Program Concerns with Care for Patients †Myassignmenthelp.Com

Question: Discuss About The Program Concerns With Care For Patients? Answer: Introducation The Monash Healthcare (Nursing and Midwifery) program concerns with care for patients to be provided under various conditions including critical care and deliver ongoing educational program. Other than these this program also concentrates on providing placement for the graduates and providing them with the best clinical experience possible during training time. The graduate nurse here can be a master of things such as clinical assessment, documentation along with the necessary training for the patients at the various level or stages of the disease. Other than the routine education program, an effort has been made for the research to include evidence based practising as well as looking into new novel aspects of nursing for the beneficiary or betterment of the mankind. (Bylund, Peterson Cameron, 2012). These programs assess the competency of nurse in critical thinking, reasoning, situation handling and decision making under emergencies for the betterment of the patient. This program t eaches the need for maintenance of standards in teaching, documentation of medication and treatment provided. It also advised the nurse of the need for the strict regime of medication for the patient and role of nurse in improving the literacy of health education both for the patient and caretaker of the patient. Being a nurse myself, I apply the principle of maintaining standards in providing holistic care for the patient and have a strong background of knowledge before analysing a situation or decision making or prioritising among more than one patient. It also looks into the factors to be considered while treating acute illness in adults in comparison to the same disease in children. Further I would like to actively participate in the research which enables me to have sound knowledge both theoretically and practically. Clinical question You are caring for a male patient who suffered a fractured shaft of femur 5 days ago. He develops chest pain and shortness of breath. What would your immediate actions be? Fat embolism syndrome (FES) is most commonly associated with the any injury or damage to skeletal system and is most common among patient with long bone fracture and pelvic fracture. Development of chest pain and shortness of breath might be due to different reasons depending on type of fracture suffered which also correlates with age, gender and other factors also. In FES, soon after injury body starts releasing free fatty acids into circulation (Cathleen, 2012). Literature sights increased risk of FES in case of multiple and closed fracture and young age. FES complications include Acute Respiratory Distress syndrome (ARDS), pulmonary dysfunction and severe hypoxemia and respiratory insufficiency. The immediate nursing intervention includes providing mechanical breathing. Record the vitals while looking for shock. Check for blood pressure and history of patient for hypertension or hypotension. This may happen due to excessive loss of blood or anaemic condition and in mean time assess haemoglobin and haematocrit values (Edwards et al., 2013). Check for infection in the wound and provide antibiotic prophylaxis to prevent wound infection occurring. (With consultation to doctor). If excessive bleeding, infection or anaemic condition is noted, record in medical history and immediately consult the doctor. Pulmonary complications also result in chest pain and reduced breathing, during the acute phase nurse has to record vital signs along with breath sounds and sputum if available. (Carpinter et al., 2014). Check for blood in sputum which is indicative pulmonary dysfunction. Increase head height of bed for patient to facilitate easy breathing. Provide mechanical breathing or mouth breathing if necessary. Hypothesis Listen for auscultation of breath sounds, assess frequency, depth of breathing and chest movement. If there is any discrepancy in rate of breathing associated with elevated body temperature hints possible infection leading to pneumonia. Give medication as prescribed by a doctor, for relaxation of smooth muscles and ease up local congestion. This helps in reducing chest pain associated with easing of breathing providing better exchange of gasses. Providing chest physiotherapy or cardiothoracic physiotherapy (includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises and coughing) will be better option for the patient to improve shortness of breath which also results in indirect removal of mucus if any (Yeo et al., 2013).Provide nutritionally balanced diet and check for electrolyte and body fluid content as diminished nutrition leads to mental shock and patient with respiratory disorders requires nutrition rich diet with proper electrolyte balance. Evaluate the level of activity tolerance and provide supplemental oxygen at standard rate to improve hypoxia condition. Observe the patient for change in nails, skin colour, and mucous membranes for cyanosis which are indicative of vasoconstriction and systemic hypoxia respectively (Votile, Hoffmann Cejna, 2015). Educate the patient and family or care taker on the need for maintaining proper nutrition-rich diet and proper electrolyte and fluid balance which helps in speedy recovery and prevents readmission to hospital for same complications or increased complication. Educate the patient and care taker on need for health literacy and in the mean time explain to them the need for cardiothoracic physiotherapy, prescribed medication and adverse effects associated