University of the East

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC

#64 Aurora Boulevard, Dona Imelda, Quezon City

COLLEGE OF NURSING

NCM 109 — SKILLS LAB

Accidental Asphyxia
MENDOZA, Lance Raven S.
N2A

An 11-month old girl was left in the car while her father went in to the grocery store.
The ignition was turned off and the father took the keys with him. The girl was sitting in
the front passenger seat and was unrestrained. The vehicle had a remotely activated lock
system that automatically closes the windows. After 5 minutes, the father returned to his
car and found his child unconscious and apneic.
The father shouted for help. You were on site and as a trained BLS healthcare provider,
what will you do?
Guide Questions:

1. Identify relevant risk factors in the development of Asphyxia

Modifiable Non-Modifiable
- Car has automatic windows that closes - 11 month old girl left inside the car
by remotely activated lock system. helplessly.
- Ignition is turned off
 2. Trace the pathophysiology of asphyxia. Be sure to include all relevant
assessment cues present in the case. (You may have a separate sheet of paper)

MODIFIABLE NON-MODIFIABLE FACTORS

Ignition is Cars door 11-months old

turned off

CO2 cannot get out of the car Oxygen cannot get in

Hypercapnia (high CO2 in the Hypoxemia (low oxygen in the blood)

Hypoxemia (low oxygen in tissues)

Inadequate alveolar Intrapulmonary shunting

ventilation (Blood not completely
oxygenated)

Normal lungs when there is

failure to breathe enough

Respiratory failure

No gas exchange Inadequate pulmonary

circulation

Pulmonary respiratory Central Nervous System Cardiovascular system

problems (CNS)

Apnea (cessation of Unconsciousnes Inadequate oxygenated

breathing) blood circulating through
the body

Asphyxi
 3. Explain the possible problems associated with unconscious state and apneic.
- The patient was kept inside the car which resulted to unconscious state and be apneic. The
11-month old girl suffered from apnea, where she lacked oxygen and had respiratory
failure. The patient’s CNS was affected since the body will not be able to function
without oxygen which resulted to being unconscious.

4. Provide 3 prioritized nursing diagnoses that are well supported with your
assessment cue

Assessment Cues Nursing Diagnoses

- The patient is observed to be unconscious First
and has apnea. - Impaired gas exchange related to
altered oxygen supply
- The patient is observed to be unconscious Second
and has apnea. - Impaired breathing pattern related to
hypoventilation syndrome (alteration of
client’s normal 02:CO2 ratio)
- The patient is observed to be unconscious Third
and has apnea. - Risk for suffocation related to leaving the
child unattended in a close vehicle

5. The nurse suspects respiratory arrest. Explain how this can be developed.
- The respiratory arrest is the cessation of respiration. This is described as when a patient
stops breathing or is ineffectively breathing. This may occur when the nerves and/or
muscles are not capable of supporting respiration, a patient may experience respiratory
arrest.

6. What are the laboratories to be tested? State the indication and your nursing
responsibility before and after the test.

Laboratory Test Purpose/ Indication Nursing Responsibilities

1 pulse oximetry - A non-invasive and painless test - Provide simple explanation of
which uses a sensor significant to pulse oximetry and its value
check pulmonary oxygen - Select a proper probe according to
saturation which checks the the age and weight. Monitor
oxygen levels in the blood. This duration of its use.
shows how well the heart pumps
oxygen throughout the body.
2 Arterial Blood - Checks O2 and CO2 and pH levels in the - Medical technologist are the ones
Gas (ABG) test blood which shows results inadequacy who usually collect but, nurses
of gas exchange. Used to diagnose should always be aware if they had
hypoxemia or if there is decreased it properly labeled and it should be
oxygen and hypercapnia or increased handled properly. They should
carbon dioxide which may indicate have collected the right amount
inefficient pulmonary gas exchange to needed for a specimen.
determine respiratory failure.
 7. Provide a nursing plan of care for the top prioritized nursing problem.

