Free Essay Example: A Peritonsillar Abscess

Peter is a 9-year-old girl admitted from the Accident and Emergency Department with quinsy. Also known as a peritonsillar abscess. Peter booked for theatre for drainage of the abscess (? Tonsillectomy) under general anesthetic.

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Regarding Peter's condition and explain how she will be prepared and managed before her transfer to the theatre.

• General Anesthesia
• Patient Preparation

General anesthesia procedure employs a combination of medication that places the patients under a sleep-like state before a medical procedure. Due to the unconscious state of the patient, the pain is completely blocked (Hertzog and Zelig Kuhn, 2010). To successfully undergo general anaesthesia, Peter should be prepared in the following way. Six hours before the anaesthesia, Peter should not eat any solid food or milk. However, two hours before Peter should only take clear liquids (Hertzog and Zelig Kuhn, 2010). These may include clear juices such as white grape juice or apple juice and water. Other clear liquids may include Pedialyte or Kool-Aid. Within the two hours, Peter should not drink or eat anything. This will, in reduce the risk of vomiting during the process of anaesthesia (Smith et al., 2011).

Additionally, to curb anxiety, one of the most significant acts should be offering Peter and her parent's emotional support. It is common for patients and their relative to experience a high level of anxiety due to uncertainties and fears surrounding surgery (Dean, 2007). Clear and detailed report regarding the whole procedure should be offered to both Peter and his parent. The doctor can also give Peter a specified medication to help her relax (Holdcroft and Jaggar 2005). To boost his confidence, she can be allowed to bring along one of her most favourite toys. The drug should be sweetened or flavoured, and the effect should be felt between ten to fifteen minutes (Google Books, 2020). Peter should also be weighed, his body temperature taken, respiration rate and the pulse rate should be determined. The Anaesthesiologist should meet both the guardian and the child to review her medical information to determine the best anaesthetics to administer to Peter. Among the content to be discussed here is, her medical history, any previous anaesthesia or surgery, and any other condition she might be suffering from, such as laryngospasm

If Peter is under medication, she can continue unless the doctor or the scheduled nurse advises against. The Anaesthesiologist should then present the consent form to the guardian or the parent before the procedure is initiated. Anaesthesiologist may allow the guardian to be present during the anesthesia procedure (Dean, 2007). Peter will get the anesthetics by the space mask which is a mixture of both air and the chosen medication. At this point Peter should choose her favorite scent to flavor the gas passing through the mask (Google Books, 2020). Local anaesthetic cream or gel is usually recommended to be applied to an IV site on Peter. Injections should not be used if Peter is still conscious. However, at her age, she can be allowed the freedom to choose direct injection or the space mask. The anaesthetic technique used should be discussed and analysed by the Anaesthesiologist and Peter's Guarding in the presence of Peter. Upon losing consciousness, Peter should be taken to the waiting room (Litman, 2004).

If not done already, an intravenous anesthetic (IV) can be started to ensure that Peter will remain unconscious throughout the surgery (Holdcroft and Jaggar 2005). While unconscious, the Anaesthesiologist or the scheduled nurse should monitor the heart rate, temperature, blood oxygen levels and blood pressure. Finally, before the procedure begins, Peter should have a breathing tube placed while unconscious (Litman, 2004).

While in recovery, Peter becomes distressed and agitated, and his breathing pattern changes, his oxygen saturations fall. Discuss the possible causes for his deterioration and what action you as an ODP would take during this period? -

Operation Department Practitioner (ODP) should shout for help, and pull the buzzer. Additionally, they should connect 100% oxygen using a non-rebreather mask. The neuromuscular blockade should be reassessed (Google Books. 2014). Adequate reversal of neuromuscular blocking agents will be diagnosed clinically through thoracoabdominal respiration with sufficient upward movement in the upper chest. Peter's case, the ODP should assure reintubation and ventilation until a reversal is (Ferrando et al., 2005). While administering this, Peter should be in an upright sitting position to enhance his breathing. If her condition persists, the anaesthetist should be alerted to assist in his recovery. There are several reasons why her oxygen saturation falls below the average level, i.e. 93 per cent. This is a significant concern (Google Books. 2014).

Causes of Oxygen Level Fall in Children

Airway obstruction may occur upon removal of the endotracheal tube (ETT). This the last step towards liberating the patient from assisted breathing. Most Anaesthesiologists prefer extubating at a deeper plane to avoid sudden spasm of the vocal codes; laryngospasm (Abelson, 2015). The practice normally elevates incidences fall back of the tongue, and is the primary cause of airway blockage in the immediate postoperative period (Bodenham, 2005). Mouth opening, neck extension, as well as jaw thrust singly or together may be sufficient solution to rectify the obstruction. Air obstruction can be avoided by treating Peter in a lateral position with the neck extended (Ferrando et al., 2005).

