Question II
While performing Claudia’s primary assessment, I would start with ABCs. Airways should be assessed for patency. Rationale: The patient was admitted with a three-day history of vomiting. Vomiting increases the patient’s risk for aspirations. Suctioning or airway adjuncts should be used if necessary in order to maintain airway patency (Gulanick & Myers, 2011). I would auscultate Claudia’s breath sounds for crackles and wheezes. Rationale: The patient could aspirate particles of gastrointestinal content. It could lead to pulmonary obstruction, aspiration pneumonia, damaged lung tissue due to acidic aspirate, and chemical pneumonitis (Gulanick & Myers, 2011).
I would assess the patient’s respiratory rate, depth, quality of breath,
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I would also assess skin color, diaphoresis, temperature, turgor, mucous membranes, and capillary refill. Rationale: Rapid, weak, irregular pulse indicates the body’s attempt to compensate for decreased cardiac output resulted from hypovolemia. Cool and clammy skin, decreased skin turgor, dry mucous membranes, increased capillary refill time are signs of hypovolemia. I would start two IV lines and would be prepared to administer IV fluids along with antidiarrheal and antiemetic medications as per doctor’s order. Rationale: Volume loss requires rapid replenishment. Medications would treat the cause of the problem. Most of antidiarrheal drugs act by suppressing the GI motility, thus increasing fluid absorption and increasing systemic volume (Gulanick & Myers, 2011). I would put the patient on cardiac monitor and perform ECG. Rationale: Caution is indicated, since the patient is tachycardic due to decreased cardiac output. Moreover, aggressive fluid replacement in older adults could lead to left ventricular dysfunction; therefore, close monitoring of the cardiac function is required (Gulanick & Myers, 2011). Hypovolemic patients are prone to electrolyte imbalance, including changes in potassium level. Potassium shifting could cause serious ECG changes, thus the cardiac activity should be closely monitored (McLafferty et al., …show more content…
Then I would perform detailed pain assessment, and notify the physician about the findings. Rationale: Decreased systemic volume related to fluids loss due to prolong diarrhea and vomiting may cause alterations in mental status, confusion, and decreased level of consciousness. Inability to keep food and fluids down may lead to hypoglycemia. Increased pain level may add to anxiety and altered mental status. Thorough pain assessment would allow confirming or ruling out other medical conditions that might cause abdominal cramps. I would be prepared to administer glucose and pain medications as prescribed. Emergency physician should be notified depending on the seriousness of findings (Gulanick & Myers,
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
-The patient was having pitting edema and inspiratory rales because the increase of sodium caused an increase of fluid in the vascular system and lungs.
A 54 year old female was presented with complaints of lethargy, excessive thirst and diminished appetite. Given the fact that these symptoms are very broad and could be the underlying cause of various diseases, the physician decided to order a urinalysis by cystoscope; a comprehensive diagnostic chemistry panel; and a CBC with differential, to acquire a better understanding on his patient health status. The following abnormal results caught the physician’s attention:
1. What is the difference between a. and a. Which K, S, and A pertain to the care you provided to the patient you have chosen? Why do you need to be a member? K- Describe the limits and boundaries of therapeutic patient-centered care. S- Assess levels of physical and emotional comfort.
Breathing is the most important AL (Roper et al, 1998). A detailed assessment of her airway would be performed because protection of the airway throughout anaesthesia is essential (Yates, 2000). This does not just include recording of respiration rate and oxygen saturation (SpO2) but also noting any use of accessory muscles, shortness of breath, auscultation of chest and lungs areas for wheezes/crackles and asking patient about history of any respiratory illness/smoking (McArthur-Rouse, 2007).
A registered nurse (RN) is someone that went through a university or college and studied nursing; and then passed the national licensing exam to obtain a license to practice nursing. The degree earned by an RN at the need of the program is deemed a professional nursing degree. The RN top nursing staff and they usually works independently. On the hand, an LPN only earns a practical nursing degree after completion of the program. LPNs are mostly recognized only in USA and Canada; they are also named as License Vocational Nurse (LVN) in the state of California and Texas. LPN work under the supervisor of an RN or a physician.