Nursing Planning Interventions Rationale

Diagnosis
- Impaired gas Short Term Goal: Independent:
exchange related - After nursing - Perform Pediatric - PBSL is administered to
to altered oxygen intervention, Basic Life support pediatric patients which are in a
supply patient will be until help has life threatening illnesses or
able to breath arrived for further injuries until they can be given
independently care. full medical care at a hospital.
until Advance life Dependent: - Necessary to the patient because
support - Advance Life it has set of life saving protocols
Long-term Goal: support will take and skills that extends the basic
- After nursing the patient to the life support to further support
intervention, hospital and may circulation and provide an open
patient will be provide further airway and adequate ventilation
able to breathe needs for the (breathing)
independently patient. - Pediatricians are doctors
without the help Collaborative specialized to manage health of
from an - Pediatricians may a child from minor to serious
equipment or a be called to help if problems which means
rescuer. there are necessary pediatricians will know the best
questions or thing for the pediatric patient.
referrals which may
help the patient.

8. What are the procedures that will be ordered for the patient?
• State the purpose of the procedures.
- Maintain sufficient blood circulation and breathing through a clear airway.
• What are the different cases where we can execute these procedures?
- Provide safety to anyone who experiences cardiac arrest, respiratory distress or an
obstructed airway.
• What are the possible complications of each procedure?
- Performing CPR may potentially break the patient’s ribs or the sternum. Giving artificial
respiration may cause vomiting, airway compromise or aspiration.
• What is the equipment needed for each procedure?
- There is less needs for equipment that to be brought in the scene for BLS since CPR will
only require the rescuer’s breathing techniques done to the patient and also hands to
perform compressions.
• What are the principles to consider in performing the procedure?
- Principles that are needed for the procedure to be performed includes the recognition of
sudden respiratory or cardiac arrest, activation of the emergency response system, early
cardiopulmonary resuscitation, rapid defibrillation with an automated external
defibrillator and chest compressions with the right rate and depth and also observe full
chest recoil. There are basic elements of BLS which are initial assessment, airway
maintenance, chest compression and air ventilation based on the foundation of ABCs
(Airway, Breathing, and Circulation).
 o Write in chronological order the steps in performing the
procedure.
1. Verify scene safety.
2. Introduce yourself to patient/significant others. (the father in this case)
3. Check for infant’s response/consciousness by gently tapping the foot and loudly
asking the child “Hey are you ok?” or calling his/her name.
4. If unresponsive, shout for help from bystanders. (Ask father to call for 911.)
5. Activate emergency response system via mobile device (if appropriate).
6. Assess need for CPR. Check if not breathing or only gasping and check for pulse
simultaneously for about 5 to 10 seconds.
7. If no breathing and no pulse, provide high quality CPR.
7.1 Locate area where you will compress which is on the lower half of sternum just
below the nipple line.
7.2 Use the 2-finger chest compression technique (middle and ring finger) if rescuer is
alone.
7.3 Following the 5 cycles of 30:2 compressions to ventilation ratio for a single
rescuer, start with 30 compressions while counting outloud to maintain rhythm and make sure
to have adequate depth of about 4cm or 1.5 inches.
7.4 Allow complete chest recoil and continue in proper rate until 30.
8. Open airways using either head-tilt chin-lift maneuver or jaw thrust maneuver if with
suspected neck injury.
9. Provide 2 ventilations or breaths by placing mouth to infant’s mouth and nose creating
a tight seal around it and giving one breath over one second watching chest wall rise. 1 breath
every 3 to 5 seconds.
10. After 5 cycles (2 minutes), reassess infant for breathing and pulse (no more than 10
seconds).
11. If infant has normal breathing and pulse, place in recovery position and monitor until
emergency responders arrive.
12. Do secondary survey and personal interview. Then do medical interview.
13. Transport and endorse patient. Do proper documentation.

Prepared by:
MAE CHRISTIE LIMBARING-ELEGADO, MAN, RN
Level II Faculty
References:
Hockenberry, M. & Wilson, D. (2015). Wong’s Nursing Care of Infants and Children
Singapore: Elsevier Publisher.
Doenges, M., et.al. (2016). Nurse’s Pocket Guide. Philadelphia, Pennsylvania: F.A. Davis
Company & iGroup Press Co., Ltd.