Disadvantages To Primary Nursing Environment Nursing Essay

Disadvantages To Primary Nursing environs Nursing EssayPrimary Nursing is a concept that emphasises on uncomplaining centred thrill. This model of deal out delivery impart answer Mr surrender to take control of and be responsible for his health. It similarly renders continuity of care by having only one protect providing complete care for Mr concession. telling coordination between members of the health care team such as physiotherapy, genial worker and the fussy entertain leave alone help towards achieving a rapid recovery for Mr concord. The primary blow is up to(p) to see the progression of Mr relent health compared to other nurses who occasion in ally care for him. Primary breast feeding empowers the primary nurse who knows Mr chip in better to decide how to provide care and give lessons Mr Grant on the steps to recovery. However the nurse may as well lack skills to provide holistic care for a diligent with entangled indigences. Tingle (1992) claims that well-nigh nurses arse find it hard to develop a close relationship with unhurrieds. Another major problem associated with practising primary treat is psychological distress the nurse may feel isolated peculiarly when their enduring is dying. The nurse also sometimes might push themselves too hard causing them to be overstressed and fatigue increasing the encounteriness of default (Melchoir et al.1999, p.89-90).Client Assessment question the importance of performing and documenting a total nursing assessment at the commencement of your care of magic. (150-200 words)A double-dyed(a) nursing assessment at the commencement of care enables the nurse to make actual and authorisation problems of Mr Grant (Fawcett Rhynas 2012). Nursing assessment provides a service broth so that the nurse can identify changes in Mr Grants condition and alerts the nurse to deviation from normal expected set (Fawcett Rhynas 2012). According to Funnell, Koutoukidis and Lawrence (2009), the information garner during the nursing assessment leave behind help the nurse to guide a plan of care for Mr Grant and address the patients specific involves. Mr Grant has a slightly high blood thrust, high respiratory rate and huskiness of breath which are signs and symptoms of respiratory distress and hypoxia on that pointfore he should be admonishered closely to negate deterioration of his health status (Funnell, Koutoukidis Lawrence 2009). Due to his vigorous behaviour and confused state, Mr Grant is at risk of a dominance fall as he is trying to get out of bed. Moreover, Mr Grant has an indwelling catheter and a office tube drainage which could be maybe dislodged when trying to get out of bed.Complex Nursing Care tail has an arterial line insitu. Discuss the reasons for insertion, nursing prudence of the device and say-so problems a client may experience. (150-200 words)According to Kaur (2006), an arterial line insitu will monitor Mr Grants blood pres trusted di rectly, endlessly, and accurately. Mr Grants oxygenation and ventilation can be assessed by measuring arterial blood gas through the arterial line insitu (Perry Potter, 2010). Measurement of the arterial blood gas provides valuable information in assessing and managing Mr Grants respiratory and metabolic disturbances (Perry Potter, 2010). Automatic blood pressure observe can cause atrocious bruising for patient taking anticoagulant, arterial monitor can be used to monitor Mr Grants blood pressure (Kaur 2006). At the beginning of each breakage, the nurse has to check the patients BP, from the oppo situation arm to avoid interrupting the arterial pressure readings, using a sphygmomanometer for comparison (Kaur 2006). Aseptic technique should be maintained when handling the arterial line. The nurse has to check that all the connections are tight and that the pressure bag is at 300 mm Hg at all times to keep the system indubitable (Kaur 2006). Only flushing solution should be inje cted or infused in the arterial line, if there is an production line bubble in the line the pipeline bubble should be withdrawn with a syringe beforehand flushing to prevent business embolism as explained by Perry and Potter (2010) . The insertion site should be monitored for haemorrhage and signs and symptoms of trans cathexis system, including erythema, warmth, tenderness, oedema, and purulent discharge (Kaur 2006). Arterial line insitu is invasive, this type of BP monitoring raises Mr Grants risk of a bloodstream infection and haemorrhage, which can occur very readily if the line becomes disconnected (Kaur 2006). An arterial line also limits the patients mobility. Monitoring the patient closely could avoid potential problems such as haemorrhage from inadvertent catheter disconnection or loose connections, thrombus formation, assembly line embolism, local obstruction with outcome ischemia, and infection (Kaur 2006).At night, John becomes tired. He is treated with CPAP while he sleeps. Discuss this mode of ventilation. In your answer, you must complicate the reasons for use on a fatigued patient, how it works at cellular level, and the nursing management of a patient on CPAP ventilation.