Showing posts with label Fundamental Procedures. Show all posts
Showing posts with label Fundamental Procedures. Show all posts

UNDERSTANDING ORGAN AND TISSUE DONATION

Posted by Admin in Wednesday, April 21, 2010

A federal regulation was enacted in 1998 requiring facilities to report all deaths to the regional organ procurement organization. The regulation was enacted so that no potential donor is missed and ensures that the family of every potential donor will understand the option to donate. According to the American Medical Association, about 25 kinds of organs and tissues are being transplanted. Although donor organ requirements vary, the typical donor's age must be between a neonate and age 60 years and be free from transmissible disease. Tissue donations are less restrictive, and some tissue banks will accept skin from donors up to age 75.
Collection of most organs, such as the heart, liver, kidney, or pancreas, requires that the patient be pronounced brain dead and kept physically alive until the organs are harvested. Tissue such as eyes, skin, bone, and heart valves may be taken after death. Contact your regional organ procurement organization for specific organ donation criteria or to identify a potential donor. If you don't know the regional organ procurement organization in your area, call the United Network for Organ Sharing at (804) 330-8500.

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FIVE STAGES OF DYING

Posted by Admin

According to Elisabeth Kübler-Ross, author of On Death and Dying, the dying patient may progress through five psychological stages in preparation for death. Although each patient experiences these stages differently, and not necessarily in this order, understanding the stages will help you meet your patient's needs.
Denial
When the patient first learns of his terminal illness, he'll refuse to accept the diagnosis. He may experience physical symptoms similar to a stress reaction — shock, fainting, pallor, sweating, tachycardia, nausea, and GI disorders. During this stage, be honest with the patient but not blunt or callous. Maintain communication with him so he can discuss his feelings when he accepts the reality of death — but don't force him to confront this reality.
Anger
When the patient stops denying his impending death, he may show deep resentment toward those who will live on after he dies — including you, the hospital staff, and his own family. Although you may instinctively draw back from the patient or even resent this behavior, remember that he's dying and has a right to be angry. After you accept his anger, you can help him find different ways to express it and can help his family to understand it.
Bargaining
Although the patient acknowledges his impending death, he attempts to bargain with God or fate for more time. He will probably strike this bargain secretly. If he does confide in you, don't urge him to keep his promises.
Depression
In this stage, the patient may first experience regrets about his past and then grieve about his current condition. He may withdraw from his friends, family, doctor, and from you. He may suffer from anorexia, increased fatigue, or self-neglect. You may find him sitting alone, in tears. Accept the patient's sorrow, and if he talks to you, listen. Provide comfort by touch, as appropriate. Resist the temptation to make optimistic remarks or cheerful small talk.
Acceptance
In this last stage, the patient accepts the inevitability and imminence of his death, without emotion. The patient may simply desire the quiet company of a family member or friend. If, for some reason, a family member or friend can't be present, stay with the patient to satisfy his final need. Remember, however, that many patients die before reaching this stage.

