Decompression Sickness: Bend's Disease

This results in the person having repetitive periods of insufficient ventilation and jeopardized gas exchange. This occurs when the inhibitory input to the brain exceeds excitatory output; or in simpler terms the brain fails to signal the muscles to breathe.

A diver descending to a depth of 10 meters, is equivalent to the entire 150km of atmospheric air (1 ATA). This is due to water being much denser than air. If the diver were to descend another 10 meters, the water will exert a further pressure, equal to another atmosphere, 2 ATA.

Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

The most serious health problem that the client has is impaired gas exchange. According to Sue Galanes (2007), impaired gas exchange is result from the balance between ventilation and perfusion is offset by a certain condition which affects the efficiency of the gas exchange. On account of client has congestive heart failure that can contribute to dyspnea, which means the efficiency of gas exchange is decreased. One of the significant defining characteristics of impaired gas exchange is dyspnea (Sabtu, 03 Agustus 2013). In addition, it was hard for the patient to talk in long sentence due to difficulty in breathing. Hence, impaired gas exchange is one of the health problems that the client suffered from. In regards of O2 is the basic element that all of cells and organs need, it can be considered as a fuel of human body. Therefore, impaired gas exchange is the most severe health problem the patient has currently.

The patient will be able to tolerate ambulation to the bathroom and to the shower with minimal shortness of breath

Conveying a human to a different atmosphere inflicts barotrauma which is the inability to equalise pressure within the body cavities. Boyle’s law explains as pressure increases on our bodies the volume of our body cavities decrease and as pressure decreases the volume is increased. A changing pressure between a gas space in our bodies causes physical damage to tissue. Astronauts experience this from the change in pressure between their space suits and the shuttle. However, divers are subjected to greater changes in pressure the deeper beneath sea level resulting in more harmful

acquired pressure injuries and lack of early signs of patient deterioration. Furthermore this is a

I swallow water and my lungs start to fill. " pg.140-141 That was the nightmare he had for over 40 years and some of the precautions he took to make sure it never happened was to avoid deep river lakes and the ocean, to not go on boats and to not use planes to travel abroad. This shows that it affected him deeply and for a very long time at

One idea is that hypoxia creates the problem. Studies have shown that physical stimuli restricting breathing, such as airway obstruction, are a

Divers who run out of air and have to surface quickly to avoid drowning can suffer from the Benz. An illness that effect blood flow to the brain of the diver and a rapid buildup of nitrogen in the joints. Drowning can occur more often in the ocean as well because of the rough surf and the waves and current holding swimmers and overboard sailors under water. On beaches the under tow can be extremely dangerous and cause drownings to even highly skilled

For a pressure ulcer to develop, damage to the lining of blood and lymphatic vessels, or endothelial damage occur over a bony prominence as the result of several processes such as a disrupting and shearing force (Gillick & Sheerin, 2004, p. 34). Once a pressure ulcer begins to develop, deep tissue damage gradually rises to shallower tissues. According to Gillick and Sheerin (2004), the extent of damage caused by a pressure ulcer is related to the pressure and repeated pressure applications and the length of time that a body part is exposed to pressure (p. 34). Therefore, locally reduce blood flow, which could cause complications if the endothelium is impaired, and locally reduce oxygen levels and increase carbon dioxide levels are a direct result of irregular pressure. When the pressure is relived,

The assessment of the skin is no different and just as important. The Braden scale evaluates the patient’s sensory perception, moisture, activity, mobility, nutrition, friction and shear. After the evaluation of these aspects, a score is given in relation to the risk that the patient is at for developing a pressure ulcer. The Braden scale is the highest predictive tool used to assess the patient’s skin integrity (Yatabe, Saito, & Ishida, 2011). According to Mallah, Nassar, Badr (2015), the sensitivity of the Braden scale in predicting a hospital-acquired pressure ulcers was 92.30%. Following the assessment, appropriate interventions can be initiated. The patients who are most at risk for developing pressure ulcers are unable to effectively reposition themselves or are not able to provide the sensory feedback needed (which is assessed on the Braden scale). With the loss of mobility and sensation, the patients need assistance in distributing their weight (Sprigle & Sonenblum, 2011). Sprigle and Sonenblum (2011) also show a study that indicates the importance of turning patients every two hours. A study concluded that redness and oxygen reduction while lying in bed can occur in less than two hours. The use of specialty beds, sheets, and redistribution devices are shown to significantly reduce the incidences or pressure ulcers. Tools such as Mepilex

In the nitrogen washout method the patient is made to inhale a breath of 100 percent oxygen. The patient then exhales through a one way valve which measures the nitrogen content and volume in the expired breath. There airways only contain oxygen but the alveoli also contain nitrogen. When the patient expires the nitrogen content is monitored. A nitrogen vs expired volume curve is plotted by increasing nitrogen concentration from zero to the concentration of nitrogen within the alveoli. The concentration of nitrogen increases as the air from the dead space is expired and eventually reaches a plateau once the alveolar air starts to be exhaled. The concentration is initially zero because the patient is exhaling dead space oxygen that they just breathed in. As we know this oxygen does not take part in gaseous exchange. It then increases as the air in the dead space mixes with that of the alveoli. The anatomical dead space can be obtained from this curve by drawing a vertical line down the curve so that the area to the left of the line is equal to that of the area to right of the line. The

Ear barotrauma is a hazard of SCUBA diving, it includes the barotrauma conditions of the external, middle and internal ear. Though there are many different types of barotrauma including lung and tooth, problems relating to the ear are the most common amongst SCUBA divers. All barotrauma conditions result from the differences in pressure in different parts of the body. The pressure differences within the parts of the ear cause the eardrum to move inward. The symptoms of barotrauma include vertigo and ear and chest pain. Boyle’s law is the gas law which is related to this condition, it states that when the pressure decreases, volume increases. So as a diver dives deeper, and the pressure increases the volume decreases, which affects the

Decompression sickness refers to injuries resulting from a rapid decrease in the surrounding pressure from being in either water or air. Decompression sickness arises from dissolved gasses coming out of solution into bubbles inside the body on depressurization. Because of the decrease in pressure, bubbles of gases form within the tissues of the body causing DCS.