Ambulation

External defibrillation was first performed in 1952 and continues as a routine procedure in hospitals and ambulances. The problem of external defibrillation has not been a technological one, but rather a legal one. Only in the 1990s have laws been passed to permit people other than doctors and paramedics to operate semiautomatic defibrillators to provide help when it is needed. New and better defibrillation devices continue to come to market and are easier and safer to use. 

St John Ambulance Association (1982) First Aid, 3rd edn, St Andrews Ambulance Association and The British Red Cross Society, London. 

The ambulance vehicle should be prepared properly to receive and transport the victim and possibly the rescuers. All personnel involved in the transport should be properly dressed in protective clothing. The hospital should be advised immediately of the situation so prepzirations can be made to prevent contamination of emergency department. Bring all available information on the contaminant to the hospital. 

After the victim has been transported to the hospital the ambulance vehicle must be decontaminated by trained personnel. 

All appropriate emergency serx ices listed by the phone, (police, fire department, ambulance, poison control)... 

Vehicle fleet owners often have their cars and/or vans converted to run on LPG and have an on-site bulk storage vessel installed complete with a dispensing pump. This is an attractive economic proposition for taxis, ambulances, local authority fleets, etc. Virtually any spark-ignition engine can be converted to run on LPG. It can therefore be considered for any engine-driven machinery. 

The sites for IM administration are the deltoid muscle (upper arm), the ventrogluteal or dorso-gluteal sites (hip), and the vastus lateralis (thigh Pig. 2-7). The vastus lateralis site is frequently used for infants and small children because it is more developed than the gluteal or deltoid sites, hi children who have been ambulating for more than 2 years the ventrogluteal site may be used. 

ETHAMBUTOL The nurse monitors for any changes in visual acuity and promptiy reports any visual changes to tlie primary health care provider. Vision changes are usually reversible if tlie drug is discontinued as soon as symptoms appear. The patient may need assistance with ambulation if visual disturbances occur. Psychic disturbances may occur. If die patient appears depressed, withdrawn, noncommunicative, or has otiier personality changes, the nurse must report the problem to the primary health care provider. 

RISK FOR INJURY Some patients with a viral infection are acutely ill. Others may experience fatigue, lethargy, dizziness, or weakness as an adverse reaction to the antiviral agent. The nurse monitors these patients carefully. Call lights are placed in a convenient place for the patient and are answered promptly by the nurse. If fatigue, dizziness, or weakness is present, the patient may require assistance with ambulation or activities of daily living. The nurse plans activities so as to provide adequate rest periods. 

IMPAIRED PHYSICAL MOBILITY. The patient may have an acute or chronic disorder with varying degrees of mobility. The patient may be in acute pain or have longstanding mild to moderate pain. Along with the pain there may be skeletal deformities, such as the joint deformities seen with advanced rheumatoid arthritis. Considering the nature of the patient s condition, the nurse s assistance with ambulation may be required. The nurse determines the degree of immobility of the patient and assists the patient as needed. 

Fhtients on bed rest require position changes and good skin care every 2 hours. The patient with an arthritis disorder may experience much pain or discomfort and may require assistance with activities, such as ambulating, eating, and grooming. Fhtients with osteoporosis may require a brace or corset when out of bed. 

SKELETAL MUSCLE RELAXANTS. These drugs may cause drowsiness. Because of the risk of injury, the nurse evaluates the patient carefully before allowing the patient to ambulate alone. If drowsiness does occur, assistance with ambulatory activities is necessary. If drowsiness is severe, the nurse notifies the primary health care provider before the next dose is due... 

Administration of penicillamine has been associated with many adverse reactions, some of which are potentially serious and even fatal. The nurse carefully evaluates any complaint or comment made by the patient and reports it to the primary health care provider. Increased skin friability may occur, which may result in easy breakdown of the skin at pressure sites, such as the hips, elbows, and shoulders. If the patient is unable to ambulate the nurse changes the patient s position and inspects pressure sites for skin breakdown every 2 hours. 

Assist the patient in bed to a sitting position and have the patient sit on the edge of the bed for about 1 minute before ambulating. 

Remain with the patient while he or she is standing in one place, as well as during ambulation. 

