Nursing Assignment
Content
Q-1.
Using referencing to support your answer outline the five stages of dying according to
Kubler-Ross (75 words)
Ans-1 In her book in 1969, On Death & Dying, Elisabeth Kubler Ross gave the model comprising of five stages of dying (http://www.azcentral.com). 1 ± Denial: It is a conscious or unconscious refusal to accept facts, information. 2 ± Anger: People dealing with emotional upset can be angry with themselves, or with those close to them. 3 ± Bargaining: It involves attempting to bargain with whatever God the person believes in. 4 ± Depression: It's a sort of acceptance with emotional attachment.
Q-2. Outline some nursing interventions that demonstrate applying a palliative approach for the following needs (150 words) y y y y y Ans-2 a. Spiritual: Raising awareness among nurses of the meaning of prayer practices in healthcare settings may strengthen holistic care. Spiritual Comfort Cultural Legal Pain
b. Comfort: ³Patients may be provided with peer counseling or referring them to support groups. Helping patients rebuild their relationships with their family by initiating contact or introducing family support groups may improve the patients' quality of life.´(Acedemon,2009)
c. Cultural: Nursing department should also take of the cultural background of the patients. There might be some Do¶s and Don¶ts in the patient¶s culture.
d. Legal: There are many such cases or situations when nurses have to take care of the legal rights of the patients. Proper training should be imparted to the nurses so that they have knowledge of the legal rights which they should provide to the patients.
e. Pain: Nurses should take proper care of the patients so that the pain which they are suffering from is reduced to some extent.
Q.3-Describe how nurses could facilitate a ³good death´ by following a palliative approach (75 words) Ans-3. Providing quality care for patients who are dying is of primary concern. Often, critical care nurses are responsible for caring for these dying patients, because about 20% of intensive care unit (ICU) patients die while hospitalized. They should encourage the family members to stay with the dying patient. Patients should also be moved to private room. It would be nice to have a comfortable, quiet, spacious room for those who are dying. Q.4- Describe how respiratory and cardiovascular factors in terminal illnesses affect the ADL¶s (activities of daily living) (100 words) Ans4. Medical diagnosis is only one of several factors associated with the need for episodic home health care after hospital discharge for medical or surgical treatment. Discharge criteria for mechanically ventilated patients have been developed on the basis of expert consensus, and include medical, respiratory, and psychological stability, and the existence of a comprehensive discharge plan. Gilmartin identified criteria specific to home management of chronically ventilated patients. It is important to note that both of these sets of criteria indicate readiness for discharge, not criteria for referral to home care. (American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1443-1464, (2005
Q.5- Research and summarise the practices of the Aboriginal people in relation to death and dying (100 words) Ans.5 In the Aboriginal tradition, death, burial and afterlife are rich in meaning and metaphysical interpretation. Aborigines use a wide variety of burial practices,
including all of those known to have been used in other parts of the world, as well varieties not practiced anywhere else. Although these rites vary, all Australian
Aborigines share many fundamental ideas about death and its relationship to life. The most fundamental concept of death in the Aboriginal tradition is the doctrine of three worlds, the unborn, the living, and the dying, and the Land of the Dead.(Essay sample).
Q.6 Go to http://www.justice.qld.gov.au/justice-services/guardianship/making-health-caredecisions/advance-health-directives and answer the following questions in your own words. What information is usually recorded in an ACD? (50 words) What are life sustaining measures? (30 words) What happens if a client has no ACD and becomes too ill to express their care wishes? (30 words) Can instructions be written for doctors to assist the client to die? (30 words) Who else can be involved in writing the ACD with the client? (30 words) Can a client change or revoke an ACD? (30 words)
y y y y y y
Ans.6 (a) By making an advance health directive, the patient can mention what treatment he/she would like to have or would like to refuse in situations when you are seriously ill and unconscious or longer in a condition to make your own decision. Whenever you are in a hospital the medical staff would refer to these document before given medications. (b) It is medical procedure or intervention that utilizes artificial means to sustain or replace a vital function, which would only serve to prolong the process of dying of an individual who has a terminal illness. © If a patient does not have an ACD; the doctor takes action as per the requirement of the illness which the patient is suffering from. If the patient is in a condition to give his opinion he I asked for it else the doctor¶s decision is the final one.
