Caring for an Adult Patient - Essay Example

Name : xxxxxxxxxxx Institution : xxxxxxxxxxx Title : Fundamentals of Nursing: Caring for an Adult Patient Tutor : xxxxxxxxxxx Course : xxxxxxxxxxx @2010 Introduction Maintaining skin integrity in adult patients whose mobility is impaired is one of the fundamental goals in nursing. Adult patients who do not receive proper care while they are hospitalized end up forming sores on their skin hence losing their skin integrity. The assignment therefore looks at the importance of maintain skin integrity in hospitalized adults and this involves assessment of pain, proper patient positioning and use of manual handing equipments by the nurse. Also looked at is the importance of maintaining proper hygiene while caring for an adult patient. This is because proper hygiene must be maintained for a successful adult patient care plan. All this follows evidence based on nursing practise. Importance of maintaining skin integrity in patients with limited mobility Immobility results to pressure, friction and shear therefore putting an adult patient at a risk of impaired skin integrity. With advanced age, the skin loses its normal elasticity. Inadequate nutrition and environmental moisture especially in an individual who cannot control his or her bowel movements may increase the potential effects of the skin pressure and may fasten the development of skin breakdown. According to the Nursing care Plans, (2010) people with the highest risk of losing their skin integrity due to limited mobility are those confined in bed and those in the wheelchair. Immobility can therefore be a great hindrance in maintaining skin integrity and this should be overcome by ensuring that the immobile adults are turned for at least once in every two hours. Turning should also be done carefully since the hands may create friction with the skin and this will also impair the integrity. Skin plays a very important role in the healing process and this call for proper nursing care in maintaining its integrity. Development of pressures and ulcers in the skin of a hospitalized adult can have an impact on the time they stay in the hospital and this predisposes the patients to other complications such as sepsis and bacteraemia. If patients develop such compilations, they will require further treatment and this may subject them to more pain. In the process of caring for an adult patient with limited mobility, pain assessment, patient positioning and use of manual handling are very important aspects. How to perform pain assessment For the nurses to be able to offer optimal care to the patients, they must have appropriate knowledge and skills on pain, its assessment and its management. Pain assessment offers information for subsequent decisions on pain intervention. Therefore the first step to take in offering pain relief is by taking into account the most current evidence-based practices related to pain assessment by nurses. The first step in pain assessment is reviewing medical history, laboratory tests and physical examinations to determine the events that may be contributing to the pain. The other step is to assess the pain that is presently felt including its intensity, its frequency, pattern and its location. Pain relieving factors should also be reviewed if any (Herr 2006). The third step is to review all the medications that have been used on the patient including those currently in use to determine which one of them has been previously effective. The nurse should also asses the beliefs and attitudes of the patient regarding the use of analgesics, adjuvant and non-pharmacological drugs. The fourth step of pain assessment is assessing the self reported pain using a standardized tool. Such tools are the vertical verbal descriptor scale and the face scales which are more effective for use in adult patients. The other step is to give medication and then asses the pain regularly at least once in four hours. This helps to monitor the pain intensity after the medication to be able to determine the effectiveness of the medication. The other step involves observing signs of pain on the patient. These include crying, aggression, and facial grimacing. Changes in patient’s behaviour from the normal patterns should also be observed. The other step involves gathering information from the family members on the patient’s experiences on the pain. The nurse should seek information about the behavioural expression of pain both verbal and non verbal. The final step in pain assessment involves drawing conclusion about the pain. If the assessment finds the pain to be still persistent, he or she should conclude that the pain is still unrelieved and should treat it accordingly (American Geriatrics Society Panel on Persistent Pain in Older Persons 2006). How to implement patient positioning Patient positioning is very important for those patients with limited mobility. Such patients should be periodically moved to prevent their skin from breakdown. People who cannot move themselves should therefore be moved once in two or four hours depending on the condition of the patient. The skin of adult patients who have limited mobility may lose its integrity due to injury while lying helpless in their beds. Most hospitals apply the “no lift policy” and therefore a slippery slide sheet should be used for proper movement of the patient. When positioning a patient, it is very important to focus on the skin and other key areas. For those patients who are acutely