Analysis Situations with Different Levels of Care Requirements in a Ward - Case Study Example

RN’s Work Day Part B Student’s Name Professor Course Date Content Abstract ..........................................................................................................................................3 Introduction ...................................................................................................................................4 Mrs. Fatma Dilma...........................................................................................................................4 Mr. Liam Ferell...............................................................................................................................6 Ben Hansen.....................................................................................................................................7 Mr. John Rassmussen......................................................................................................................9 Ms Hannah Brown.........................................................................................................................11 Mrs Cathy Williams.......................................................................................................................12 Analysis of four peer reviewed articles ........................................................................................12 Conclusion ....................................................................................................................................15 Abstract Registered nurses face numerous unforeseen events when caring for clients in a ward during their shifts. This essay focuses on unforeseen events, which come up when caring for six Clients with different levels of care requirements in a ward. All the six experience varying unforeseen events and nursing decisions are made in relation to their needs. This essay covers the nursing decisions made in relation to these unforeseen events. This paper will also critically evaluate four peer review journal article that are related to the health of four of six clients. The nurse used various diagnostic and therapeutic procedures related to deal with the unforeseen events and ensured that the clients attained maximum cure. Different procedures and medications were required and the RN undertook the procedures with the help of the MO. The nursing care offered made an important difference in assisting the six clients to cope and survive the unforeseen events. The paper concludes that nurses have to be very conversant and skilled to deal with unforeseen events to care for clients with different conditions. Introduction Nursing intervention is usually required during a RN’s shift, especially when unexpected events crop up. This essay covers the nursing interventions required for six clients placed in a ward who experience various unexpected events. All the six clients suffer from different conditions and hence different interventions are required to ensure full recovery. Various medications will be administered and procedures undertaken in collaboration with other health specialists. The interventions used will ensure that the clients are on the right path to recovery. They will enable restoration of Mrs. Dilma vital signs to normal. Mr. Farell central chest pain will be eased and the nurse will prepare him for an endoscopy. Hansen will admit to the circumstances that led to his drug overdose so that he can be assisted to solve his problem. Mr. Rassmussen pain will be eased and also he will be counselled to ensure that he is emotionally ready to be placed in a home. Ms Brown blood transfusion will go as planned. Ms Williams abdominal pain will be eased. The patients will thus be free of any pain and will be able to go back to their normal state. Four peer reviewed articles related to the patients treatment will also be critically reviewed. Mrs Fatima Dilma Mrs. Dilma requires various nursing intervention to deal with the increased temperature, heart rate, Blood Pressure (BP) and the low Arterial Oxygen Saturation (Sp02). The goal for the intervention is to restore her body temperature, heart rate, BP and Sp02 to prevent her vital functions from suffering and to prevent progression to a more serious problem. Since the client is an elderly and lying on her back, pressure need care will be taken. The first step will be assessing the client; determining the reasons for the high temperature, high pulse rate, irregular BP and low SP02. The nurse will check for a source of infection, wound or other causal factors. The implementation will prevent traumas and complications, maintain normal functions, assess the basic needs of the clients, and guarantee Mrs. Dilma best condition to benefit from rehabilitation. First there is need to maintain a patent airway to promote enough oxygenation and to administer oxygen therapy with mechanical ventilation and intubation to facilitate enough tissue perfusion (Funnell et al. 2009). There is need to reduce the high body temperature as quickly as possible through a treatment that focuses on stabilizing oxygenation using ABC (Airway, Breathing and Circulation) of basic life support. At 135/80, the blood pressure can be considered “normal” but Mrs. Dilma BP reading is twice as likely to have a stroke or heart attack. Hence, there is need to withdraw the running IV therapy of 1000. Nursing interventions to monitor the blood pressure include maintaining bed rest and elevating the head of the bed, maintaining drugs and fluids, measuring inputs and expenditures and monitoring Blood Urea Nitrogen (BUN), electrolytes and creatinine. Mrs. Dilma is also high at 38.3 degrees