Showing posts with label Nursing Skills. Show all posts
Showing posts with label Nursing Skills. Show all posts

Infection control : Principles of universal infection control precautions

NURSING PROBLEM

Problem: Health care personnel at risk of virus infection from blood and direct and indirect patient contact.

Goal: Staff will get an infection.

Principles of preventive infection control

Universal precautions for infection control (UICP) procedures, which apply to all patients, transfer of blood-borne diseases reduced - such as Human Immunodeficiency Virus (HIV) or hepatitis B or C or other health worker or patient. As it is impossible to know which patients may be infected without the blood test is recommended that all patients should be considered as a potential risk (Research 1997). The most likely mode of transmission is through an acute injury or from blood or body fluids splash directly on mucous membranes or eyes, and therefore, routine measures to protect staff and patients. UICP application of patient care will be the spread of MRSA before they are confirmed by laboratory results.

The measures for infection control are:

● Prevention of blood or fluids to come into contact with broken

● skin or mucous membranes

● reduce the blood or body fluid contact with intact skin

● avoid injury from sharp objects

● protection of workers against hepatitis B and C

● Prevention of contaminated items from patients receiving (Ayliffe et al. 1999).

Current measures

There are several common measures should always be taken:

● It is your own responsibility for vaccination against hepatitis B is to make sure that your continuously updated

● Hand washing is essential before, between and after patient contact opportunities (Figure 3.2).

● Skin: broken skin should be covered with a waterproof dressing, which acts as a barrier to micro-organisms, steer clear of persistent procedures as unrelieved skin wounds.

● Gloves be supposed to worn at some point in procedures that transmit risk of infection throughout blood or fluid (see below).

● Protective clothing such as aprons to wear to reduce pollution (see below).

● nasal mucous membranes of eyes, mouth and must be protected against splashes of blood or body fluids, such as safety goggles during tracheal suction can be used. If contamination of water with saline and following steps 4-6 below.

● know the procedure for processing of needle stick injury. Concentrate and engage in the process to prevent from happening.

TIP!

Slim's really a needle stick injury to happen, or steps leading to infection, but make sure you know, assuming that it happens. Do not be tempted to have to deal with later because you are busy. Trust is the responsibility of specialists in their Trust, which will be able to reduce infection risk assessed and appropriate advice and support (UK health departments 1998), provided to allow.

Disposal of sharps

● Sharps should be used and disposed of very carefully:

● Take personal responsibility for waste with sharp, you are using

● immediately after use

● Never resheath needle

● be sharp as near as possible using

● crowded containers that are not sharp (it should be more than two-thirds full).

Measures in case of acute injury

1st Encourage wound to bleed, suck.

2nd Wash the area with warm water and soap or an antiseptic completely.

3rd Cover with a waterproof dressing.

4th If you notice a patient is known.

5th Immediately notify the health department at work if possible, or slot (eg emergency) per hour. This allows you to post-exposure prophylaxis of HIV and hepatitis B get

6th Inform your supervisor and document the incident (Department of Health 1998).

Spilled blood or fluid

Blood stains require treatment or hypochlorite solutions (еg Domestos οr Milton) οr sodium dichloroisocyanurates (NaDCC), whіch іs chlorine-free (еg, rule οr Haz Tabs) before the area is cleared by writing the local infection control protocols (Ministry of Health of Great Britain 1998).

Intervention

● Wipe leakage of body fluids immediately.

● Wear gloves and apron, or livestock to store paper towels, or if the ground is suitable, covered with grains NaDCC.

● Allow a few minutes.

● Clear towel or granules and dispose of biological waste bag (usually yellow).

● Created with sodium hypochlorite.


Waste

Use the color codes for the household and clinical waste. The common color coding in the UK:

● black or clear garbage bags for household and family

● yellow bags for medical waste, including human or animal tissue, feces, blood or body fluids or pharmaceutical glass, cans and sharp objects are disposed separately.

● waste bags and containers be labeled showing clinical area where the search originated, if necessary.

Laundry

It should also be bagged in bags color-coded:

● white bags, used and dirty laundry

● red outer bag to freedom of bleeding and infectious, potentially dangerous laundry staff notice.

TIP!
When cleaning up after the procedure, or need to make sure that sharp objects were deleted accidentally in linen - it causes additional risks to personnel laundry.

Infection control : Preventing transmission of infection

Patients аt risk οf infection frοm thеir resident micro-organisms( Endogenous infection ), or an exterior micro-organisms (exogenous infection), as a result of transmission from infected patients carriers or devices during their treatment. Health workers' Hand is also known that the main source of transmission, and efforts to cross-infection between patients and staff to avoid During the treatment should be (Department of Health 2001).
A recent government report (Mayor 2000) showed that if as many as 5,000 patients die in ospital-acquired infections (HAI) every year. HAI full impact can not be fully accounted for because this type of infection hidden costs

° longer hospitalization pain and discomfort
° increased pain and discomfort
° additional loss of earnings
° Increased consumption of drugs with potential side effects
° extended disruption to the patient’s lifestyle and family
° lengthened recovery time.

identifiable costs for health trust include the use of more equipment such as protective clothing, and more time processing The length of the adoption and use of specialized services, such as micro-biology and infection control personnel (Ayliffe et al 1999) ..

Nurses should ensure that best practices for infection control saved, it is always safe and promote income The interests and welfare of the patient (UKCC 1992), pro-tecting their patients from acquiring infections from the possible source. A common problem in hospitals, Methicillin-distribution Resistant Staphylococcus aureus (MRSA), resistant bacteria Most of the known antibiotics, which is a virulent infection tions in susceptible patients. This is a worldwide problem, and This makes it much more difficult to determine whether different bacteria developed pressures over time, and otherwise appear in different places (Ayliffe et al. 1999). Principles of infection prevention important to deal with known infections, prevention is always better than cure.

To be able to spread infection from one person to avoid Another "chain infections" (May 2001) to be broken (Fig. 3.1). Appropriate measures in each stage of the chain reduce the risk of spreading infection.





Observations : NURSING PROBLEM - Blood glucose levels

Blood glucose levels have an effect on the ability of brains in general functioning. Causes contrast, but include:

° poorly controlled diabetes mellitus
° Malnutrition
° physiological anxiety
° kidney, liver or pancreatic disease
° endocrine disorder.

Several patient presenting with a distorted level of consciousness should have his blood sugar monitor to stay out hypoglycemia.

Intervention: Measuring blood sugar

Mr. Ellis measuring blood glucose every x hours.
EQUIPMENT
° Glucose meter (if available).
° Not reusable lancing device or lancets.
Mesh
° swab. / Cotton ball.
° Not reusable injection .. tray.
° Blood Glucose Strips Analysis.
° Not reusable gloves.
° Pen and documentation sheets.

PROCEDURE

° Prepare equipment.

• Place the procedure to Mr. Ellis.

• Ask Mr. Ellis for his hands to wash or to help him to do so.

• Wash your hands and wearing protective gloves.

° Select the proper course of action for the finger. Sites should be rotated. Significantly, an insulin or glucose combination is not going on the side chosen for obtaining the lecture while this may be a misleading result.

• Check the expiration date of the test strips and prepare glucose meter measurements according to the manufacturer's instructions.

• Ask Mr. Ellis to hand hold down to get the circulation to the fingers. Using the right tool, prick the side of his finger.

• Place the lancet in the injection tray for disposal.

° right of the drop of blood to the test strip, make sure the blood drop on the strip rather than to smear it on.

