'Nursing Care Study Essay\r'

'The aim of this nursing cautiousness find out is to demonstrate that, as a schoolchild nurse, the author is cap commensurate of exploitation and delivering the skills take for assessing and addressing separately man-to-man unhurried’s wield needs. include in these set of skills, is the ability to develop decisive thinking, decisive decisiveness making and the ability to contrive on events so as to become a better health c atomic number 18 provider. The persevering in which the generator will discuss was based upon an fourscore trio year old man, pseudonym Mr. Scott who was admitted into virgule and emergency via a referral from his general practitioner pre directing with irritation inveterate impeding pneumonic disease (COPD) with a invoice of congestive cardiac failure (CCF). On entrance fee to accident and emergency Mr. Scotts’ group took arterial blood gases, entraped a pulmonic work out tests and a pectus X-ray.\r\nPrior to the exacerbatio n of Mr. Scotts’ con alignrateness he regularly attended a cardiac clinic receivable to being a long line sufferer of congestive cardiac failure and excessively attended pulmonary function clinic for tests (pulmonary function tests). through these clinics Mr. Scott was educated on his medications and current cause. On admission of Mr. Scott, the writer decided to use the frameworks Roper Logan and Tierney (2000); Orem’s egotism Care Framework (1995) and Gibbs (1988); which incorporates each dick of judicial decision known as, plan, implementation, evaluation, educate and reflectivity. Using the preceding(prenominal) frameworks, an improvement of Mr. Scotts’ current exacerbation of continuing preventive pulmonary disease (COPD) was readn to keep been resolved and a new evaluation of Mr. Scotts’ make out was developed.\r\nThe chosen puppet of reflection used is known as the Gibbs wheel around of reflection. The writer applied this ray in straddle to evaluate the unhurried of tutorship. The rule behind this was to taste to fully understand reflection so as to apply this to every mean solar day practice, thus improving as a pupil nurse. The Gibbs cycle involves a translation of the incident, happenings and thoughts experient plus the evaluation and analysis of the incident, conclusions and fol unkept through plan (Gibbs, 1988). According to Barnett (2005) using a tool of reflection, to give an account of experiences in the clinical aspect can aid the nurse to analyse and explore their feelings regarding patient care.\r\nMain body\r\nEighty three year old Mr. Scott was admitted to accident and emergency with a referral from his general practitioner, presenting with a recurrent upper respiratory tract infection and a history of exacerbation of degenerative obstructive pulmonary disease (COPD) and congestive cardiac disease. Due to his history of degenerative obstructive pulmonary disease (COPD), Mr. Scot t was sent for a chest x ray to assess the deterioration of his lungs ascribable to his condition. (Alexander et al. 2009) Post admission into accident and emergency, Mr. Scott was sent to St. Pat, Thomas, Johns’ harbor where the writer was working at the time as a student nurse.\r\nThe writer found, when assessing Mr. Scott, that he lived alone, topical anestheticly, was a widower of ten years and had two daughters who as well as lived near by. Although Mr. Scott had m any concerns, he to a fault had a well social network such as the support of family and a home help big bucks of six hours a week, which included meals on wheels. The local public health nurse also called to see Mr Scott on a social capacity. Presently the principal(prenominal) health concerns which faced both(prenominal) Mr. Scott and his family were; the deterioration of his dyspnoea, colligate to his chronic obstructive pulmonary disease; twinge ulcers, referable to developing pressure ulcers wh ile in hospital in previous years and dread from both Mr. Scott and his family due to the unknown. Reassurance was given and they were explained what care he was to receive.\r\nIssue # 1 Breathing.\r\nThe key feature of chronic obstructive pulmonary disease (Barnett, 2009) is that of experiencing piteous-windedness. Being breathless for most patients can be both a stressful and frightening experience, which can raise disturbance aims. In other(prenominal) studies, men predominantly more(prenominal) than women were found to be affected by chronic obstructive pulmonary disease (COPD); but in a recent study carried out by Meilan et al. (2007); research has found that cases of chronic obstructive pulmonary disease (COPD) are increasing in women military man wide. The care Mr. Scott received was split in two, short term and long term care; both of which were constantly re-evaluated to maximise efficiency and quality of care.