(d) Yes instructions can be written to the doctor in case to assist the client to die but only when the patient is in a persistent vegetative state, permanently unconscious due to brain damage or the patient has some terminal illness which has no cure. (e) Along with the patient himself, he can also take the help of his attorney while writing an ACD. In case the patient is too sick to make decisions his attorney can write the ACD in place of him. (f) Yes a patient can change his ACD as per the current illness since the situation might change. But it can only be done if the patient is in a condition to make decisions.
Q-7 Should a client be able to die with dignity with controlled pain or live longer in pain?
y y
Reflect on your personal thoughts to this question? (75 words) How would you support a family in conflict with each other in this situation? (75 words)
Ans-7. (a)The physician's role is to make a diagnosis, and sound judgments about medical treatment, not whether the patient's life is worth living. They have an obligation to perform sufficient care, not to refrain from giving the patient food and water until that person dies. Medical advances in recent years have made it possible to keep terminally ill people alive for beyond a length of time even if it is without any hope of recovery or improvement. (b) In such a situation, personally I would encourage the family to give full emotional support to the patient and also may suggest the family to take the patient home where he can feel much more comfortable. I would advise the family that it is their moral duty to take care of their family member in his last moments rather than leave all hope and allow him to die. Q.8 The care plan states that your patient is to have a shower every day at the family¶s request. You are helping her get out of bed and she states, ³I don¶t think I can shower today´. You also note that she is very short of breath.
y y
What is the appropriate response to this situation? (50 words) What would your input be when the family arrived? (50 words)
Ans.8 (a). The most appropriate response to a patient who has been requested to be given bath every day, would be give her a sponge bath. This would take care of the family¶s request; also keep the patient¶s wish of taking a complete bath. Even medically this would be appropriate as she is having very short breath so a full bath might make her breathless. (b) On arrival of the patient¶s family I would inform them that the patient was not feeling well and was having very short breath so as to keep her wish and also avoid breathlessness and further complications I have given her a sponge bath so that the family¶s request is also taken care of.
Q.9 Consider the following and LIST strategies you could use to implement to assist the client (150 words)
y y y y y y y
Abdominal bloating and discomfort Moist gurgling respirations Reddened sacrum Dysphagia Dysphasia Fatigue Abdominal bloating and discomfort Bloating is not a disease by itself. It is more of an indication of some other serious underlying medical condition related to digestive disorders such as indigestion. It most often occurs in the small intestine rather than the stomach, as most people believe. And the most common cause is irregular digestion that produces gas at a higher rate than normal. Some of the causes of bloated stomach are; eating too fast, swallowing air, eating food too fast, lactose intolerance or certain food
intolerances. A tablet of antacid might help relieve the patient from the discomfort.
y
Moist gurgling respirations
While breathing, which may be loud; breathing that is irregular and shallow; decreased number of breaths per minute; breathing that alternates between rapid and slow Breathing may be easier if the patient's body is turned to the side and pillows are placed beneath the head and behind the back. Although labored breathing can sound very distressing to the caregiver, gurgling and rattling sounds do not cause discomfort to the patient. An external source of oxygen may benefit some patients. If the patient is able to swallow, ice chips also may help. In addition, a cool mist humidifier may help make the patient's breathing more comfortable.
y
Reddened sacrum
Apply some cooling lotion which will moisturize and hydrate the skin. Also confirm whether its having allergic symtopms. Give medications accordingly.
y
Dysphagia
It can be difficult to achieve a complete cure for high dysphagia because the underlying neurological problems cannot usually be corrected using medication or surgery. Dilation is a widely used technique in cases of obstruction. It involves placing a small balloon inside your oesophagus. The balloon is inflated, which gradually widens your oesophagus, and then the balloon is deflated and removed.
y
Dysphasia
Speech therapy can be used effectively to improve their communication. Using techniques like talking slowly and repeating things, using gestures or drawings and avoiding noisy areas can be great help while dealing with dysphasia.