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POSTMORTEM CARE

Posted by Admin

After the patient dies, care includes preparing him for family viewing, arranging transportation to the morgue or funeral home, and determining the disposition of the patient's belongings. In addition, postmortem care entails comforting and supporting the patient's family and friends and providing for their privacy.
Postmortem care usually begins after a physician certifies the patient's death. If the death occurs within 24 hours of admission, or if the patient died violently or under suspicious circumstances (for example, an accident, a suicide, or a homicide), postmortem care may be postponed until the medical examiner completes an autopsy. Be aware that if an autopsy is necessary, it will influence the postmortem care.
Equipment
Gauze or soft string ties • gloves • chin straps • ABD pads • cotton balls • plastic shroud or body wrap • three identification tags • adhesive bandages to cover wounds or punctures • plastic bag for patient's belongings • water-filled basin • soap • towels • washcloths • stretcher.
A commercial morgue pack usually contains gauze or string ties, chin straps, a shroud, and identification tags.
Implementation
  • Document any auxiliary equipment, such as a mechanical ventilator, still present. Put on gloves.
  • Place the body in the supine position, arms at sides and head on a pillow. Then elevate the head of the bed 30 degrees to prevent discoloration from blood settling in the face.
  • If the patient wore dentures and your facility's policy permits, gently insert them; then close the mouth. Close the eyes by gently pressing on the lids with your fingertips. If they don't stay closed, place moist cotton balls on the eyelids for a few minutes, and then try again to close them. Place a folded towel under the chin to keep the jaw closed.
  • Remove all indwelling urinary catheters, tubes, and tape, and apply adhesive bandages to puncture sites. Replace soiled dressings.
  • Collect all the patient's valuables to prevent loss. If you're unable to remove a ring, cover it with gauze, tape it in place, and tie the gauze to the wrist to prevent slippage and subsequent loss.
  • Clean the body thoroughly, using soap, a basin, and washcloths. Place one or more ABD pads between the buttocks to absorb rectal discharge or drainage.
  • Cover the body up to the chin with a clean sheet.
  • Offer comfort and emotional support to the family and intimate friends. Ask if they wish to see the patient. If they do, allow them to do so in privacy. Ask if they would prefer to leave the patient's jewelry on the body.
  • After the family leaves, remove the towel from under the chin of the deceased patient. Pad the chin, and wrap chin straps under the chin and tie them loosely on top of the head. Then pad the wrists and ankles to prevent bruises, and tie them together with gauze or soft string ties.
  • Fill out the three identification tags. Each tag should include the deceased patient's name, room and bed numbers, date and time of death, and physician's name. Tie one tag to the deceased patient's hand or foot, but don't remove his identification bracelet to ensure correct identification.
  • Place the shroud or body wrap on the morgue stretcher and, after obtaining assistance, transfer the body to the stretcher. Wrap the body, and tie the shroud or wrap with the string provided. Then attach another identification tag
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    to the front of the shroud or wrap, and cover the shroud or wrap with a clean sheet. If a shroud or wrap isn't available, dress the deceased patient in a clean gown and cover the body with a sheet.
  • Place the deceased patient's personal belongings, including valuables, in a bag and attach the third identification tag to it.
  • If the patient died of an infectious disease, label the body according to your facility's policy.
  • Close the doors of adjoining rooms if possible. Then take the body to the morgue. Use corridors that aren't crowded and, if possible, use a service elevator.

Special considerations
  • If the patient is a trauma victim, the victim of a violent crime (such as a gunshot wound or stabbing), or has been in the hospital less than 24 hours, don't remove tubing or wash the patient until it's confirmed that an autopsy won't be done. If an autopsy is to be performed, keep all I.V. and other patient tubes intact and document as such.
  • Give the deceased patient's personal belongings to his family or bring them to the morgue. If you give the family jewelry or money, make sure a coworker is present as a witness. Obtain the signature of an adult family member to verify receipt of valuables or to state their preference that jewelry remain on the patient.
  • Offer emotional support to the deceased patient's family and friends and to the patient's facility roommate, if appropriate.
Documentation
Although the extent of documentation varies among facilities, always record the disposition of the patient's possessions, especially jewelry and money. Also note the date and time the patient was transported to the morgue.

