Concept Caring in Nursing - Assignment Example

Q1. Identify (8) eight important assessments and/or forms you should perform and/or fill out as part of the admission. (This is to exclude name, age, and address.) 1. The history of the patients to assess the possible past illnesses that the patient might have suffered before. 2. The general appearance of the patient that can be concerning the behavioral state, emotional and physical state of the patient. 3. The level of personal hygiene of the patient 4. Vital signs that can include respiratory rate, temperatures, heartbeat, blood pressure, pain, and oxygen saturation. 5. Additional measurements such as height, weight, blood sugar. 6. Physical assessment of the patient that can include breathing, circulation, and airway (Andrews and Boyle, 2002). 7. The social and cultural factors of the patient 8. The wellbeing of the patient Reference Andrews, M.M. and Boyle, J.S., 2002. Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), pp.178-180. Q2. Discuss the cultural and religious considerations that may be relevant when caring for Mrs. Akimoto. The cultural and the religious considerations of Mrs. Akimoto are likely to affect the level of satisfaction due to the effects of culture on the service delivery. The fact that Mrs. Akimoto is a Buddhist and follows some cultural practices that are likely to affect her perception towards the care provided (Morton, et al. 2005). Therefore, it is important for the caregivers to make sure they consider the religious aspects of the patients that can affect the satisfaction of the patient towards the care provided. Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q3. In your health assessment of Mrs. Akimoto, name four (4) physiological things do you need to assess for each of the following areas: A. Respiration: air present within the tissues, carbon dioxide transportation, cellular respiration and the metabolic process. B. Pulse; anxiety, breathlessness, head movement and pulsations taking place in the neck. C. Neurological status: the physiological things that can be assessed include speech deficits, vocal deficits, the pain response, and brain stem reflexes (Morton, et al, 2005). Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q4. Identify four (4) hazards/risks in the operating theatre to the patient and/or staff. 50 to 100 words 1. Physical hazards that can include pricks, cuts, electrical shocks, falls and burns. 2. Biological hazards that can include contacting body fluids that can transmit diseases. 3. Chemical hazards like poisonous gasses that can put the patients in the operating room at risk (Martinez, et al, 2011). 4. Health hazards that include physical injuries in the theatre room. Reference Martinez, E. A., Thompson, D. A., Errett, N. A., Kim, G. R., Bauer, L., Lubomski, L. H., ... & Pronovost, P. J. 2011. High stakes and high risk: a focused qualitative review of hazards during cardiac surgery. Anesthesia & Analgesia, 112(5), 1061-1074. Q5. What are 2 common types of skin prep use in surgery? 1. Topical antiseptics that are usually applied on skin with the aim of reducing the SSI risks (Zinn, et al, 2010). 2. Patients showering with antiseptic solutions before surgery that include iodine. Reference Zinn, J., Jenkins, J.B., Swofford, V., Harrelson, B. and McCarter, S., 2010. Intraoperative patient skin prep agents: is there a difference? AORN journal, 92(6), pp.662-674. Mrs Akimoto has an uneventful operation and recovery in PACU. She returns to your ward. Q6. List 10 observations / assessments / information you need to receive during handover from the PACU nursing staff on Mrs Akimoto’s return to the ward. (excludes Vital Obs). 1. The admission status assessment that contains the general information concerning the patient. 2. The changes in health of the patient 3. The information concerning the illness of Mrs. Akimoto 4. The appropriate documentation 5. The disposition information of the patient after evaluation 6. The severity of the illness with the aim of establishing her health (Catchpole, et al, 2010). 7. Any special attentions concerning her health 8. Reasons for return to the ward 9. The new file information for the patient 10. Observation consultations Reference Catchpole, K., Sellers, R., Goldman, A., McCulloch, P. and Hignett, S., 2010. Patient handovers within the hospital: translating knowledge from motor racing to healthcare. Quality and Safety in Health Care, 19(4), pp.318-322. Q7. A. What is the regime for general post-op vital signs? It is the regime in which the vital signs such as pulse, temperature, respiration, pressure, pain rating and oxygen saturation obtained the moment the patient is being received post-op into the unit for med-surg (Morton, et al. 2005). Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. B. What are 10 observations that would be required for Mrs Akimoto’s management other than vital signs? 