° pursue the instructions of the manufacturer with an eye on how long to leave the blood on the strip, and using the meter.

Mr. Ellis Assist

° The gentle pressure on the site, through the cotton or gauze to stop the bleeding and prevent bruising.

• Read the results of the meter when the meter that the result is to be held, or, using a blue-collar technique, the color of the strip to match that on the container after the designated time .

• Set of sharp objects, take gloves and wash hands.

• Document observations inform Mr. Ellis of the implication of reading and adapting to a senior colleague of the result date.

TIP!
Do not use alcohol swabs to clean the patient's finger as it changes the end result and can cause cracking of the skin of the patient.

ALERT!
And through one meter, it is important to check for accurateness before use. Mistaken readings may lead to improper management, which can be incurable. It is suggested that quality checks are made every day and the first new batch of test strips.

Observations : NURSING PROBLEM - Assessing level of consciousness

The GlasgowComaScale(Figure 2.1), used in concurrence with vital signs, a patient is repeatedly used to appraise the level of perception. The scale uses three indicators of consciousness: eye opening, motor response and verbal response. A score is awarded for routine patients in each area.

Figure 2.1 Map of conscious level (copy of this kind is, the Royal Free Hospital NHS Trust). 

The level of consciousness can be assessed by a variety of methods. Explain to the patient, whether consciously or unconsciously, with frequent observations are needed, both during the day and night. It is generally believed that patients remain unaware of the voices, even if they can not act in response, and if explanations are not specified, they can become anxious and sad. 

All comments must be included in the local documentation.


INTERVENTION: assess the level of awareness
Mr. Ellis assess the level of consciousness every few minutes.



EQUIPMENT 
•  A pen torch.
• Table Glasgow Coma Scale.
• Equipment for the assessment of vital signs, as detailed above.



TIP!
Before the critical-evaluation of a patient of consciousness, other sub-carrier to try him for the prescription of sedation or conditions, paralysis, paraplegia, language barriers or degrees of deafness, because it affects its ability to respond.



Share price in the evaluation of the response reveals

This reaction is assessed against the following criteria:


"Open your eyes impulsively," open your eyes to the lack of stimulation of the observer, such as voice or touch. This can be seen from space. If the patient is unable to eye because of swelling, nerve palsy or the presence of a link must be documented eye open. If the eyes are open and not blinking shows, close your eyes and observe if they open of your own accord.


"Eyes open to oral stimuli: If no spontaneous eye opening, to converse to the patient and observe the reaction to begin the fight against the patient and greets him by name, without touching If no response, go to the woman for him ask .. eyes. If still no response, Raise Your Voice and repeat the instruction.


"Eyes open to pain": If no response to voice, touch the patient's hand or shoulder or shake. If it does not cause a reaction, a slight pressure on the trapezius (muscle at the base of the neck to the top of the shoulder) apply, rub the breastbone and apply a light pressure on the superciliary region. This technique and others are discussed in more detail (page 38, see also Lowry, 1998).


ALERT! 
See instructions for "pain response" on the testing of patient response to pain. This procedure must be used with caution to avoid injury.


No: the patient to open his eyes. This may indicate a lesion of the oculomotor nerve or brain stem.

Procedure for assessing verbal response

Thіs response іs assessed according tο thе following criteria:

"Makes the thoughtful discourse: if the patient is able to accurately describe the details of time, the person and the place where he is said to have directed (Jennett and Teasdale, 1974; Auck and Crawford, 1998).

"Is this confusing the speech at this level the patient's ability to sentences (it can be a good attention span and be able to participate in a conversation) form, but is unable to questions that show that it is oriented to meet time, place or person (Auck and Crawford, 1998).

"Inappropriate words: This category may be appropriate if the patient can not speak, if there is a tendency to words rather than sentences, when the answers are coming the following painful stimulation, when words or phrases are repeated or when there is a steady loss of attention.


TIP! 
A patient whose first language is not English may return to his mother seem so confused. An interpreter may be of assistance.


"Incomprehensible sounds ": the patient is responding to stimuli or spontaneously sounds instead of words used.

None: no sounds at all are made independent of the stimuli. If this is due to the presence of an endotracheal tube or tracheostomy should be noted.

Procedure tο assess motor response


Thіs response іs assessed according tο thе following criteria:

ALERT!
Using a painful stimulus іs highly contentious when determining a patient’s neurological status аnd should only be used wіth great caution (Lowry 1998).


‘Obeys commands’: thе patient іs able tο obey simple commands, such as ‘Lift up your right arm’.

‘Localizes tο pain’: if thе patient іs unable tο obey simple commands, a central pain stimulus should be applied briefly. ‘Localizing tο pain’ іs said tο occur when a patient raises hіs hand tο at least chin level, when thе painful stimulus іs above thаt level, e.g. trapezius pinch or supraorbital ridge pressure, or when he tries tο remove thе painful stimulus.


Suggested techniques for applying central painful stimuli аre:

peak pressure eyebrows by placing the hand on the forehead of the patient, using the palm of thumb on the supraorbital point (the lean ridge on the apex of the eye). Steadily increase the pressure until a response or a maximum pressure. Do not apply pressure or prolonged use today because it could lead to tissue damage. This site may be used as an injury or orbital facial fractures or skull are present (Lowry, 1998, Shah, 1999) pinch of Keystone:. Bare shoulder and gently squeezing the trapezius muscle. This muscle is located at the base of the neck, shoulder. Gradually increase the pressure until a response is generated or the maximum pressure. Do not apply pressure or use extended several times, as this can cause tissue damage at the end (Lowry, 1998, Shah 1999).


Comment 
Rub the sternum or by applying pressure to the nail bed is not recommended as it may cause permanent damage to tissues (Lowry, 1998) the cause.


Normal flexion to pain "turns up arms at the elbows, wrists, without rotation, in response to pain (Figure 2.2.1) (Shah, 1999).


"Abnormal flexion to pain" fold out the arms from the elbows, wrists bent posture due to spasticity, the pain response (Figure 2.2.2) (Shah, 1999).
"Extends to pain" extending the arms at the elbows, withdrawal, after painful stimulus (Figure 2.2.3) (Shah, 1999).



"No comment" No response is observed after the application of
painful stimuli.


Pupillary size and reaction procedure to assess

If intra-cranial pressure іs rising within thе skull, thе optic nerve may be compressed, interfering wіth thе pupil’s normal reaction tο light.

To assess the size of the pupil of the patient, observing the size of each student. Refer to map patterns of observation and write the correct format for each eye. This observation should be made before the light is applied directly to the eyes (see below).

To evaluate the response of students, dim the lights in the room, the patient gradually eyelid open and light the torch of the pupil of patient and further than, look right for a change in pupil size ( Lowry, 1998). Repeat on the other eye. Record of each student something strong, slow to respond to the observation grid by local documentation.

Procedure for motor function / branch to assess the movement of the upper end for the conscious patient, the patient holds the hands one after the other and ask him to get away or you pull him, as you apply some resistance. Assess the strength and equality movement to determine whether each side is lower than the other. Document your observations using the categories in Table 2.2


For the unconscious patient's previous responses to hurting stimuli should be documented (see Table 2.2).

Procedure for motor function / branch to assess the movement of the lower


For the conscious patient, rather than resistance to the knees of the patient and him on his knees to ask. Assess the strength and equality movement. Record your observations using the categories listed in Table 2.2. For the unconscious patient's previous responses to pain are recorded (see Table 2.2). Record your observations using the categories below. You'll find that on the Observation Chart(Figure2.1) spastic flexion is not integrated in the listing to the legs, because the bending of the leg pain is a regular reaction. In a spontaneous movement of the extremities in an unconscious patient should be observed, although not in response to external stimuli.



