nur250-nursing-care-plan

NUR250 Nursing Care Plan | Msnbc | Medical Surgical Nursing

succinct statements NUR250 Nursing Care Plan

NUR250 Nursing Care Plan | Msnbc | Medical Surgical Nursing

NUR250 Nursing Care Plan Assessment 1 information, a cover sheet, title and contents pages are not required

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Task 1: Understanding nursing problems

The respiratory problem is the core issue faced by many healthcare providers in the acute care settings. According to the handover, Neville has the core issues with his health like blocked airway, malnutrition, and possibility of infection. Neville’s airway may be affected by bronchitis because the production of thick secretions is increased due to bronchitis. The bacterial growth may occur due to the accumulation of mucus in the airway which leads to respiratory infection and impairment of airway clearance (Ramos, Krahnke, & Kim, 2014). Impaired gas exchange of Neville may be due to emphysema because emphysema impairs the lung tissue which is responsible for gasses exchange in alveoli and collapse the airway. The exacerbation also causes deterioration of gas exchange (Lemone et al., 2017). Neville has a risk of impaired gas exchange due to smoking habit. Due to continue oxygen administration, CO2 retention may occur and it causes the loss of hypoxaemic respiratory drive and fatigue of respiratory muscles and may impair the ventilation of Neville (Lemone et al., 2017). He might have fatigue due to dyspnoea which may result in increased consumption of energy that may be unable him to take the full diet (Lemone et al., 2017). The side effect of medicines as Neville has prescribed amoxicillin antibiotic also may cause nausea, vomiting, and anorexia to him and decreased his intake (Tiziani, 2013). Due to decreased acquired immunity and chronic disease process, Neville has the risk of further infection. The malnutrition also a responsible factor to prone him at risk of infection. Moreover, the work of cilia has been decreased due to smoking and persistence secretions in airway lead to infection (Lemone et al., 2017). The acute exacerbation cause bacterial and viral infection in COPD. The hospitalization also may lead to the risk of hospital-acquired pneumonia (Müllerova et al., 2012).

Task 2: Care planning

Nursing Care Plan:   Neville

Note:  Dot points recommended in care plan.   Click and type in each cell, click enter in a cell to make it longer

A reminder that all information must be referenced

Nursing problem: Activity intolerance
Underlying cause or reason: generalized weakness and dyspnea
Goal of careNursing interventions/actionsRationaleIndicators your plan is working
 

·       Ensure Neville performs daily activities and reduce the risk of respiratory distress.

 

·         Monitor vital signs closely immediately after any activity and note the abnormalities.

 

·         Assist Neville to perform activities of daily living (ADL).

 

 

 

·         Provide proper rest to the patient between treatment and activity periods.

 

 

·         Provide oxygen therapy as prescribed.

 

·         Encourage patient to perform activities by giving positive feedback.

 

·         Support the patient emotionally and reassure the patient about regain of energy.

 

·         It helps to detect the early symptoms of deteriorating condition (Li et al., 2014).

 

·         It helps to promote functional dependence and prevent the loss of motion and reduce the risk of fall injuries (Zarowitz, & O’Shea, 2012)

·         Adequate rest prevents fatigue and preserves energy (Lemone et al., 2017).

 

·         It helps to promote activity and exercise tolerance (Lemone et al., 2017).

 

·         This may help the patient to hope for activity tolerance after curing of disease (Lemone et al., 2017)

·         Neville is able to tolerate activities with less breathlessness or episodes of dyspnea.

 

Nursing problem: Altered sleep pattern
Underlying cause or reason: a persistent cough
Goal of careNursing interventions/actionsRationaleIndicators your plan is working
To ensure that Neville has no disturbance in sleep pattern

 

·         Monitor sleep pattern with objective and subjective information.

 

·         Provide fowler’s or semi-Fowler’s position to the patient.

 

 

·         Administer cough expectorants and bronchodilators as prescribed.

