What is Complex Care in Nursing - Assignment Example

MРLЕХ NURSING САRЕ Student’s Name Institution Affiliation Question 1 I. Determining to what extent is the patient coping with self-management and self-care in managing the diabetes situation. II. Whether the patient understands fully matters that deals with diet to ensure that he manages the diabetic situation well. Also at this point determination whether the patient understands the relationship that exists between diet and insulin. III. Whether the patient has received or is ready to receive education that is concerned with education regarding diabetes so as to understand how to manage the condition well. IV. Seek to understand whether the patient is a smoker or not. If he is smoker seek to know whether he will be ready to be assisted to get out of the smoking habit. V. Understand whether the patient has been able to be admitted in the recent past in any hospital with a diabetes related cases. VI. Understand whether the patient has had any diabetes treatment in the recent past VII. Understand whether the patient has been having any problem that is different from diabetes VIII. Understand the mood of the patient currently and the recent past (Dionne, 2012, pg. 18) Question 2 When it comes to the control of diabetes culture and religion are some of the barriers that may make it difficult when it comes to handling diabetic patient. There are some cultural practices that usually will bar the medical practitioners from fully undertaking the required activities to ensure that the diabetic condition is contained. There are some cultures that are misinformed that make it difficult for patients to take certain deities. They may at end make the patient not to make the meals that should have assisted in controlling the conditions that they are in. Also, some religions may not practice certain practices that will assist in ensuring that the diabetic conditions are contained. There in the case of Mrs. Akimoto it is important to understand all these to ensure that everything is under control so that no conflict that will occur in the course of treatment. Also, it can be used as a basis of educating her about the diabetic conditions and how to contain it (Toni, et al, 2001, pg. 13). Question 3 a) Respiration- in the respiration one has to observe whether there is enough oxygen in the blood. This shows us if the whole process of respiratory is moving well hence making everything to be right. The respiratory rate has to be observed well to ensure that the right rate is maintained in the process to avoid problems that may be caused by the abnormalities. Here you observe; the airway, behavior and feeding, respiratory rate, accessory muscle use and oxygen levels b) Pulse – the pulse rate indicates the rate at which blood is being oxygenized in the body. This will make the patient have the right levels of oxygen hence a well-balanced level of energy in the process. Here you observe; oxygen therapy, nasopharyngeal airway or tracheostomy, invasive or non-invasive ventilation and conscious status c) Neurological status- this is used to observe the conscious status of a patient. Here one observes; patient Alertness, response to voice, response to painful stimulus and unresponsive of any stimulus (ACSQHC, 2011, pg. 6) d) Consciousness of the patient. It is important to know this so that the response should be keenly be observed. Question 4 There may be incidents of stables and cuts from sharp objects in the operating room Burns that may occur from the hot water that is used in the sterilization of the equipment used in the operation room Electric shocks that may occur in the operation room in the process of using electric equipment. Some acute pain that may be occurring due to the poor positioning of the body during operation The medical personel may sometime forget to undertake the complete processes required in the process of operation exposing the patient to danger (ACSQHC, 2011, pg. 11). Question 5 Some common types of skin prepare; iodine, povidone-iodine, and ethyl alcohol. All these methods are meant to ensure that the skin is cleaned before undertaking a surgery process. They are meant to ensure that everything in the surgery is protected from getting any contamination that might be external. However, the methods may have some allergic reactions to the one who is using them. This should be taken into consideration before using them (ACSQHC, 2011, pg. 12). Question 6 Positive Patient Identification Physical Assessment of patient including Airway, Breathing, Respiratory effort, Circulation & Disability Clinical Handover Actual Complications / Potential Complications Identified Documentation that Handover has been given/received between PACU Nurse and Ward Nurse accepting care Documentation of altered Emergency Response Criteria if required. Investigations – biochemistry, procedures Social history/issues Education needs (patient and parent/care-giver) Mobility Restrictions Nutrition (NBM / Oral Intake) (ACSQHC, 2011, pg. 15) Question 7 For the general non-surgical patient, the standard is every 4 hr. x 24 hr., then at least every 6-8 hr. (based on shift length) if stable. Airway, Breathing, Circulation & Disability Assessment Baseline Observations including, RR, Respiratory effort, SpO2, HR, BP and Temperature Oxygen requirements IV Fluids Analgesia Urine Output Reportable Blood Loss Assessment of Wound Sites / Dressings Presence of drains and patency of same NGT In situ Airway – to ensure effective breathing Baseline observation- to ensure that the body is functioning properly Oxygen requirements- to ensure that the patient receive the right quantity of oxygen IV fluid- to ensure he has the right quantity Analgesia- to ensure proper functioning of the body Urine output- ensuring proper excretion Reportable blood loss- to ensure the right quantity of blood in the body Assessment of wound sites- to ensure well protection of the wounds Presence of drains- to ensure proper functioning of the body NGT in situ- ensure proper functioning (ACSQHC, 2011, pg. 15) Question 8 Sadness, anxiety, or depression Sexual dysfunction Impaired immune function Poor appetite and weight loss Lack of concentration and mental clarity Skin ulcers Irritability Incontinence All these are some of the results got out of the untreated pain in the body of a patient who has undergone surgery. Due to this it is necessary for the treatment to take place as the patient will have comfort to ensure that she heals faster and start normal life. (ACSQHC, 2011, pg. 17). My first nursing act that I would have taken is doing the wound assessment and the patient. Then I will inquire from the patient if she is experiencing any pain or