\r\nAs part of the short term care plan the writer ensur ed that the bedside was set up with suctioning equipment help inclined(p) for potential complications. To avoid complications, for ex deoxyadenosine monophosphatele tachypnoea (rapid eupnoeic) which is found to be an early indication of respiratory distress (Jevon and Evens 2001); the friendly rule of thumb, depth and rate of breathing was monitored and enter accurately (Jevon, 2010). pass on reducing the peril of complications occurring, Mr. Scott was encourage to sit up in a turnout fowler position while enduring deep breathing exercises enabling him to breathe with greater ease and sympathiser. The principle behind this was supported by a study carried out by Duggan et al. (2005).\r\nThe long term design was to ensure that an group O saturation level amidst 88%-94% is maintained (Alexander et al 2009). To monitor guinea pig O saturations levels, a pulse oximeter was place on Mr. Scott’s finger. The rationale for this is to detect oxygen absorption of haemogl obin (Plaice &Graham, 2000). A study carried out by Groeben (2003) shows that administering high concentrations of oxygen to patients with chronic obstructive pulmonary disease (COPD) will reduce the respiratory drive, resulting in respiratory depression. This finding gives rationale to why a low flow of oxygen therapy is given to patients with chronic obstructive pulmonary disease (COPD). Humidification was added to Mr. Scotts’ oxygen therapy to affectionate and moisten the gas (Jevon and Ewens 2001) promoting secretions while enhancing patient comfort (Woodrow 2005).The rationale for this is that oxygen is known to dehydrate opened membranes in the upper respiratory tract.\r\nIssue #2 Pressure ulcers.\r\nAccording to Lawrence et al (2010), every individual’s strip changes with time, this is a normal adjoin of ageing. With this change comes a decrease in its ginger nut and turgor, therefore with age one has to ensure that spanking care of skin is given in an elbow grease to avoid skin breakdown. Due to Mr. Scott being an ancient man of eighty three, the writer was concerned about(predicate) skin integrity. A tool known as the water low score was used in order to assess the likelihood of Mr. Scott developing any pressure ulcers during his stay in the hospital (Whiteing 2009). As Mr. Scott had developed pressure ulcers in a past experience, he would have an increase chance of a re-occurrence. In an attempt to prevent this situation the writer requested that Mr.Scott be nursed on an walkover mattress. (Stafford and Brower 2009). Issue #3 safety and delerium\r\nAnxiety is an steamy state influenced by past experience, which exists at a given point in time with a level of intensity related to an upcoming perceived threat (Passer and Smith 2007) The provision of information is extremely important to the patient as studies from, Biswajit et al. (2009) has shown that an informed patient with a good understanding of their condition reduces anxiety. Harvey (2002), exhort shared control in patient-practitioner interactions in that patients in effect participate in controlling important events. after liaising with Mr Scott’s’ medical team regarding his anxiety, a low dose of alprazolam brand name alprazolam 5mg, was charted and given in an attempt to relieve his anxiety. Alprazolam reduces anxiety within patients (De Witte, et al 2002).\r\nMedical care administered\r\nOn admission to the ward Mr. Scotts’ medical team ordered pulmonary function tests. These tests rule what typewrite and extent of restriction the patient is experiencing (Alexander et al 2009); what is more indicating any increase/decrease in their condition (Daly 2009). Arterial blood gasses were checked in order to determine the amount of O2 to be administered reducing the risk of hypoxia. The rationale for taking arterial blood gases was to determine the bloods Ph and the O2 levels circulating within the blood. (Alexander et al 2009). A sputum sample was also attained from Mr Scott and sent to the lab for culture and sensitivity testing to phantom which bacteria is present in the sputum so as to treat the infection (Gray et al 2008). by reflection the writer recalled that oedema may be present in the lower extremities secondary to Mr. Scotts history of congestive cardiac failure and chronic obstructive pulmonary disease (COPD) and recorded the findings.\r\nThe rationale for this was that, Mr. Scott suffered with congestive cardiac failure which increased the risk of developing oedema while in juxtaposition, putting increased pressure on functioning internal variety meat (Morley et al. 2009). During the writers assessment of Mr. Scott it appeared that he was suffering from a explosive onset of dyspnoea, (laboured breathing). Using critical thinking, the writer administered oxygen therapy at maximum of twenty four share and immediately informed Mr. Scotts’ team on his condition. The rationale beh ind administering low dose O2 is due to the detail that the hypoxic drive can be decreased by administering a large dose of O2 leading to respiratory failure and the worsening condition of the patient, (Simmons et al. 2004). Using the Gibbs reflection cycle, the writer believes students should be under constant watch in order to attain the familiarity of administering O2 to patients diagnosed with chronic obstructive pulmonary disease.