 

 

·         Advise the patient to perform relaxation activities before bed.

 

 

·         Check the prescribed medication of patient and if there is any drug at bedtime that interferes with sleep then consult the doctor.

·         The subjective and objective data helps to assess accurate sleeping time (Lemone et al., 2017).

·         This position promotes the ventilation and decreases breathing workload (Lemone et al., 2017).

 

·         These agents help to loosen and spit out the mucus in the airway and make the airway clear and patent (Lemone et al., 2017).

·         Relaxation therapies help to divert mind and beat the sleeping problems (Volpato, Banfi, Rogers, & Pagnini, 2015).

·         Some medication may disturb the sleeping pattern (Lemone et al., 2017).

Neville has decreased cough episodes.

Neville can sleep comfortably without any disturbance.

Nursing problem: Deficit fluid volume
Underlying cause or reason: less oral intake and nausea and vomiting possible side effects of medicines.
Goal of careNursing interventions/actionsRationaleIndicators your plan is working
To maintain adequate hydration of the patient.·         Maintain intake and output chart of the patient.

·         Check weight daily.

·         Check vital sign regularly- pulse rate, temperature, and respiration rate.

·         Check oral mucosa and skin turgor for dryness.

·         Assess the orientation level of the patient with Glasgow coma scale.

·         It may help to assess the body requirements of fluid (Lemone et al., 2017).

·         Tachypnoea, hypotension and tachycardia indicate the risk of dehydration (McGloin, 2015).

·         Dryness of oral mucosa and decreased skin turgor are signs of dehydration (McGloin, 2015).

 

·         Electrolytes imbalance may lead to disorientation.

The intake and output of Neville are adequate as the requirements of the body.

There is no sign of dryness of oral mucosa and decreased skin turgor.

Nursing problem: Risk of constipation
Underlying cause or reason: imbalanced diet and limited fluid intake
Goal of careNursing interventions/actionsRationaleIndicators your plan is working
Ensure Neville get relief from discomfort during defecation.·         Check the stool for consistency and frequency.

 

·         Encourage the patient to drink a glass of warm water in morning.

 

·         Monitor dietary habits of patient and advise taking the nutritious diet.

 

·         Administer stool softener or bulk laxatives as prescribed.

zEncourage patient to increase fluid intake.

·         Consult the nutritionist for the diet chart as required.

·         This will help to know about the normal condition for the patient (Lemone et al., 2017).

·         This helps to promote to natural elimination (Lemone et al., 2017).

 

·         Irregular and less food intake may lead to constipation (Sun et al., 2013)

 

·         Laxatives relieve constipation and maintain normal elimination (Lemone et al., 2017).

·         Increased fluid intake softens the stool consistency and improves intestinal movements (Lemone et al., 2017).

 

Neville has passed soft and formed stool.

Neville states no discomfort or pain on defecation.

Nursing problem: self-care deficit
Underlying cause or reason: fatigue secondary to dyspnoea.
Goal of careNursing interventions/actionsRationaleIndicators your plan is working
To enable the patient to perform self-care activities- bathing, eating, defecating and more on.

 

 

·         Assess the ability of the patient to perform activities.

·         If a patient wants to walk, provide support or walker.

·         Assist the patient in activities that need an assistant.

·         Provide an atmosphere that permits the patient to perform daily care independently such as clean teeth or feeding.

·         Encourage the patient to perform ADL’s according to his ability.

·         Allow the family members to help the patient.

·         Assessment helps to plan interventions to meet particular needs (Lemone et al., 2017).

 

·         Minimum assistance may encourage the patient for self-care (Lemone et al., 2017).

 

·         This may improve self-esteem and increase independence (Lemone et al., 2017).

 

Neville performs his ADL’s with little assistance.

Neville cares for himself and well dressed.

Neville cleans teeth and comb hair independently.

