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The basics of pressure ulcers
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On May 24, 2016, I performed a physical assessment on patient LW who is a 79 year old, Caucasian, female. She came in to the hospital on April 5, 2016 with a diagnosis of hyperkalemia, LW no longer has hyperkalemia instead over the time of her stay at the hospital she developed respiratory failure which is now her diagnosis. During my time with LW, I performed a full body system physical assessment while also obtaining a thorough medical history from the patient, her primary nurse, and her family members. LW is scheduled to be discharged to home on May 25, 2016, with her two sons wh are also her caregivers. While performing LW’s physical assessment, LW was noted with the following normal and abnormal aging changes. LW is alert and oriented …show more content…
The reddened areas on LW’s sacrum and mid back, her decreased mobility, urinary incontinence, and difficulty turning herself puts her at a great risk for the development of pressure ulcers over boney areas. The reddened areas can easily become stage II pressure ulcers if the skin isn’t properly cared for. If LW stays in one sport for a long period of time because of decreased mobility and inability to turn and reposition herself without assistance, skin break down occurs because of excessive pressure to one area. A cause of LW’s decreased mobility could be related to her history of osteoporosis. Osteoporosis is known to cause pain during mobility and transfers and bone fractures which can both contribute to decreased mobility. As a result of LW’s decreased mobility and medical history, LW has an increased risk for many complications which includes blood clots. LW’s decreased mobility along with her history of A-fib puts LW at an increased risk for the development of blood clots. In addition to pressure ulcers and blood clots, LW’s decreased mobility and poor fluid intake puts her at a greater risk for constipation. Older adult’s gastric motility decreases with age which puts them at greater risk for constipation. Ambulation and adequate nutrition decreases the risk for constipation. Poor fluid intake doesn’t only put LW at an increased risk for …show more content…
In order for LW’s risk of pressure ulcer development to be decreased, LW needs to be turned and reposition every 1-2 hours and as needed, which keeps pressure off of the boney areas. Because LW needs assistance with turning and positing, LW and her 2 sons who are also her caregivers will be educated on proper turning and repositioning techniques in which they will have to demonstrate prior to discharge. LW will be kept clean and dry at all times and moisture barrier will be applied. This will be done because increased moisture from urine and feces causes skin breakdown. LW and sons will be educated about the importance of keeping LW clean and dry, verbalizing understanding. LW will be encouraged to ambulate more often, this also relieves pressure from boney prominence increasing blood flow throughout the body. LW and sons will verbalize importance of encouraging LW to ambulate while also demonstrating proper body mechanics when assisting LW with ambulation. LW will be encouraged to spend less time in bed, sitting in recliner or chair occasionally lifting butt from chair/recliner. This also alleviates pressure from sacrum and back. LW and sons will verbalize and demonstrate the importance of lifting butt from chair or recliner when sitting for long periods of
This case involves a patient, Dixon, who suffered irreversible brain damage because a code cart was not properly stocked. The medical team had to intubate her in order for her to be placed on a ventilator. Once she was stabilized, it was determined by her physician to begin the weaning process and have the patient extubated. Following the extubation, the respiratory therapist felt that it was in the best interest for Dixon to continue to receive oxygen support through a mask; however, there was not one available in ICU so he went to another unit to obtain one. Upon returning, the patient was not breathing appropriately and another code was called which required her to be immediately reintubated.