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CARE OF THE DYING PATIENT

Posted by Admin

A patient needs intensive physical and emotional support as he approaches death. Signs and symptoms of impending death include reduced respiratory rate and depth, decreased or absent blood pressure, weak or erratic pulse rate, lowered skin temperature, decreased level of consciousness (LOC), diminished sensorium and neuromuscular control, diaphoresis, pallor, cyanosis, and mottling.
Emotional support for the dying patient and his family usually means reassurance and the nurse's physical presence to help ease fear and loneliness. More intense emotional support is important at much earlier stages, especially for patients with long-term progressive illnesses, who can work through the stages of dying. (See Five stages of dying, page 112.)
Respect the patient's wishes about extraordinary means of supporting life. The patient may have signed a living will. This document, legally binding in most states, declares the patient's desire for a death unimpeded by the artificial support of defibrillators, respirators, life-sustaining drugs, auxiliary hearts, and other artificial means. If the patient has signed such a document, the nurse must respect his wishes and communicate the physician's “no code” order to all staff members.
Equipment
Clean bed linens • clean gowns • gloves • water-filled basin • soap • washcloth • towels • lotion • linen-saver pads • lemon-glycerin swabs • petroleum jelly • suction and resuscitation equipment, as necessary • optional: indwelling urinary catheter.
Implementation
  • Assemble equipment at the patient's bedside as needed.
Meeting physical needs
  • Take vital signs often, and observe for pallor, diaphoresis, and decreased LOC.
  • Reposition the patient in bed at least every 2 hours because sensation, reflexes, and mobility diminish first in the legs and gradually in the arms. Make sure the bed sheets cover him loosely to reduce discomfort caused by pressure on arms and legs.
  • When the patient's vision and hearing start to fail, turn his head toward the light and speak to him from near the head of the bed. Because hearing may be acute despite loss of consciousness, avoid whispering or speaking inappropriately about the patient in his presence.
  • Change the bed linens and the patient's gown as needed. Provide skin care during gown changes, and adjust the room temperature for patient comfort if necessary.
  • Observe for incontinence or anuria, the result of diminished neuromuscular control or decreased renal function. If necessary, obtain an order to catheterize the patient, or place linen-saver pads beneath the patient's buttocks. Put on gloves and provide perineal care with soap, a washcloth, and towels to prevent irritation.
  • With suction equipment, suction the patient's mouth and upper airway to remove secretions. Elevate the head of the bed to decrease respiratory resistance. As the patient's condition deteriorates, he may breathe mostly through his mouth.
  • Offer fluids frequently, and lubricate the patient's lips and mouth with petroleum jelly or lemon-glycerin swabs to counteract dryness.
  • If the comatose patient's eyes are open, provide eye care to prevent corneal ulceration. Such ulceration can cause blindness and prevent the use of these tissues for transplantation should the patient die.
  • Provide ordered pain medication as needed. Keep in mind that, as circulation diminishes, medications given I.M. will be poorly absorbed. Medications should be given I.V., if possible, for optimum results. Some medications can be given
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    sublingually or rectally if the patient can't swallow or has no I.V. access.

Meeting emotional needs
    • Fully explain all care and treatments to the patient even if he's unconscious because he may still be able to hear. Answer any questions as candidly as possible without sounding callous.
    • Allow the patient to express his feelings, which may range from anger to loneliness. Take time to talk with the patient. Sit near the head of the bed, and avoid looking rushed or unconcerned.
    • Notify family members, if they're absent, when the patient wishes to see them. Let the patient and his family discuss death at their own pace.
    • Offer to contact a member of the clergy or social services department, if appropriate.
    Special considerations
    • If the patient has signed a living will, the physician will write a “do-not-resuscitate (DNR)” order on his progress notes and order sheets. Know your state's policy regarding the living will. If it's legal, transfer the DNR order to the patient's chart or Kardex and, at the end of your shift, inform the incoming staff of this order.
    • If family members remain with the patient, show them the location of bathrooms, lounges, and cafeterias. Explain the patient's needs, treatments, and care plan to them. If appropriate, offer to teach them specific skills so they can take part in nursing care. Emphasize that their efforts are important and effective. As the patient's death approaches, give them emotional support.
    • At an appropriate time, ask the family whether they have considered organ and tissue donation. Check the patient's records to determine whether he completed an organ donor card. (See Understanding organ and tissue donation.)
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    Documentation
    Record changes in the patient's vital signs, intake and output, and LOC. Note the times of cardiac arrest and the end of respiration, and notify the physician when these occur.