with it. Prioritization; The request for the addressing will be made in the order of attending Patient 2 first then patient 1, followed by patient 4 and patient 3. The rationale for the decision has been discussed below;( I think patient 4 should be first cus of shortness of breath, then patient 1 cus she needs help with ensuit and she can use her bowel, patient 2 and patient 3) Patient 2 needs medical attention first as she has to undergo analysing glucose levels before her meal. It was actually scheduled for 0600hrs but is due even at 0730. For a patient suffering the situation of patient 2 (Mrs. Walters) it isalways necessary to run on schedule with insulin scaling as it decides the amount of carbohydrate to be taken in the meal (breakfast) depending upon the blood glucose content of the body at rest(Tsujita, Sakamato Kojima, 2013). The dosage remains varied depending upon the amount of blood glucose level. As it is already 0730 and breakfast will be served by 0740 it is highly recommended to attend patient 2. Another reason to attend patient 2 is increased or decreased blood glucose severely affects body function, if not controlled may lead to coma and death. The next patient to get priority nursing facility is patient number 4, suffering from asthma. Slight coughing will help in increasing breath rate. The patient can help himself to move to take the aerosol (spacers or inhalers) and help himself to free bronchospasm. Further, the patients with asthma will be always advised have the spacers and inhalers nearby and will be given guidelines on importance of health literacy. The nurse can intervene by assessing situation with her knowledge on asthma and can help the patient by provide mechanical breathing or assist with the nebuliser with the suitable medication to increase the comfort of breathing (Vertino, 2014). This patient will be helping himself to have spacers and inhalers to ease up breathing later the nurse can intervene with the situation, analyse and can proceed further with assisting patient 4. The next immediate attention will be seek by patient 1 for Mrs Peterson is asking for help to the ensuite to use her bowels. As she has been classified as high falls risk and suffering from moderate left hemiplegia therefore attempt made by patient to move may lead to her falling from bed leading to further complications, including bone fractures (Ting et al., 2014). Patient 3 with IV infusion will be receiving last attention. The reason that Mr Young is left till last is because the infusion pump has air sensor and pressure sensor which automatically stops giving alarm indicating some error in the function. The error can be managed within stipulated period of time and there will not be complications associated with this patient. The only factor to be worried is about air embolism, but the automatic setting of the instrument for detection of air will prevent entry of air into veins creating the embolism (Sebastianet al., 2015). Professional A colleague has removed every second suture from a long wound on the lower leg. She has asked for your assistance to support the patients limb while she reapplies a dressing. A small area at the end of the suture line is moist. The wound is being dressed with MelolinTM, Combine and crepe bandage for protection and support. During the dressing your colleague drops a piece of Melolin TM on the bed and retrieves this placing it back on the dressing tray. She remarks it will be fine up the clean end of the wound. My immediate response will be to assist her to be more careful while dressing and to have sound knowledge on handling the wounds. I also suggest her to be more attentive and the mistakes she has done by not following the nursing standards and for not providing the holistic care. Firstly this represents the negligence of the nurse towards the patient and questions the holistic management and dedication by her to give the treatment to the patient. Although she has taken care to remove suture which is assisted by the another nurse (my self in this case) she forget to wash the wound with disinfectant (70% alcohol) which also assists in removing any amount of water present in and around the wound there by preventing the sepsis or further complications associated with wound healing (Craig et al., 2014) The dressing has been done with Melolin which contains strong adsorbent cotton which also assist in removal of any amount of moisture. It also helps in quick healing of the wound also. Further the nurse has taken care to provide an extra layer of dressing, protection and support with crepe bandage which is nice idea, which helps the Melolin to remain in its position intact and provide with some heat further assists in quick healing and fixing of Melolin to the wounded area (Konstantinos et al., 2012). But the nurse fails to maintain aseptic conditions and strict standards of nursing neglecting the moisture at the end of wound and dropping Melolin during the course of dressing. Although we consider that hospital premises are maintained aseptically one cannot give 100% assurance on the same as there are chances of 0.1% infection chances. Since the nurse has dropped Melolin and she thinking to apply at the end of the wound which is already having bit of moisture may further create sepsis complicating the healing of the wound. The moisture at the end acts as a good source for the growth of bacteria or bacterial activity (Langslet et al., 2014). The nurse must be more careful while applying the dressing taking proper care with use of disinfectant to remove any amount of moisture thus preventing sepsis and to be more