Helping a Patient Who Experiencing Pain - Case Study Example

? Nursing Case Study Assessment of Nursing Case Study Assessment Q1. From the case study, there are various priority nursing problems that the nurse must note during diagnosis. Priority problems are those issues that can negatively affect the overall performance of a patient (Shen, Johnston and Hays, 2011). One of the priority problems that can be noted in the case of Jane is Respiratory- problem where it is noted that when Jane is sitting upright, she is demonstrating auditory wheeze and is using accessory muscles. This shows that she is staining to breathe. The other priority problem that the nurse should note in the diagnostic statement is that Jane is experiencing dehydration. Dehydration is shown by dryness of the lips and the fact that her skin has lost its turgor and has become (Shen, Johnston and Hays, 2011). The other priority problem that should be noted by the nurse is that the patient is experiencing pain. During the examination it is observed that Jane is having problems forming sentences and she is not able to take Ventolin. Q2. During the diagnosis, it has been identified that Jane’s oxygen saturation is alarming which suggests that the oxygen saturation are 90 percent of Room air. To deal with this problem, the nurse will use the four components of the nursing interventions. The intervention will be performed by the nurse who will be in contact with the patient for most of the time during her stay in the hospital. The other nursing component that will be included in the intervention is performance of respiratory evaluations of the respiratory rate and effort that Jane is using when breathing (Shen, Johnston and Hays, 2011). Assessment of the respiratory rate is critical given that Jane has already shown signs of having problems in breathing and asthma is usually characterized by respiratory problems. The other nursing intervention to be implemented to rectify the problem is to carry out frequent assessment of the patient at least once daily. Frequent monitoring will allow the nurse note the progress of the patient and in case any emergency care is required, a physician can be called in immediately. The fourth nursing intervention that will used to rectify the problem is to administer pain relief to the patient. This is because the patient has shown signs of being in pain (Shen, Johnston and Hays, 2011). Q3. During the assessment of Jane, it becomes evident that she is experiencing chronic pain as she coughs. According to Gagnon (2011), pain is a subjective symptom and when measuring pain, the medical practitioner aims at identifying pain location, its intensity, temporal patterns, relieving factors and interference. It is hard to measure pain that Jane is experiencing given that she is an infant and has difficulties in communication. However, the best assessment tool should be relying on behavioral assessment of the child. The nurse should therefore observe facial expression as the child coughs and how she makes facial expression after medication has been administered. Therefore the best tool for the case should be the Wong-Baker Faces Pain Rating Scale which uses to evaluate the level of pain based on the face. Q4. The recommended dosage of paracetamol is 15mg of paracetamol per kilogram. This is calculated by dividing 210 by 14 which gives 15mg per kg. Therefore the dosage recommended by the RMO is correct. Q5. Given the age of Jane and her present condition that gives her difficulties when swallowing, the nurse can utilize different strategies to administer paracetamol to her. The nurse can administer the paracetamol through a syringe placed at the corner of the mouth after which the nurse pushes the syringe slowly to release the medicine into the throat of the child (Ganzewinkel et.al., 2012). The other strategy that the nurse can use is by giving the paracetamol using a teat bottle where Jane will suck the medicine. The nurse may also administer the paracetamol through the intravenous fluid that is given through the vein of the child. The other strategy to be used when administering paracetamol to Jane is to give the dosage as the child is lying down (Ganzewinkel et.al., 2012). Q6. In addition to using paracetamol to relieve pain in Jane, the nurse can also used several non-pharmacological strategies in pain management. The nurse can use massage and physical strategies in managing pain. Consequently, the nurse can caress, massage and stroke the child’s shoulders, back, neck, arms and legs (Ganzewinkel et.al., 2012). The other strategy to be used in relieving pain is use of positive reinforcement. Positive reinforces can include praising the child for brevity to bear pain by giving rewards such as games, toys, stickers and trinkets. These strategies help to relieve and manage pain to the child (Ganzewinkel et.al., 2012). Q7. After a nasogastric tube has been inserted, I will use the tube in carrying various nursing interventions. NGT will also be used in assessing the bleeding on the upper gastro-intestinal and collection of gastric contents for analysis (Egan and Shami, 2011). In addition, the inserted nasogastric tube will be used when administering nutrients and medications to the patient. Q8. The position of a nasogastric tube should be checked after it has been inserted and its position documented on the patient’s diagnostic statement. The nurse should also check the position of NGT before the patient is fed and after the patient vomits or coughs. The position of the NGT should also be checked in case there is a decrease in oxygen saturation, if the tube becomes dislodged accidentally or the patient complains of discomfort. To check the position, the nurse can either use X-ray or pH tests and Egan and Shami (2011) explain that other methods should never be used. Q9. In case the medical practitioner is unable to draw adequate aspirate for checking the position of the nasogastric tube inserted in Jane, the chest x-ray may be used to confirm its position. The chest x-ray involves taking x-rays of the higher half of the abdomen (Khanna, Garg and Singh, 2012). In the x-ray image, the tip of a tube is seen as a white radio-opaque line and must be seen to be below the left side of the diaphragm. The other approach in assessing the position of NGT is to assess the pH level in the stomach as this indicates the level of food in the stomach (Egan and Shami, 2011). Q10. There are various nursing interventions that nurses should adopt when taking care of pediatric patients who have a nosagastric tube inserted in them. One of the