Vital Signs 
It is important that the patient's temperature, blood pressure, pulse and respiration are also included because changes in vital signs may indicate a compression or damage in the brain stem.

the quality is good practice eneurologi-TIP! Nurse of the transfer is made by the nurse for a number of comments the nurse present at the following CAL consistency of results for the transfer.

Observations : NURSING PROBLEM - Body temperature

Core temperature is controlled by the hypothalamus. Normally, the body temperature remains relatively constant, fluctuating only 0.6 ° C in body temperature averaging 36 ° C to 38 ° C (Perry and Potter, 1998). The temperature is affected by:

• Infection
• Exposure to prolonged heat or cold
° burns
• Changing white blood cells
• Some drugs
• Comments on blood products
° exercise
• Changes hormonal
° Damage to the upper hypothalamus / brain.

Body temperature can be measured at different sites. Intensive Care, body temperature is controlled via the pulmonary artery, esophagus and bladder. It is further common for axillary, oral, , tympanic or rectal are used to inexact the base body. There are disadvantages and advantages for every of these places, but an accurate measurement of body temperature is essential that the road is used correctly gain.


TERMINOLOGY 
Fever, hyperpyrexia stemperature above the normal value for high temperatures above 40 ° C.
Hypothermic temperatures below 34.4 ° C fever free without fever


The normal average temperature varies with the measurement site.


The average cost for adults are: 


Oral temperature: 37 ° C
• Site rectal: 37.5 ° C
• Site axillary: 36.5 ° C
Road ° the eardrum: from 36.8 to 37.9 ° C (Braun et al,1998;Perry and Potter1998).

In the United Kingdom, the mainstream of trusts eliminate mercury thermometers and replace it w/ electronic devices. This reflects concerns about potential releases of mercury, reducing cross-infection from the use of disposable probe covers, and measurements of electronic devices faster than mercury thermometers.

ElectronicThermometers
The recording position of the temperature of a patient with an electronic thermometer is the same as a mercury thermometer for each site. However, the manufacturer must always be followed with respect to the amount of time the probe is still in place and to prepare, enable and cleaning of the unit.

Intervention: taking and recording body temperature

Mr. Ellis record the temperature every few minutes.
Measurement of oral temperature

the site would not be appropriate for Mr. Ellis because of the level of oral hisNote consciousness.altered

BENEFITS oral

• Easy to reach.
° The introduction of the thermometer just above the sublingual artery, which is close to the external carotid artery, changes in the kernel to appear immediately (Watson 1998).

DISADVANTAGES

Readability can be affected by the ingestion of food or liquids, smoking, mouth breathing and oxygen delivery (Braun et al. 1998).

This site is not appropriate if the patient is incapable of the thermometer in the position or when the thermometer may cause injury to keep - for example in the case of oral pain or trauma, confused or unconscious patients, those with history of seizures, and patients with chills. It is also against-indicated for people who need to breathe through the mouth because the air flow, the accuracy of the result (Braun et al. 1998) influence.

Risk of exposure to body fluids.

EQUIPMENT
Mercury thermometer ° / electronic thermometer.
• Coverage disposable (according to hospital policy leading).
° Pen and documentation sheets.
Disinfectants ° to clean the thermometer according to local policy.

PROCEDURE
• Examine and safe use of the site by mouth.
• Make sure that the patient is not hot or cold liquids or foods eaten or smoked in the previous 20 minutes, as this influences the accuracy of measurement (Braun et al. 1998).
• Prepare the equipment.
• Place the procedure to the patient the importance of maintaining the correct position of the thermometer understand.
• Wash your hands.

Glass thermometer:
• Keep the end of the glass thermometer in your fingertips, comprehend the mercury point.
° If the mercury is higher than 35.5 ° C, stirring the mercury touching the wrist down until it is below 35 ° C.
• Provide disposable cover.
• Ask the patient to open his mouth, and place the bulb of the thermometer of money in the pocket sublingual on both sides of the brake under the tongue.
• Ask the patient to the thermometer with mouth closed, which will ensure that the thermometer is in place.
• Leave the thermometer in place for at least 2 minutes (Torrance and Semple, 1998).
• Remove the thermometer, remove the cover and read at eye level.
More Infor patient reading and measuring of the document.
• Report changes to several older colleagues.
• Own thermometer in accordance with local policy.

TIP!
Each patient must be assigned its own glass thermometer or probe cover to avoid cross-contamination. If mercury thermometers are used in your clinical area make sure to distinguish how to clear a spill of mercury, a mercury thermometer at the break.

Measurement of rectal temperature

Reward

° It will be used as the main advantage of this site is that it is safe for use in the insensitive and the patient was moderately accurate. Although rectal body temperature reflects more accurately the axillary site is rarely used, because the measure of the eardrum was found to be cheaper (Stavem et al. 2000) and just as accurate (Cronin and Wallis 2000).

Disadvantages

• Potential painful and uncomfortable for patients.
° Not suitable for patients who underwent rectal surgery or rectal disorder.

Comments

• Risk of exposure to body fluids.
° C. below the site by the oral and tympanic due to changes in core temperature, because it is a cavity and are therefore more heat than other sites (Severine and McKenzie, 1997).

Equipment

° Glass thin rectal mercury thermometer (rectal thermometers are marked with a hint of blue) or electronic thermometer with rectal probe.
• Cover not reusable.
° Water .. soluble lubricant.
° tissues.
° Pen and documentation sheets.
Disinfectants ° to clean the thermometer according to local trust policy.

Procedure

• Examine the relevance of the rectal site (see the pros and cons above).
• Prepare the equipment.
• Place the procedure for the patient.
Characters • curtains around the bed.
• Position the patient on the side, left lateral position, if possible, with knees bent. Keep the body completely covered, ensuring that the anal area can easily be exposed.
• Wash your hands and pertain disposable gloves.

GlassThermometer:
• Keep the end of the glass thermometer in your fingertips, read the mercury level.
° If the mercury is higher than 35.5 ° C, stirring the mercury touching the wrist down until it is below 35 ° C.
• Provide disposable cover.
• Apply the lubricant on a cloth. Dip the tapered ending of the thermometer in the lubricant, up to 5 cm, which reduces the trauma to the rectal mucosa.
° Rendering rectal area. With the non-dominant hand for the customer than the buttocks stabbed to expose the anus.

More Infor patient to take a deep breath, slow down the anal sphincter. When the patient exhales, gently put the thermometer into the rectum two inches towards the navel (Severine & McKenzie year1997). If a conflict, remove the thermometer.
• Keep the thermometer in place for a minimum of 3 minutes (Torrance and Semple, 1998).
• Remove the thermometer, remove the cover and read at eye level.
• Clean the client area of anal lube and / or remove excrement.
• Remove gloves and wash hands.
• Help the patient to replace clothing and a more comfortable position to resume.
Infor read more patient and able to document clearly indicates that the site is used rectally.
• Report changes to several older colleagues.
• Own thermometer in accordance with local policy.

TIP!
Place the thermometer Hold the thermometer to break. - Sudden movement can cause hypothermia is suspected as a low reading thermometer used.

Measurement of axillary temperature

Benefits
• Non-invasive.

Disadvantages
° takes longer to achieve an accurate reading.
• Less accurate than other sites, because: the armpit is not close to several large vessels, skin temperature varies with changes in the environment, and readings will be affected by peripheral vasoconstriction.