Celsius, which is high. To restore the client to normal body temperature, the nurse will administer antipyretics as per the order of the doctor, remove the excess blankets and clothing, evaluate the possible cause of the increased body temperature, also encourage, and offer oral fluids intake every two hours to Mrs Dilma. Mrs. Dilma heart rate is also very high at 112 beats/per/min. The cause of faster than the normal heart rate in the client is what is regarded as tachycardia. Her conditions have caused the heart rate to increase above the normal range. Such rapid heart rate causes a decreased blood flow to most major organs and the brains and can lead to weakness symptoms and other harmful side effects (Crisp & Taylor 2008). The nursing intervention would hence also entail placing the client on compete bed rest, placing her on semi-Fowler’s position. These interventions will reduce mycocardial oxygen demand to reduce the risk of tissues injuries. They will also relieve shortness of breath and decrease the myocardial workload. The cardiac output is usually compromised by a rise and fall of blood pressure. A fall in cardiac output causes tachycardia to develop and persists when the output fall further (Crisp & Taylor 2008). Mrs. Dilma Sp02 is slightly low as normal levels should be greater than 95%. By maintaining Mrs. Dilma in Fowler’s position, it will facilitate chest expansion through lowering the abdominal organs away from the diaphragm, thus increasing the possibility for a greater volume of inspired aid. Oxygen will also be administered at 45% using Venturi mask. A Venturi mask will deliver the exact amount of prescribed oxygen: 45% is double the oxygen amount in the room air and the supplement oxygen will help to stabilize the moderate hypoxemia. The nurse will also monitor SpO2 with pulse oximeter at all times; the oximetry will measure the amount of oxygen bound to haemoglobin (Schub & Cabrera 2012). The nurse will also consider various ethical and legal considerations. Primarily, before any procedure, consent will be sought from Mrs. Dilma or her daughter. This will prevent any legal dilemma, which might crop up in case the treatment procedure does not go as planned. The nurse will also stay within the scope of practice, carry out the procedures carefully, request guidance from the physician before taking action against a questionable situation and also keep the Client well being and safety foremost in mind (South Australia Health 2009). Ethical considerations will also be taken into account in the client treatment. All Mrs. Dilma belief systems and religion beliefs will be considered to ensure that the treatment procedures do not contravene them. The nurse will intentionally apply gentle traction on the in dwelling catheter and ensure that the secure device stays in place and the traction is maintained till the MO gives the order to alter the securement device or remove the catheter. The MO will be contacted in case the securement device is not in place. De Man-Van Ginkel et al. (2010) showed strong evidence support that information provision to clients has a positive effect. In case of communication barriers, the nurse will enhance the client understanding through seeking a common ground. The nurse will bridge any language barriers through thinking critically and creatively with Mrs. Dilma in case she speaks a different language. Mr Liam Farrell The first intervention entails performing a thorough assessment of pain to include the location, onset, characteristics, severity, intensity, frequency, and the precipitating pain factors. Pain is usually a subjective experience and hence the client has to describe it to plan efficient treatment (Australian Nursing Federation 2009). Mr. Farell has chest pain which will be treated as cardiac until it is proved otherwise. The pain will be accessed while doing obs and Electrocardiogram (ECG). The nurse will contact the Medical Officer (MO) for further tests including a repeat ECG. The nurse will also start oxygen stat. Cultural influences on pain responses such as Mr. Farell cultural beliefs regarding pain which might result in stoic attitude will also be taken into consideration. The nurse will obtain the wishes of the client early to avoid any legal or ethical drama. The nurse will ascertain Mr. Farell wishes to ensure that the treatment used is not against his belief. Any procedures performed on him will require a consent form. Lack of a consent form may create legal and ethical issues (Guido 2010). In case Mr. Farell cannot formulate personal decisions because of pain or change in the consciousness level, consent will be sought from his relatives or next of kin. The autonomy concept and consent importance becomes the overriding ethical principle for the consent basis (Cole 2012). Documented and clear discussions will be held with the family. In the course of care for the client, any ethical decision, which the nurse will reach, will demand deliberation and the client’s rights deliberation to attain the objective of maximum human potential. Ben Hansen Ben Hansen is a minor and hence not permitted to consent. In Australia, a minor is a person under the age of 18 years (Australian Government, 2012). In this case, the client should be given priority and the nurse should inform him that she will comply with his wishes to ensure that he does not become distressed further; he is an underage person and since his reasons for taking a drug overdose are not yet known and the causal factors might even be his parents. The nurse will convince Ben to agree to inform his father and in case he does not consent the father will not be informed to ensure that breach of confidentiality does not occur. Secondly, to