(150-200 words)Continuous positive airway pressure is a self ventilating form of positive and expiratory pressure (Woodrow P, 2012). The persisting positive airway pressure (CPAP) keeps the terminal airways, alveoli, partially embellishd, reducing the risk for actelectasis (Perry Potter, 2010). During exhalation, the continuous positive airway pressure machine continues to blow air to keep the airway open and also pushes the exhale air and coke dioxide out through holes in the mask (Perry Potter, 2010). The application of a continuous course of gas to the airway creates a positive pressure which makes it easier for Mr Grant to breathe in. The positive pressure maintained at the end of decease by the positive end expiratory pressure valve prevents alveolar go bad and improves lung compliance (Perry Potter, 2010). The patient does require as much effort is to inflate the alveoli. indeed rationalises respiratory effort or work of eupnoeic, and oxygen expenditure and helps to reduce work of breathing in respiratory fatigued patients (Marshall Pittard 1998). The nurse needs to continuously assess the patient as there is of all time the potential for their condition to deteriorate. CPAP has the potential to cause gastric distension by forcing air down the oesophagus which may lead to vomiting and puts the patient at significant risk for aspiration. According to Marshall Pittard (1998) continuous monitoring of the patients respiratory status and arterial blood gases is or so-valuable for the early staining of worsening respiratory failure. Respiratory assessment should include monitoring the patients rate, depth, spirit and pattern of respiration as well as inspection, palpation, percussion and auscultation of the knocker (Marshall Pittard 1998). Regular assessment of blood pressure, heart rate, peripheral perfusion and urine output will provide the nurse with important information about the adequacy of circulation and assessment of patients haemodynamic status (National Heart Lung and Blood Institute 2011). The nurse should provide full explanation of the circuit and constant reassurance this can significantly reduce anxiety and improve patient compliance with the therapy. Patient education is fundamental to the success of CPAP (National Heart Lung and Blood Institute 2011)John has an intercostal catheter insitu. What is the intention of an inter-costal catheter and why is it on underwater seal drainage? Discuss the nursing assessment and management of this device during client treatment. (150-200 words)Mr Grant has sustained sedate trauma to the chest in the MCA, which could have caused a collection of air in the pleural space and an accumulation of blood and fluid in the pleural cavity. Intercostal Ca theter Insitu is used for chest trauma to remove air and fluid (Perry Potter, 2010). Perry Potter (2010) explains that the underwater seal drainage device acts as a one-way drainage device allowing drainage out of the pleural space, but preventing air from entering or re-entering the pleural space when the patient breathes in. An underwater seal drainage bottle can give some visual clues about the progress of a pneumothorax which indicates decrease of bubbling and lightsome in the underwater seal drainage bottle (Briggs 2010). The nurse should monitor the appearance of the drainage and document this at least once a shift. The chest tube drainage appearance and output may need to be put down more frequently than once a shift in cases where the patient has a large amount of drainage or if the nurse suspects that Mr Grant is having an unexpected amount of drainage (Sullivan 2008). Briggs (2010) outlines that all chest tubes should be routinely monitored for the presence of an air lea k should be documented in the patient record and reported during hand over. Regular disorder assessments are required to maintain adequate analgesic relief from the innervation and pain caused by chest drains (Crisp Taylor 2009). The chest drain should always he kept blow the level of the patients chest to prevent back flow of fluid in to the pleural space. If the drain needs to be embossed above the patients chest, when moving the patient in bed, the tube can be kinked to prevent back flow (Sullivan 2008). Chest dressings should be assessed every sidereal day for oozing and signs of inflammation and changed if oozing is present. Inflammation should be monitored and if worsening a swab should be sent for analysis as stated by Sullivan (2008). The drain tubing should never be secured to the patients bedding or clothing, as sudden movements by the patient could cause the drain to become dislodged, allowing air to enter the pleural cavity (Crisp Taylor 2009). It is also important to encourage the patient to mobilise this can be in the form of deep breathing for bed-bound patients, or short walks and raising arms in the more bustling patient (Perry Potter, 2010). The movement will help with fluid and air drainage. record based practiceWhen administering S/C heparin, some nurses swab the subject with an intoxicant swab before injecting and some nurses do not. What Evidence of go around Practice (EBP) can you find that supports or does not support mop up skin with alcohol preparation before a subcutaneous injection. In your answer, you must include journal references. (150-200 words)According to Cocoman and Murray (2007), swabbing the injection site with a saturated 70% alcohol swab for 30 seconds and allowing to wry for 30 seconds is essential in order to reduce the number of trackogens. However, new-made evidence demonstrated that in instances where the skin was not disinfected before injection, no single case of local or systemic infection was obser ved. seek supports that skin preparation before injection should be administered when giving injections to particular patients as stated by Gittens and Bunnell (2009). These include older patients, those who are ill, or those who are immunocompromised, as it has been shown that certain groups in society are at greater risk of developing infection (Gittens Bunnell 2009). Certain bacterium on the skin have a low potential to cause infection if the immunity of the patient is not impaired or compromised as researched by Gittens Bunnell (2009). In conclusion, my research