careful while handling the bandages such as Melolin. The idea of nurse to keep the Melolin dropped back into dressing tray questions the nurse on maintaining the standards of treating and providing the h).It is always preferred to wash the wound either with hot tap water and then with agents such as hydrogen peroxide and other so that excess amount of moisture or any contaminants on the wound are completely washed and provided with the highest possible hygiene for the better curing of the wound. olistic care for the patient (safe and atraumatic removal of dressing) (Langslet et al., 2014) The nurse should employ better technique and handling of wound with a thorough knowledge on dos and donts during treating a wound. It appears that the knowledge level and training for the nurse is not adequate and sufficient enough that she is going to provide a holistic and good care for the patient. The standard guideline says to use warm water, sodium chloride, antibiotics and use of hydrogen peroxide for the cleaning of the wound prior to the applying dress (how do we know she didnt wash her hands) The nurse should have a knowledge on the type of the wound she is going to handle and the priority given to type of the bandage used and the material or ointment (Hydrophobic, low adsorbent or high adsorbent) used for the curing. Although nurse seeks help of other nurse in suture and creep bandage, she fails to recognise the moisture in the wound and neglects the moisture and doesnt maintain aseptic and proper handling of the bandage which is evident by the fact that she drops the Melo lin and puts it back in the dressing tray and suggests using it for the end of wound, which is not a standard practice according to the guideline for wound caring (Yeo et al., 2013). She doesnt worry about this although it is not a standard practise and tries to convince her friendthat its not a big problem. Finally, nurses should pay attention to their work and should have a strong background of the condition being handled (Ropp, Lin White, 2015). If faced by any dilemma nurse should consult the physician or any other experienced nurse before treating it by herself otherwise she may complicate the disease further. References Brinkert, R. (2012). A literature review of conflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management, 18, 145-156. Doi: 10.1111/j.1365-2834.2010.01061.x. Bylund, C., Peterson, E., Cameron, K. (2012). A practitioners guide to interpersonal communication theory: An overview and exploration of selected theories. Patient Education and Counseling, 87(3), 261-267. Doi: 10.1016/j.pec.2011.10.006 Carpintero, P., Ramn, J., Caeiro, Carpintero, R., Morales, A., Samuel, S., Manuel, M. (2014). Complications of hip fractures: A review. World Journal of Orthopedic, 5(4), 402-411. Cathleen, S. C.(2012). Postoperative management of hip fractures: interventions associated with improved outcomes.A review.BoneKEyReports. 1, 241. doi: 10.1038/bonekey.2012.241 Craig, C. A., Cameron, S., Jesse, O.,Matthew, K. (2014). Fat embolism syndrome after femur fracture fixation: a case report. The Iowa Orthopaedic Journal.34, 5562. Edwards, H., Gibb, M., Finlayson, K., Jensen, R. (2013). Wound dressing guide. Promoting healthy skin, champions for skin integrity Brisbane: Queensland University of Technology. ISBN 978-1-921897-79-5 Konstantinos, P., Michael, K., Zarogoulidis, P., Maria, K., Kalliopi,D., Alexandros,M., Panagiotis, B., Stamatia,B., Alkis,I., Vasilis,Z., Nikolaos,C., Nikolaos,K., Konstantinos Z. (2012). Fat embolism due to bilateral femoral fracture: a case report. International Journal of General Medicine, 5, 5963. Langslet, E., Frihagen, F., Opland, V., Madsen, J. E., Nordsletten, L.,Figved, W. (2014). Cemented versus uncementedhemiarthroplastyfor displaced femoral neck fractures: 5-year followup of arandomized trial. ClinicalOrthopedics and Related Research,472, 1291-1299. Ropp, A., Lin, C. T., White, C. S. (2015). Coronary computed tomographyangiography for the assessment of acute chest pain in the emergencydepartment: evidence, guidelines, and tips for implementation. Journal of Thoracic Imaging, 30, 169175. Sebastiaan, H., Lucia, J. K., Alberto, L. H., Ruben, L., Albert, R. (2015). Chest CT examinations in patients presenting with acute chest pain: a pictorial review. InsightsImaging, 6, 719728. Shapiro, J. (2014). Does medical education promote professional alexithymia? A call for attendance to the emotions of patients and self in medical training. Academic Medicine, 86(3), 326-332. doi: 10.1097/ACM.0b013e3182088833 Ting, B., Zurakowski, D., Herder, L., Wagner, K., Appleton, P., Rodriguez, E. K. (2014). Pre-injury ambulatory status is associated with 1-year mortality following lateral compression Type I fractures in the geriatric population older than 80 years. Journal of Trauma and Acute Care Surgery, 76(5), 1306-1309. doi: 10.1097/TA.0000000000000212. Tsujita, K., Sakamoto, K., Kojima, S. (2013) Coronary plaque component in patients with vasospastic angina: a virtual histology intravascular ultrasound study. International Journal of Cardiology, 168, 2411-2415. Vertino, K. (2014). Effective Interpersonal Communication: A Practical Guide to Improve Your Life. The Online Journal of Issues in Nursing. 19(3), doi: 10.3912/OJIN.Vol19No03Man01. Voitle, E., Hofmann, W., Cejna, M. (2015) Aortic emergencies diagnosis and treatment: a pictorial review. Insights Imaging 6, 1732. Yeo, S. H., Chang, H. W., Sohn, S. I., Cho, C. H., Bae, K. C. (2013) Pulmonary and cerebral fat embolism syndrome after total knee replacement. Journal of Clinical and Medical Research, 5, 239242.