y
Fatigue One should perform a complete physical examination, paying special attention to your heart, lymph nodes, thyroid, and nervous system.Tests that may be
performed include the following: y y y Blood tests to check for anemia, diabetes, and possible infection. Thyroid, kidney, and liver function tests Urinalysis
Q.10 Describe ways that you as an enrolled nurse within your scope of practice can include the family/carer in assisting to maintain a supportive environment (100 words)
Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting. The ways in which family can provide a supportive environment is through (a)Giving respect and dignity (b) Information sharing (c) Participation (d)Collaboration Family practice is a medical specialty. Although the principles of familycentered care are particularly suited to the practice of family medicine, they
transcend and cross medical specialties. Health professionals in all disciplines can practice family-centered care. (IPFCC)
Q.11 Describe how you would respond to the following questions/requests for information
y
Why is he continuing to have pain medication when he is barely conscious? (50 words)
y y
Why does her breathing sound so bad? (50 words) How much longer will this go on for? (50 words)
Ans.11 (a) The patient though unconscious but needs to be given pain medication so that once he gets conscious he is relieved of the pain. Moreover, pain medication is also given so as to heal the ailments by relaxing the muscles or the injury so that the patient gains consciousness soon. (b) The patient is having problem in breathing since she is not able to inhale oxygen problem due to obstructions in her respiratory system. It is nothing to worry much, because we are going to give oxygen mask which will improve her breathing. (c) We have given proper medications and taking care of other symptoms, as soon as the medicines work, the patient will feel much better. At present everything is under control and the patient is out of danger.
Q.12 Your client is close to death and you have to document in the file your care. Using the FACTUAL acronym how would you document? (200 words)
FACTUAL :- Focused on the client Accurate Complete Timely Understandable Always objective
Legible y y y y y y y Respirations 8 and moist Pain score 7 after administration of analgesia Patient motionless, groans on movement when turned Bowels not opened for 4 days Oral intake ± 150 ml in last 24 hours Urine output ± zero Family asking questions about condition
Ans-12. The patient had been admitted 7days back. The treatment was provided to the patient without any loss of time. Timely medications were given and complete care was being taken of him. As on the final day the following observations have been made. Respiration of the patient was 8 and moist. Oxygen was being given to the patient. After the administration of analgesia the pain score recorded was 7. It was being observed from past few days that the patient was motionless, whenever he was moved, he groaned with pain. It was recorded that he did not have bowel for past 4 days. The oral intake recorded for the patient was 150ml in last 24 hours. For past few days urine output recorded was zero. Family has been very supportive and had been frequently asking questions regarding the progress in the improvement of the health of the patient.
Q.13 LIST nursing actions that can assist in the client/family family after the death of the client (50 words)
Ans.13 After the patient has passed away, there is no need to hurry with arrangements. Family members and caregivers may wish to sit with the patient, talk, or pray. When the family is ready, the following steps can be taken.
y
Place the body on its back with one pillow under the head. If necessary, caregivers or family members may wish to put the patient's dentures or other artificial parts in place.
y
Contact the appropriate authorities in accordance with local regulations. If the patient has requested not to be resuscitated through a Do-Not-Resuscitate (DNR) order or other mechanism, do not call 911.
y y y
Contact the patient's doctor and funeral home. When the patient's family is ready, call other family members, friends, and clergy. Provide or obtain emotional support for family members and friends to cope with their loss.
Q.14 While doing Mary B¶s mouth care, she says to you that she feels that although she is having a lot of regular pain relief that she does not feel that she is getting the same level of relief. What actions would you take and how would you document this? (50+50 words)
Ans.14 I would first take down the whole history of the patient as to from when she is having the pain. The amount of medicine which was prescribed to her and the percentage of relief she was experiencing before. I would then prescribe a pain killer with a higher dose or might increase the dose of the medicine which was taking. While documenting the patient¶s case, I would mention the patient¶s past history of pain and ailment. Also would add the previous dosage of medicine which was taking and also the number of days she was on medication. After which as an advice I would add my prescription of the increase in the dosage of her present medicine or the change is medicine to a higher dosage one.
Q.15. Mr Jones care plan states that he must have 1000mls of fluid per day, his condition has deteriorated and his gag reflex is minimal. What actions would you take and how would you document these actions? (50+50 words)
Ans.15 The pharyngeal reflex or gag reflex is a reflex contraction of the back of the throat,
evoked by touching the soft palate. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking. I would give the fluid as a drip to Mr. Jones so that he could have his requisite 1000mls of fluid without actually drinking it.