 

Task 3: Medication management

Eosinophils the main cause of the COPD to exist are targeted by prednisone as a corticosteroid (Akdis, 2012).  The use of prednisone must be monitored along with the check that patient doesn’t have any fungal infection. Also, the steroid medication weakens the immune system. Neville must be briefed with the complications arising due to the use of steroids with the smoking (Tiziani, 2013). The prime responsibility of nurse during medication administration is that nurse should follow the six rights (right dose, right route, right patient, right documentation, right drug and right time) of medication administration to avoid the medication errors (Ferguson, Delaney & Hardy, 2014). Another drug Ipratropium bromide is used for the treatment of lung obstruction as it anticholinergic agent and act as a bronchodilator by reducing the airborne passages (Tiziani, 2013). Before providing the nursing intervention with the Ipratropium bromide is its contraindications to cause hypersensitivity. The possible side effects of this are tachycardia, acute angle-closure glaucoma, nausea, palpitations, and headache. The nurse should provide sips of water to the patient to avoid dryness of the mouth (Lemone et al., 2017). The excessive use through nebulizer would cause the prostatic hypertrophy in Neville. The use is required on a regular basis for the situation like that of Neville (Stephenson et al., 2011).

NUR250 Nursing Care Plan

Antibiotics are recommended to a patient with COPD to relieve breathlessness by alleviating the increased purulent sputum production and cough (Bailey et al., 2012). Oral corticosteroids are prescribed with a combination of broad-spectrum antibiotics to cure a bacterial infection. Oral amoxicillin is given to Neville in addition to prednisone for controlling the possible infection spread in lungs and to treat the bacterial infections (Brusse-Keizer, VanderValk, Hendrix, Kerstjens & van der Palen, 2014). There is a chance that Neville could be allergic to such medication so the alternative must be given in such cases. The nurse should aware of possible side effects of amoxicillin. The main side effect of it is diarrhea. Diarrhea results in the nutrition loss which must be treated otherwise situation could be worsened as Neville is already malnourished (Tiziani, 2013). Neville has prescribed oral medications because the oral route of medication administration is convenient and safe and it is the ideal route to achieve desired curative outcomes (Cyriac & James, 2014).

Task 4: Patient teaching

(Khdour, Hawwa, Kidney, Smyth & McElnay, 2012). Quitting smoking improves the COPD conditions. The nicotine replacement therapy or medication program could be used to help the patient recover from vulnerable smoking habits. Counseling session and group discussions must be arranged for the patients with other smokers so they can share their experiences (Hoogendoorn, Feenstra, Hoogenveen & Rutten-van Mölken, 2010). The effect of passive smoking must also be avoided as it is more deteriorating than active smoking (Cao, Yang, Gan, & Lu, 2015). The information must be given to Neville that smoking is chief reason behind just not cancer, but also the reason for many other diseases like diabetes, cataracts, rheumatoid arthritis, and other coronary diseases (Jha & Peto, 2014). Patient-centred care is required in such cases to help him come up with the rehabilitation process and make it easy for them. Proper care and monitoring could help the rehabilitation and hence the symptoms of COPD would vanish, which helps in respiratory breathing problems (Lemone et al., 2017).

Task 5: Clinical judgment and handover

As per the recognition of the fact, Neville has been prescribed with salbutamol nebulizer. As a nurse, one would attend the patient and assess the situation. Seeing the condition Neville was restless, dyspnoeic, and another parameter like high oxygen saturation, heartbeat, and depressed respiration, it has been diagnosed with hypoxia.  Such situation must be considered as an emergency and patients must be elevated by 45° during supine. Ventilation must be provided, and the patient must be checked every 2 hours, to avoid complications. Hydrated oxygen must be given during the COPD condition as excessive oxygen can cause apnoea. Medication must be given to prevent any infection and monitored if granted to Neville. Slow breathing must be introduced via spirometer to improve the oxygenation

I am Veerpal Kaur, a student nurse from the medical surgical ward. I am concerned about patient Neville who is 62 years old man admitted to hospital with complaints of dyspnoea, cough and increased purulent sputum. He is known case of COPD and history of smoking. He has tachycardia and slightly increased blood pressure. Oxygen is continued @2L/min as medically advised. On return to the ward, he became restless and anxious. His skin has flushed and diaphoretic. On examination, he has tachycardia and heart rate was 110 beats/minute and respiratory rate has declined to 8-10 breaths/minute. According to the condition, Neville is restless, having tachycardia and bradypnea. These are the sign and symptoms of hypoxia. All required nursing care is provided to the patient. Salbutamol nebuliser is given and nasal prong oxygen @ 2L/min continue. Medications are administered and to continue as prescribed. Intake and output chart is maintained. The close monitoring of the patient is required as per condition of the patient. The doctor’s team has checked the patient and advised to transfer the patient to the High Dependency Unit to provide BIPAP support.

Veerpal Kaur Dhaliwal

STUDENT NURSE.

Nurse Veerpal I can see you put in a lot of time and effort to research and write your assignment.  You had some of your better work in Task 2 Care Plan.

You have some more relevant points in some tasks, but have struggled in others.  You need to work on your explanations to demonstrate better understanding of the connections between Neville’s condition, underlying pathophysiology, prescribed treatments and nursing interventions.  In some sections the explanation may have not been clear due to grammar problems. Even so there could be an easy improvement in your work if you had attention to paragraphing and headings so that your work could be followed s much more easily.

NUR250 Nursing Care Plan | Msnbc | Medical Surgical Nursing

Try to write the answers in the terms of the question, and in an order that either follows the question, or discusses each component of the question before moving onto the next. This ensures that the reader can follow your responses, and for yourself you can see that you have answered all components of the question.

You do have a good number of journal articles. There are a number of journals from medicine and other disciplines. Using these tends to deflect focus from nursing and makes it difficult to respond with nursing actions and explanations.

If you use journals from other disciplines it needs to be appropriate to the case. You will find that its easier to get nursing responses from nursing journals, and that journals from other disciplines can provide a lot of irrelevant information which side tracks students from the valuable time they have to complete their studies. The CDU Library can help you with locating and evaluating sources, referencing and using APA.

References

Akdis, C. A. (2012). Therapies for allergic inflammation: refining strategies to induce tolerance. Nature medicine, 18(5), 736-749. doi: 10.1038/nm.2754

Bailey, P. H., Boyles, C. M., Cloutier, J. D., Bartlett, A., Goodridge, D., Manji, M., & Dusek, B. (2012). Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD. Journal of Nursing Education and Practice3(1), 108.
doi: https://doi.org/10.5430/jnep.v3n1p108

Blanco, I., Gimeno, E., Munoz, P. A., Pizarro, S., Gistau, C., Rodriguez-Roisin, R., … & Barberà, J. A. (2010). Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension. American journal of respiratory and critical care medicine, 181(3), 270-278. doi: 10.1164/rccm.200907-0988OC

Brusse-Keizer, M., VanderValk, P., Hendrix, R., Kerstjens, H., & van der Palen, J. (2014). Necessity of amoxicillin clavulanic acid in addition to prednisolone in mild-to-moderate COPD exacerbations. BMJ open respiratory research1(1), e000052. doi: 10.1136/bmjresp-2014-000052

Cao, S., Yang, C., Gan, Y., & Lu, Z. (2015). The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. PloS one10(10), e0139907. doi:

Cuquemelle, E., Pham, T., Papon, J. F., Louis, B., Danin, P. E., & Brochard, L. (2012). Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respiratory Care, 57(10), 1571-1577. doi:

Cyriac, J. M., & James, E. (2014). Switch over from intravenous to oral therapy: A concise overview. Journal of Pharmacology and Pharmacotherapeutics5(2), 83. doi: 10.4103/0976-500X.130042

