Nursing Observations of Clients - Assignment Example

Nursing Observations of Nursing Observations of The setting of priorities for these three patients is through Maslow's hierarchy of needs and the National League for Nursing Educational Competencies Model. Hence, the ultimate goal for these three patients nursing priorities is to facilitate human flourishing and conduct nursing judgments based on substantiated nursing science evidence. The nursing priorities tend to focus on the three patients’ reactions to their medical situations and to effect nursing roles which reflect integrity, accountability, ethical practices, as well as evolving identity. Moreover, Maslow's theory asserts that an individual fundamental level of needs ought to be fulfilled before proceeding to the higher level of needs. This comprises physiological needs like food, safety and love. This is then followed by the fulfillment of self-actualization and self esteem. Hence, based on Maslow model, nurses should ensure that the needs of each patient are met individually, so as to facilitate them to feel contented, cared for and accommodating. When prioritizing care for these three individuals it is crucial to identify the predicament of each one of them, review their nursing diagnoses, and then determine which of one of them has most urgent . This is based on fundamental needs, patient variations in status, intricacy of their problem. Discussion Based on the National League for Nursing Educational Competencies Model, the key e value of nursing care should be caring, excellence, holism, and patient-centeredness (2010). Hence, client #3 Anita Bonfire should be the first in the priority list, since she seems to be having some serious complication as a result of the Appendectomy and requires at most care and constant monitoring. This then calls for the monitoring of vital signs, especially commencement of fever, chills, or diaphoresis. In particular, if she is breathing so shallowly, then a physical examination of her cardiovascular system should be conducted in order to ascertain vital signs and presence or nonexistence of either jugular -venous distension, edema, or abnormal heart sounds (Lipe & Beasley, 2004). Moreover, a day following the surgery she should be encouraged to sit up in her bed for nearly 5-30 minutes and on the following day to stand or sit outside her room. Based on Maslow hierarchy of needs model, people are prepared to act upon other health development needs when their absence needs are fulfilled. Hence, the intention should be to offer Anita nursing care that is safe, while being developmentally appropriate to her. What Anita requires is a creating and sustaining upbeat and healthful relationships with her and her family. Maslow asserts that needs within higher levels are less leaning towards an individual physical survival, and more toward his or her psychological comfort and development. Furthermore, there has to be the monitoring of any changes in her mentation and signs of growing abdominal pain. Hence, patient has to be given continuous nasogastric suction to counter abdominal tenderness, vomiting, and tachycardia. She has to be at rest in a semi-fowler’s position, so that gravity confines exudates towards her lower abdomen and pelvis, thus, easing abdominal tension. In order to refocus her attention from just sleeping, it is crucial to offer her diversion activities, so as to improve coping abilities. Under nursing priorities using Maslow model, the key is to prevent complications, promote comfort and offer her and her family information regarding potential complications (Lipe & Beasley, 2004). The National League for Nursing Educational Competencies Model (2010) Spirit of Inquiry states that, nursing decision should be in a manner that assesses the evidence which underlies a particular clinical nursing practice, so as to confront the physician status quo, or query underlying assumptions provided so as to provide new insights to improve patient quality of care. Therefore, Client #2 known as Ella should be given the second priority, since she faces environmental risk factors and which the physician seems not to take into consideration that augment her restlessness and confusion. She is as a result applying physiological responses as defense measure, in order to adjust to stressors. The fact that she is confused and always calling out in pain, even as her family is being in and out means that she requires holistic nursing approach. Hence, the safe care scope under National League for Nursing Educational Competencies Model necessitates that her nurse should provide her with care that is safe, while being culturally appropriate (2010). This should be based on human flourishing, whereby the nurse needs to advocate Ella Mopet needs and that of her family in a manner which will enhance their self-determination and ongoing growth as human beings. As a nurse it is crucial to help Mopet family to take charge and sustain positive and healthful relationships through a relationship-centered care integrating care on her behalf but within the legal plus ethical scope. Therefore, the patient skin turgor along with mucous membranes needs to be evaluated constantly, and then an administration of oxygen should be done prn (Kelly & Marthaler, 2010). Her needs at this phase should entail avoiding harm while maintaining comfort in a physically secure environment without fear. Based on Maslow’s Hierarchy of needs model, there should be emphasis on her personal motivation, so that she attains self actualization. Her physiologic need is ineffective breathing pattern due to ineffective airway clearance. Also undersupplied fluid volume associated with loss of appetite and inadequate oral intake can also be a stressor. Hence, this calls for the assessment of any acute illnesses which can lead to an increase in restlessness, such as urinary tract infection, in addition to evaluation and documentation of her lung sounds after some period and prn (Kelly & Marthaler, 2010). Other measures that can be taken includes, maintaining elevating her head when in bed 45 degrees as endured and the pathways to be free of clutter, while ensuring that she has a quiet environment free of excessive stimulation (Lipe & Beasley, 2004). It is also important for her to verbalize her feelings together with concerns, so that her anxiety can be dealt with. Most importantly is to offer her psychosocial support as well as restful environment. According to National League for Nursing Educational Competencies Model (2010) integrating concepts, nursing care should entail context with environment, knowledge with science, in addition to quality and safety. It also entails relationship-centered care as well as teamwork. Therefore, these are the key issues with regard to Client # 1: Ben with the critical aspect being having a feedback mechanism which acknowledges his health within the family, especially the wife and community context. Thus, the major nursing intervention includes weighing his body weight every day and assessing and recording any auscultation bowel noises. Furthermore there should be the recording and evaluation of abdominal pain or abdominal bloating. He should also be offered a liquid diet having nutrients together with electrolyte instantly if he bears it orally. His wife should be involved, especially in meal digestion and insulin treatment The reason for placing Client # 1: Ben Jones as priority number three based on Maslow model is that his crucial needs have been satisfied and now the focus is on other higher needs. These needs are more so prejudiced through learning as well as experiences (Kelly & Marthaler, 2010). There should be the observation of any signs of hypoglycemia, particularly changes in consciousness levels, rapid pulses, and extreme sensitivity to stimuli, headaches and skin moist (Lipe & Beasley, 2004). It is equally crucial to monitor any signs of infection or inflammation, such as flushed appearance or cloudy urine due to previous infection. In addition he should be given catheter or perineal care, since high glucose in his body provides a perfect base for bacterial growth. He should be in semi-Fowler’s position so as to ease lung expansion and minimize danger of aspiration. Emphasis on hygiene is also important and administration of antibiotics will be fitting. Suction airway through sterile method is necessary, as this will facilitate ventilation of his lung areas while mobilizing secretions, which in the end will put off stasis of secretions (Rosdahl & Kowalski, 2008). Hence, safe care calls for the provision of Ben with culturally and progressively appropriate care, which is centered on building and sustaining positive and healthful relationships with his wife and family. References Kelly, P., & Marthaler, M. T. (2010). Nursing Delegation, Setting Priorities, and Making Patient Care Assignments. Boston: Cengage Learning. Lipe, S. K., & Beasley, S. (2004). Critical Thinking in Nursing: A Cognitive Skills Workbook. New York: Lippincott Williams & Wilkins. National League for Nursing. (2010). National League for Nursing (NLN) Educational Competencies Model. Retrieved March 1, 2013, from http://www.nln.org/facultyprograms/competencies/index.htm Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of Basic Nursing, 9e. Newyork: Lippincott Williams & Wilkins. Read More