Equipment
• Thermometer / glass mercury thermometer.
° Pen and documentation sheets.
Disinfectants ° to clean the thermometer according to local trust policy.

Procedure
• Review or other location can be used (see the pros and cons above).
• Prepare the equipment.
• Place the procedure for the patient.
Characters • curtains around the bed.
Position the patient • in a sitting or lying position. Keep the body completely covered, so axillary area easily accessible.
• Make sure armpit is dry.
• Wash your hands.

Glass thermometer:
• Carry on the end of the glass thermometer in your finger tips, read the mercury level.
° If the mercury is higher than 35.5 ° C, shaking the mercury down by flicking the wrist downward until it is below 35 ° C.
• Insert a thermometer into the center of the armpit patient, patient to put his arm below the thermometer and place the forearms on his chest to keep the thermometer in place.
• Keep the thermometer in place for at least 5 minutes (Torrance and Semple, 1998).
• Remove the thermometer and read at eye level.
• Help the patient to replace clothing and a more comfortable position to resume.
• Wash your hands.
Infor read more patient and able to document clearly indicates that the site is used axillary.
• Report changes in senior colleague.
• Own thermometer in accordance with local policy.

TEMPERATURE MEASUREMENT eardrum

Benefits
• Easy access.
• Provides accurate heart reading because of its proximity to the eardrum to the hypothalamus and the blood supply shared with the hypothalamus by the internal carotid arteries (Severine and McKenzie, 1997).
• Measure fast.
• Exposure limited to bodily fluids.

Disadvantages
• Requires removal of hearing aids.
° Not suitable for patients who have undergone ear surgery, or blood or fluid is present in the ear canal.
Measures ° can be distorted if the earwax (cerumen) or otitis media is present.

Equipment
° tympanic ear thermometer with disposable cover.
° Pen and documentation sheets.

Procedure
• Review of this site are appropriate.
• Prepare the equipment.
• Place the procedure for the patient.
• Place disposable cover on the thermometer.
• Presentation patient external ear canal, and insert the probe by pulling the auricle up and back, that rectifying the external auditory canal, exposing the eardrum. Probe fit perfectly into the gap, so it is closed. This will eliminate the effect
flow in the channel can have a significant impact on the accuracy of reading (Braun et al. 1998).
• Keep the thermometer in place until a reading is displayed on the digital camera.
• Perform cover the probe.
• Wash your hands.
More Infor reading of the patient, and able to document clearly showing that the site is used eardrum.
• Report made several changes to a colleague of superior quality.

Observations : NURSING PROBLEM - Blood pressure

Blood pressure is an indication of peripheral vascular resistance, the effectiveness of cardiac output, and the amount of blood volume. When measuring blood pressure values recorded two. First, the systolic pressure is measured. It is the pressure produced in the arteries when the left ventricle contracts, pushing blood into the aorta. Diastolic pressure is the pressure in the arteries when the heart is "diastole" (ie, relaxes stuck between beats).

Terminology
hypertension, high blood pressure compared to standard values for the patient's age and hypotension is blood pressure below normal levels

Intervention: taking and recording blood pressure

Mr. Ellis has high blood pressure every few minutes. For the evaluation of blood pressure via a mercury sphygmomanometer, the BritishHypertensionSociety (Beevers et al.2001) recommends the following course of action.

EQUIPMENT
° stethoscope.
° to the right size cuff pressure
° Pen and documentation sheets.

PROCEDURE
• Prepare the equipment.

ALERT!
The bladder of the cuff should cover 80 percent of the circumference of the upper arm. Starved or obese patients will also be large or small wrists.

• Explain the procedure to Mr. Ellis. Make sure he understands he can not speak, while his blood pressure is measured, because it falsely high value.

• Have Mr. Ellis to sit or lie down. As a comparison between standing and lying blood pressure is required, the first record of the underlying blood pressure.

• Make sure that Mr. Ellis is comfortable. Differ summary measure up, giving them at least 30 minutes, resting after a meal or alcohol or caffeine.

° When selecting a cuff placement, steer clear of using an arm hit as a result of an intravenous an arteriovenous shunt, cannula, trauma, total or incomplete paralysis, or the side of a mastectomy as these conditions the effect of absorption and can be painful.

• Wash your hands.

• Remove restrictive clothing arm chosen. If necessary for Mr. Ellis's outerwear privacy.

• Place Ellis arm horizontally, and supported so that the cuff is at heart level, management palm up.

° Palpate the brachial artery (which can be found in the shoulder / elbow arm).

• Place the cuff so that the center of the bladder over the brachial artery. The lower edge of the cuff should be 2 to 3 cm above the site of the largest pulse of the brachial artery. Consistently discouraged cuff wrapped around the arm with the rubber tube from the bladder positioned on the top of the sleeve, allowing easy access to the elbow to auscultation.

• Install a pressure gauge at eye level and no more than 3 m (92 cm) apart, so that the balance can be easily read.

° Palpate the brachial artery, although the balloon inflated to thirty mmHg above the point where the pulse disappears. Gradually abandoned the cuff, note the pressure at which the wrist. This is the estimated level of systolic blood pressure. Reduce the cuff. Estimate how high the air with the cuff must be completed by the pulse is important because phase I sounds (just see Table 2.1) can evaporate when the pressure is reduced and reappear at a lower level.

• Place the diaphragm of the stethoscope over the brachial artery at the point of maximum heart rate. The stethoscope should not touch the cuff, cloth or rubber hose as this could cause friction noise. In the haste to rise the cuff to 30mmHg exceeding palpated systolic rate. Gradually reduce the cuff at 2-3 mmHg per second. The first Korotkoff sound is the systolic blood pressure. The disappearance of sounds represents the diastolic pressure. Registration card of blood pressure to the nearest 2 mmHg trademarks used the arm and the position of Mr. Ellis. Document deviations or changes.

• Help Mr. Ellis dress if necessary and a more comfortable position to take.

• Wash your hands.

More Ask Mr. Ellis of your results.

• report any discrepancies or changes in observing a more experienced colleague.

Is this the first occurrence, grade blood pressure in these patients in both arms (Beevers, all 2001). When included in and

Phase I
The first sign of weakness, clear tapping sounds that gradually increase in concentration of at least two consecutive beats of SBP.

Phase II
A brief period may follow when the sounds soften and acquire
a rustling quality. Auscultatory gap in some patients sounds may disappear for a short time.

Phase III
The return of sharper sounds, sharpen or repair
exceed the intensity of the phase I sounds.

Phase IV
The sudden weakening of different sounds that are soft and
folding.

Phase V
The point at which all sounds disappear.

Avoid errors in blood pressure

There are several factors that often lead to errors in determining the blood pressure of a patient. These may relate to the patient, the nurse or equipment.

If a patient has pain, will be anxious, or cold, affect blood pressure. Try to ensure that the patient does not have a full bladder, and has not had a meal or just a cigarette. When you take blood pressure, make sure that the patient's arm is horizontal and supported, and is not restricted by tight clothing.

If the nurse perform the procedure, do not round wrong numbers, and do not guess the pressure. Make sure the cuff and gauge the correct position and not rapid deflation of the cuff. Other errors can be caused if a nurse has poor hearing, or to accurately interpret the Korotkoff sounds.

Check your equipment. The following factors are sources of error: the mercury is set to zero, the glass is dirty, the numbers on the meter are not clearly visible, the equipment can be tilted, or not properly calibrated or installed, there may be a faulty valve or leakage caused by rubber hose cracked or perished.