The ability to carry out and document a full respiratory and cardiovascular assessment is an essential skill. The severity of illness can be initially evaluated by inspection, palpation, percussion, and auscultation. During analysis, specific locations of symptoms can be identified using landmarks such as the midaxiallary, midclavicular, and, the midsternal line. Indicate anterior or posterior thorax, and use the midaxillary line location when applicable (Bickley & Szilagyi, 2013).
Throughout the Practical Nursing program, there has been many opportunities to closely observe working nurses in different hospitals and facilities. It also has been a great chance to grasp the general idea about professionalism in the workplace and how it can have a great impact in a successful work environment. Combining what was observed and what was learnt from the class, there were three particular aspects of professionalism that seemed to be key characteristics of professional nurses: knowledge from continuous education, autonomy, and positivity. Out of all other characteristics for professionalisms in nursing, those three were the most remarkable features found from the some of the great nurses observed from the clinical sites.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
When diagnosed with hyponatremia treatment usually immediately begins. Treatment must be a restriction of both salt and water (Gheorghita et. al 2010). Hyponatremic patients must receive a slow increase in sodium with a restriction of liquids. Intravenous hypertonic saline solution of 3% NaCl can be administered to patients who have been diagnosed with hyponatremia. There is a precise formula that is used in determining the quantity of NaCl that is used in increasing sodemia and the rate at which it should be administered (Gheorghita et. al 2010).
There are many who believe that the next shortage will be worse and the demand for nurses will increase. There will be more jobs available especially with the baby boomer nurses retiring. Wood believes that when nurses retire, the next shortage could be even worse than the previous shortage. According to Wood this would lead to an “intellectual drain of institutional and professional nursing knowledge” (Wood, 2011, para 15). Staiger agrees as well that a shortage of nurses is expected again when nurses retire and since the economy will be more stable full-time nurses will go back to being part-time (Huston, 2017). Huston expects for the supply of nurses to grow minimally in the next couple of years and for a large number of nurses
“We can’t turn away from a patient’s pain just because it’s difficult” (chapman, 2015, p. 88). I know the path of least resistance is taking a path of ignorance. Easy, is to ignore or neglect the true pain patients experience in times of crisis. As caregivers I believe we all want to heal others or we wouldn’t be in the field of nursing, but there are only handfuls willing to be present during the healing process because sharing one’s pain hurts. As a surgical nurse, I find being genuinely present takes hard work on my behalf, not only mentally but emotionally. On a unit where patient’s needs and conditions are changing at astonishing rates, being present requires mental strength in order slow down enough to recognize the value presence
I have been a registered nurse for the past six years. I started my nursing career in a long-term care facility where I worked for a year and half . I always wanted to challenge myself so l left long-term care and went to work in the intensive care unit for four years where I saw how people with diabetes are suffering when the disease in not managed well. I am currently working in post anesthesia care unit(PACU) where I recover many patients with diabetes complications post-surgery. I am committed in the innovation in order to provide an effective care for the people suffering from diabetes. For many years the disease has been killing people and introduction of the control tools will help in making the condition manageable. The innovation
Ask someone to depict a nurse, what will they tell you? Many hold the stance that the nursing profession is composed of angelic people in starched white uniforms, primarily women, whose main focus is patient care and following doctor’s orders. This image, though iconic and attractive to some, is not accurate when applied to modern nurses. In an effort to assess the attributes currently needed of nurses, I interviewed Jordan Kreklau. Ms. Kreklau is 25 years old and attained her BSN from The University of Eau Claire in May 2014. After attaining her RN license in July 2014, she was hired on for the medical/surgical unit at St. Joseph’s in Marshfield, WI, where she had worked as a graduate student. In 2015, she also began working in a progressive
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical