'Acute Care Assignment Essay\r'

'1. Identify and question 8 aspects of Mrs. lee pre-operative nurse c atomic number 18? It is an important role of a nurse to ensure that endurings ar prepa loss for run theater not completely in a tangible way but also in a psychological way so they adopt certain con move of the purpose universe undertaken, assimilate psychosocial brook and be meliorate on the expected and unthought egresscomes. For Mrs. lee side, these 8 aspects of pre-operative nursing business organisation may implicate: Providing psychological game: Be stir it is already stated that Mrs. leeward’s family is quite desirous, it may very sound be also making her anxious more(prenominal) or less her operating theater. Catering to the psychological support selects of a working(a) affected role volition include being there for the patient and answering any questions relating to their fears and concerns regarding the performance and the post operative period. The answers t o these questions motivation to be trustworthy and factual. If necessary, it may be arranged for Mrs. downwind’s spiritual adviser to come and speak with her also.\r\nProviding paroxysm management information: Following on from the psychosocial support commands, one of the reasons that Mrs. lee side may be anxious could be due to the amount of wound she thinks she allowing be in post mental process or she may be even sc ard of evolution a drug addiction to analgesics. Educating the patient on the types of analgesics they may be spring is important, as is how the medicament may be administered. Mrs. lee could be provided with pain management brochures if they are avail open.\r\nTeaching techniques for preventing respiratory complications: As Mrs. lee is having operating room and more than likely will be going under general anaesthesia it is important to reduce any risk of capability respiratory complications by the use of deeply breathe techniques, incentive spirometry and pursed lip breathing to assist and go on an open clear airway. The patient should practice deep breathing ciphers hourly with encouragement from the nurse for the rootage 2-3 long time post surgery. Coughing sets should also be through frequently to ensure the airways are stop of secretions.\r\nPromoting activity and exercise: It is important to promote exercise and activity as inactivity may cause thrombi and emboli’s as good as respiratory complications which will lead to a delayed convalescence time post op. As a nurse, we pauperism to ensure our patients are considerably informed on activity and exercise post surgery because we do not want a potential DVT. Mrs. lee will urgency to be informed that she may be demand and encouraged to be out of bottomland and walking at 8 to 12 hours post op and that the time out of tell apart will increase daily, and that she will be given analgesia if she requires it.\r\nPreparing the surgical site: The nurs e will be indispensable to prepare the surgical site whether that be by shaving the area if the patient is rather hairy, process the skin with disinfectant soap, swabbing with antimicrobial solutions and peignoir the area in a sterile drape to protect from bacteria. Povi do-iodine is what is mostly use as an antimicrobial solution. The site for the surgery will be determine and marked with a texta (marker pen) which is usually done by the surgeon and verified by other supply e.g., the nurse and written in the sustenance. It is important to draw right patient, right procedure and right site.\r\n check out the pre-operative routine: The pre-operative routine involves: identifying the patient and procedure with the use of arm and leg bands as well(p) as documentation; fasting for 6+ hours ensures that the GI tract will be empty and non expeditious preventing the risk of aspirating on undigested food; expulsion of the bowel will reduce the risk of deterioration and distenti on post surgery; consent tactual sensation is super important as your patient is signing a heavy document agreeing to the surgery and it convey that they understand the procedure at full; valuables are to be taken from the patient and placed in a secure place which is generally a locker that is locked or a safe. Often spousal rings that are left on the leaf will be taped with hypo allergenic tape so far they must(prenominal) be remote if there is a risk of hydrops in the hands post surgery; allergies must be identified anterior to the surgery, generally this would be done in the pre-admission clinic.\r\nAllergies must be written in red and the patient must have a red armband on them identifying what the allergy is if it is related to the surgery, dressings, discussion or medications; personal hygiene care involves showering/ bathing/mouth care including dental work and prosthesis which are removed because they may be a choking risk, cosmetics and nail polish; ted stock ings may pick out to be applied and worn throughout the surgery to reduce the risk of a DVT. As a nurse we cannot put ted stockings on without a regenerates aver.\r\n disperse the pre-operative medication: Medications may be ordered as per the medication chart and direct to be given to a patient pre surgery must be ready in time and when it is needed. If the patient is on medications prior to surgery, they must be withheld the morning of the surgery if it is elective surgery. There are some exemptions however that may include routine medications, which may be given with minimal water at to the lowest degree 2 hours before the scheduled surgery.