Aneroid and automated equipment

For the evaluation of blood pressure using a sphygmomanometer aneroid or automated device, the cuff should be applied as described above. The aneroid device is also used, although the position of the wheel is not so important. When using an automated device, it is essential that the manufacturer's instructions are followed, as each machine is different.

Interpretation of results

The treatment of hospitalized patients should never be based on a BP (Beevers et al. 2001). Mean blood pressure normal for a young adult is 120/80 mmHg for an elderly person is 140/90 (Potter and Perry, 1997).

Observations : NURSING PROBLEM - Pulse Rate

Case History: Mr. Ellis is a young man and was called to service after a head injury. He was beaten unconscious, but has started to improve.

Problem: Mr.Ellis has an tainted level of awareness.

Objective: rapid changes in a number of neurological order to classify.

Pulse
When the left ventricle of the heart contracts it pushes blood into the aorta and sends a surge through the arterial system that can be felt in the marginal arteries as a pulse.

Evaluation of a patient's wrist is an effective method to assess the state of the heart and circulatory system (Perry and Potter, 1998). There are several pulse points on the body, the most common is the radialpulse. The radialartery is to be found near the radius on the thumbside of the wrist. If the radialpulse is out-of-the-way, or is irregular, listening (auscultation) the wrist at the top of the heart can be used as an alternative or an impulse to the carotid artery may feel that s executes on the side of the trachea (windpipe) in the neck.
Factors that can affect the wrist, the body, the blood comes from hemorrhagic shock m or fluid loss, medicines such as digoxin, or a severe head injury.

Terminology
dysrhythmia in cardiac tachycardia, an abnormally high heart rate (over 100 beats / minute), bradycardia, an abnormally slow heartbeat (less than 60 beats / minute)

When a pulse is palpated, it is important to determine the following:

Tempo - the usual range for adults is 60to100 beats/min.(Potter and Perry1997) rhythm - the rhythm is a standard pulse sequence of normal beats. You should be able to feel if the pulse is regular or amplitude - the strength of the pulse.

The pulse may feel low, low, and "spent", or well-built and bounding.

Intervention: consideration of peripheral pulses

Equipment

• View second hand or digital display.

• Black pen.

Documentation sheets •.

Procedure

• Prepare the equipment.

• Wash your hands.

• Place the procedure to Mr. Ellis.

• Ask Mr. Ellis to sit or lie down. Make no doubt that he is as comfortable and relaxing as possible, rest for a minimum period of five minutes, when it occurs.

• Place the end of the first two or three middle fingers of the groove along the side of the thumb of Mr. Ellis wrist and squeeze gently.

° If the wrist is often count the number of beats in 30 seconds and multiplying the total by 2. If it is irregular, count the pulse for a full minute.

• Examine pulse amplitude and rhythm.

• Wash your hands.

• Record the heart rate graph on observation and the differences in amplitude and rhythm.

More Info Ellis of your results.

• Report discrepancies or changes in observing a more experienced colleague.

TIP
peripheral pulses is irregular! As patient's interpretation the radialartery of the wrist with headvisable theapical to measure up to to determine whether there is a difference. The most accurate method of doing this is the rhythm of two nurses apical and radial pulse measured simultaneously. This is described as a "top-radial recording.

Evaluation of the apical impulse is to listen to heart sounds with a stethoscope placed on the top of the heart. At the same time, the nurse takes half the radial pulse.

Equipment

° stethoscope.
• Sight secondhand or digital display.
Rumen ° in two colors (according to Trust policy).
Documentation sheets

Procedure

• Creation of material: support the application of a fellow nurse.

• Wash your hands.

• Close the curtains around the bed.

• Place the course of action to Mr.Ellis.

• Ask Mr. Ellis.

• Presentation to the left of the sternum and chest. Place the diaphragm of the stethoscope over the apex of the heart. It is located on the fifth intercostal space, in line with the left mid-clavicle.

• Listening sounds double beating heart. The heart sounds are called S1 and S2.

° If your colleague is complete, you begin to count the pulses apical and starts counting the radialpulse. One of you, a regular count of the apex beat, will need to take the lead in starting the counting and timing of the procedure. Count the pulse for a full minute, counting each beat Apex Double (the S1 and S2) as a full beat.

• Assist Ellis dress.

° For hand washing.

Conference record

° observation grid, using different colors for the measures radial and apex, and document the changes in the rhythm.

• Apply to Mr. Ellis to your closing date.

• Report discrepancies or changes in observing a more experienced colleague.

Observations : Patient assessment

Assessment of a patient’s vital signs includes observations of temperature, pulse, blood pressure, respiratory rate and oxygen saturation, blood glucose levels and level of consciousness. These observations provide an efficient and accurate method of monitoring a patient’s condition. They also enable evaluation of response to treatment and early detection of problems.

Observations give vital information about a patient’s condition and therefore you have a duty to:

° hold on to the UKCC guiding principle with reference to documentation
(UKCC 1998)

· Report the average deviations from the basic level or another senior staff member and / οr medical colleagues

· Make sure all equipment is calibrated, it is safe and fully functional

• Choose the right equipment, such as the right size cuff to use only one arm, the size of the patient to follow the local infection control policy.

For more observations are made, the patient should be encouraged to relax and be comfortable. In patients with mild exercise should he be allowed to rest for a few minutes. For the state to accurately assess the patient's pain can be alleviated and prevented, in order to reduce anxiety, as these factors can affect vital functions. The body temperature, body position and end-products will also change the patient's perceptions.

Assessment Process : Focused assessment

During the interview, you can get to know that the patient has a specific problem, such as mobility. You would then need to explore this area further, or to give the patient a member of a multidisciplinary expert.

During the interview, you can get to know that the patient has a specific problem, such as mobility. You would then need to explore this area further, or to give the patient a member of a multidisciplinary expert.

TIP!
If the patient if you think health care professionals, ask to participate in the hearing as an observer, so that you can enlarge your comprehension and skills.

Preparing for discharge

Preparation of discharge to be initiated as soon as an initial assessment has been completed. Research Tierney et al. (1994) showed that the majority of patients and carers consulted on policy implementation. 2 weeks later than discharge, half of the patients did not remember whether they had received no information or treatment. A large part of the patient back to w / n three months of the approval, usually in an emergency. Various health care organizations in different ways to synchronize your authorization. Some institutions employ nurse discharge planning, while others leave the Ward team. Basically, it is clear communication between patient, family, and all members of the multidisciplinary should be initiated and monitored through the successful reception of the approval.

Driscoll (2000) makes the following recommendations for nursing discharge planning the next of kin:

• Include caregivers in all patient education programs.

• Be aware that some of the work of caregivers and, therefore, time limits on the formation of your health plan.

• To ensure that all members of the multidisciplinary treatment shall be informed of the needs.

° Arrange the location of certain members of the multidisciplinary nurses, such as a nutritionist or a newly diagnosed diabetic.

• Take a patient organizations and managers of planning decisions to keep the patient after discharge.

Following the evaluation,

If the assessment is complete and you have an interview and an appropriate measure vital signs, you should be able to draw up a management plan, in which the problem statements, make sure that the patient receives treatment he needs. Description of the problem should focus on the patient using a language which they understand and use. For example, if the patient is a difficult area to grab your soul, it describes your problem. Nurses have access to the jargon and writes that the problem is the shortness of breath, the patient's own words to use. As soon as the problem has been identified, objective opinions are formed. Sometimes it is valuable to obtain measurable and achievable short-and long-term goals, or the patient may get frustrated and feel no progress. The next step is to identify the nursing care to ensure the target is reached, and then to evaluate the effectiveness of treatment.