avoid any legal issues by the parents, the nurse will inform Ben’s father about his son’s medical conditions. Ben is underage and hence decision making on his healthcare should flow from the responsibility that the parents and the physicians share. Physicians are supposed to seek permission from the parents for underage parents except in emergency cases when the parents cannot be reached (Guido, 2010). There is thus need for informed permission of Ben’s parents regarding his overdose problem. Parental permission is articulated as the best interests on an underage person. The main responsibility for offering consent and care for a child or young person should lay with her/his parents and general consent principles have to occur (Client Safety & Quality Unit 2011). The law generally offers parents or guardians with wide flexible authority regarding issues related to the children (Guido, 2010). In this case, the parent should also be informed of what to expect with the treatment and tests. During most instances, family intervention has shown a lot of success when combined with drug therapy in teenagers (Crisp & Taylor, 2008). A clinical assessment of Ben understanding of the situation and the factors influencing his response will also be important. Ben insists that his parents not be informed and this hints that they might have something to do with his problem. The nurse should interact with the client and give encouragement to express feelings to understand the causal factors of the overdose. Ben should also be instructed in trying other alternatives for solving problems (Baum, 2009). These interventions will help the client to understand that he can conquer despair, which result in drastic actions such as drugs overdose and committing suicide. The nurse should also assess and make use of individual’s external sources such as parents, support groups, religion, and health care team (Baum 2009). The nurse should also evaluate the support system beliefs such as experiences, religion activities, beliefs, and values and make referrals as required such as counselling, religious leaders. This sort of therapy would identify and address the aspects associated with self-harm such as anxiety, depression, hopelessness feelings, and negative point of view in solving problems (Guido, 2010). The main aim of this therapy is to assist Ben to adapt perspectives and to develop different coping means and ways of expressing their feelings. The interventions focus of developing coping skills and problem solving skills, which are usually taken as valuable alternatives to self-inflicted harm. According to Wachtel and Staniford (2010), nurses are in a good position to deliver such interventions, however a standardized method is needed to guarantee constancy. Mr. John Rassmussen The nurse will first assess the client for history and future risk of falls. The nurse will observe neurological observations and assess Mr. Rasmussen. He will not be put back to bed until the pain is determined (McCauley, 2009) and there are enough individuals who can comfortably lifts the client to the bed. The client has very serious ethical and legal issues regarding his fall, his left his may have been broken, and the family could sue the nurse or the hospital. It is important to document his fall as all writing can be used in court to prove that the client consented to a particular treatment procedure. The nurse will ascertain the client wishes through talking to him to ensure that the treatment used is not against his belief. Any procedure will require a consent form. The nurse will seek the client permission and inform him what the physician and the nurse will do to ease his hip pain and every activity, with regard to his care. The other implementation in this case will be to ease Mr. Rassmussen’s pain as he is in pain and to determine whether it is chronic or acute pain. The nurse will administer pain relievers if needed to provide optimum relief to the client. In case the pain resulted from the fall, the nurse will use Nonpharmacologic strategies such as application of hot and cold massage, breathing techniques and acupuncture. The nurse will continuously assess the level of pain using the pain intensity skills. Mr. Rassmussen inability to cope is also a sign that he requires therapeutic intervention before he is placed in a home. There is need to prepare him for the change. Fraher and Coffey (2011) argue that by enabling older people to be part of decisions about their future and respecting their individual preferences and needs, nurses have a critical function to play in minimizing all negative effects of this event. The client has various stressors, which are causing his inability to cope, and the way he responds to such stressors will depend on the resource for coping. The resource for coping includes personal health, optimistic beliefs, and problem solving skills (McCauley 2009). Mr. Rassmussen is vulnerable because of his complex medical problem, such as angina and hypertension and hence he lacks the skills to cope with the stressors. The defining aspects of his stressors are his inability to cope, destructive actions towards himself and emotional tension resulting to crying. The expected outcome of therapeutic intervention is Mr. Rassmussen identifying his personal maladaptive coping action, his acceptance of staying in the elderly home, his description and initiating of alternative coping methods. He should be discharged to the home with sufficient support for effective coping. To facilitate this intervention, the nurse will establish a working association with him through continuity of care (Australian Nursing Federation 2009). The ongoing relationship will