Ferguson, A., Delaney, B., & Hardy, G. (2014). Teaching medication administration through innovative simulation. Teaching and Learning in Nursing9(2), 64-68. Retrieved from 99assignmenthelp.com.sciencedirect.com.ezproxy.cdu.edu.au/science/article/pii/S1557308713001418

Hoogendoorn, M., Feenstra, T. L., Hoogenveen, R. T., & Rutten-van Mölken, M. P. (2010). Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD. Thorax65(8), 711-718. doi:

Jha, P., & Peto, R. (2014). Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine370(1), 60-68. doi: 10.1056/NEJMra1308383

Khdour, M. R., Hawwa, A. F., Kidney, J. C., Smyth, B. M., & McElnay, J. C. (2012). Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD). European journal of clinical pharmacology, 68(10), 1365-1373. doi: 10.1007/s00228-012-1279-5

Lemone, P., Burke, K., Bauldoff, G., Gubrud, P., Levett-Jones, T., Hales, M., … Reid-Searl, K. (2017). Medical-surgical nursing, critical thinking for person-centred care. (3rd Australian ed.). Melbourne, Victoria: Pearson Australia.

Li, J. M., Cheng, S. Z., Cai, W., Zhang, Z. H., Liu, Q. H., Xie, B. Z., & Wang, M. D. (2014). Transitional care for patients with chronic obstructive pulmonary disease. International Journal of Nursing Sciences1(2), 157-164. doi:

McGloin, S. (2015). The ins and outs of fluid balance in the acutely ill patient. British Journal of Nursing24(1). doi: 10.12968/bjon.2015.24.1.14

Müllerova, H., Chigbo, C., Hagan, G. W., Woodhead, M. A., Miravitlles, M., Davis, K. J., & Wedzicha, J. A. (2012). The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respiratory medicine106(8), 1124-1133. doi:

Ramos, F. L., Krahnke, J. S., & Kim, V. (2014). Clinical issues of mucus accumulation in COPD. Int J Chron Obstruct Pulmon Dis9, 139-150. doi:

Stephenson, A., Seitz, D., Bell, C. M., Gruneir, A., Gershon, A. S., Austin, P. C., … & Gill, S. S. (2011). Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study. Archives of internal medicine171(10), 914-920. doi: 10.1001/archinternmed.2011.170

Sun, Y., Zheng, F., Li, Y., Wu, R., Liu, Y., Liu, M., … & Gao, K. (2013). Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease. Journal of Traditional Chinese Medicine33(5), 608-614. doi:

Tiziani, A. P. (2013). Havard’s nursing guide to drugs (9th ed.). Elsevier Health Sciences.

Volpato, E., Banfi, P., Rogers, S. M., & Pagnini, F. (2015). Relaxation techniques for people with chronic obstructive pulmonary disease: A systematic review and a meta-analysis. Evidence-Based Complementary and Alternative Medicine2015. doi:

Zarowitz, B. J., & O’Shea, T. (2012). Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. Journal of Managed Care Pharmacy18(8), 598-606. doi:

There is plenty of information about gas exchange in COPD- the umbrella term

Collapsed airways causing oxygen to become trapped distally with less oxygen available for diffusion across alveoli. Collapsed and damaged alveoli impairing the diffusion of carbon dioxide from the blood.

Cite all authors in the first instance, then et al in subsequent citations

Indicators are the measure of whether the goal has been achieved. Indicators need to include objective and, where appropriate subjective indicators and should be short/succinct specific statements.

Goals should be short succinct statements of what you want to achieve, and be directly related to the problem. They should also be SMART – specific, measurable, attainable, relevant, time-limited. Most importantly they need to reflect the nursing problem.

The nurse would make an emergency call, stay with Neville and remove the oxygen if it was still on. Reasons for the actions would be that oxygen will worsen the hypercapnia/hypoxia, and Neville should not be left unattended while he is confused  and deteriorating while awaiting urgent medical attention.

David Marks

Dear sir/Ma'am

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