TIP!
Many students feel that the main problem is not easy to write applications that are related to the patient. You may be ready to use medical jargon, but it does not relay to the patient. Take the time to talk to patients and the use of words. Two trained nurses can also leave the wording of problem statements. It does not matter: it is important that patients receive the help he needs.

Some rely on a treatment plan prescribed for specific problems and nursing care. They should be used, if necessary, because they save time and ensure that all precautions have been documented, but the patients' individual needs and preferences are taken into account.

Preliminary assessment clinics

In many areas, patients who have booked an investigation or surgical intervention may be invited to participate in a pre-assessment clinic visit prior to their receipt. During the visit the nurse has time to prepare for the reception of the patient and explain what happens during a hospital. Routine investigations are carried out: for example, blood tests to detect anemia, chest X-rays to detect lung problems, or electrocardiograms observed in many cardiovascular diseases. If problems are detected, they can be corrected prior to admission.

If the patient has since received several days later, they have had time to absorb what is happening and is willing to ask questions they may have before they act. Pre-assessment visits mean that patients have access to the morning of the surgery and you can spend an extra night at home. Apparently it only works for planned admissions, and it is impossible for patients admitted as emergencies. Emergency admissions do not have this possibility, and the patient can be very frightening events has been very rapid. The patient needs reassurance that he is concerned about his needs, and expected, and he supposed to be given apparent explanations of measures. It is normal to anticipate to carry out a full review within 24hours after all required maintenance documented.

Assessment

Evaluation of the achievement of long-term care, looking collected to evaluate and compare the actual results of treatment with the expected results (Lippincott 2000). It's like a second assessment, but are not as extensive as the first assessment. It focuses on the objectives and the extent to which they have achieved, and the service may need to be adjusted. Dates and evaluation of the measures is a management plan so that progress can be monitored.

This chapter focuses on using assessment to evaluate the patient's interview, and by observing some of the physical and behavioral characteristics, which collect some of the subjective and objective information. If the patient if you think health care professionals, ask to participate in the hearing as an observer, so that you can expand your knowledge and skills.

Preparing for discharge

Research of discharge to be initiate as soon as preliminary assessment has been completed. Research Tierney et al. (1994) showed that the majority of patients and carers consulted on policy implementation. Two weeks after discharge, half of the patients did not remember whether they had received no information or treatment. A large part of the patient back to w / n three months of the approval, usually in an emergency. Various health care organizations in different ways to synchronize your authorization. Some institutions employ nurse discharge planning, while others leave the Ward team. Basically, it is clear communication between patient, family, and all members of the multidisciplinary should be initiated and monitored through the successful reception of the approval.

Driscoll (2000) makes the following recommendations for nursing discharge planning the next of kin:

• Include caregivers in all patient education programs.

• Be aware that some of the work of caregivers and, therefore, time limits on the formation of your health plan.

• To ensure that all members of the multidisciplinary treatment shall be informed of the needs.

° Arrange the location of certain members of the multidisciplinary nurses, such as a nutritionist or a newly diagnosed diabetic.

• Take a patient organizations and managers of planning decisions to keep the patient after discharge.

Following the evaluation,

If the assessment is complete and you have an interview and an appropriate measure vital signs, you should be able to draw up a management plan, in which the problem statements, make sure that the patient receives treatment he needs. Description of the problem should focus on the patient using a language which they understand and use. For example, if the patient is a difficult area to grab your soul, it describes your problem. Nurses have access to the jargon and writes that the problem is the shortness of breath, the patient's own words to use. As soon as the problem has been identified, objective opinions are formed. Sometimes it is valuable to obtain measurable and achievable short-and long-term goals, or the patient may get frustrated and feel no progress. The next step is to identify the nursing care to ensure the target is reached, and then to evaluate the effectiveness of treatment.

TIP!
Many students feel that the main problem is not easy to write applications that are related to the patient. You may be ready to use medical jargon, but it does not relay to the patient. Take the time to talk to patients and the use of words. Two trained nurses can also leave the wording of problem statements. It does not matter: it is important that patients receive the help he needs.

Some rely on a treatment plan prescribed for specific problems and nursing care. They should be used, if necessary, because they save time and ensure that all precautions have been documented, but the patients' individual needs and preferences are taken into account.

Preliminary assessment clinics

In many areas, patients who have booked an investigation or surgical intervention may be invited to participate in a pre-assessment clinic visit prior to their receipt. During the visit the nurse has time to prepare for the reception of the patient and explain what happens during a hospital. Routine investigations are carried out: for example, blood tests to detect anemia, chest X-rays to detect lung problems, or electrocardiograms observed in many cardiovascular diseases. If problems are detected, they can be corrected prior to admission.

If the patient has since received several days later, they have had time to absorb what is happening and is willing to ask questions they may have before they act. Pre-assessment visits mean that patients have access to the morning of the surgery and you can spend an extra night at home. Apparently it only works for planned admissions, and it is impossible for patients admitted as emergencies. Emergency admissions do not have this possibility, and the patient can be very frightening events has been very rapid. The patient needs reassurance that he is concerned about his needs, and expected, and he should be certain apparent explanations of procedures. It is normal to suppose to carry out a full assessment within 24 hours after all required maintenance documented.

Assessment

Evaluation of the achievement of long-term care, looking collected to evaluate and compare the actual results of treatment with the expected results (Lippincott 2000). It's like a second assessment, but are not as extensive as the first assessment. It focuses on the objectives and the extent to which they have achieved, and the service may need to be adjusted. Dates and evaluation of the measures is a management plan so that progress can be monitored.

In this section, the use of an assessment interview to assess the patient and by observing some of the physical and behavioral characteristics, which collect some of the subjective and objective information.

Assessment procedures : Assessment interview

When you first meet with the patient, introduce yourself and the address of her relationship, using his proper title. This gives him the opportunity to choose what they want to play during their stay. If he is patient, other patients to report to him in his room and show her around the clinic, so he knows where the toilet and bathtub or shower rooms, and where to find the phone, or day room. Often, the patient's first experience of health care and can not be nervous. It is worth taking the time to explain and make him feel that he is a multi-disciplinary care, and how to distinguish the different uniforms, it is likely to meet with staff. If English is not their first language, you may find that there is a language barrier, so before you proceed for an interview, if you can find a translator.

Tip: If a patient needs an interpreter to family members want to order, but some private information about a patient may not be suitable for family members, especially children, to interpret. For example, a woman can not find it easy to talk about abuse within the family, his son is a translator, it may be appropriate to use the official interpreter.

Preparing for an interview

Before interviewing the patient, it is important to prepare for the interview and the assessment of the patient. Explain that you will need to gather some information and that it is a convenient time to interview him. For example, a patient can go to the bathroom, to change his position because of pain, or say goodbye to relatives first. You need to collect the key personal medical records, so you can check the details of such information as date of birth, address and telecommunications numbers of relatives.

Could it be useful to include the relative Tip: If you look at some of the details of a major career in an interview with them or separately. However, the patient is aware that all information that it gives you the information to be kept confidential and only, other health professionals if necessary. In some cases, it may be particularly important for both the caregiver and the patient is able to express real anxiety, and other discussions. This should be considered sensitive and must take place in the preliminary assessment.