on evidence based practice on swabbing the skin shows that the use of alcohol swabs is not necessary before a subcutaneous injection. However to ensure the site is not contaminated, it is passing important to adhere to thorough hand hygiene. If using an alcohol preparation, it is important to wait thirty seconds to reduce the incidence of stinging and inoculation of bacteria at the site.Critical ThinkingJohn has bee n decreed six medications. Discuss the reasons he may have been prescribed these medications based on his presenting complaint. Should John be prescribed a sedation for his restless behaviour? wherefore/why not? (150-200 words)MetoclopramideAccording to Tiziani (2010, p.208-209), Mr Grant was prescribed metoclopramide control illness and vomiting. To reduce the side effects of nausea and vomiting as most of the medications that have been prescribed for him will cause this adverse reaction. Metoclopramide will also help with aspiration due to the CPAP.CeftriaxoneMr Grant is coughing up green sputum which indicates an infection in the lungs. Ceftriaxone is used as a broad spectrum antibiotic to treat respiratory tract infection which Mr Grant might have (Tiziani 2010, p. 100)ParacetamolMr Grant has sustained two fractures to the expert ankle and right clavicle which will cause severe pain. Hence paracetamol has been prescribed for pain relief (Tiziani 2010, p. 11). This medicati on will also help to reduce the high temperature of Mr Grant.PhenytoinMr Grant incurred a head soil in the force back vehicle cerebrovascular accident. Phenytoin is used after severe head trauma and prevents the spread of seizure activity across the motor cortex (Tiziani, p. 222).IrbersartanTiziani (2010, p. 265) states that this medication is prescribed for patients with mild to moderate blood pressure. In this scenario, Irbersartan is used to treat Mr Grants high blood pressure of 159/90 and he also had an unstable blood pressure in ICU.ClexaneThis medication will help to dissolve clots formed as a result of terms to the head, chest and abdomen in the impact of the motor vehicle accident. Since he is having a lot of respiratory problem it could also indicate a possibility of pulmonary embolism and this is why clexane has been prescribed.Yes, John should be prescribed a sedation to help him settle down. CPAP is very invasive and whence this will help him to have a restless sle ep. A sedation will help to decrease his respiratory rate.Reflective ThinkingJohns path to recovery will be a process of bodily and delirious challenges. Discuss the physical and emotional needs that John may need when being discharged from hospital. (150-200 words)When discharged from hospital, Mr Grant recovery will be challenged by physical and emotional needs. Mr Grant lost his wife in the car accident and he was under the influence of alcohol. This might soberly impact his self esteem as he might living himself responsible for the car accident. Moreover, grief might have a potential impact on Mr Grants physical kindly, cognitive, emotional behavioural and spiritual aspects of his common life. Mr Grant has sustained multiple injuries and this will severely impact on his ability to do run his everyday life. This can cause emotional and psychological distress as he was an active person. The primary nurse has to work in collaboration with the social worker, occupational ther apist, physiotherapist and psychiatrist to develop a discharge plan which will address the physical and emotional needs of Mr Grant. Mr Grant was driving under the influence of alcohol when he had the motor vehicle accident, referring Mr Grant to clinicians with specialists skills in alcohol and be up monitoring and care coordination will be help towards his recovery. complicate the church community to support him with his spiritual needs and also include the family in the discharge planning.Mission/ Value StatementsHealthcare facilities define their mission contention/ determine/philosophy. This statement underpins their decree of practice. Select a statement/mission/philosophy of one Australian hospital and discuss how their code of practice may be reflective of John and his familys in the flesh(predicate) and social belief system. (150-200 words)As Mr Grant was actively involved in the local Catholic church and regularly attended mass. I chose St Vincent Private values and care statement as it is a catholic hospital and it will be beneficial for Mr Grant due to his religious faith. St Vincent Private (2012) values are Compassion, Justice, Integrity and excellence. Compassion is a vital aspect of good nursing care. It involves the nurse developing a rapport with Mr Grant and providing holistic care. St Vincent values that, nurses showing compassion plays a major role in providing dignified care to patients. Compassionate care will enable Mr Grant to remain independent and retain his dignity. St Vincent hospital aim to make sure that nurses are available to render care and that Mr Grant is aware that note care is available to them. Care will be given check to Mr Grants needs. Integrity is about being truthful to the patient and about the care he is receiving. It is also about providing the right care according to Mr Grants personal and social belief. Excellence is dedicated to provide outstanding care and guest service to Mr Grant and his family. St Vincent embodies the drive to perfect their competencies and enhance the quality, timeliness, and cost-effectiveness of their care. Being in a catholic hospital Mr Grant will be able to receive pastoral care and attend mass regularly depending on his health condition. Mr Grant lost his wife in the car accident and confession can help him to deal with grief.