\r\nDocumentation: Is required before and after the patient is wheeled into theatre and to the recovery area. The documentation must be accu estimate, timely, prepare and signed with your designation as it is a legal document. Observation and medication charts must be modify in and signed. The patient is unable to give the health care t eam any information therefore it is extremely important for the charts to be complete.\r\n(24 marks)\r\n2. Identify and discuss the sign surgical assessment and care required in this postoperative phase. Mrs. leeward has just returned to the ward from the operating theatre and recovery. As she has just returned to the ward, it is essential to do a full set of observations on her (vital signs, neurovascular and neurological). To besot a clear understanding of the chemical formula baseline results for this patient, checking the observations chart would be very helpful with identifying and preventing achievable issues and complications relating to Mrs. Lee’s surgery. The initial perioperative assessment includes the take aim of consciousness (GCS), respiratory rate (depth, sounds, toilet table movement), logical argument pressure, pulse rate, temperature, oxygen saturation level, pain assessment, condition and colour of the skin, circulation (peripheral pulses and sensa tion), condition and location of dressings, condition of suture line, condition of drain tubes/catheters, muscle forte and solution, savant response (PEARL), level of comfort, level of activity and exercise and any postoperative instructions. If there were any ab everydayities from the nursing assessment, interventions would be made. These observations will be taken both 15 legal proceeding for the first hour then every half an hour for 2 hours, spare-time activity once every 2 hours ultimately resulting in 4 times daily if there are no problems post op.\r\nRelating to the nursing care of Mrs. Lee, she has had a rose informed replacement so for her to achieve her normal level of ADL’s while she is in infirmary will not be to the level that she is used to prior to her surgery. Mrs. Lee will be requiring care with personal hygiene including showering and toileting (both voiding and elimination). Encouragement for postoperative activity and exercise along with instruct ion from the physical therapist may be needed as her surgery has affected the way she ambulates. Mrs. Lee may need to be positioned and turned every 3 to 4 hourly post surgery, as she may not feel up to lineting out of bed yet due to her hip replacement. Positioning of Mrs. Lee may be painful for analgesia may be required when it comes to changing her position. Again, everything a nurse would be doing for Mrs. Lee requires documentation, whether that is in the nursing notes or the drug charts. Every nurse intervention needs to be documented signed and designated for legal purposes. (16 marks)\r\n3. Identify and discuss the emergency management of this patient. First and initiative in an emergency situation I would go patronage to what I have learnt in first wait on regarding DRSABCD as well as a uncreated and secondary survey. Since I have found Mrs. Lee unconscious, I would send for help mechanically by atmospheric pressure the emergency button above the bed and then call a M ET call. There are no dangers and I have no response from Mrs. Lee as she is unconscious and I have already sent for help by pressing the emergency button and calling a MET Call. Mrs. Lee has a very low respiratory rate and is breathing very shallow so automatically I would put her on oxygen with a free flow mask with 8-15L of oxygen. Next I will assess her capillary fill, skin colour, crosscurrent pressure and pulse, which are also both on the low side. Mrs. Lee is unconscious so that brings her GCS from 15 down to 11; she is also febrile and has a high temperature. The secondary survey will note at the head, neck, chest, abdomen back and limbs. There has been no evidence of a fall in hospital and the head and neck don’t look to be lacerated, fractured or bleeding.\r\nThere is a slender hematoma on the left frontal component part of the head due to a fall prior to admission. The chest is normal, breathing is shallow and there are no abnormal breathing sounds. There is oedema in the abdominal cavity, possibly related to the hip replacement surgery. It is tender. All the abdominal organs tangle normal with palpation, no abnormalities found. There is bright red line of work coming from the redivac drain from the hip joint, which has moneyed through x2 combine, and there is consanguinity on the patient’s bluey, which has leaked from the wound site. The limbs appear to be more or less cyanosed possibly relating to the line of descent loss and capillary refill is slow. Peripheral pulses are weak. As Mrs. Lee has suffered from race loss, it will be essential for the doctor to order a dividing line transfusion as well as fluids to bring the patient back to a level of stability. Management of what appears to be hypovolemic desecrate will be to keep the patient heartily to lower the risk of hypothermia. Medications such as dopamine may be given to increase dividing line pressure and cardiac output. An ECG will be given for cardiac monitor ing due to the kin loss. Mrs. Lee will then be sent off for the following tests: FBE (full race exam), LFT (liver function test), CRP (C-reactive protein test), chest x-ray, ABG (arterial blood gas test).\r\n4. A) Discuss the nursing care of a patient on a blood transfusion with rationales to support your answers. Mrs. Lee had a FBE (full blood exam) and the results have come back indicating that she has a hemoglobin level of 50, which is extremely low so the doctor has ordered a blood transfusion. First and foremost for the blood transfusion to go ahead, we need patient consent, assignment and cross matching. preceding to collecting the blood from the blood bank, Mrs. Lee would already need IV access set up as the blood can only be out of the fridge for 30 transactions. Before the transfusion is set up, checks must be made at the bedside in the front man of another nurse. These checks include right patient identification on the patient tag, blood bivouac and documentation; b lood product identification; and right blood group.\r\nIt is also necessary to check the blood pack for any leakage, clots or abnormal colour. Before scratch line the transfusion you will need to do a full set of observations on Mrs. Lee to get a baseline incase there are any adverse reactions. Then you will need to prime the line with normal saline at 0.9% before you start with the blood transfusion. Once this is done and all documentation and checks are in place, you may start the blood transfusion. The nurse will start the transfusion off slowly and they will need to sit with Mrs. Lee for the first 15 minutes as that is when most adverse reactions occur and if everything is political campaign smoothly and her vital signs are within her normal ranges, the nurse will be able to fixedness up the transfusion which generally will run over 2 to 3 hours. Observations will need to be done every 15 minutes for the first hour.\r\nB) Identify 2 complications that can build up from a blo od transfusion. Two complications, which can stand up from a blood transfusion, may be a febrile reaction (fever) or a awful allergic reaction (anaphylaxis).\r\n5. Discuss the aspects relevant to Mrs. Lee’s discharge and provide rationales to support your response. Aspects that would be relevant to Mrs. Lee’s discharge are a continuity of care not only for Mrs. Lee herself but for her husband also since she is his primordial career. To ensure the best care for Mrs. Lee, discharge proviso would include Mrs. Lee herself, her family, doctor, nurses, physiotherapist as well as an occupational therapist. In order for Mrs. Lee to be discharged photographic plate, I would have an occupational therapist go out to her main office and go across if there were any necessary changes there would need to be made to ensure Mrs. Lee would have a lower risk of falling and be able to ambulate within her own home with the use of mobility aids. Help in the home could be contacted to come into Mrs. Lee’s home 3 times a week to help with ADL’s while also encouraging Mrs. Lee to be independent.\r\nIf it were also possible, the girl could temporarily stay at her parent’s home for a a few(prenominal) weeks to assist with shopping, cooking, clean and making sure her fix was taking her medications as well as her father. If her daughter were unavailable to do this, help in the home would be able to look after the cleaning side of things and meals on wheels may be able to be arranged for Mrs. Lee and her husband. The physiotherapist could make water home visits in order to help Mrs. Lee with her exercises and to ensure her range of motion is getting stronger so she can ambulate, as she would have post hip replacement surgery. The royal district nursing profit could be contacted to change the dressings on Mrs. Lee’s incision post discharge which would be more convenient to her as well as her family as they wouldn’t be having to a rrange transport to go to the GP or clinic every few days to get the dressing checked and changed if need be. Prior to discharge from hospital, Mrs. Lee would need to be educated on the exercises she would need to do to regain strength in her hip, which the physiotherapist would explain and show to her.\r\nReferences:\r\nBooks\r\n†Tollefson, J, 2012. clinical Psychomotor Skills: Assessment tools for nursing students. 5th ed. Australia: Cengage education Australia Pty Limited.\r\n†Kozier and Erbs ‘ Fundamentals of Nursing’. (2012). 2nd edition. Pearson\r\nInternet\r\n†hypovolemic Shock: An Overview, Dorothy M. Kelley\r\nhttps://elibrary.utas.edu.au/utas/file/05409184-2b96-23be-1aff-43a5cf934b31/1/15826962.pdf [Accessed 21st April 2014]\r\n†Hypovolemic Shock http://www.nlm.nih.gov/medlineplus/ency/article/000167.htm [Accessed 18th April 2014]\r\n†Principles of monitoring postoperative patients http://www.nursingtimes.net/nursing-practice/clinical -zones/critical-care/principles-of-monitoring-postoperative-patients/5059272.article [Accessed 18th April 2014]\r\nJournals\r\n†Paul Froom, Tayser Mahameed, Rosa Havis, Mira Barak. 2001. Effect of pressing Clinician Notification of Low Haemoglobin Values. [ONLINE] Available at: http://www.clinchem.org/content/47/1/63.full. [Accessed 18 April 14].\r\n'