establish trust, reduce isolation feelings, and facilitate coping. Ms Hanna Brown The first intervention is to obtain Ms Brown baseline data before the transfusion. The nurse will assess the baseline data: blood pressure, pulse, temperature, and respiration; determine any previous adverse reaction to blood or any known allergies (Collins 2011). In addition, she will check for any abnormalities, cloudiness, dark colour, excess air, gas bubbles. This will reduce the risk for reaction (Collins, 2011). In case the blood sample is correct, the nurse will establish the blood transfusion-invert the blood bag gently several time in order for the cell within the plasma to mix. The nurse will also ensure that the client has completed the blood transfusion request form (Collins, 2011). The nurse will wash and dry her hands, prepare the client, explain to the client the aim of the procedure and its purpose, the duration of transfusion and the desired outcome from the transfusion. The infusion will be started slowly at 2ml/mnt and the nurse will stay at the client bedside for about 30 minutes. In case there are no signs of circulatory overloading, the nurse will increase the rate of infusion. The nurse will observe her closely for early sign and symptom reaction and check vital signs at least every hourly until 1 hour after transfusion. Acute reactions signs might include low back pain, sudden chills, fall in blood pressure, respiratory disorders, nausea and flush agitation. In case of any signs and symptoms of reaction, they will stop the transfusion, contact the blood bank of the reactions and immediately contact the MO to lessen consequences. After the blood transfusion, the nurse will prepare the client for the scheduled Dilation & Curettage (D&C). Before the procedure, the nurse will ensure that the consent form is signed and NBM will be continued till after the procedure. Lack of a consent form may create legal and ethical issues (Guido 2010). Consent will be sought from her relatives or next of kin in case she can’t make the decision. The nurse will consider the cultural influences on pain responses such as the client cultural beliefs regarding pain which might result in stoic attitude. The nurse will ascertain the wishes of the client to ensure that the treatment is not against her belief. The autonomy concept and consent importance becomes the overriding ethical principle for the consent basis (Cole 2012). Mrs Cathy Williams The client has not had any post op analgesic so complaining of pain is not unexpected (Ahmed et al. 2011). The first intervention will entail assessing Mrs. Williams for pain. In addition, fever, hypotension, tachycardia, observe wound for abnormal swelling, referred pain (shoulder tip), post op bleed and infection (Daly et al. 2010). In case of such complications, the nurse will implement procedures to ease her pain as pain causes preventable distress. The pain can be controlled using the ordered morphine 10mg IMI and metoclopramide 10mg IMI. The nurse will also implement measures for managing Mrs. William anxiety, through providing enough information levels as this aid self-recovery. Nursing intervention also include accurate recording and monitoring to establish the frequency and depth of respirations, encouraging the client to breathe deeply as this allows full lung prevention (Hardy 2011). The nurse should also check the fluid balance, give solid liquids and foods as tolerated, place the client in semi-fowler’s positions, provide dressing changes, and wound care as directed. The nurse should also monitor and maintain positions and patency of drainage tubes: wound drainage, NG, and T tube. Analysis of four systematic peer reviewed articles Lubman et al. (2007) investigated the beliefs of young people and their parents regarding the role of marijuana, tobacco, and alcohol in the treatment and prevention of mental disorders. This study is valid because of the large sample size (3746 young persons aged 12-25 years and 2005 parents) and the research design- both the parents and adolescents were presented with a case vignette which portrayed depression, psychosis, depression with misuse of also and social phobia in young persons. The study findings are relevant to Ben Hansen case as he is a teenager aged 16 years with a substance abuse problem. The study findings showed that 85% of the young persons’ interviewed agreed that marijuana, tobacco and alcohol are harmful for the young persons’ showed in the vignettes. Additionally, the young people indicated that not using marijuana or drinking excessively would decrease the risk of developing mental health problems; parents also reported similar views to the children. However, this knowledge did not translate to behaviour owing to the high rates of cannabis, tobacco, and alcohol use among young people in Australia (Lubman, 2007). Ben Hansen thus might have a health problem, which might be reduced by therapeutic interventions for informing him about the negative impact of substance abuse on mental disorders. Fraher and Coffrey (2011) in the review “Older people's experiences of relocation to long-term care” provides evidence for therapeutic interventional needs of Mr. Rassmussen. This paper is a valid source because of the design- focussed purposively on the eight respondents to generate quality data and the effect- the eight patients generated the required data. This article is also valid because there are limited Australian sources on lack of preparation of older people before relocation to long-term care. Fraher and Coffrey (2011) investigated the older people’s experience of relocation to long-term care. This study is relevant to Mr. Rassmussen as it indicates there is need for