Interview with the atmosphere

To provide a comfortable and peaceful place to interview, if possible, and that you are not so close to the patient that you invade her personal space, but not so far away that you do not need to shout. Make sure that the patient can see and that you are placed in the light behind him. Try to calm, slow and non-judgmental atmosphere. By giving the patient time and attention, he is more likely to relax and open, and provide all the necessary information. If you show your disapproval, disgust, impatience, or it may inhibit communication (Bates and Hoekelman 2000), so you need to develop their professional behavior that does not make the patient feel guilty about, or vulnerable to some of your lifestyle - such as alcohol or tobacco consumption.

Effective communication

Keep in mind that some of the medical jargon may prevent the patient's understanding of the questions asked to use layman's language and terminology. Encourage the patient, as he says, nodding the head, and say things like "Go". Help him to tell his story, asking questions such as "Can you tell me where the problem started?".

Non-verbal communication can also tell the person. Listen carefully and watch the body language signals. If a person is uncomfortable half the questions, it does not make eye contact. In some cultures, however, can be regarded as disrespectful to the eye, or aggressive and may not meet your eyes at all during the interview (Spring House 2002). It is important to check that you understand the signals correctly. For example, if the patient is to keep the pain itself, for example, you might ask, "You look very uncomfortable right now, can you tell me how you feel?" It provides an opportunity to talk about all the pain, he may be feeling, or concerns they may have. Outbursts of anger, aggression, arrogance, or the tears of this type of non-verbal behaviors that communicate emotions such as anxiety, insecurity and fear.

their story so many tips! Some patients say they are bound by a finding that it actually impoverishes them to take up important things first, especially in emergency admissions. You can fill the gaps in any of the following medical records, letters, other health professionals, primary care staff in communications, emergency medical records, or with friends and relatives.

There are a variety of communication skills, you can use when interviewing. Closed questions used to get one or two word answers, and to establish specific categories of information such as address information. Open-ended questions give the opportunity to express their feelings and thoughts, and to share their experiences of the patient. Hoekelman and Bates (2000) to identify other communication strategies used to present information on:

Flexibility:

This encourages the patient to continue his story. You can use the position of attention, such as nodding or leaning forward and listening to the silence, the patient collects his thoughts.

Reflection:

Playing in the patient's back to the words he just said, can help him to collect his thoughts, and to develop further.

Confirmation:

It makes you so sure of the exact number of tracks and clear the misunderstandings.

Explanation:

Іf thе patient is a bit vague, unclear, or you can ask him to explain in more detail.

Ask your emotions:

You can ask the patient what he thought about the situation or event, because it can give him to articulate anxiety, anger or fear.

Total:

This is another information that is certain to you to do this mutually.

Conclusion:

This indicates the end of the interview, but it offers the patient the opportunity to say something, it can be added.

Structural Assessment Interview

Hoekelman and Bates (2000) Evaluation of an interview with an overview of the structure, including the following:

• Personal Information
• Whether the admission
° A History
• Family History
° the ability to do everyday activities
• All the psychosocial factors that may affect the health of
° A physical assessment of vital signs.

In addition, more detailed assessment can be carried out some specific features of the daily diet, breathing, restraint, or other specific areas, depending on the patient's needs and problems.

Recording the information

Most of the evaluation forms are certain areas that have been made in writing and the same structure as the selected model for nursing.

Without the experience can be very dependent on paper and you can be the next question, and not be able to view the patient tips his true feelings. You may be beneficial for some notepaper, you can take some important points, which can then be recorded clearly in the right order, so the local documents. Be sure to explain to the patient, you want to save the data accurately. Write down the key phrases and dates, not the whole story, especially when complex issues are dealt with. There may be some moments of the interview, if there is reason to listen to, rather than writing, especially if the person is speaking, or sensitive to embarrassing questions.

Personal

First of all, check the bibliographic information. This should include the patient's full name, address, telephone number, age, date of birth, marital status and religion. Contact the number of people who can be included in an emergency and it could be a close relative or, if they live farther away, a partner or spouse. It is common for that who could be contacted during the night, especially if a partner or spouse is elderly and ill. Patients may be concerned about the implications for someone to call in an emergency, so it makes sense to clarify that it is important to ensure that all emergency contact information up to date and the number of rarely needed.

Enquirie the patient the opportunity to practice his religion, he claimed to express whether they want to monitor in particular religious traditions, such as by participating in the service of particular times or saying prayers. There may be cultural practices, in particular, that he would like to monitor the condition of time and should be available so as you can. For more information about cultural awareness may be advisable to monitor the processing of texts.

September admission

Use the patient's own words to explain in detail in September to access treatment. Framework for the use of PQRST to monitor a lot more (Spring House, 2002), in order to direct questions:

P - palliative or provocative. What help or aggravate the symptoms? There are certain situations such as stress or specifically state change?

Q - quality or quantity. What is a symptom of view, feel or sound like? Does he feel it during the interview? How does that affect his daily life?

R - regions or radiation therapy. If a symptom does not occur in the body? Is there anywhere else in the work?

S - severity. How serious is it a symptom of range of 1-10 (10 is the worst)? Does it get better, worse or staying the same?

T - time. When does it start? Does it begin gradually or suddenly? If you happen on a regular basis? How long will it last?

History

UK Medical information stored in these key states, but it is important that nurses, in order to determine whether allergies, elastoplast, perfume or other substances. Previous activities and accomplishments are together, so that it is understandable that when the last event is suitable for the patient's health status and experience of how it may impair the response to current treatment.

Find out the current treatment: whether prescribed by a doctor, pharmacist, or advised the patient self-dosing. For example, this may mean some inconvenience to the patient occurred when the pain has not been effective and the patient is over the counter medications by supplementing it without realizing the effect of increasing dose.

Family history of

It is not unusual to find no medical conditions such as heart disease, certain types of cancer or blood disorders, high blood pressure or diabetes are common in the family.

Ability to perform daily living activities,

This part of the evaluation is to establish whether areas that require focused evaluation. Nursing models outlined in Pearson et al. (1996) can be used to identify deficiencies in activities of daily living skills. Accurate account of the following areas.

Nutrition

Was it taking effect on appetite? Will he be able to shop and cook? Are there any special diet, such as diabetes or religious preferences?

The patient is such that the tip! Make sure areable I want to meet special diets, and, as noted. If it requires a kosher or vegetarian dishes to make sure it is ordered, or it can make the "extra" food that does not meet your needs.

Removal

What are the patient's normal elimination patterns, and they have recently changed? If constipation is a problem, which is the usual measures to alleviate the patient to use it? Is urinary incontinence, or a problem?

Mobility

This includes all body movement: walking, moving bed, and manual dexterity. The amount of subsidy is required to keep the patient should be considered mobile, and special equipment may be necessary. For example, when the movement of the assessment, you may decide that the patient is not sufficient to support the monkey moving bed, or walking to support the toilet. It may be desirable to provide a better assessment of the patient physiotherapist. If the patient does not move and they may be at risk of complications of bed rest.

Senses

This consideration should be given to see, hear, smell, touch and taste. It is worth considering whether the patient is hearing impaired, which require a hearing aid, or if he or she has read lips or use sign language. Vision problems are the need to wear glasses, and if so what kind: short or long sight, the existence of glaucoma or tunnel vision. Patients with definite neurological disorders can detect the odor or taste senses are provisionally or enduringly changed.

Sleep

The patient may have had their sleep disturbed, and the remainder of his current problems, so it is important to know the normal sleep cycle. It may be a special evening rituals, such as a hot drink or drugs or alcohol before bedtime. His sleep may be disturbed because of urination, or because he does not expect, especially in a situation in which to sleep in the BEC. of his illness. For example, if he has a soul, he might not be able to lie down comfortably, but feels that it sat in sleep disorders.

