The document discusses nursing care for several patients with various medical conditions:
1) A 90-year-old man with end-stage heart failure requiring daily assessments of edema, fluid balance, and symptoms. Strategies to prepare the family for impending death and relieve patient discomfort are discussed.
2) A 47-year-old woman with asthma exacerbated by smoking requiring health education on triggers and proper breathing techniques. A nursing care plan to improve breathing is outlined.
3) A 72-year-old man with COPD and pneumonia prescribed chest physiotherapy who only wants to sit requiring nursing considerations during treatment and health teaching on recovery. A nursing care plan to improve breathing is provided.
4) An 85-year
The document discusses nursing care for several patients with various medical conditions:
1) A 90-year-old man with end-stage heart failure requiring daily assessments of edema, fluid balance, and symptoms. Strategies to prepare the family for impending death and relieve patient discomfort are discussed.
2) A 47-year-old woman with asthma exacerbated by smoking requiring health education on triggers and proper breathing techniques. A nursing care plan to improve breathing is outlined.
3) A 72-year-old man with COPD and pneumonia prescribed chest physiotherapy who only wants to sit requiring nursing considerations during treatment and health teaching on recovery. A nursing care plan to improve breathing is provided.
4) An 85-year
The document discusses nursing care for several patients with various medical conditions:
1) A 90-year-old man with end-stage heart failure requiring daily assessments of edema, fluid balance, and symptoms. Strategies to prepare the family for impending death and relieve patient discomfort are discussed.
2) A 47-year-old woman with asthma exacerbated by smoking requiring health education on triggers and proper breathing techniques. A nursing care plan to improve breathing is outlined.
3) A 72-year-old man with COPD and pneumonia prescribed chest physiotherapy who only wants to sit requiring nursing considerations during treatment and health teaching on recovery. A nursing care plan to improve breathing is provided.
4) An 85-year
Major in Medical-Surgical Nursing 1. You are caring for a 90 year old man with end-stage heart failure in a hospital chronic unit. There are peripheral edema and cachexia with dyspnea at rest and with activity intolerance. a. What daily assessments should you do? Elaborate briefly. Assess edematous areas every shift for skin break down. Assess patient daily for nocturia and monitor input and output every shift to monitor fluid balance. If possible weigh patient daily to monitor fluid retention and weight reduction. Assess for nausea, vomiting and anorexia. Assess also for orthopnea, cough, palpitations, dizziness and syncope to determine level of activity that can be performed. Assess for paroxysmal nocturnal dyspnea. If present we should also assess the number of pillows the patient is using during sleep. Assess behavioral changes such as restlessness, confusion, and decreased attention span or memory. Assess the skin for diaphoresis, cyanosis and pallor in the skin. We should also assess the Respiratory Rate and breath sounds. Assess the heart rate, presence of S3 and S4 and distended neck veins. Lastly we should also assess the abdomen for distention, hepatosplenomegaly, ascites, RUQ pain, and discomfort. b. What are your strategies to relieve anxiety of significant others? One way of decreasing the significant others of the patient is by allowing them to ask questions for it relieve some anxiety by having accurate information. We should always inform and explain to the relatives of the patient the things that we are doing (why it is necessary and how will it help the patient) which includes the daily nursing assessment, interventions and care we render to the patient so that their anxiety will be lessen and may be able to participate in the plan of care for the patient. c. How will you initiate conversation to prepare the patient and his family of the impending death? Discuss. d. Give ways to relieve discomfort of the patient. Have patient rest in bed or chair when tired to reduce work. Provide emotional and physical rest to reduce consumption and to relieve dyspnea and fatigue. Have sleep with two or more pillows to relieve dyspnea. Elevate
cardiac oxygen patient head of
bed to Fowlers position to improve ventilation by decreasing