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BELIEFS AND PRACTICES OF SELECTED RELIGIONS

Posted by Admin

A patient's religious beliefs can affect his attitudes toward illness and traditional medicine. By trying to accommodate the patient's religious beliefs and practices in your care plan, you can increase his willingness to learn and comply with treatment regimens. Because religious beliefs may vary within particular sects, individual practices may differ from those described here.
RELIGION BIRTH AND DEATH RITUALS DIETARY RESTRICTIONS PRACTICES IN HEALTH CRISIS
Adventist None (baptism of adults only) Alcohol, coffee, tea, narcotics, stimulants; in many groups, meat is also prohibited Communion and baptism performed. Some members believe in divine healing, anointing with oil, and prayer. Some regard Saturday as the Sabbath.
Baptist At birth, none (baptism of believers only); before death, counseling by clergy member and prayer Alcohol; in some groups, coffee and tea is also prohibited Some believe in healing by laying on of hands. Resistance to medical therapy occasionally approved.
Christian Scientist At birth, none; before death, counseling by a Christian Science practitioner Alcohol, coffee, and tobacco prohibited Many members refuse all treatment, including drugs, biopsies, physical examination, and blood transfusions, and permit vaccination only when required by law. Alteration of thoughts is believed to cure illness. Hypnotism and psychotherapy are prohibited. (Christian Scientist nurses and nursing homes honor these beliefs.)
Church of Christ None (baptism at age 8 or older) Alcohol discouraged Communion, anointing with oil, laying on of hands, and counseling by a minister.
Eastern Orthodox At birth, baptism and confirmation; before death, last rites (For members of the Russian Orthodox Church, the arms are crossed after death, the fingers are set in a cross, and the unembalmed body is clothed in natural fiber.) For members of the Russian Orthodox Church and usually the Greek Orthodox Church, no meat or dairy products on Wednesday, Friday, and during Lent Anointing of the sick. For members of the Russian Orthodox Church, cross necklace is replaced immediately after surgery and shaving of male patients is prohibited, except in preparation for surgery. For members of the Greek Orthodox Church, communion and Sacrament of Holy Unction.
Episcopal At birth, baptism; before death, occasional last rites For some members, abstention from meat on Friday, fasting before communion (which may be daily) Communion, prayer, and counseling performed by a minister.
Jehovah's Witnesses None Abstention from foods to which blood has been added Typically, no blood transfusions are permitted; a court order may be required for an emergency transfusion.
Judaism Ritual circumcision on eighth day after birth; burial of dead fetus; ritual washing of dead; burial (including organs and other body tissues) occurs as soon as possible; no autopsy or embalming For Orthodox and Conservative Jews, kosher dietary laws (for example, pork and shellfish are prohibited); for Reform Jews, usually no restrictions Donation or transplantation of organs requires rabbinical consultation. For Orthodox and Conservative Jews, medical procedures may be prohibited on the Sabbath—from sundown Friday to sundown Saturday—and special holidays.
Lutheran Baptism usually performed 6 to 8 weeks after birth None Communion, prayer, and counseling performed by a minister.
Mormon At birth, none (baptism at age 8 or older); before death, baptism, and gospel preaching Alcohol, tobacco, tea, and coffee are prohibited; meat intake is limited Belief in divine healing through the laying on of hands; communion on Sunday; some members may refuse medical treatment. Many wear a special undergarment.
Moslem If spontaneous abortion occurs before 130 days, the fetus is treated as discarded tissue; after 130 days, it's treated as a human being. (Before death, confession of sins with family present; after death, only relatives or friends may touch the body.) Pork is prohibited; daylight fasting during 9th month of Islamic calendar Faith healing for the patient's morale only; conservative members reject medical therapy.
Orthodox Presbyterian Infant baptism; scripture reading and prayer before death None Communion, prayer, and counseling performed by a minister.
Pentecostal Assembly of God, Foursquare Church None (baptism only after age of accountability) Abstention from alcohol, tobacco, meat slaughtered by strangling, any food to which blood has been added and, sometimes, pork Belief in divine healing through prayer, anointing with oil, and laying on of hands.
Roman Catholic Infant baptism, including baptism of an aborted fetus without signs of clinical death (tissue necrosis); before death, anointing of the sick Fasting or abstention from meat on Ash Wednesday and on Fridays during Lent; this practice is usually waived for the hospitalized Burial of major amputated limb (sometimes) in consecrated ground; donation or transplantation of organs allowed if the benefit to recipient outweighs potential harm to donor. Sacraments of the Sick also performed when patients are ill, not just before death. Sometimes performed shortly after admission.
United Methodist None (baptism of children and adults only) None Communion before surgery or similar crisis; donation of body parts encouraged.