In patient¶s record, I would document about the patients symptom of gag reflex and the consequences which could follow it. I would add my advice of giving the patient drip of fluid rather than oral drinking so that his requisite 1000mls of fluid without actually drinking it is fulfilled.
Q.16.Discuss ways in which you could identify ineffective coping in yourself and what you could do to care for yourself (150 words). Ans.16 Ineffective coping is an applicable nursing diagnosis evident in several of the patients. Coping mechanisms are usually conscious methods that the individual uses to overcome a problem or stressor. They are learned adaptive or maladaptive responses to anxiety based of problem solving, they may lead to changed behavior Inappropriate coping mechanisms can be changed because the patient is usually aware of using them. I could take care of ineffective coping by Talking out problems with others Expressing emotion²yelling, crying, laughing Seeking comfort from friends, food, treasured objects, smoking, or mind-altering substances
Using humor to relieve tension in a way that avoids fully acknowledging a difficult situation Exercising Avoidance of upsetting situation or confrontation Using step-by-step approaches to resolution of the problem. The nurse¶s psychosocial assessment of the patient and family should focus on the effect of the illness rather than the physical symptoms.
REFERENCE http://www.azcentral.com/health/wellness/articles/0824ross-stages-ON.html http://www.academon.com/Term-Paper-The-Comfort-Theory-in-Nursing/113113,2009 Holistic Nursing Practice - Featured Journal,July/August 2005,Volume 19 Number 4,Pages 147 ± 154 American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1443-1464, (2005) © 2005 American Thoracic Societydoi: 10.1164/rccm.2504001 http://www.essaysample.com/essay/002469.html http://www.ipfcc.org/faq.html Dellasega, D., & Zerbe, T. M. (2002). Caregivers of frail rural older adults: Effects of an advanced practice nursing intervention. Journal of Gerontology, 28(10). Gorman, L.M., Raines, M. L., Sultan, D.F. (2002). Psychosocial Nursing for General patient Care 2nd Ed. F.A. Davis Company: Philadelphia.) p.13 and 16 A voice for nursing education, Kaiser Permanente, 1948 to 1991 : oral history transcript / 2004 Advanced Emergency Nursing Journal July/September 2010 Volume 32 Number 3
Using referencing to support your answer outline the five stages of dying according to
Kubler-Ross (75 words)
Ans-1 In her book in 1969, On Death & Dying, Elisabeth Kubler Ross gave the model comprising of five stages of dying (http://www.azcentral.com). 1 ± Denial: It is a conscious or unconscious refusal to accept facts, information. 2 ± Anger: People dealing with emotional upset can be angry with themselves, or with those close to them. 3 ± Bargaining: It involves attempting to bargain with whatever God the person believes in. 4 ± Depression: It's a sort of acceptance with emotional attachment.
Q-2. Outline some nursing interventions that demonstrate applying a palliative approach for the following needs (150 words) y y y y y Ans-2 a. Spiritual: Raising awareness among nurses of the meaning of prayer practices in healthcare settings may strengthen holistic care. Spiritual Comfort Cultural Legal Pain
b. Comfort: ³Patients may be provided with peer counseling or referring them to support groups. Helping patients rebuild their relationships with their family by initiating contact or introducing family support groups may improve the patients' quality of life.´(Acedemon,2009)
c. Cultural: Nursing department should also take of the cultural background of the patients. There might be some Do¶s and Don¶ts in the patient¶s culture.
d. Legal: There are many such cases or situations when nurses have to take care of the legal rights of the patients. Proper training should be imparted to the nurses so that they have knowledge of the legal rights which they should provide to the patients.
e. Pain: Nurses should take proper care of the patients so that the pain which they are suffering from is reduced to some extent.