1. The background information 2. The problems realized by the care givers 3. The distress information 4. Any stress related information 5. Her airway 6. Drinking and eating problems 7. Any excretion challenges 8. Any pain experienced by the patient 9. Physical examination of the patient (Morton, et al, 2005) 10. Her complaints Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. C. Give a rationale for each of the 10 observation identified. 1. Knowing the background helps in assessing the possible challenges facing the patient 2. The patient's problems can be the contributing factor to her illness 3. Distress effects the psychological well-being of the patient 4. Stress can affect the general health of the patient hence affecting the healing process 5. Airway determines the oxygen saturation 6. Challenges in drinking and eating affects the health of the patient 7. Excreting determines the rate of eliminating waste in the body 8. Detecting the pain experienced by the patient determines the progress in of the recovery process 9. Through the physical examination of the patient other challenges facing her wellbeing can be realized (Morton, et al, 2005). 10. Through complaints, the care giver can realize the areas that need attention Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q8. After settling Mrs Akimoto into her room, on the second set of observations she starts complaining of severe pain at the wound site. A. Identify and give a rational for four (4) possible effects of untreated pain on her body related to recovery. 1. Decrease in the mobility of the patient because the pain can disrupt the movement of the patient. 2. Can lead to an increase in the sympathetic activity resulting in the release of catecholamines because of some adverse effects like hypertension (Bellack, 2006). 3. The decrease in the respiratory movement. The untreated pain can easily affect the breathing of the patient leading to a low oxygen supply. 4. Challenges in the metabolic and hormonal activity that result from surgery because the pain can increase the protein breakdown. Reference Bellack, A.S., 2006. Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophrenia bulletin, 32(3), pp.432-442. Q9. Identify four (4) non-verbal signs that Mrs Akimoto may exhibit when experiencing unrelieved pain? 1. Vocal complaints that can include gasps, cries, groans, sighs and moans 2. Facial grimaces such as tightened lips, narrowed eyes, and distorted expressions (Broughton, Janis and Attinger, 2006). 3. Restlessness 4. Rubbing skin surface especially the affected areas. Reference Broughton 2nd, G., Janis, J.E. and Attinger, C.E., 2006. The basic science of wound healing. Plastic and reconstructive surgery, 117(7 Suppl), pp.12S-34S. Q10. With her pain unrelieved, Mrs. Akimoto starts to become angry and verbally abusive. When you answer her call bell, you find she has pulled out her IDC and is trying to climb out of her bed. A. What are three (3) actions will you take to ensure her SAFETY? 1. I can ensure that I provide the necessary guidance and counseling to her as psychological challenges can be responsible for her actions. 2. Monitoring her actions by making sure that the care giver is always near to make sure that she does not move out of her bed (Morton, et al, 2005). 3. Controlling her anger can also help in improving her safety where I can make sure that I explain to her the dangers of climbing out of bed. Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q11. In the second hour post op, you check Mrs. Akimoto’s dressing and observe the dressing has filled with bloody ooze that was not present on your last observation and has leaked out of the dressing. A. Identify and give a rational regarding four (4) actions you will take on discovering this bloody ooze? 1. After discovering her blood oozing, I can let her lie down while elevating the bleeding site to reduce the blood loss by slowing the rate. 2. Removing the visible objects that are in the wound to be in a better position to manage the bloody ooze by eliminating any possible destruction (Andrews and Boyle, 2002). 3. Controlling the bleeding rate before starting to clean the wound as that can help in reducing the loss of blood that can be experienced during cleaning of the wound. 4. Applying direct pressure while elevating the area for around 15 minutes to help in stopping the bleeding of the wound. Reference Andrews, M.M. and Boyle, J.S., 2002. Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), pp.178-180. Q12. In the fourth hour post op, you notice that Mrs Akimoto’s respiratory rate has decreased to 8/min and her oxygen saturation has dropped to 89%. A. Identify and give the pathophysiology behind why this complication could be the cause of this deterioration? The rate of respiration can decrease due to the decline in the pressure of pumping blood to the body parts due to fatigue (Folke, et al, 2003). The oxygen saturation can decrease due to decline in the amount hemoglobin in the blood that is responsible for transporting oxygen. Reference Folke, M., Cernerud, L., Ekström, M. and Hök, B., 2003. Critical review of non-invasive respiratory monitoring in medical care. Medical and Biological Engineering and Computing, 41(4), pp.377-383. B. Identify six (6) nursing interventions you would perform in this situation? 1. Administering humidified oxygen using the appropriate devices such as nasal cannula 2. Scheduling nursing care with the aim of providing enough rest for minimizing fatigue (Morton, et al, 2005). 3. Providing adequate fluids 4. Ensuring proper nutrition of the patient 5. Referring the client to primary rehabilitation team 6. Ensuring the head of the patient is elevated when on bed Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q13. Two days later, Mrs Akimoto complains of pain in her right chest on inspiration and shortness of breath. A. Identify the complication that Mrs Akimoto is experiencing and give a rational for your answer. The complications that can result in shortness of breath and pain in right chest on inspiration can include cardiovascular causes. The cardiovascular causes entail blocking the flow of blood to the heart that might be accompanied by nausea, sweating, and breathlessness. Besides, pulmonary causes can result in shortness of breath and right chest pain during inspiration (Andrews and Boyle, 2002). It involves the lung conditions such as inflammation and infections because of pneumonia that can be accompanied by fever and cough. Reference Andrews, M.M. and Boyle, J.S., 2002. Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), pp.178-180. B. What are five (5) nursing interventions that you should perform? 1. Enough bed rest using Fowler position 2. Observing the vital signs 3. Installing a drip 4. Reducing the environmental stimuli 5. Observing the complication signs (Folke, et al, 2003). Reference Folke, M., Cernerud, L., Ekström, M. and Hök, B., 2003. Critical review of non-invasive respiratory monitoring in medical care. Medical and Biological Engineering and Computing, 41(4), pp.377-383. C. Identify four (4) preventive measures for the identified complication. 1. Taking the necessary medication 2. Ensuring a healthy lifestyle and changing dietary (Folke, et al, 2003). 3. Surgery when necessary 4. Consulting the doctor regularly Reference Folke, M., Cernerud, L., Ekström, M. and Hök, B., 2003. Critical review of non-invasive respiratory monitoring in medical care. Medical and Biological Engineering and Computing, 41(4), pp.377-383. Q14. After you come back from your dinner break, you enter Mrs Akimoto’s room to find her unresponsive. A. As an Enrolled Nurse, what are four (4) ways you could contribute to the emergency management/resuscitation of Mrs Akimoto? 1. Assess her airway, circulation, and breathing 2. Facilitate and anticipate the diagnostic testing (Folke, et al, 2003) 3. Ensure adequate ventilation 4. Help stabilize the unconscious patient Reference Folke, M., Cernerud, L., Ekström, M. and Hök, B., 2003. Critical review of non-invasive respiratory monitoring in medical care. Medical and Biological Engineering and Computing, 41(4), pp.377-383. B. What equipment may be brought to the bedside to assist in Mrs Akimoto’s care? 1. Waste receptacle. 2. Connecting tube 3. Sterile whistle-tip 4. Disposable cup and tap water (Parida, et al, 2012). Reference Parida, M., Shukla, J., Sharma, S. and Rao, P.L., 2012. Loop-Mediated Isothermal Amplification (LAMP) in Medical Microbiological Research and Diagnosis. The Role of New Technologies in Medical Microbiological Research and Diagnosis, p.119. C. Name the two (2) first line drugs found on the resuscitation trolley. 1. Adrenaline 2. Amiodarone (Hogh, et al, 2005) Reference Hogh, L., Kane, I., Bhalla, A. and Ward, M.C., 2005. Variations in the provision of resuscitation equipment: survey of acute hospitals. Postgraduate medical journal, 81(956), pp.409-410. D. Identify the actions of these 2 drugs and their route of administrations. 1. Adrenaline is emergency necessary of the cardiac arrest. It is administered through injection using pre-filled syringes. 2. Amiodarone is used to prolong the potential of cardiac action. Its administration involves pre-filled syringes or even diluted in glucose (Hogh, et al, 2005). Reference Hogh, L., Kane, I., Bhalla, A. and Ward, M.C., 2005. Variations in the provision of resuscitation equipment: survey of acute hospitals. Postgraduate medical journal, 81(956), pp.409-410. Q15. Three days later you are assigned to care for Mrs Akimoto. You observe her wound and notice that the dressing is clean and dry although around her drain site dressing it is reddened and she states that it stings. A. What could be the wound complication? The rapid pulse in the wound is the major cause of the bad smell because of the infections. The reddened wound can be because of blood clotting at the wound because of the affected blood vessels (Diegelmann and Evans, 2004). Reference Diegelmann, R.F. and Evans, M.C., 2004. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci, 9(1), pp.283-289. B. What three (3) other signs and symptoms would confirm your diagnosis? 1. Inflammation signs that include swelling (Diegelmann and Evans, 2004). 2. Infection signs due to dead tissue 3. Nerve damage Reference Diegelmann, R.F. and Evans, M.C., 2004. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci, 9(1), pp.283-289. Q16. A. What four (4) changes to the presentation of the wound and patient would make you suspect an expanding infection process is occurring? 1. Drainage or Pus 2. Bad smell coming from the wound (Morton, et al, 2005). 3. Fever 4. Pain because of muscle ache. Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. B. Identify the name of a generalized infection in the blood stream and its treatment. - Septicaemia (Morton, et al, 2005) Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. C. What is the potential side effect of this generalized infection if left untreated? 1. Low platelet hence clotting problems. Platelets are responsible for enhancing the clotting process where the low content of platelet can result in increased bleeding. 2. Abnormal heart functions. The functioning of the heart can be affected due to the fatigue especially due to the reduction in the volume of blood (Morton, et al, 2005). 3. Extreme weakness. The patient can be weak due to the low oxygen saturation hence resulting in low respiration in the body. 4. Unconsciousness can be experienced especially the time the patience losses high amounts of blood. Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Q17. A. Identify four (4) concerns Mrs Akimoto may have regarding her discharge. 1. Preoperative anemia because of the possible increase in the loss of blood through bleeding. 2. Depression that can result from the increased stress of the patient due to the condition. 3. Chronic pulmonary disease as clotting of the blood can lead to blocking of the blood passages (Morton, et al, 2005). 4. Renal disease Reference Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. B. Name three (3) supporting health care team members and identify how they can assist her specifically with those concerns. 1. Nurses: they can help her in the treatment of the diseases such as renal disease where nurses can advise her on how to manage the condition. 2. Pharmacists: they help in availing the necessary drugs that can help with the concerns hence helping her in treating the condition (Andrews and Boyle, 2002). 3. Physician Assistants: she can get the necessary advice from the physician assistants in the process of diagnosing the concerns. Reference Andrews, M.M. and Boyle, J.S., 2002. Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), pp.178-180. Reference list: Andrews, M.M. and Boyle, J.S., 2002. Transcultural concepts in nursing care. Journal of Transcultural Nursing, 13(3), pp.178-180. Bellack, A.S., 2006. Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophrenia bulletin, 32(3), pp.432-442. Broughton 2nd, G., Janis, J.E. and Attinger, C.E., 2006. The basic science of wound healing. Plastic and reconstructive surgery, 117(7 Suppl), pp.12S-34S. Catchpole, K., Sellers, R., Goldman, A., McCulloch, P. and Hignett, S., 2010. Patient handovers within the hospital: translating knowledge from motor racing to healthcare. Quality and Safety in Health Care, 19(4), pp.318-322. Diegelmann, R.F. and Evans, M.C., 2004. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci, 9(1), pp.283-289. Folke, M., Cernerud, L., Ekström, M. and Hök, B., 2003. Critical review of non-invasive respiratory monitoring in medical care. Medical and Biological Engineering and Computing, 41(4), pp.377-383. Hogh, L., Kane, I., Bhalla, A. and Ward, M.C., 2005. Variations in the provision of resuscitation equipment: survey of acute hospitals. Postgraduate medical journal, 81(956), pp.409-410. Martinez, E. A., Thompson, D. A., Errett, N. A., Kim, G. R., Bauer, L., Lubomski, L. H., ... & Pronovost, P. J. 2011. High stakes and high risk: a focused qualitative review of hazards during cardiac surgery. Anesthesia & Analgesia, 112(5), 1061-1074. Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2005. Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins. Parida, M., Shukla, J., Sharma, S. and Rao, P.L., 2012. Loop-Mediated Isothermal Amplification (LAMP) in Medical Microbiological Research and Diagnosis. The Role of New Technologies in Medical Microbiological Research and Diagnosis, p.119. Zinn, J., Jenkins, J.B., Swofford, V., Harrelson, B. and McCarter, S., 2010. Intraoperative patient skin prep agents: is there a difference? AORN journal, 92(6), pp.662-674. Read More