nursing interventions required in caring for infants is to ensure that there is a nurse to monitor the position of the NGT. This is because the tube may become dislodged and therefore the nurse will ensure that such cases are dealt with appropriately. Another intervention required from nurses caring for infants having NGT is that the tube should be clamped or capped to avoid backflow of contents from the stomach and air accumulation in the stomach (Khanna, Garg and Singh, 2012). The nurse must always ensure that the patient remain in an upright or is half-sited whenever she is receiving food through the tube to avoid regurgitation and enhance peristalsis. The nurse should also monitor the amount of gastric aspirate and in case it becomes higher before bolus, the gastric aspirate should be re-instilled (Gagnon, 2011). Additionally, the amount of feeding should be reduced in case it is noted that the child is not digesting. Q11. Immunizations to children are given during different age groups. During the discussion with Jane’s mother, the nurse learns that Jane is due to receive immunization after getting to three years. Some of the immunizations given at this age include diphtheria, whopping cough and tetanus (acellular pertussis). In addition, the child is given polio (inactivated poliomyelitis), mumps, and measles and rubella immunizations (Australian Government Department of Health and Ageing, 2012). Q12. Jane’s mother has expressed concerns over administration of vaccines following her experience with flu vaccine. To convince her to have Jane immunized, the nurse should provide advice to her. Firstly, the nurse should explain to her that immunization helps the child fight against disease in case they come across disease causing organisms (Moore et. al, 2011). Furthermore, in case more and more children are not immunized over diseases such as mumps and polio, the risks of outbreaks of such diseases become increased. An immunized child can not be affected by those diseases she is immunized against and therefore her growth will not be delayed. In addition, by ensuring that the child is immunized, the child is little affected by other diseases (Moore et. al, 2011). For instance, currently Jane is asthmatic and therefore by giving her immunization against the diseases described above, she will reduce the risks from multi-diseases. Q13. Like when different medications are taken, vaccines may have side effects which the Jane’s mother must be on the look-out. Immunizations may lead to soreness on the area where the injection is administered (Gagnon, 2011). The other side effects of immunization include mild fever, drowsiness and runny nose. Furthermore, immunization can result to coughing, puffy eyes and swollen salivary glands. In rare cases, immunization can lead to serious effects such as allergic reactions and the parent is advised to seek medical attention in the same health facility where the child received immunisation. Q14. When caring for patients with IVT, the nurse should put in place various considerations. The nurse will be involved in changing of the giving set and document the particular time and date when such changes are made (Guy and Peterson, 2011). The other nursing intervention that the nurse would do is to teach the patient how to move the arm safely. The patient should take out the arm affected last but put it first when changing clothing. Moreover, a patient should not raise the arm too high when wheeling the IVT stand which is intended to allow gravity to offer a consistent pressure and avoid blood backflow (Guy and Peterson, 2011). The nurse should also check for any signs of inflation on the skin or redness and in case of redness, the infusion should be discontinued. Q15. PIVAS refers to Peripheral intravenous assessment score and is the basis in designing the characteristics of the operating environment of the drug. It is applied in accordance of strict to the operating procedures comprising cytotoxic and nutrients drug intravenous antibiotics (Klein, 2012). Q16. Preparation for discharge of a patient begins immediately after a patient has been admitted. The family of Jane will be involved in preparing for the discharge of Jane to ensure that they have all the information and resources needed to offer care to Jane in a home setting. The family of Jane should be offered information on complications that Jane can develop following the discharge (Ou et al., 2011). Jane’s mother will also be given information on how to manage the medication of her daughter and ensure that she is aware of next appointment to the hospital. The other information that the parent will be equipped with is on the emergency contact that they can make in case of any need (Ou et al., 2011). References Australian Government Department of Health and Ageing (2012). National immunisation program schedule as at May 2012. Retrieved 6th September, 2012 from www.immunise.health.gov.au. Egan, D. and Shami, N. (2011). Self-knotting of a nasogastric tube. Western Journal of Emergency Medicine 12 (2): 266-267. Gagnon, A. (2011). Asthma update. Pharmacy Practice, 27(2), 27-33, 64. Retrieved August 29, 2012 from http://search.proquest.com/docview/869890010?accountid=45049 Ganzewinkel, C et. Al (2012). Paracetamol serum concentrations in preterm infants treated with paracetamol intravenously: a case series. Journal of Medical Case Reports Vol., 6:1: Pp 1-5. Guy, L. and Peterson, M. (2011). The impact of dilution on intravenous therapy. Journal of Infusion Nursing Vol. 34 (2): Pp117–123 doi: 10.1097/NAN.0b013e31820b7899 Khanna, P., Garg, R. and Singh, A. (2012). The nasogastric tube in the thorax after gastric pull up!. Open Journal of Anesthesiology, 2, 36-37. Klein, L. (2012). A pilot project to improve neonatal peripheral intravenous site assessment and documentation. Journal of Obstetric, Gynecologic and Neonatal Nursing Vol. 41 (1): S31. Moore, et. al (2011). Achieving high immunisation rates amongst children in the australian capital territory: A collaborative effort. Australian Health Review, 35(1), 104-10. Retrieved from http://search.proquest.com/docview/857744076?accountid=45049 Ou, L., Chen, J., Young, L., Santiano, N., Baramy, L., & Hillman, K. (2011). Effective discharge planning - timely assignment of an estimated date of discharge. Australian Health Review, 35(3), 357-63. Retrieved from http://search.proquest.com/docview/910806272?accountid=45049 Shen, J., Johnston, M., & Hays, R. D. (2011). Asthma outcome measures. Expert Review of Pharmacoeconomics & Outcomes Research, 11(4), 447-53. doi: 10.1586/erp.11.48. Read More