communication before his relocation to long-term care. This study is supported by Tse (2007) study and Coffrey (2006) which show that there is limited participation and poor communication with the older people regarding the decision to be relocated. In this study, a purposive sample of eight respondents aged 65 years and above took part in individual interviews. The study laid emphasis on the significance of communication with people regarding their need to relocate and communicating them in the relocation decision. Fraher and Coffrey concluded that nurses have a critical role to play in lessening the negative upshots related with the persons being transferred to long-term care. Most decisions to move the elderly to long term care are mostly made quickly in acute hospital setting with very little preparation without giving the patients time to adjust to decision made. This article thus support the nursing intervention for Mr. John Rassmussen for inability to cope- he may require to be prepared on the decision to place him in a home. He requires therapeutic intervention before he is placed in a home. There is need to prepare him for the change. George et al (2008) study point to the importance of using normal saline solution to ease pain after the laparoscopic cholecystecomy to ease his pain. This study is valid due to the large sample size entailing 120 patients assigned to six groups randomly. Also valid because the researchers used both experimental and control groups. This study is applicable in Mrs Cathy Williams case as she experiences pain after the procedure and hence there is need for a normal saline infusion to ease her pain. George et al. (2008) designed a clinical trial for assessing the effect of use of intraperitoneal and preincisional ropivacaine, together with normal saline to ease pain after laparoscopic cholecystectomy (LC). The researchers chose 120 patients and assigned them to 6 groups randomly. These results showed that intraperitoneal ropivacaine infusion and preincisional local infiltration at the start of the procedure and infusion of normal saline at the end is a valid and safe method for easing pain after LC. De Man-Van Ginkel et al. (2010) study on indicate the need for therapeutic interventions for post stroke clients with possibility of depression. This research is valid because it was based on 15 systematic and peer reviewed articles in well-known journals such as PubMed, CINAHL, Medline and PsychINFO. The research design used revealed important factors leading to the need for therapeutic inte for post stroke clients with possibility of depression. The study is relevant to Mrs Dilma case as she has previously suffered from stroke and hence need to ease her uneasiness from her condition. There is thus need to provide her with information, motivate her, encourage her to take physical exercise and implement a specific nursing support programme for the patient. De Man-Van Ginkel et al. (2010) systematic review explored the role of nurses in managing post stroke depression and identified important non-pharmacological interventions which nurses can employ when offering day to day care for stroke clients. The results showed that depression after stroke is a significant issue with bad effects on the ability of the patient to take part in rehabilitation and on the outcomes of the rehabilitation. There was strong evidence that information provision, motivational interviewing, life review therapy, physical exercise and a specific nursing support programme can be put into practice in the patients with post stroke depression nursing care. These diverse inventions and their wide variety are consistent with the rehabilitation nursing practice. Conclusion The nurse used different procedures and medications to deal with the unexpected events with the help of the MO. The nursing care offered made an important difference in assisting the six clients to cope and recover from the events. The nursing interventions facilitated the clients to be on the right trajectory to recovery. Various legal considerations such as signing of a consent form before an invasive procedure have been taken into account to ensure that the hospital does not get into legal problems. Ethical considerations such as consideration on patients religion, culture and beliefs ensure that the nurse does not disregard the client belief when undertaking various procedures and giving medication. The nurse worked to promote the six clients best interests and attempt to attain the best possible outcomes. The nurse upheld a knowledgeable practice level to ensure that the clients do not suffer any injury. The clients also had the self determination right and the capacity to refuse or consent to treatment. Mrs. Dilma vital signs such as blood pressure, temperature, SP02, beats/per/min and respirations will be restored to normal. Mr. Farell central chest pain will be eased and the nurse will prepare him for an endoscopy. Hansen will admit to the circumstances that led to his drug overdose so that he can be assisted to solve his problem. Mr. Rassmussen pain will be eased and also he will be counselled to ensure that he is emotionally ready to be placed in a home. Ms Brown blood transfusion will go as planned. Ms Williams abdominal pain will be eased. The patients will thus be free of any pain and will be able to go back to their normal state. Reference List Ahmed S, Khan R, Khurshid T, Boota M, Ishaque M. Waseem S 2011, Postoperative analgesia following open cholecystectomy; is intermittent epidural bupivacain bolus administration more effective than continuous administration? Professional Med J , 18, 3, pp. 411-417. 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