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SPIRITUAL CARE

Posted by Admin

Religious beliefs can profoundly influence a patient's recovery rate, attitude toward treatment, and overall response to hospitalization. In certain religious groups, beliefs can preclude diagnostic tests and therapeutic treatments, require dietary restrictions, and prohibit organ donation and artificial prolongation of life. (See Beliefs and practices of selected religions, pages 108 to 110.)
Consequently, effective patient care requires recognition of and respect for the patient's religious beliefs. Recognizing his beliefs and need for spiritual care may require close attention to his nonverbal cues or to seemingly casual remarks that express his spiritual concerns. Respecting his beliefs may require setting aside your own beliefs to help the patient follow his. Providing spiritual care may require contacting an appropriate member of the clergy in the facility or community, gathering any equipment that may be necessary to help the patient perform rites and administer sacraments, and preparing him for a pastoral visit.
Equipment
Clean towels (one or two) • teaspoon or 1-oz (30-ml) medicine cup (for baptism) • container of water (for emergency baptism).
Some facilities, particularly those with a religious affiliation, provide baptismal trays. The clergy member may bring holy water, holy oil, or other religious articles to minister to the patient.
Preparation of equipment
For baptism, cover a small table with a clean towel. Fold a second towel and place it on the table, along with the teaspoon or medicine cup. For communion and anointing, cover the bedside stand with a clean towel.
Implementation
  • Check the patient's admission record to determine his religious affiliation. Remember that even patients who claim to have no religious beliefs may desire spiritual or pastoral care. So watch and listen carefully for subtle expressions of this desire.
  • Evaluate the patient's behavior for signs of loneliness, anxiety, or fear—emotions that may signal his need for spiritual counsel. Also consider whether the patient is facing a health crisis, which may occur with chronic illness and before childbirth, surgery, or impending death. Remember that a patient may feel acutely distressed because of his inability to participate in religious observances. Help such a patient verbalize his beliefs to relieve stress. Listen to him and let him express his concerns, but carefully refrain from imposing your beliefs on him to avoid conflict and further stress. If the patient requests, arrange a visit by an appropriate member of the clergy. Consult this clergy member if you need more information about the patient's beliefs.
  • If the patient faces the possibility of abortion, amputation, transfusion, or other medical procedures with important religious implications, try to discover his or her spiritual attitude. Also try to determine the patient's attitude toward the importance of laying on of hands, confession, communion, observance of holy days (such as the Sabbath), and restrictions in diet or physical appearance. Helping the patient continue his normal religious practices during hospitalization can help reduce stress.
  • If the patient is pregnant, find out her beliefs concerning infant baptism and circumcision, and comply with them after delivery.
  • If a neonate is in critical condition, call an appropriate clergy member immediately. To perform an emergency baptism, the minister or priest pours a small amount of holy water into a teaspoon or a medicine cup and sprinkles a few drops of water over the infant's head while saying, “(Name of child), I baptize you in the name of the Father, the Son, and the Holy Spirit. Amen.” In an extreme emergency, you can perform a Roman Catholic baptism, using a container of any available water. If you do so, be sure to notify the priest because this sacrament must be administered only once.
  • If a Jewish woman delivers a male infant prematurely or by cesarean birth, ask her whether she plans to observe the rite of circumcision, or bris, a significant ceremony performed on the eighth day after birth. (Because a patient who delivers a healthy, full-term baby vaginally is usually discharged quickly, this ceremony is normally performed outside the facility.) For a bris, ensure privacy and, if requested, sterilize the instruments. (For more information, see “Circumcision,” page 775.)
  • If the patient requests communion, prepare him for it before the clergy member arrives. First, place him in Fowler's or semi-Fowler's position if his condition permits. Otherwise, allow him to remain supine. Tuck a clean towel under his chin, and straighten the bed linens.
  • If a terminally ill patient requests the Sacrament of the Sick (Last Rites) or special treatment of his body after death,
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    call an appropriate clergy member. For the Roman Catholic patient, call a Roman Catholic priest to administer the sacrament, even if the patient is unresponsive or comatose. To prepare the patient for this sacrament, uncover his arms and fold back the top linens to expose his feet. After the clergy member anoints the patient's forehead, eyes, nose, mouth, hands, and feet, straighten and retuck the bed linens.
Special considerations
  • Handle the patient's religious articles carefully to avoid damage or loss. Become familiar with religious resources in your facility. Some facilities employ one or more clergy members who counsel patients and staff and link patients to other pastoral resources.
  • If the patient tries to convert you to his personal beliefs, tell him that you respect his beliefs but are content with your own. Likewise, avoid attempts to convert the patient to your personal beliefs.
Documentation
Complete a baptismal form and attach it to the patient's record; send a copy of the form to the appropriate clergy member. Record the rites of circumcision and last rites in your notes. Also, record last rites in red on the Kardex so it won't be repeated unnecessarily.