Q.3-Describe how nurses could facilitate a ³good death´ by following a palliative approach (75 words) Ans-3. Providing quality care for patients who are dying is of primary concern. Often, critical care nurses are responsible for caring for these dying patients, because about 20% of intensive care unit (ICU) patients die while hospitalized. They should encourage the family members to stay with the dying patient. Patients should also be moved to private room. It would be nice to have a comfortable, quiet, spacious room for those who are dying. Q.4- Describe how respiratory and cardiovascular factors in terminal illnesses affect the ADL¶s (activities of daily living) (100 words) Ans4. Medical diagnosis is only one of several factors associated with the need for episodic home health care after hospital discharge for medical or surgical treatment. Discharge criteria for mechanically ventilated patients have been developed on the basis of expert consensus, and include medical, respiratory, and psychological stability, and the existence of a comprehensive discharge plan. Gilmartin identified criteria specific to home management of chronically ventilated patients. It is important to note that both of these sets of criteria indicate readiness for discharge, not criteria for referral to home care. (American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1443-1464, (2005
Q.5- Research and summarise the practices of the Aboriginal people in relation to death and dying (100 words) Ans.5 In the Aboriginal tradition, death, burial and afterlife are rich in meaning and metaphysical interpretation. Aborigines use a wide variety of burial practices,
including all of those known to have been used in other parts of the world, as well varieties not practiced anywhere else. Although these rites vary, all Australian
Aborigines share many fundamental ideas about death and its relationship to life. The most fundamental concept of death in the Aboriginal tradition is the doctrine of three worlds, the unborn, the living, and the dying, and the Land of the Dead.(Essay sample).
Q.6 Go to http://www.justice.qld.gov.au/justice-services/guardianship/making-health-caredecisions/advance-health-directives and answer the following questions in your own words. What information is usually recorded in an ACD? (50 words) What are life sustaining measures? (30 words) What happens if a client has no ACD and becomes too ill to express their care wishes? (30 words) Can instructions be written for doctors to assist the client to die? (30 words) Who else can be involved in writing the ACD with the client? (30 words) Can a client change or revoke an ACD? (30 words)
y y y y y y
Ans.6 (a) By making an advance health directive, the patient can mention what treatment he/she would like to have or would like to refuse in situations when you are seriously ill and unconscious or longer in a condition to make your own decision. Whenever you are in a hospital the medical staff would refer to these document before given medications. (b) It is medical procedure or intervention that utilizes artificial means to sustain or replace a vital function, which would only serve to prolong the process of dying of an individual who has a terminal illness. © If a patient does not have an ACD; the doctor takes action as per the requirement of the illness which the patient is suffering from. If the patient is in a condition to give his opinion he I asked for it else the doctor¶s decision is the final one.
(d) Yes instructions can be written to the doctor in case to assist the client to die but only when the patient is in a persistent vegetative state, permanently unconscious due to brain damage or the patient has some terminal illness which has no cure. (e) Along with the patient himself, he can also take the help of his attorney while writing an ACD. In case the patient is too sick to make decisions his attorney can write the ACD in place of him. (f) Yes a patient can change his ACD as per the current illness since the situation might change. But it can only be done if the patient is in a condition to make decisions.
Q-7 Should a client be able to die with dignity with controlled pain or live longer in pain?
y y
Reflect on your personal thoughts to this question? (75 words) How would you support a family in conflict with each other in this situation? (75 words)
Ans-7. (a)The physician's role is to make a diagnosis, and sound judgments about medical treatment, not whether the patient's life is worth living. They have an obligation to perform sufficient care, not to refrain from giving the patient food and water until that person dies. Medical advances in recent years have made it possible to keep terminally ill people alive for beyond a length of time even if it is without any hope of recovery or improvement. (b) In such a situation, personally I would encourage the family to give full emotional support to the patient and also may suggest the family to take the patient home where he can feel much more comfortable. I would advise the family that it is their moral duty to take care of their family member in his last moments rather than leave all hope and allow him to die. Q.8 The care plan states that your patient is to have a shower every day at the family¶s request. You are helping her get out of bed and she states, ³I don¶t think I can shower today´. You also note that she is very short of breath.
y y
What is the appropriate response to this situation? (50 words) What would your input be when the family arrived? (50 words)
Ans.8 (a). The most appropriate response to a patient who has been requested to be given bath every day, would be give her a sponge bath. This would take care of the family¶s request; also keep the patient¶s wish of taking a complete bath. Even medically this would be appropriate as she is having very short breath so a full bath might make her breathless. (b) On arrival of the patient¶s family I would inform them that the patient was not feeling well and was having very short breath so as to keep her wish and also avoid breathlessness and further complications I have given her a sponge bath so that the family¶s request is also taken care of.