venous return to the heart and increasing thoracic expansion. Support patients arms with pillows to move arms off and away from chest to facilitate breathing. Use footboard to give patient a surface to press feet against to improve circulation through muscle contraction. Administer oxygen via nasal cannula to improve oxygen saturation and relieve dyspnea and fatigue. 2. A newly diagnosed 47 year old woman of asthma came to the emergency room due to exacerbation of her symptom of difficulty of breathing. She is a smoker. a. What health educating tips should be covered? Discuss about the negative and harmful effects of smoking to health. Explain effect of dehydration on sputum production and consequent effect on bronchospasm. Discuss about the different triggers of asthma. Assist in identifying factors that precipitate attacks to develop plans to prevent them. Teach patient to seek medical attention if taking medicine does not relieve attack or if dyspnea occurs at night. Teach patient technique of breathing in through nose and out through pursed lips, two to three times to prevent bronchiolar collapse and maintain open airways. b. What nursing care plan would you do for her? Nursing Diagnosis: Ineffective breathing pattern related to increased airway resistance caused by bronchospasm, mucosal edema and mucus production as manifested by dyspnea, wheezing, rapid respiratory rate, and use of accessory muscles. Outcome Criteria: Have absence of wheezing, dyspnea and chest tightness, return of appropriate breath sounds indicating better airflow, respiratory rate of 12 20/ min; Nursing Interventions: Provide comfortable position (bed rest in high Fowlers position or recliner chair) to maximize chest expansion and promote prolonged expiratory phase to reduce trapped air. Administer bronchodilators as ordered to treat bronchospasm. Administer O2 as ordered to increase oxygen saturation, Auscultate breath sounds to monitor effectiveness of treatment and patient status. Assess BP, HR, respiratory rate and level of consciousness to determine change in status. Premedicate with bronchodilators before doing deep breathing and coughing exercises or chest physiotherapy to open airways for more efficient movement of sputum toward mouth. Teach patient to breathe deeply through the nose and exhale two to three times as long as inspiration through pursed lips to remove trapped air and increase PaO2. Assess and document breathing pattern including respiratory
rate, depth, relationship of inspiration to exhalation, use of
accessory muscles, presence of chest discomfort to provide ongoing parameters to measure effects of treatment. c. What non pharmacologic intervention would you initiate? Provide comfortable position (bed rest in high Fowlers position or recliner chair). Teach patient to breathe deeply through the nose and exhale two to three times as long as inspiration through pursed lips. 3. A 72 year old man who has COPD from being a coal miner has pneumonia on his right lower and middle lobes. To help mobilize and drain his secretions, a CPT was prescribed. This patient only wants to sit in bed because it helps him breathe better. a. Discuss the most important nursing considerations and interventions in a patient having CPT? Perform procedure 1 hour before meals or 1 3 hours after meals. Administer bronchodilators as ordered 15 minutes before the procedure. Help patient assume correct position for postural drainage based on finding from x ray, auscultation, palpation and percussion of chest. Position should be maintained for 5 15 minutes to mobilize secretions via gravity. Observe patient during treatment to assess tolerance. Particularly observe breathing and color changes, especially duskiness in face. Have patient take several deep abdominal breaths. Percuss appropriate area for 1 2 min. Vibrate the same area while the patient exhales 4 5 breaths. Assist patient to cough while assuming same position. Splinting with towel or hands may be necessary to aid in effective coughing. b. What health teaching can you give to the patient? Enumerate and discuss briefly. Encourage patient to continue on full course of antibiotic therapy to prevent relapse of pneumonia and development of resistant strains of the organism. Instruct patient on importance of rest and limited activity to maintain progress toward recovery and prevent relapse. Encourage patient to obtain adequate rest, nutrition and fresh air to assist healing process. Teach patient to continue coughing and deep breathing exercises to remove secretions and improve ventilation. Teach patient importance of follow up care and need to seek medical attention for symptoms related to respiratory infections to prevent relapse. Teach patient to cover nose and mouth during sneeze or cough and to use tissues when
coughing and expectorating sputum
contribute to the spread of infection.
to
reduce
factors
that
c. Give your nursing care plan for this patient.
