Clinical Remediation Activities

Questions: 1. What do you consider to be the main priorities of care for Mr. Teng in the first 24 hours post-op? 2. Describe the assessments that you would undertake in the post-operative period to enable early detection of potential post-op complications? 3. Day 1 post-op. At 1000hrs you assess Mr. Tengs vital signs to be? 4. Identify the immediate nursing priorities of care, with associated rationales, for James on admission to the Emergency Department? 5. Explain why rest and reassurance are an important aspect of James ongoing care? 6. James asks you if he is having a heart attack. What would your response be? 7. How do pre-existing medical conditions predispose Bill to post-operative complications? 8. What are the most likely post-operative complications to develop for Bill? 9. What pre and post-operative nursing interventions will be essential while taking care of this patient? 10. What are the priority nursing interventions on admission to the ward? 11. What are Mrs Johnsons risk factors for peripheral arterial disease? 12. Outline the primary nursing responsibilities when caring for Mrs Johnson? Answers: 1. The key priority of Mr. Teng in first 24 hours post-op include the pain management, control of patients breathing after anaesthesia and proper wound care. 2. The assessments that would be undertaken in post-operative period include: A-E assessment Pain score measurement Consciousness of patients 3. The assessment of data is suggesting a fluid imbalance of Mr. Teng, as a post-operative complication. Other data that helped in clarifying findings are a lower BP, 98/65 and 100 ml urination since 12 midnight. The student nurse will inform the registered nurse, who is patients in-charge and administration of fluid retention medication. 4. James would be admitted to the emergency department immediately and then he would be assessed through cardiac MRI and ECG (Doenges, Moorhouse Murr, 2016). Based on diagnosis, nitroglycerin would be administered, as it helps in widening blood vessel and more blood flow to heart muscle with relieving pain. 5. Sometimes, in case of angina pecortis, chest pain lasts for longer period, in other cases, like exercise-induced chest pain last for less time, however, it becomes difficult to distinguish the cause of chest pain, thus, rest and reassurance of the cause of chest pain is important to be considered for getting proper ECG result. 6. The immediate response to Jamess query would be not sure, prior having the ECG and CT scan reports, which would confirm whether he had an angina or heart attack. 7. Bill has previous history of type 2 diabetes mellitus, smoking history and hypertension and on auscultation, respiratory tract disease. Thus, these medical conditions can pre-dispose to poor immunity, tendency of delayed recovery and breathing problem. Answer 2 8. Bill can have several post-operative complications like delayed wound recovery, blood loss during surgery and risk of revive after anaesthesia. 9. Pre and post operative assessments are required to ensure healthy condition of patient. A-E assessment, fluid balance and consciousness should be assessed during both pre and post operative period. 10. During admission, taking the incident report, medical history and reason for admission should be noted. 11. Risk factors of developing peripheral arterial disease by Mrs. Johnson are her medical history of hypertension, myocardial infarction, smoking history and type 1 diabetes. 12. The key responsibilities of the caring nurse towards Mrs. Johnson include proper wound management, surgical site infection prevention, control of blood pressure and blood sugar level (Gulanick Myers, 2013). Bedside check AM Shift Patient/time 0700 0800 0900 1000 1100 1200 1300 1400 1500 Mr. Campbel Atenolol due Mr. Nash Oral antibiotic due Physiotherapy appointment, dressings are stained and peeling Panadol due Oral antibiotic due Mr. Bates Usual meds Appointment with hand physiotherapist Panadol due Discharge Mrs. Brason Sinemet tablet due Regular meds due Sinemet tablet due Regular meds due Sinemet tablet due Regular meds due Triggers Patient Triggers Bed 1 What are the complications related to abdominal polyps? Why doctors ordered to cease IV fluids immediately? What is the cause behind patients infrequent urination? What is the role of atenolol at this time? Bed 2 Why the team doctors of the patient suggested ceasing PCA and starting Oxycotin BD with Endone PRN? What are the post knee surgery complications? What others information a nurse should know to ensure proper wound management? Bed 3 What complications may the patient experience, while travelling by train after 1 day of left hand surgery? What complications he can experience during post surgery period? What is the information, which should be conveyed to patient regarding recovery and follow ups? Bed 4 What are patients input and output data? What are the risk factors associated with her symptoms like poor skin turgor and dry mucous membrane? What is the role of Sinemet tablets in her care plan? What should be key priorities of a nurse dealing with a patient experiencing parkinsons disease along with additional complications? Nursing priorities Patient Triggers Bed 1 To ensure ending the IV fluid after receiving the order of doctor Assessment of abdominal discomfort and documenting the assessment findings Conveying the findings to doctors and work according to the doctors orders Taking observations of the patients vital signs after every 4 hours Proper administration of scheduled medications (Kalisch et al., 2011) Completing all the documentation prior patients discharge Communication with the patient and family regarding follow up and further threatments Bed 2 Post-surgical wound management and infection control through maintaining hygiene measures Dressing to be reviewed and dressed accordingly - ensure wound chart in place (Urden, Stacy Lough, 2014) Ensure patient has been charted for regular Oxycontin BD and Endone PRN regime after PCA has been taken down Pain score assessment after scheduled interval Keep patient adhered to the physiotherapy sessions at scheduled time Bed 3 To ensure proper wound dressing and management To ensure proper infection control and hygiene measures while dealing with the surgical wound Documentation of pain score Communication with the patient regarding complications he may have, while travelling by train at this condition Administering due medicines at the scheduled time ordered by doctor(Kalisch et al., 2011) Assisting the patient in the physiotherapy session Communicating with patient regarding the follow up sessions Bed 4 To assist the patient in her ADLs To assist the patient with