Q.9 Consider the following and LIST strategies you could use to implement to assist the client (150 words)
y y y y y y y
Abdominal bloating and discomfort Moist gurgling respirations Reddened sacrum Dysphagia Dysphasia Fatigue Abdominal bloating and discomfort Bloating is not a disease by itself. It is more of an indication of some other serious underlying medical condition related to digestive disorders such as indigestion. It most often occurs in the small intestine rather than the stomach, as most people believe. And the most common cause is irregular digestion that produces gas at a higher rate than normal. Some of the causes of bloated stomach are; eating too fast, swallowing air, eating food too fast, lactose intolerance or certain food
intolerances. A tablet of antacid might help relieve the patient from the discomfort.
y
Moist gurgling respirations
While breathing, which may be loud; breathing that is irregular and shallow; decreased number of breaths per minute; breathing that alternates between rapid and slow Breathing may be easier if the patient's body is turned to the side and pillows are placed beneath the head and behind the back. Although labored breathing can sound very distressing to the caregiver, gurgling and rattling sounds do not cause discomfort to the patient. An external source of oxygen may benefit some patients. If the patient is able to swallow, ice chips also may help. In addition, a cool mist humidifier may help make the patient's breathing more comfortable.
y
Reddened sacrum
Apply some cooling lotion which will moisturize and hydrate the skin. Also confirm whether its having allergic symtopms. Give medications accordingly.
y
Dysphagia
It can be difficult to achieve a complete cure for high dysphagia because the underlying neurological problems cannot usually be corrected using medication or surgery. Dilation is a widely used technique in cases of obstruction. It involves placing a small balloon inside your oesophagus. The balloon is inflated, which gradually widens your oesophagus, and then the balloon is deflated and removed.
y
Dysphasia
Speech therapy can be used effectively to improve their communication. Using techniques like talking slowly and repeating things, using gestures or drawings and avoiding noisy areas can be great help while dealing with dysphasia.
y
Fatigue One should perform a complete physical examination, paying special attention to your heart, lymph nodes, thyroid, and nervous system.Tests that may be
performed include the following: y y y Blood tests to check for anemia, diabetes, and possible infection. Thyroid, kidney, and liver function tests Urinalysis
Q.10 Describe ways that you as an enrolled nurse within your scope of practice can include the family/carer in assisting to maintain a supportive environment (100 words)
Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting. The ways in which family can provide a supportive environment is through (a)Giving respect and dignity (b) Information sharing (c) Participation (d)Collaboration Family practice is a medical specialty. Although the principles of familycentered care are particularly suited to the practice of family medicine, they
transcend and cross medical specialties. Health professionals in all disciplines can practice family-centered care. (IPFCC)
Q.11 Describe how you would respond to the following questions/requests for information
y
Why is he continuing to have pain medication when he is barely conscious? (50 words)
y y
Why does her breathing sound so bad? (50 words) How much longer will this go on for? (50 words)
Ans.11 (a) The patient though unconscious but needs to be given pain medication so that once he gets conscious he is relieved of the pain. Moreover, pain medication is also given so as to heal the ailments by relaxing the muscles or the injury so that the patient gains consciousness soon. (b) The patient is having problem in breathing since she is not able to inhale oxygen problem due to obstructions in her respiratory system. It is nothing to worry much, because we are going to give oxygen mask which will improve her breathing. (c) We have given proper medications and taking care of other symptoms, as soon as the medicines work, the patient will feel much better. At present everything is under control and the patient is out of danger.
Q.12 Your client is close to death and you have to document in the file your care. Using the FACTUAL acronym how would you document? (200 words)
FACTUAL :- Focused on the client Accurate Complete Timely Understandable Always objective
Legible y y y y y y y Respirations 8 and moist Pain score 7 after administration of analgesia Patient motionless, groans on movement when turned Bowels not opened for 4 days Oral intake ± 150 ml in last 24 hours Urine output ± zero Family asking questions about condition
Ans-12. The patient had been admitted 7days back. The treatment was provided to the patient without any loss of time. Timely medications were given and complete care was being taken of him. As on the final day the following observations have been made. Respiration of the patient was 8 and moist. Oxygen was being given to the patient. After the administration of analgesia the pain score recorded was 7. It was being observed from past few days that the patient was motionless, whenever he was moved, he groaned with pain. It was recorded that he did not have bowel for past 4 days. The oral intake recorded for the patient was 150ml in last 24 hours. For past few days urine output recorded was zero. Family has been very supportive and had been frequently asking questions regarding the progress in the improvement of the health of the patient.