Laryngospasm forms one of the leading causes of airway blockage, this despite the modern improvements made on monitoring as well as the advancement in standards of care in anaesthesia practice (Abelson, 2015). The phenomenon is more prominent in infants. This condition is more recurrent when particular anaesthetics agents are used; these include Sevoflurane and Desflurane. In an attempt to reduce these occurrences, there exists a conflict between practitioners and researchers on whether to employ light or deep plane of anaesthesia.

Some studies suggest that to minimise the incidences of sudden spasm of the vocal codes, the sick person should be extubated at a deeper plane of anaesthesia (Bodenham, 2005). Other studies suggest that there are no traces of sudden spasm of the vocal codes present in patients undergoing tonsillectomy and adenoidectomy when extubated while conscious (Perioperative Laryngospasm - Review of literature, 2009). However, the majority of the studies have shown that there is no substantial difference in the postoperative period if the two techniques of extubation are used. To significantly reduce sudden spasm of the vocal codes, artificial coughs are induced by applying positive pressure extubation to expel subglottic secretions as it decreases the adductor reception of the vocal code muscles (Hatfield and Tronson, 2014).

A sudden spasm of the vocal codes has three times higher chances of occurrence in younger children compared to older children. This explains why Peter experienced agitation and breathing problems (Bodenham, 2005). This condition increases with an increase in the number of anaesthesia performed on an infant. Noxious stimuli on a lighter plane of the anaesthesia are significant factor related to anaesthesia (Morton and Peutrell, 2003). When Peter is coming out of the theatre, the effects associated to anaesthetics may are apparent; however, the insertion an airway tube, a suction catheter, laryngoscope blade may be the cause of sudden spasm, gasp or agitation in his regular breathing pattern (Pawar, 2012).

After 30 minutes' Peter's condition improves sufficiently for her to be transferred to the pediatric ward. What specific information should the ODP include for the handover of Peter's care to the relevant staff?

Among the many processes within a hospital, patient transfer is one of the most complex and involving process. In most facilities, the transfer involves three main phases; Setting which involves patient preparation and setting up all the critical equipment, physical transport of the patient (Lees, 2013). In this case, Peter being transported from the operation towards the ward and lastly, handing over the patient to the receiving staff at the ward. Operation Department Practitioner plays a critical role during the transfer of the patient and documentation.

Before Transfer

After the operating team has confirmed to the Operation Department Practitioner that Peter is stable for transfer, Peter and her guardian should be notified first, by giving them all the details regarding the transfer process (Lees, 2013). The information will contain the ward location, time of the transfer and the best time the Peter can be visited. All the equipment necessary for the transfer should be counterchecked, particularly the 100% oxygen cylinder and other air cylinders have sufficient air for the transfer of a patient from the operation room until they are well settled in their ward bed. The Operation Department Practitioner should also ensure that all the surgeon reports, observational charts, Anaesthesiologist report and nursing report must accompany Peter (Lees, 2013). It is mandatory that the ODP must have these to transfer a patient. In some incidences, a patient might be required to have a Do Not Attempt a Resuscitation Form (DNAR) which must be included in the medical reports (Pawar, 2012). Before leaving the surgery room, the ODP should call the recipient to notify them.

During Transfer

During the transfer, Peter's guardians can be allowed to accompany him. An Operating Department Practitioner plays two critical roles during transportation. These are maintaining the safety of the patient as well as maintaining the dignity of the patient. Peter should be adequately dressed to maintain the highest level of dignity (Lees, 2013). To reduce fear and anxiety, especially that of the patient and relatives, excellent communication is critical. An excellent example of what the ODP should communicate is, information about the new ward, its condition and feature, and what to expect during the stay.

Additionally, the Health and Care Professionals Council requires the OPD to communicate to a multi-level team, including the service users and caregivers of Peter. The communication will give the caregivers ample time to prepare Peter's bed as well as ensuring that there will be a member of ward staff awaiting her arrival. During the transfer, the ODP should be in a position where they can manage to observe the patient from head to toe to ensure that their attention is entirely on the patient. Also, for effectiveness, besides an ODP, Peter should be accompanied by two qualified members of the staff, one of whom must be qualified in post-surgery complication (Lees, 2013). All the team should have the necessary lifesaving skills. In cases where a lift is required, the patient in transit should be given the priority to eliminate transfer delays significantly. The ODP is required to act as the patient's advocate in cases where the lifts are engaged.