Symptoms of postural or orthostatic hypotension often lessen with time, and tire patient may be allowed to get out of bed or chair slowly without assistance The nurse must exercise good judgment in this matter. Allowing tire patient to rise from a lying or sitting position without help is done only when tire determination has been made that tire symptoms have lessened and ambulation poses no danger of falling. 

DIARRHEA. When these dragp are used orally they occasionally result in excessive salivation, abdominal cramping, flatus, and sometimes diarrhea The patient is informed that these reactions will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse ensures that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse keeps a record of the fluid intake and output and tlie number, consistency, and frequency of stools if diarrhea is present. The primary health care provider is informed if diarrhea is excessive because this may be an indication of toxicity. 

MINIMIZING RISK FOR INJUFY These drugs may cause drowsiness, dizziness, and blurred vision. Patients (especially the elderly) may require assistance with ambulation. 

OXAZOLIDINEDIONES. Drowsiness is the most common adverse reaction and, as with the other anticonvulsants, tends to subside with continued use Visual disturbances may also occur. The patient with a visual disturbance is assisted with ambulation and oriented carefully to the environment. The nurse ensures that the environment is safe The patient may be especially sensitive to bright lights and may want the room light to be kept dim. Because photosensitivity can occur, the nurse must keep the patient out of the sun. The nurse instructs the patient to use sunscreens and protective clothing until the individual effects of the drug are known. 

Ability of the patient to carry out any or all of the activities of daily living (eg, bathing, ambulating, dressing)... 

Visual difficulties (eg, adverse reactions of blurred vision and diplopia) may be evidenced by the patient s sudden refusal to read or watch television or by the patient bumping into objects when ambulating. The nurse carefully evaluates any sudden changes in the patient s behavior or activity and reports them to the primary health care provider. The patient with visual difficulties may need assistance with ambulation. The room should be kept well lighted, the use of scatter or throw rugp should be avoided, and any small pieces of furniture or objects that might increase the risk of falling should be removed. The nurse carefully assesses the environment and makes the necessary adjustments to ensure the patient s safety. 

If the patient experiences dizziness or drowsiness, it is important to provide assistance with ambulation. If drowsiness is severe or if other problems such as dizziness or a disturbance in muscle coordination occur, the patient may require assistance with ambulation and other activities. The nurse places the call light within easy reach and instructs the patient to call before attempting to get out of bed or ambulate. The nurse informs the patient that this adverse reaction may lessen with continued use of the drug. 

ANTIASTHMA DRUGS. Some antia tiimadrugp may cause an unpleasant taste in the mouth. Having the patient take frequent sips of water, suck on sugarless candy, or chew gum helps to alleviate die problem. If dizziness occurs, the patient may require assistance with ambulation. For nausea, the nurse provides frequent small meals, rather than three larger meals. 

Then call your doctor NOW. Go to the hospital or call for an ambulance if ... 

If die patient has frequent chest pain or reports dizziness or light-headedness, the nurse monitors die blood pressure frequendy. The patient may need help during ambulation if dizziness occurs. In addition, the nurse must evaluate die patient s response to therapy by questioning the patient about die anginal pain. In some patients, die pain may be entirely relieved, whereas in others it may be less intense or less frequent or may occur only widi prolonged exercise. The nurse records all information in the patient s chart because tiiis helps die primary health care provider plan future therapy, as well as make dosage adjustments if required. 

Angina is a common problem in older adults When an older adult requires an antianginal drug, the dosage maybe reduced to compensate for impaired renal function or heart disease. Older patients are at increased risk for postural hypotension. Blood pressure and ability to ambulate should be monitored closely. 

Some patients may experience dizziness and lightheadedness, especially during early therapy. If these effects should occur, the nurse assists the patient with all ambulatory activities and instructs die patient to ask for help when getting out of bed or ambulating. 

HISTAMINE H2 ANTAGONISTS. During early therapy with these drug, the patient may experience dizziness or drowsiness. The patient may require assistance with ambulation. These reactions usually must be tolerated, but the nurse reassures the patient that they will disappear after several days of therapy. 

MANAGING SODIUM AND WATER RETENTION. Sodium and water retention may occur during female hormone therapy, hi addition to reporting any swelling of die hands, ankles, or feet to the primary health care provider, die nurse weighs the hospitalized patient daily, keeps an accurate record of die intake and output, encourages ambulation (if not on bed rest), and helps the patient to eat a diet low in sodium (if prescribed by the primary health care provider). 

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