\r\nThe medical team sounding after Mr. Scott prescribed an antibiotic drug called Tazocin (4.5grams three time a day) to be given intravenously. The rationale for administering this antibiotic was to attempt to fight any infection that the patient may have developed. Also prescribed for Mr. Scott was a steroid and bronchodilator. The rationale for charting a steroid and bronchodilator was that, they are found to decrease inflammation in the atmosphere way and also to open up the air lane (Greenstein et al 2009). Due to Mr. Scotts’ condi tion he was a long term user of unwritten Corticosteroids. Studies (Walters et al. 2008) have shown that, corticosteroids reduce the need for additional medical therapy while, also shorting hospital stay.\r\nOn previous reflection (Gibbs 1988) as a student nurse, the writers’ knowledge developed due to reflection from previous patient care. The writer knew that due to Mr. Scott being on steroids, his blood cultivated cabbage levels needed to be checked once a day as to ensure it stayed within the normal range. The rationale behind monitoring Mr. Scott’s’ blood sugar once a day was due to the side effects that are directly related to the presidentship of corticosteroids. Such side effects are as back talk ulcers, weight gain and increased skin thinning (mayoclinic.com). The writer encouraged Mr. Scott to rinse his mouth out with water post administration of oral steroids to reduce the development of oral ulcers or a candida infection of the mouth, (Greenstein et al 2009).\r\nThe Roper, Logan, Tierney (RLT) 2000 nursing framework aided the writer in focusing upon the care study. This prototype encompasses key factors such as social status, environmental factors as well as the physical/ mental factors which influence people in their daily lives (Roper et al 1991; 2003, Newton 1991). This flummox is designed to be filmable to any patient and not for the patient to suit towards the model of nursing; therefore it allows the nurse to care for each patient on an individual level (Roper et al 2000).\r\n nursing can therefore be defined through this model in monetary value of helping people to prevent, alleviate, solve or bed with problems (actual or potential) when relating to the activities of daily living, (Roper et al. 1990).\r\nConclusion\r\nAlthough the Roper Logan and Tierney’s’ model of nursing covers a holistic view, a model known as the Orem’s Self Care Framework according to Fawcett (1995) concentrates on the individuals’ ego maintenance and regulation through a type of action known as self-care. This model could be seen as beneficial to Mr.Scott as a patient whom has been diagnosed with chronic obstructive pulmonary disease as a main part in maintaining good health is a good understanding/ communication, knowledge and education of how to care for ones’ self (Eva et al. 2009).\r\nThe aim of this fix of work was to assemble while using tools of assessment an individual care plan. This was to be drawn up together with the patient and the writer so the frame of care would be of an individual status. The writer also aimed to demonstrate that with critical thinking and decisive decision making the patient involved received preventive when needed.\r\nAs the writer worked on the ward mentioned a strong therapeutic relationship had been built betwixt patient and student nurse, this allowed the patient to feel at ease when asking questions regarding his condition enabling t he writer to educate the patient at a higher(prenominal) understanding. Upon Mr. Scott’s discharge he expressed a better understanding of his knowledge about his condition, he also felt that if or when he experienced another exacerbation he would not feel as anxious and be better able to cope with it. Hearing this as a student nurse the writer felt that it had enhanced professed(prenominal) development for further nursing practice.\r\nReference leaning:\r\nAlexander, M.,Fawcett, J., Runciman, P.2009. Disorders of the Respiratory System IN: Edmond, C., Mc Clean, I., Mc Clean, J., Wilson, L.(eds.) Nursing course session Hospital and Home. 3rd ed. Edinburgh: Livingstone.\r\nAlexander, M.,Fawcett, J., Runciman, P.2009.Nursing Practice Hospital and Home. 3rd ed. Edinburgh: Livingstone.\r\nBarnett, M. 2005.Caring for a patient with COPD: a reflective account. Nursing Standard.[online].19, (36),pp41-46. unattached from: http://web.ebscohost.com.remote.library.dcu.ie/ehost/pdfvie wer/pdfviewer. 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Effectiveness of smooth Air Mattress Overlay and Static Air butt Cushion For The Prevention Of Pressure Ulcers. Journal of pain Ostomy & continence care. 36(2),Pp 50-53.\r\nThe cochrane collaboration. 2009. Surgical Decompression for cerebral Odema in sagacious Ischaemic Stroke. The cochrane library.\r\nWalters, J., Gibson, P., Wood-Baker, R., Hannay, M., Walters, E. 2008. Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. [Online]. Available from: http://www.mrw.interscience.wiley.com.remote.library.dcu.ie/cochrane/clsysrev\r\n'