emotional and moral support To ensure the patient is consuming required amount of water needed To document proper input and output data of the patient To assess the patients skin integrity and inform the doctor regarding this To ensure proper dressing of wound and infection control (Urden, Stacy Lough, 2014) To ensure proper administration of patients regular medication at scheduled time To document patients vital signs at scheduled time interval Progress Notes Bed 1 Patient name: Mr. Campbell Sex: Male Age: 40 yrs Date and time Notes 0400 hrs Temp- 37.2 degree Celsius, HR- 80 bpm, BP- 150/75 mmHg and RR- 14 rpm. 0800 Patient reported mild abdominal discomfort BP has been lowered to 120/70 mmHg and there was no complain regarding abdominal discomfort prior discharge Passed urine 3 times with a bladder scan result of 40 mls 1400 hrs Patients wife will pick him up upon discharge Bed 2 Patient name: Mr. Nash Sex: Male Age: No information Date and time Notes 0600 hrs Temp- 36.5 degree Celsius, HR-65bpm, BP-110/65mmHg and RR-12rpm, patient appeared to be drowsy but conscious, he was able to communicate 0800 hrs After PCA has been taken down, he had been administered with Oxycontin and Endone 0900 hrs Patient visited physiotherapy session and mobilisation would be reviewed in the afternoon Dressing was done after physiotherapy session. It was observed that the surgical site is oozing. Gauze and Mepilex border has been used for dressing. Dressing need not to be changed regularly, it should be changed only when needed Bed 3 Patient name: Mr. Bates Sex: Male Age: No information Date and time Notes 0800 hrs His regular medicine has been administered 1000 hrs Patient had a physiotherapy appointment. Patient is able to elevate his arm as much as possible and recommended to use arm sling, if needed 1200 hrs Panadol has been administered 1400 hrs Patient will be discharged after review at hand clinic Analgesia script ready for patient Discharge forms and instruction provided to the patient Bed 4 Patient name: Mrs. Branson Sex: Female Age: 90 yrs Date and time Notes 0700 Sinement administered to the patient 0800 Patients regular medicine has been administered 1100 Sinement administered to the patient 1200 Patients regular medicine has been administered 1300 Sinement administered to the patient 1400 Patients regular medicine has been administered Oral intake of the patient has been increased after consulting with speech pathologist and geriatric consult The patient appears to be confused and facing difficult in communicating with staff The patient needs assistance during shower and incontinence pad applied Mrs Branson has been put on a strict fluid balance chart. With the help of assistance and encouragement, she is drinking fairly well Patient has been categorized to have falls risk, for this, fall assessment form and Waterlow charts updated ISBAR Handover Information What do you like to include? I Introduction Parkinson disease is the key concern of Mrs. Bransons case. In addition, she has undergone a fall. Information about patient other medical history are needed to be included S Situation Experiencing a fall, Mrs. Branson has been admitted to the hospital since 5 days. She has a poor appetite and appeared confused, she has hearing difficulty also. She is mobile, but she is not willing to drink water. However, no input and output data for the patient has been found. She is being administered with Sinemet tablets at scheduled intervals. No information regarding current vital sign and pain assessment has been provided to evaluate the situation. These information needed to be included B Background Mrs. Branson is 90 years old. Patient has a medical history of Parkinsons disease. She is undergoing a poor appetite and confusion and refusing to intake water. The team doctors recommended increasing her oral intake. She has several complications related to her health status including hearing issue. But she is mobile. No background information about the patient has been provided, her family back ground, family medical history, since when she is experiencing the neurological disorder and other issues has not been included, which are needed to be included. In addition, information regarding her current family members, occupation and social support are also needed to be included A Assessment A- Airway- No information B- Breathing- No information C- Circulation- No information D- Disability- Needs assistance during shower, inconsistency pad application, hearing difficulties, difficulties in communicating with staffs and confused E- Exposure- Poor skin turgor, dry mucous. Dressings on her skin tears were not appropriate. F- Fluids- Refusing to drink water initially, but now she is drinking fairly well, upon assistance and encouragement G- Glucose- No information Neurological- Experiencing Parkinsons disease, Confusion, communication difficulty, hearing difficulty Respiratory- No information Cardiovascular- No information Gastrointestinal- No significant information found Urology- The input and output information are not available. Patient has urine inconsistency problem, for which she needs to wear pad by taking assistance Musculoskeletal- fall injury, categorised to have fall risk and fall assessment form and Waterlow charts updated Integumentary- Poor skin turgor, dry mucous, dehydrated skin No particular information regarding the assessment tools has been provided, which has been used for assessing the patients vital signs. Patients information regarding airway, breathing, circulation, blood glucose level, BP, gastrointestinal and cardiovascular status are needed to be included R Recommendation Proper information regarding patients background and vital signs are needed to include in the progress note A good moral and emotional support should be provided to the patient to encourage her towards her care plan Her family members should be involved in the care process The fall injury should be assessed along with the pain score, after scheduled intervals A proper speech therapy should be undergone along with geriatric consultation She should be effectively communicated for encouraging her to adhere with the fluid balance chart for improving her appetite References Doenges, M. E., Moorhouse, M. F., Murr, A. C. (2016). Nursing diagnosis manual: planning, individualizing, and documenting client care. FA Davis. Gulanick, M., Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences. Kalisch, B. J., Tschannen, D., Lee, H., Friese, C. R. (2011). Hospital variation in missed nursing care.American Journal of Medical Quality, 1062860610395929. Urden, L. D., Stacy, K. M., Lough, M. E. (2014).Critical care nursing: diagnosis and management. Elsevier Health Sciences.