discomfort. This could be followed with marking the edges of the wound drainage which is on the dressing with a pen then followed by the recording of the time and date. The finding then will be documented and inform the nurse on duty offer the event and follow the instructions that will be given by the nurse. Question 9 Facial expression and tension like frowning, wincing and grimacing increased muscle tone Tearing and diaphoresis Immobility Restlessness Agitation Tense body language orany repetitive movement All the above can be non-verbal observations made in a patient who is experiencing pain (ACSQHC, 2011, pg. 19). Question 10 My first nursing act that I would have taken is doing the wound assessment and the patient. I will then administer the right painkiller to her. After which I will leave her to settle. After sometime I will come back to inquire how she is feeling and from which I will determine the next course of action. However, I will explain the case to the registered nurse to give further instruction Question 11 My first nursing act that I would have taken is doing the wound assessment and the patient. Then I will inquire from the patient if she is experiencing any pain or discomfort. This could be followed with marking the edges of the wound drainage which is on the dressing with a pen then followed by the recording of the time and date. The finding then will be documented and inform the nurse on duty offer the event and follow the instructions that will be given by the nurse. After sometime I will come back to the patient and inquire whether there are changes and continue with my report. (ACSQHC, 2011, pg. 25). I will first make observations of the patient and know what is the exact cause of the problem. Then after which I will need to observe the patient using the cardiac monitor from which I will ensure that the heart has not been affected in anyway. After undertaking this process I will get into other tests. If no any indication of a different problem occurring. I will apply morphine to control the pain. The case also will be reported to the registered nurse for further advice Question 12 a) She may be experiencing Pulmonary Embolism. b) I will first try to stabilize Mrs. Akimoto; then I will perform an ECG, after which I will encourage her to use her PCA and maintain a high Fowlers position. I would continue to monitor her vital signs, would remain with her and try to have her remain calm. I would increase oxygen under RN advice who would call the MET. Then after which I will need to observe the patient using the cardiac monitor from which I will ensure that the heart has not been affected in anyway. After undertaking this process I will get into other tests Question 13 a) Mrs. Akimoto is displaying all signs and symptoms of suffering from a complication of a pulmonary embolism, such as labored breathing, resp rate of 30, cyanotic, pain on inspiration. b) I will first make observations of the patient and know what is the exact cause of the problem. Then after which I will need to observe the patient using the cardiac monitor from which I will ensure that the heart has not been affected in anyway. After undertaking this process I will get into other tests. If no any indication of a different problem occurring. I will apply morphine to control the pain. The case also will be reported to the registered nurse for further advice. I will first try to stabilize Mrs. Akimoto; then I will perform an ECG, after which I will encourage her to use her PCA and maintain a high Fowlers position. I would continue to monitor her vital signs, would remain with her and try to have her remain calm. I would increase oxygen under RN advice who would call the MET c) Taking an anticoagulant Wearing Compression stockings Increasing mobility Avoiding smoking Eating balanced diet Question 14 a) Ensuring that the circulation is taking place well Ensuring that the patient is breathing well Ensuring that the airway is not obstructed in anyway Determining the level of consciousness b) Head-tilt/chin-lift Cardiac monitor Pocket mask with oxygen port Oxygen mask with reservoir Clear face masks, sizes 3, 4, 5 Oropharyngeal airways, sizes 2, 3, 4 Nasopharyngeal airways, sizes 6, 7 (and lubrication) Portable suction (battery or manual) with Yankauer sucker and soft suction catheters c) Adrenaline Atropine 300*1 Amiodarone 300gm*1 d) Adrenaline is a drug used to increase the heart beat it is administered via injection Atropine is a drug used to increase blood velocity it is administered via injections (ACSQHC, 2011, pg. 36) Question 15 a) It is an indication of an infection that may be occurring on the wound. b) Presence of foreign particles in the wound Some living organism being manifested in the wound The presence of some particles that are not supposed to be at the wound area (ACSQHC, 2011, pg. 115) Question 16 a) Continuous reddening of the wound, stinging of the wound, and also some pain around the wound. Is an indication of continued infection? b) Septicaemia c) Sudden high fever with chill Generally feeling unwell Gastrointestinal symptoms including nausea, vomiting and diarrhea Abdominal pain Confusion and anxiety Shortness of breath Rapid heart rate (tachycardia). (Bonafide et al, 2012, pg. 52) Question 17 a) What are some of the issues that he/she will need to observe upon discharge Some of the drugs that she will be taking upon discharge She will seek to know whether she has fully regained her health She will seek to know when she will come for a check up Some of the issues that will affect her activities b) Nurse Educator Registered Dietitian Endocrinologist Eye Doctor Podiatrist Pharmacist Dentist Exercise Physiologist (Dionne, 2012, pg. 179) References Toni Tripp-Reimer, PhD, RN, FAAN, Eunice Choi, DNSc, RN, CS, Lisa Skemp Kelley, MA, RN and Janet C. Enslein, MA, RN, (2001). Cultural Barriers to Care: Inverting the Problem, pg. 13-22. Victorian Paediatric Clinical Network, Melbourne, AUSTRALIA, The Victorian Children's Tool for Observation and Response (ViCTOR), available from www.victor.org.au (retrieved Jan 2015) Australian Commission on Safety and Quality in Healthcare (2011). National Safety and Quality Health Service Standards. Sydney: ACSQHC. Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C. (2013). Development of heart and respiratory rate percentile curves for hospitalized children. Pediatrics,131 (4), e1150-e1157. Dionne, J., Abitbol, C., & Flynn, J. (2012). Hypertension in infancy: diagnosis, management and outcome. Pediatric Nephrology, 27(1), 17-32. Dionne, J., Abitbol, C., & Flynn, J. (2012). Erratum to: Hypertension in infancy: diagnosis, management and outcome. Pediatric Nephrology, 27(1), 159-160. Read More