ill, the nurse should ensure that the patient is comfortable and safely positioned. The skin must be regularly examined by the nurses to help them prevent injury (Carpenito-Moyet 2007). Nursing considerations when using manual handling equipment Nurses face a very high risk of developing musculoskeletal illnesses while positioning and handling patients with limited mobility. The risk is high due to the weights and the awkward positioning of those patients. A team of medical practitioners from the National Association of Orthopaedic Nurses the American Nurses Association, and the National Institute for Occupational Safety and Health developed a manual tool for safe turning of such patients (Schultz, Bien & Dumond 2009). However, there are some factors that the nurses need to consider when using the manual handling equipment. The nurses must first of all consider the weight of the patients and his or her ability to initiate movement. Where the patient is completely immobile, more nurses should be involved in positioning. When handling patients with spinal cord injury, the burses should maintain care to ensure that the patient’s body is on one plane. For safe patients handling, he or she should be regularly monitored for spasticity in the process of manual handling. The nurse should also consider the sheering force of the handling equipment to prevent them from forming pressure ulcers due to friction. If the patient is uncooperative, mechanical devices or bed assisted devices should be used. For cooperative patients who can assist themselves, the nurses should asses the amount of assistance that is required or give them a repositioning aid. Hygiene care to an adult patient and the nursing diagnosis of self-care deficit Nurses may be faced with patients with self-care deficit in the hospital. The deficit may be as a result of temporary problems especially those that may arise while recovering from surgery or illnesses that may decrease the patient’s ability to care for him or herself. The nurse should therefore monitor the patient’s inability to ascertain that the failure is not due to lack of material resources or the environment. It is important that the nurse should organize all services and the environment to ensure maximum independence of the patient and that the environment supports his or her needs (Ackley & Ladwig, 2008). Evidence- based nursing research provided by Nursing Care Plans (2010) states that the therapeutic interventions for patients with bathing/hygiene deficit should include maintaining privacy during bathing. Privacy is very important for most patients and should be maintained at maximum. The nurse should also ensure be able to instruct the patient to choose bathing time that is convenient for her. This should be time that she or he is not in hurry and is at rest. Hurrying may lead to accidents and the patients may lack enough energy for this Frenkel, Harvey & Newcombe 2007). Proper assistive equipments such as long-handled bath sponge should be provided to assist in bed bathing. The nurse should also encourage the patient to do simple tasks such as combing the hair. He or she can suggest to the patient hair styles that are easy to maintain. This will help the patient to remain autonomous longest time possible. The nurse can also encourage the patient to do minimal oral-facial hygiene immediately after waking up. This will involve brushing teeth and shaving (Jorgensen 2007. Assisting the patients to care for their finger and toe nails is also important. This may also require the help of a podiatric to prevent them from injuring their fingers and toes. Patients need to be frequently encouraged since they mostly don’t notice any progress. When the patient is being discharged from the hospital, the nurse should arrange teaching sessions with the patient so that he or she can be able to practise the instructed tasks. The nurse should encourage the patient on the use of the assistive devices as much as possible. The family and the caregivers should also be taught so that they can encourage independence and be there to intervene when the patient is unable to carry out the task (Sas & Baatz 2010). Conclusion Nursing care for adult patients with limited mobility is very important. This is because as age progresses, skin integrity also decrease and illness may worsen this if there is no proper care. It is very important for the nurses to assess the pain on the patient to be able to determine the proper care to give. This will also assist in knowing the required positioning and the patient as well as the patient handling manner. Another concern in nursing care is those patients with self care deficit. The nurse should work to assist them achieve proper hygiene. Bibliography Nursing Care Plans (2010),Nursing Diagnosis: Risk for Impaired Skin Integrity retrieved on 9th July from American Geriatrics Society Panel on Persistent Pain in Older Persons, 2006, The management of persistent pain in older persons. Journal of the American Geriatrics Society, 50, S205–S224. Evidence Level VI: Expert Opinion. Herr, K., et al., 2006, Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44–52. Evidence Level VI: Expert Opinion. Carpenito-Moyet, L., 2007, Nursing diagnosis: application to clinical practice, Williams & Wilkins, New York. Schultz, A., Bien, M., & Dumond, K., 2009, Etiology and incidence of pressure ulcers in surgical patients. AORN J.; 70:434, 437–440, 443–449. 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