Condition	Assessment: Signs and Symptoms	Prehospitalization Nursing Care	In-hospital Nursing Care
	Improve ventilation (decrease Pco₂) by: Liquefying secretions - oral and parenteral fluids; if intubated, frequent instillations of normal saline or sodium bicarbonate Frequent suctioning IPPB indicated if tidal volume decreases Chest physiotherapy Administer drugs as ordered: sympathomimetics, xanthines, antibiotics, and steroids Monitor: arterial blood gases, electrolytes, Het, Hgb, and WBC Do not: Administer sedatives Correct acid-base problems without monitoring electrolytes Overcorrect PaCO₂, Leave patient alone while oxygen therapy is initiated Once patient is stable, transfer to ICU
Near-drowning—asphyxiation or partial asphyxiation due to immersion or submersion in a fluid or liquid medium	Conscious victim: Acute anxiety, panic; increased rate of respirations Pale, dusky skin Unconscious victim: Shallow or no respirations Weak or no pulse	Conscious victim: Try to talk victim out of panic so can find footing and way to shore Utilize devices such as poles, rings, clothing to extend to victim; do not let panicked victim grab you; do not attempt swimming rescue unless specially If you suspect head or neck injury - handle carefully, floating victim back to shore with body and head as straight as possible; do not turn head or bend back Unconscious victim: If victim not breathing: as soon as you have firm support begin mouth-tomouth resuscitation Tilt head back, bring jaw forward, pinch nostril shut, give two quick breaths	Non-symptomatic near-drowning victim: Draw blood for arterial blood gases with patient breathing room air PA and lateral chest x-ray Auscultate lungs Admit to hospital for further evaluation if. PaO₂ < 80 mm Hg pH < 7.35 Pulmonary infiltrates present, or auscultation reveals crackles Victim inhaled fluids containing: choline, hydrocarbons, sewage, or hypotonic or fresh water

Condition

Assessment: Signs and Symptoms

Prehospitalization Nursing Care

In-hospital Nursing Care

Improve ventilation (decrease Pco₂) by:

Liquefying secretions - oral and parenteral fluids; if intubated, frequent instillations of normal saline or sodium bicarbonate
Frequent suctioning
IPPB indicated if tidal volume decreases
Chest physiotherapy Administer drugs as ordered: sympathomimetics, xanthines, antibiotics, and steroids

Monitor: arterial blood gases, electrolytes, Het, Hgb, and WBC

Do not:

Administer sedatives
Correct acid-base problems without monitoring electrolytes
Overcorrect PaCO₂,
Leave patient alone while oxygen therapy is initiated

Once patient is stable, transfer to ICU

Near-drowning—asphyxiation or partial asphyxiation due to immersion or submersion in a fluid or liquid medium

Conscious victim:
Acute anxiety, panic; increased rate of respirations
Pale, dusky skin
Unconscious victim:
Shallow or no respirations
Weak or no pulse

Conscious victim:

Try to talk victim out of panic so can find footing and way to shore
Utilize devices such as poles, rings, clothing to extend to victim; do not let panicked victim grab you; do not attempt swimming rescue unless specially
If you suspect head or neck injury - handle carefully, floating victim back to shore with body and head as straight as possible; do not turn head or bend back

Unconscious victim:

If victim not breathing: as soon as you have firm support begin mouth-tomouth resuscitation
Tilt head back, bring jaw forward, pinch nostril shut, give two quick breaths

Non-symptomatic near-drowning victim:

Draw blood for arterial blood gases with patient breathing room air
PA and lateral chest x-ray
Auscultate lungs
Admit to hospital for further evaluation if.
1. PaO₂ < 80 mm Hg
2. pH < 7.35
1. Pulmonary infiltrates present, or auscultation reveals crackles
2. Victim inhaled fluids containing: choline, hydrocarbons, sewage, or hypotonic or fresh water