...cared for a patient with idiopathic pancreatitis. This was the first patient I assessed, because the patient was intubated and had two chest tubes. The patient also had a Zassi tube in place; this was my first encounter with a fecal diversion device. Later in the shift, I discovered an opening in the indwelling urinary catheter line. I discontinued the catheter to prevent further urinary leakage and the transmission of bacteria. My other patient was admitted for a COPD exacerbation. This patient was stable all shift. I provided teaching to both the patient and her family, and call the family to update them on which room she would be transferring to. I gave the patient report to the floor nurse over the phone and helped transport the patient. I feel that I did well educating and communicating with the patients and their families. I also feel that I did better giving report. I could still improve on my time management skills....
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...Q.1. Describe in detail the nursing care necessary to provide for the needs of the patient with a diagnosis of hypothermia during the first 24 hours of their hospital admission. [100Marks] Q.2. List at least four clinical signs of dehydration. (20 marks) Describe the care of a patient with an indwelling catheter. (80 marks) [100 Marks] Q.3. Mrs. Mary Smith is and 80 year old widowed lady who lives alone in an inner city terraced house. She has been admitted to hospital presenting with abdominal pain and distension. The home help who visits her for one hour per day has noticed that Mrs. Smith had reduced mobility and episodes of constipation the past number of weeks. Describe the nursing care Mrs Smith will require under the following: (a) Communication (30 marks) (b) Eating and drinking (40 marks) (c) Mobility (30 marks) [100 Marks] Q.4 Describe the role of the nurse in preventing cross-infection in the ward setting. [100 Marks] Q.5 Describe the role of the nurse in the assessment of a patient with a respiratory problem. Q.1. Describe the nursing care and management of a patient with hypothermia. [100 Marks] Q.2. Describe the assessment of a patient requiring mouth care on a daily basis. [100 Marks] Q.3. (a) Define the term ‘standard precautions’. (10 Marks) (b) Describe the principles of infection control. (90 Marks) [100 Marks] Q.4. (a) List 5 factors that may affect the accuracy of a blood pressure recording. (10 Marks) ...
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...This initiative is estimated to have saved the hospital $100,000 and six patient lives. The initiative also led to enhanced teamwork and greater awareness of CAUTIs (Payton, 2013). There have been multiple nurse driven protocols to reduce CAUTI’s in the acute care setting and protocols on when to discontinue an indwelling catheter at the appropriate time that is safe and reasonable for the patient’s overall health and wellbeing. It is important to question the Foley’s need in the patient and assess it throughout the nurse’s shifts. As a nurse advocating for timely removal and being aware that the criteria for it is no longer in effect will prevent infections. The physician is part of the healthcare team and he...
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...Sciences Center School of Nursing 1. Discuss the general differences between the Associate Degree/Diploma nurse and the Baccalaureate prepared nurse with regards to Provider of Patient-Centered Care as stated in the Competencies. Do some of these differences surprise you? Were you aware that the BON had these differences in competencies in writing? In patient-centered care, the patients are actively involved in their care and the services they receive are focused on their individual needs. Patients’ involvement and shared decision making promote adherence and lead to improved outcome (Hinds, 2013). Nursing curricula include patient-centered care strategies in order to prepare and empower nurses about this level of care. According to the Texas Board of Nursing (2010), with regards to the provider of patient-centered care, diploma and associate degree nursing (ADN) prepare the nurses particularly to provide safe, compassionate bedside patient care in the hospital setting. A nurse with a baccalaureate degree in nursing (BSN) is prepared for greater orientation to community health, public health issues, leadership and management in addition to what a registered nurse holding ADN or diploma is required to do. A nurse with a baccalaureate degree is also required to develop a plan of care for patients, families, populations, and communities based on evidence-based practice and published research. In addition to the courses taught in associate degree, the BSN student takes additional...
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...Obtain exact weight. Document the amplitude of femoral and distal arterial pulses in both legs. Check patient name and medical record number on the patient identification band (ID). Obtain a complete history of allergies before the procedure for administration of fluids, sedation, and emergency medication. Obtain a concise and targeted medical, surgical, catheterization, PCI history, and current medication. Oral and intravenous prophylaxis should be administered as soon as possible before the procedure. Insert a patent intravenous (IV) access, hydration should be established as soon as possible, the amount of hydration depends on renal status and cardiac function. Record a baseline set of vital signs, including oxygen saturation by pulse oximetry. (Moser, & Riegel,...