Nursing Diagnosis: Ineffective breathing pattern related to pneumonia, anxiety, and pain as manifested by rapid respirations, dyspnea, tachypnea, nasal flaring, altered chest excursion, inability to lie down. Outcome Criteria: Have respiratory rate of 12 20 breaths/min; express feeling of comfort. Nursing Interventions: Assess degree of pain and anxiety to provide guidelines for intervention. Take vital signs and auscultate lungs q2 4 hr. to provide ongoing data on patients response to therapy. Administer oxygen as indicated to maintain optimal oxygen level and increase patients comfort. Decrease anxiety (relaxation techniques, diversion) and provide a quiet, restful environment to encourage rest and to prevent a relapse. Position patient in semi Fowlers or other comfortable position for breathing to maximize lung expansion. Prepare patient for CPT.
4. An 85 year old woman is admitted at a medical surgical
ward and complaining of a sudden onset of very sharp and severe pain in her flank. A CT scan of the kidneys showed renal stones in both ureters. a. Discuss assessment methods for pain. Investigate pain which may be indicative of infection: location, duration, intensity; b. Give some non pharmacological pain relief and discuss rationale. Hydration has remained the mainstay of any treatment program aimed at preventing kidney stones. Stones form by the crystallization of one or more substances which exist in high concentrations in the urine. Increased fluid intake will decrease the chance of stone formation by maintaining a high urinary output and by decreasing the likelihood that these substances will crystallize by diluting them. There are no strict recommendations with regards to the number of glasses of fluid to drink, however, the goal should be to achieve a urine output of greater than two liters per day. Stones that are less than 5 millimeters in size have a high chance (90%) of passing through the urinary tract spontaneously with hydration therapy alone. Larger stones (>6 millimeters) have a much lower
chance of passing intervention.
on
their
own,
and
often
need
surgical
Dietary modifications can reduce the chance of stone formation
for certain stone types. Therefore, each patient should seek the advice of their urologist before changing their diet. In general, a diet low in animal protein, sodium, and oxalate can reduce the chance of calcium oxalate stone formation. Foods rich in oxalate include: chocolate, tea, spinach, asparagus, and nuts. A diet rich in fiber is also advised. Patients should not restrict dairy products, but should avoid overindulgence - i.e. no more than 3 glasses of milk a day. c. When and how will you stop pain medications and elaborate briefly Pain relievers can help control the pain of passing the stones (renal colic). For severe pain, you may need to take narcotic pain killers or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. 5. A 25 year old male patient is scheduled for below knee amputation of the right lower extremities due to osteosarcoma stage II. a. Discuss the pre op preparation for this patient. 1. Provide care preoperatively by initiating exercise to strengthen muscles of extremities in preparation for crutch walking. 2. Encourage coughing and deep breathing exercises. 3. Monitor vital signs and stump dressing for signs of hemorrhage. 4. Elevate stump for 12 to 24 hours to decrease edema. 5. Maintain elastic bandage to shrink and shape stump in preparation for prosthesis. 6. When wound is healed, wash stump daily, avoiding the use of oils which may cause maceration. 7. Apply pressure to the end of the stump with progressively firmer surfaces to toughen stump. 8. Encourage the client to move the stump. 9. Place the client with a lower extremity amputation in a prone position twice daily to stretch the flexor muscles and prevent hip flexion contractures. 10. Teach the client about phantom limb sensation. 11. Support the client through fitting, application, and utilization of prosthesis. 12. Encourage family to participate in care. 13. Allow the client to express emotional reactions.
