their job and leave the body (Afzal et al., 2021). These cells are not supposed to accumulate in the human body as too much of them cause’s chronic inflammation that damages body tissues. When this disorder occurs in the respiratory system it hinder the gaseous exchange process and hence resulting into breathing difficulties. These respiratory drugs can be given by inhalation, parenteral, trasdermal or through the tropical routes that May be used by some agents for administration. However, this condition can be treated by applying the following pharmacological treatments:

Bronchodilators, these are the frequently used inhaled medications which have been divided into sympathomimetic (adrenergic) and parasympatholytic (anticholinergic) drugs(Afzal et al., 2021) . the former are used to stimulate the sympathetic nervous system while the later block the parasympathetic system which act for about 12 hrs , while the adrenergic drugs take the shortest time (4-6 hours) to perform its functions. Albuterol is a commonly used type of the bronchodilators and is also a short acting drug. Salmeterol drugs are delivered in powder inhalers that are ingested in the respiratory system by breathing.

Formoterol was added to the list of adrenagertic drugs and it is a long acting B2 –adrenergic agonist (Lee et al., 2020). The food and drug administration in 2006 October in US approved the R-Renantiomer of the formoteral for the purpose of marketing it and it was sold to users as arformoterol.it is a single isomer that has only been instructed for use acute problems in the respiratory system. Arformoterol is not effective to use in chronic obstructive pulmonary diseases and in pediatric patients. The dosage is twice a day and is supplied in 2mLunit doses for nebulization. these medications are used to provide short term relief from the respiratory illness such as asthma .the longer lasting medications are used to relive patients of disorder for longer times

In the current practice of health care, respiratory diseases have been treated by these medicines be it long term or short term depending on the severity of the infection (Lee et al., 2020). Anticholinergic medications can also be used alone or in combination with the long and shorter relief medicines. Patients with asthmatic cases are normally prescribed this kind of medicines. Of the anticholinergic drugs, respiratory specialists are seen to be more familiarized with the ipratropium. These works at the muscarinic receptors by blocking transmissions from parasympathetic responses, hence a combination of the albuterol drugs and the ipatropium has significant effects on the patients than when they are used alone. A lot of patients with respiratory disorders take in these medications that block the B1- receptors.

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Reference

Afzal, S., Ahmad, H.I., Jabbar, A., Tolba, M.M., AbouZid, S., Irm, N., Zulfiqar, F., Iqbal, M.Z., Ahmad, S. and Aslam, Z., 2021. Use of Medicinal Plants for Respiratory Diseases in Bahawalpur, Pakistan. BioMed Research International, 2021.

Dougherty L, Lister S, 2015. The Royal Marsden Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell.

Kelly, C. , 2018 Respiratory rate 1: why accurate measurement and recording are crucial. Nursing Times; 114: 4, 23-24.

Lee, J.H., Jo, E.H., Jung, J.Y., Kim, Y.E., Son, M.J., Kang, S.J., Yang, G.J., Shim, Y.H. and Park, M.C., 2020. Efficacy and Safety of Socheongryong-Tang Among Atopic Dermatitis Patients With Respiratory Disorders: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial. Frontiers in Pharmacology, 11.

Li, S., Qi, D., Li, J.N., Deng, X.Y. and Wang, D.X., 2021. Vagus nerve stimulation enhances the cholinergic anti-inflammatory pathway to reduce lung injury in acute respiratory distress syndrome via STAT3. Cell Death Discovery, 7(1), pp.1-9.

Mok, W., Wang, W., Cooper, S., Ang, E., & Liaw, S, 2015. Attitudes towards vital signs monitoring in the detection of clinical deterioration: scale development and survey of ward nurses. International Journal For Quality In Health Care, 27(3), 207-213. doi: 10.1093/intqhc/mzv019

National Institute for Health and Care Excellence, 2007. Acute Illness in Adults in Hospital: Recognising and Responding to Deterioration.

Ramanavičiūtė, J., Burbaitė, K. and Adamonienė, I., 2021 Asthma: definition, etiology, pathogenesis, risk factors, diagnosis and treatment.