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...Contraindications A. Patients with abdominal surgery B. Abdominal ascites Discussion Lecture 5 minutes Educator PowerPoint Projector & Computer Pen & paper Handouts Pamphlets Return verbalization & a five-question post quiz At the conclusion of the teaching session, registered nurses will be able to demonstrate the steps in using the bladder scanner in the surgical unit. (Psychomotor) 111. Bladder scanner steps A. Drape the patient appropriately B. Supine position with HOB elevated at 30 degrees C. Turn the machine to the on switch and enter time and facility information that will appear on the console screen D. Identify the symphysis pubis (pubic bone) IV. Mode Selection A. * Female * Male * Small children B. Select to scan a male, female, or a small child C. Choose the male mode for a female patient who had a hysterectomy D. If measuring PVR, have patient void before the procedure V. Application of Ultrasonic – Gel A. Applied a right amount of gel to the midline of the pubic area 1” above the symphysis pubis B. Aim the probe head downwards towards the pubic bone C. Press and release the scan bottom Educator Lecturing Demonstration Video...
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...One cold day in December, nurse Betty came to work ready for her day. She got report on her patients and began her day. Noticing that one of her patients had a med due at 7:30; she decided to get started on that. She retrieved the med, checked the MAR again, and proceeded to the patient’s room. Upon entering she states, “Good morning, I am here to give you your morning dose of protonix for your stomach before you have breakfast”. Nurse Betty asks the patient “Can I see your arm band?” and “Can you tell me your full name and date of birth?” After she finishes with her patient, nurse Alice asks her to come with her to verify a blood transfusion for her patient. Nurse Betty and Alice both check the MAR, 2 patient identifiers and the correct blood type. Once they confirmed the correct blood type and patient, Nurse Alice begins her patient’s transfusion. Nurse Betty returns to the nurses station and begins looking at the lab results from this morning. One of her patients has a low potassium level. She sends a message to the physician stat to get an order for potassium. The doctor responds to the message and sends the order. Nurse Betty proceeds to check the MAR for the rest of her patients. She then goes to the medication room to gather her supplies. One of her patients is due to get 2g of morphine IVP. She retrieves the morphine from the pixus, has another nurse verify the amount ordered, amount in the syringe and the amount wasted. Nurse betty then places a...
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...catheterization is a task that many patients have to perform themselves after they are discharged home. The main issue with straight catheterization that was recognized was the occurrence of infections, such as urinary tract infections, and patients learning how to straight catheterize themselves once they are discharged home. The teaching project focuses on the actual insertion of the catheters among men and women, tips and tricks, and proper cleaning techniques for both genders. Identification of Clinical Issue Intermittent self straight catheterization is not a common practice for the everyday person therefore it is an important topic to teach patients that require this procedure before they leave the...
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...and Systems (HCAHPS) are at the forefront of patient care. These quality measures of nursing care are evaluated in hospital settings. These indicators and survey scores allow nurses and their administrators to assess how the care they are providing is following evidence-based practices, and how they can improve their practices towards a better patient outcome. The American Nurses Association (in promoting these indicators as the definitive standards for patient care and quality ANA) has made steps improvement. The purpose of this paper will define NSIs, HCAHPS and include examples of each from Good Samaritan Medical Center, the outcomes and interventions...
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...Professional Learning Experience Proposal Proposed Criteria to Conduct a Research Study on Backfill Assisted Voiding Professional Socialization December 2, 2008 Title and Description a. Research Study for Backfill Assisted Voiding b. Backfill assisted voiding is a procedure that is performed in the post anesthesia care unit. An indwelling catheter is placed preoperatively in selected patients in order for the procedure to take place. The “bladder was filled retrograde with room temperature sterile normal saline”. (Foster, RT Sr., Borawski, KM, pg. 627). Retrograde filling was stopped when the woman had a strong urge to void. The catheter was removed and the patient voided. c. A cause for concern was initiated by the surgical outpatient unit because a MD is currently ordering the procedure on post-operative vaginal surgery patients with no standard practice. There is concern from members of the Nurse Practice Committee and Infection Control due to lack of evidence to support it and data to show the patient does not have negative consequences as a result of this procedure. Professional Outcome and Related Competency a. The outcome of this proposal is to articulate the contributions of professional nursing to health care via research by defining the boundaries of nursing while gathering, organizing, planning, problem solving and reviewing in order to format an acceptable policy and procedure for standards...