The patient is a 45 year old male who was in a car accident that
I cared for a 76-year-old end-staged chronic obstructive pulmonary disorder patient who was admitted for respiratory distress. The doctor requested that my nurse and I get the family together for a family meeting. During the meeting, the doctor communicated to the patient and his family members that the patient will be palliative and no longer be in the ICU. The family members were concerned about the transfer of care to the medicine unit, what to expect from palliative care and other options for care. This scenario did not go well because the patient and family would have benefited from a palliative nurse with expertise, respiratory therapist to discuss other options, pharmacist about medication change if needed, social worker to help guide the family through end of life care for their father. In addition, there was no collaboration with interprofessionals prior to the family
Anthony is a 40-year-old Asian American male who presents on the unit from RRC-W. He is SMI designated and on COT. He is ACOT for non-compliance. Per clinical team, client has been ignoring his diabetic condition due to increase psychosis and delusions. His team believes once he is stabilized on medication, he will begin to recognize his diabetic condition. Upon arrival, client refused intake assessment and vital signs. He will benefit from meeting with provider to discuss medication
Currently health care facilities use individual, multi-component interventions, or series of interventions to prevent pressure ulcers. Either health care staff is not implementing these strategies into their patient’s care or some changes obviously need to be made. Interventions to prevent pressure ulcers consist of using the Braden Scale for initial and repeated skin assessments to determine the patient’s risks for pressure ulcers, specialized support mattresses, heel supports, and frequent repositioning for bed bound patients, encouraging mobility, moisture management, nutrition, hydration, and reducing friction or shear forces on parts of the body at increased risk for pressure ulcers (Sullivan & Schoelles, 2013).
Kinesiology is a complimentary therapy used to identify and correct internal issues to relieve stress, allergies, and pain. Being described as a complimentary therapy, kinesiology is not meant to be a cure-all for the patient, but a secondary method of increasing positive results of the original therapy; this method however can be used as a primary or secondary form of therapy depending on the results for the patient and satisfaction with said results. During treatment the doctor tests 14 different areas of muscles balance, these major muscles and how they react are believed to uncover problems that need correction which cannot be found with any other testing (Rude Health).
Description Clinical rotation for spring 2018 started off at the recovery unit at the General Hospital, it was quite a slow start to my day. The task began with 66-year-old G.L, male who entered the recovery room at 10:35 am from his haemorrhoidectomy. After, Mr. G. L we had several other patients who came to the recovery room from operating theatre, which all the patient underwent different procedures, from D&C to Laparotomy just to name a few. Although the nurses and ward manager stated that we choose a slow day to do our clinical rotations, we made the best of our days. The patient was G.L. 66-year-old male who was diagnosed with Prolapse Hemorrhoid.
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer de...
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
The staff and myself got the patient on the CT table, on the monitor, and on oxygen. The physician came to CT for the procedure he ordered starting sedation doses of 2 mg versed and 100 mcg of fentanyl, I told this physician I felt the doses should start at 1 mg versed and 50 mcg of fentanyl, and then we can always give more. He insisted the doses he ordered be administered. I was not comfortable with the order, but I administered the medications as ordered. The patient quickly developed snoring respirations, he was maintaining a good oxygen saturation, but I know he was on the brink of decompensating. I was concerned he would not be able to maintain his own airway, he was over sedated. The physician and the CT staff were in the control room waiting for me to step out of the CT room so they could do the preliminary CT scan and start the biopsy. I refused to leave the CT room until I felt comfortable with the patient’s respiratory status. Once the biopsy was over I discussed with the physician that I would never administer a dose so high at one time for any
Modalities such as Ultrasound, Cryotherapy and LASER promote healing; stretching programs prevent muscle inhibition and improve flexibility, while eccentric loading restores muscle strength and coordination to the normal. Addressing lifestyle modifications such as cigarette smoking, stress management and diet must also be emphasized in
SÍTAR, M.E., YANAR, K., AYDIN, S. and ÇAKATAY, U., CURRENT ASPECTS OF AGEING THEORIES AND CLASSIFICATION ACCORDING TO MECHANISMS. .
I believe to assess a person for medications, medical problems, and mental capacity a patient should be thoroughly evaluated and have multiple sessions with a professional to determine what he/she might need and if the problem they have can be improved. It is important to take into consideration all options of treatments before medications because once a treatment it’s started it should be follow through. A person should expressed their desired to start a drug treatment in order to receive benefits from it if not they will not take their medications. Focusing on the patient’s struggles and difficulties of their personal life can be another way to confirm the use of medications. Assessing medical problems requires extensive interaction with a patient to determine if they are any possible issues.