Q.13 LIST nursing actions that can assist in the client/family family after the death of the client (50 words)
Ans.13 After the patient has passed away, there is no need to hurry with arrangements. Family members and caregivers may wish to sit with the patient, talk, or pray. When the family is ready, the following steps can be taken.
y
Place the body on its back with one pillow under the head. If necessary, caregivers or family members may wish to put the patient's dentures or other artificial parts in place.
y
Contact the appropriate authorities in accordance with local regulations. If the patient has requested not to be resuscitated through a Do-Not-Resuscitate (DNR) order or other mechanism, do not call 911.
y y y
Contact the patient's doctor and funeral home. When the patient's family is ready, call other family members, friends, and clergy. Provide or obtain emotional support for family members and friends to cope with their loss.
Q.14 While doing Mary B¶s mouth care, she says to you that she feels that although she is having a lot of regular pain relief that she does not feel that she is getting the same level of relief. What actions would you take and how would you document this? (50+50 words)
Ans.14 I would first take down the whole history of the patient as to from when she is having the pain. The amount of medicine which was prescribed to her and the percentage of relief she was experiencing before. I would then prescribe a pain killer with a higher dose or might increase the dose of the medicine which was taking. While documenting the patient¶s case, I would mention the patient¶s past history of pain and ailment. Also would add the previous dosage of medicine which was taking and also the number of days she was on medication. After which as an advice I would add my prescription of the increase in the dosage of her present medicine or the change is medicine to a higher dosage one.
Q.15. Mr Jones care plan states that he must have 1000mls of fluid per day, his condition has deteriorated and his gag reflex is minimal. What actions would you take and how would you document these actions? (50+50 words)
Ans.15 The pharyngeal reflex or gag reflex is a reflex contraction of the back of the throat,
evoked by touching the soft palate. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking. I would give the fluid as a drip to Mr. Jones so that he could have his requisite 1000mls of fluid without actually drinking it.
In patient¶s record, I would document about the patients symptom of gag reflex and the consequences which could follow it. I would add my advice of giving the patient drip of fluid rather than oral drinking so that his requisite 1000mls of fluid without actually drinking it is fulfilled.
Q.16.Discuss ways in which you could identify ineffective coping in yourself and what you could do to care for yourself (150 words). Ans.16 Ineffective coping is an applicable nursing diagnosis evident in several of the patients. Coping mechanisms are usually conscious methods that the individual uses to overcome a problem or stressor. They are learned adaptive or maladaptive responses to anxiety based of problem solving, they may lead to changed behavior Inappropriate coping mechanisms can be changed because the patient is usually aware of using them. I could take care of ineffective coping by Talking out problems with others Expressing emotion²yelling, crying, laughing Seeking comfort from friends, food, treasured objects, smoking, or mind-altering substances
Using humor to relieve tension in a way that avoids fully acknowledging a difficult situation Exercising Avoidance of upsetting situation or confrontation Using step-by-step approaches to resolution of the problem. The nurse¶s psychosocial assessment of the patient and family should focus on the effect of the illness rather than the physical symptoms.
REFERENCE http://www.azcentral.com/health/wellness/articles/0824ross-stages-ON.html http://www.academon.com/Term-Paper-The-Comfort-Theory-in-Nursing/113113,2009 Holistic Nursing Practice - Featured Journal,July/August 2005,Volume 19 Number 4,Pages 147 ± 154 American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1443-1464, (2005) © 2005 American Thoracic Societydoi: 10.1164/rccm.2504001 http://www.essaysample.com/essay/002469.html http://www.ipfcc.org/faq.html Dellasega, D., & Zerbe, T. M. (2002). Caregivers of frail rural older adults: Effects of an advanced practice nursing intervention. Journal of Gerontology, 28(10). Gorman, L.M., Raines, M. L., Sultan, D.F. (2002). Psychosocial Nursing for General patient Care 2nd Ed. F.A. Davis Company: Philadelphia.) p.13 and 16 A voice for nursing education, Kaiser Permanente, 1948 to 1991 : oral history transcript / 2004 Advanced Emergency Nursing Journal July/September 2010 Volume 32 Number 3