b. If he will be given spinal anesthesia, what are the probable
complications and how will you monitor for these complications? Spinal anesthesia medicine is injected into the fluid that surrounds the spinal cord (cerebrospinal fluid). The most common complication of spinal anesthesia is a headache caused by leaking of this fluid. It is more common in younger people. A spinal headache may be treated quickly with a blood patch to prevent further complications. A blood patch involves injecting a small amount of the person's own blood into the area where the leak is most likely occurring to seal the hole and to increase pressure in the spinal canal and relieve the pull on the membranes surrounding the canal. c. Is there a need for using the Aldrete Scoring for this patient? Why? I think Aldrete Scoring is a must in every surgical procedure to determine if the patient is ready for that surgical procedure. Another one is with Aldrete scoring we can determine if there are obvious complications that the patient experiences. Lastly I do believe that most of the hospitals requires aldrete scoring before and after surgery, upon admission and discharge. 6. How do you respond to an apneic patient with desaturation? 7. Enumerate the equipments that you have seen at the ER and tell something about them. 8. How will you participate in a Code Red situation? Try to manage the patients as quickly and safely as possible and try to work with other members of the health care team so that when the Code Red is finished all tasks are fulfilled and the ward is now ready to cater to other patients. 9. What are the roles of nurse in Anesthesia Care Unit? The PACU nurse is responsible for taking a patient's vital signs following surgery, including blood pressure, respirations, lung sounds and pulse. This means having proper training and knowledge for all related equipment, including blood pressure monitor, cardiac monitoring, pulse oximeter and other oxygen devices. For example, for a patient who requires cardiac monitoring, the PACU nurse must know how to connect the patient to a cardiac monitor (typically a 12-lead) and how to interpret the results. The vital signs are typically recorded every 5 to 15 minutes until the patient's vital signs are stable and at pre-admission levels. When this occurs, the patient is either moved to a room to be admitted to the hospital or discharged home. A large part of the PACU nurse's responsibilities lies in pain management for the post-operative patient. This means having
knowledge of pain medications and their effects, as well as knowing how
to properly administer them. Sometimes, the post-operative patient requires a PCA (patient controlled analgesia) pump and IV fluids or infusions. The PACU nurse must know how to set up the PCA pump, as well as instruct the patient in how to use it. Taking care of post-operative patients isn't the only responsibility of the PACU nurse. Maintaining a safe environment, not just in the PACU, but hospital-wide is also important. This means knowing the correct safety procedures, including proper handling of hazardous material or waste. The PACU nurse must also be aware of proper fire safety procedures. Additionally, the PACU nurse is also responsible for knowing the location and proper use of personal protective equipment, including latex gloves, masks and goggles. The PACU nurse's most important responsibility is to maintain proper certification. This includes keeping up with certifications in advanced cardiac life support (ACLS), CPR (cardiopulmonary resuscitation), and if applicable, pediatric advanced life support (PALS). Additionally, nurses are also required to take CEUs (continuing education units), which help in maintaining their nursing certification. 10.
How can you promote infection control?
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Include infection control tips (e.g. hand washing steps, common
cold / flu symptoms) and upcoming events (e.g. flu shot clinics). We can include complete hand washing steps with pictures, tips on how to keep your family from getting sick, and ways to keep your immune system strong. Lunch and Learn Host a presentation to educate the community on a variety of infection control topics. Doctors or nurses can come in to talk about the flu and the best ways to protect against it (this can be teamed up with a flu shot clinic). Food handlers can talk to employees about safe storage / handling of foods to guard against illness. Infection Protection Health Fair Invite organizations to provide handout materials to the issues related to the theme. Health professionals to invite could include food safety educators, Registered Nurses, Registered Dietitians, Certified Asthma Educators, Respirologists, Veterinarians, and internal Health and Safety representatives from your workplace. Organizations could include your local Public Health department, internal food service
providers, centres.
cleaning
product
suppliers
and
community/recreation
Get Caught Practicing Infection Protection
Practicing a healthy lifestyle including eating balanced meals, being active on a regular basis and managing stress are important ways that we can boost our immune system. This can help to reduce the susceptibility to many infectious diseases. Also important are using proper hand washing and sneezing techniques, and getting an annual flu shot. Beat the Bite Raccoons, skunks, bats, dogs, cats, and mice: furry friends or infected foe? Educate the people in the community about keeping their homes, families, and pets safe from potentially infected small animals that are commonly found in our urban and rural areas. Host an education seminar and invite a local Veterinarian or the Humane Society to deliver a presentation that outlines how to "animal proof" your home or cottage before winter, how to safely and humanely deal with nesting sites, how to recognize the signs of an animal that is infected with a disease, and steps to take if you have been bitten or scratched by a wild animal.