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...practitioner, has demonstrated the highest level of professionalism and dedication. Nurses provide a continuous service around the clock for the benefit of all citizens in the country. In many cases, nurses work double or triple shifts, to provide holistic nursing care. Nurses contribute major roles in the healthcare systems and as competent health care providers. Nursing is a dynamic profession and forever striving to meet the challenging needs due to constant change occurring in the profession. Nowadays, nurses generally became accountable for their own practices and they have been at the vanguard of new role development. However, nursing at times, will cross their boundaries in providing care, as an individual or teamwork to save patient lives. This may result overlapping of roles. Nurses adapting the changing environment and continually develops new skills (Chaboyer et.al., 2001). Doyal (1998) argues on nurses and others medical practitioner is doing physician’s work, which has involved the creation of new roles. As described by Nancarow & Borthwick (2005), the nurses have an opportunity to identify a new role in getting change within their expertise boundary. This paper will explore, discuss and critically analyze on the impact on professional roles on crossing professional boundary that often occur in my practice performs task which is suppose done by anesthetic physicians. The issues that I am going to debates here is on my daily activities, cross professional boundary...
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...group has analyzed the current/existing situation of the nursing department and following is the analysis. 5 standards with objective : - CQI.2 The organization identifies key indicators to monitor the clinical structures, processes and outcomes • Objective elements a) Monitoring includes appropriate patient assessment. b) Monitoring includes diagnostics services’ safety and quality control programmes. c) Monitoring includes all invasive procedures. d) Monitoring includes adverse drug events. e) Monitoring includes use of anaesthesia. f) Monitoring includes use of blood and blood products. g) Monitoring includes availability and content of medical records. h) Monitoring includes infection control activities. i) Monitoring includes clinical research. CQI.3 The organisation identifies key indicators to monitor the managerial structures, processes and outcomes Objective elements • Monitoring includes procurement of medication essential to meet patient needs. • Monitoring includes reporting of activities as required by laws and regulations. • Monitoring includes risk management. • Monitoring includes utilisation of facilities. • Monitoring includes patient satisfaction. • Monitoring includes employee satisfaction. • Monitoring includes adverse events. • Monitoring includes data collection to support further study for improvements. • Monitoring includes data collection to support evaluation of the improvements. CQI.4 The quality improvement programme...
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...CLINICAL CLARIFICATION • Normal pressure hydrocephalus (NPH) is caused by decrease uptake of cerebrospinal fluid leading to a dilatation of the ventricular system and eventual damage to the adjacent parenchyma causing neurological deficiency 1 CLASSIFICATION • Primary (idiopathic) 12 • Secondary to other diseases such infection,trauma to the brain or brain tumors • Absence of an obstruction of cerebrospinal fluid outflow inside the ventricular system of the brain is a common feature of both idiopathic and secondary normal pressure hydrocephalis 2 • Idiopathic normal pressure hydrocephalus 7 o Affect the elderly • Secondary normal pressure hydrocephalus 7 o Affects all ages DIAGNOSIS CLINICAL PRESENTATION • History o Patients...
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...peripheral nervous system. (Carolyn Jarvis, Physical Examination and Health Assessment, 3rd ed., pages 688-692 Structure and function of the CNS and PNS --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- Potter and Perry, Fundamentals of nursing (8th), Chapter 16 p. 210-211 Types of Data --There are two primary sources of data: subjective and objective. Subjective data are your patients’ verbal descriptions of their health problems. Only patients provide subjective data. For example, Mr. Jacobs's report of incision pain and his expression of concern about whether the pain means that he will not be able to go home as soon as he hoped are subjective findings. Subjective data usually include feelings, perceptions, and self-report of symptoms. Only patients provide subjective data relevant to their health condition. The data sometimes reflect physiological changes, which you further explore through objective data collection. --Objective data are observations or measurements of a patient's health status. Inspecting the condition of a surgical incision or wound, describing an observed behavior, and measuring blood pressure are examples of objective data. The measurement of objective data is based on an accepted standard such as the Fahrenheit or Celsius measure on a thermometer, inches or centimeters on a measuring...
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...the patient process of essential care for the elderly. It summarizes the IHI map and then discusses the specific goals of The Joint Commission (TJC) and how they relate to the IHI map. The paper then continues on to discuss how the standards of TJC are put into effect at McKenzie Willamette hospital to provide the essential care for the older patient. Essential Care of Frail Older Adults Overview On the improvement map from the Institute for Healthcare Improvement’s (IHI) website, the patient process “Essential Care for Frail Older Adults” is outlined. IHI states that the purpose of this process is to “Ensure coordinated, reliable, and safe care for frail older patients as they enter the hospital.” As the title of the map indicates this patient process is related to the care of our older adult patients. The IHI website indicates that it would be moderately challenging to implement this patient process for the following reason “Either it involves multiple units or disciplines OR requires a substantial shift in culture an/or operations, but not both of these.” This patient process will need to be implemented in any medical facility that may treat the frail older adult including medical, surgical and emergency departments of hospitals along with nursing homes and intensive care units and also in the transfer of care between the above-mentioned agencies. This patient process aims towards delivering safe, fair, and evidence –based care for our older adult patient population...
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