Trade

The patient may be affected by the current professional problem, and may be a factor, even though he is no longer gainfully employed. The work may cause the patient to recover from an illness or to help their rehabilitation. If a person is unemployed or is terminated, the impact on its financial position, and quite possibly his mental health. Individual disease can also affect what kind of work they will be able to continue, so that this information may be relevant in preparing the budget. Tobacco, alcohol and other drugs to find out how many cigarettes or how much tobacco smoke, or if he has given up. Amount of alcohol, the patient typically uses it is also important, and if you are able to ask him if he uses illegal drugs or the presence of a minor, this information is helpful as well. For example, a patient may be suffering from multiple sclerosis and cannabis for pain may be quite willing to admit to regular use. However, a person involved in an accident may be less open to drugs or alcohol. Conventional therapy - such as birth control pills or hormone replacement therapy - is also registered.

role to play tricks! BEC. You are the alcohol health worker, a patient may want to be honest, how much alcohol, tobacco, or drugs they consume, especially if he thinks the problem may be with them, or if he feels you are likely to be judgmental. Do not suggest he should start smoking cessation programs at a time just trying to get an honest assessment of how much he smokes a day. For example, instead of saying, "Do you smoke one or two packs a day?" Ask him how many packs a long time, and when they purchase, which will take him.

Psychosocial factors that may affect the health of

Professional patient information is already given an indication of the financial position. Ask the property: if it is rented or owned by the patient, or if it has central heating, or a lot of stairs, it gives a hint quality of accommodation. If the patient is that he can not do a lot of the BEC. Elevator rarely works that may affect the design is cleared, mainly in its ability to shop or cook.

Recent experience of grief, such as divorce, separation or bereavement can affect the patient's mood and the usual coping mechanisms. If you find yourself during the interview, when the patient has experienced in recent grief, it may seem difficult to figure out what to say, especially if you're inexperienced. Very often the patient appreciates the opportunity to talk about the damage, but his closest friends and family may have heard it all before, it can still be considered, so listening is often irreplaceable.

the trick! It is useful to know the patient has not received support from the social or voluntary work prior to admission. This means that if these services is to start the discharge, the patient is already known that the reference to the server, and it makes it easier. You will also need to check if the organization is aware of the fact that the patient is accepted, so that resources are not wasted.

Assessment Process : First impressions

Part of the evaluation will include some first impressions of what you know about the patient. If you feel that the development of this observation to develop. Creating a patient is added to this neighborhood. Spring House (2002) gives a list of memory - some of the teams - Key words to help patients through research

Symmetry:
It is his vision and the body symmetrical? Is there swelling or body parts?

Old:
She looks her age? If not, why?

Mental focus:
When he wakes up, confused, restless, inattentive, or respond inappropriately? He is a depressed mood, happy, or tired?

Expression:
It seemed that he was sick, pain, anxiety or upset?

Trunk:
This tends to waste, fat, overweight, or barrel-shaped me?

Limbs:
This is a common disease, or edema? This is a hot or cold hands and feet? This is her pale skin, well-perfused or blue (cyanotic) protection?

Appearance:
It is clean, but still a good ride, and? It is not appropriate or excessive wear and tear during the year? Is his skin condition, or symptoms such as rash, bruising, dry skin, or inflammation?

Movement:
This is his posture, coordination, and normal? He can manipulate buttons or zippers and fingers managed to remove their shoes?

Speech:
His voice is soft, clean, strong and straightforward, right? Does that sound like anxiety, stress, anxiety or confusion? This first informal research can provide a gentle footprint of the patient's health, and it is useful to reflect on later, if you think you become a patient, but is unable to determine what changes are.

Assessment Process

It is important to understand that assessment is important for all activities that he could do. It does not happen just once, but is a continuous process at regular intervals, depending on the patient's condition. The most common time for a thorough evaluation, the patient has acute or continue treatment, but there may be other times when it is determined to be necessary.

When assessing a patient includes both formal and informal assessment. A formal evaluation of a collection of objective information on the patient's condition by asking him questions and get answers. An informal evaluation will cover the things you see a patient, when you talk to them and may have physical symptoms and subjective information, such as their mood and behavior. Structure of these estimates, discussed in more detail in this chapter. Estimate of the physical symptoms of life will also be taken. To ensure effective assessment, patient care is necessary and provides a baseline from which progress can be measured. In order for an effective treatment plan and delivered a structured approach called the nursing process is used.

"Nursing process" is being planned, problem-solving approach to meet the patient's health and medical needs (Lippincott 2000). This is a systematic series of events, where the first step is to assess the needs of the patient gathering of objective and subjective information. The next step is the interpretation of this data when the actual or potential problems that the patient has taken place. It could be called the nursing diagnosis (Lippincott 2000). Nursing is designed to correct or prevent these problems, and problems can then be given priority, so that he is patient care needs are met. These objectives are used to plan the direction and type of nursing intervention is necessary.

They should be patient, focused, and SMART:
Special
Measurable
Be achieved
Realistic
Time Bound

For example, a patient may indicate his or her concerns to the extreme shortness of breath at rest. Short-term goal may be to his respiratory rate is 25-28 breaths per minute for four hours. This would give time to the medical and nursing care measures to take effect. For this purpose, the SMART study meets the special care that helps to achieve the objective. There are examples of problems and objectives for the whole book, and medical intervention to achieve the goals.

If the results of the implementation of nursing care should be assessed. The assessment provides an opportunity to see how the patient reacts in nursing, and the extent to which objectives have been achieved (Lippincott 2000). As a result, the evaluation may be necessary to change the targets, as has previously been the problem no longer exists, and it can appear in a new one. If targets are not met then the case should be re-examined and re-objectives of the intervention.

The whole series of the nursing process, which is:

Assessment - the collection of objective and subjective information

nursing diagnosis - potential or actual health problems

Planning - plan for maintenance work to address identified problems, or termination of appointment - the delivery of nursing

Evaluation - Evaluation of the effectiveness of nursing care and the success rate of solving the problem.

Although the nursing process provides the framework needed for nursing care model provides a structure in which the treatment is given. He takes the role of nurse, patient care needs and objectives, if it is delivered. Nursing model is established beliefs and values, people, society, environment, health and nursing, criteria, and it covers the social, physical and mental health determinants, all of these sites (Pearson et al. 1996).

Preferably choose a model to the needs of each patient's care (Roper et al. 1998). For example, a patient needs for rehabilitation after an accident benefit model, which encourages a progressive return to independence, rather than depending on the health-care professionals. Another patient in the terminal phase of illness may become increasingly dependent on the health-care professionals to meet their physical therapy should focus on providing comfort and relief of symptoms, and make the most of the remaining time. In general, nursing his clinic model is selected, it is proposed to increase the supply of nursing is clearly the nature and purpose of the service and provide the structure for recording and documenting the findings and activities to promote continuity of care (Iyer and Camp 1999).

If you follow a good assessment is often difficult to see how they got all their information, because they difficult process seem easy. It may look more like an informal discussion of the patient and his sister-structured assessment process. But the experience of interacting with patients' ability to identify important information and guidelines for discussion and information-gathering tools. The patient is first seen in the treatment of certain evaluation activities that take place, and when they ripen, they will gather the required information. These steps are: first impressions, assessment interview, focused on the evaluation and physical assessment.
 
Support : Creating Website | SEO Template | Free Template
Copyright © 2011. Heart Disease Symptoms - All Rights Reserved
Proudly powered by Blogger