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USING AN ELECTRONIC VITAL SIGNS MONITOR

Posted by Admin in Tuesday, December 29, 2009


An electronic vital signs monitor allows you to track a patient's vital signs continually, without having to reapply a blood pressure cuff each time. In addition, the patient won't need an invasive arterial line to gather similar data.
Some automated vital signs monitors are lightweight and battery-operated and can be attached to an I.V. pole for continual monitoring, even during patient transfers. Newer models can also display patient temperature and pulse oximetry as well as blood pressure. A built in printer is also available on certain models. Make sure that you know the capacity of the monitor's battery, and plug the machine in whenever possible to keep it charged.
Before using any monitor, check its accuracy. Determine the patient's pulse rate and blood pressure manually, using the same arm you'll use for the monitor cuff. Compare your results when you get initial readings from the monitor. If the results differ, call your supply department or the manufacturer's representative.
Preparing the device
  • Explain the procedure to the patient. Describe the alarm system so he won't be frightened if it's triggered.
  • Make sure that the power switch is off. Then plug the monitor into a properly grounded wall outlet. Secure the dual air hose to the front of the monitor.
  • Connect the pressure cuff's tubing into the other ends of the dual air hose, and tighten connections to prevent air leaks. Keep the air hose away from the patient to avoid accidental dislodgment.
  • Squeeze all air from the cuff, and wrap the cuff loosely around the patient's arm or leg, allowing 2 fingerbreadths between cuff and arm or leg. Never apply the cuff to a limb that has an I.V. line in place. Position the cuff's “artery” arrow over the palpated brachial artery. Then secure the cuff for a snug fit.
Selecting parameters
  • When you turn on the monitor, it will default to a manual mode. (In this mode, you can obtain vital signs yourself before switching to the automatic mode.) Press the AUTO/MANUAL button to select the automatic mode. The monitor will give you baseline data for the pulse rate, systolic and diastolic pressures, and mean arterial pressure.
  • Compare your previous manual results with these baseline data. If they match, you're ready to set the alarm parameters. Press the SELECT button to blank out all displays except systolic pressure.
  • Use the HIGH and LOW limit buttons to set the specific parameters for systolic pressure. (These limits range from a high of 240 to a low of 0.) You'll also do this three more times for mean arterial pressure, pulse rate, and diastolic pressure. After you've set the parameters for diastolic pressure, press the SELECT button again to display all current data. Even if you forget to do this last step, the monitor will automatically display current data 10 seconds after you set the last parameters.
Collecting data
  • You also need to tell the monitor how often to obtain data. Press the SET button until you reach the desired time interval in minutes. If you've chosen the automatic mode, the monitor will display a default cycle time of 3 minutes. You can override the default cycle time to set the interval you prefer.
  • You can obtain a set of vital signs at any time by pressing the START button. Also, pressing the CANCEL button will stop the interval and deflate the cuff. You can retrieve stored data by pressing the PRIOR DATA button. The monitor will display the last data obtained along with the time elapsed since then. Scrolling backward, you can retrieve data from the previous 99 minutes.

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EFFECTS OF AGE ON BLOOD PRESSURE

Posted by Admin in Sunday, December 27, 2009

EFFECTS OF AGE ON BLOOD PRESSURE
Systolic and diastolic blood pressure will vary according to the patient's age.
AGE
BLOOD PRESSURE (MM HG)
Neonate
Systolic: 50 to 52
Diastolic: 25 to 30
Mean: 35 to 40
3 years
Systolic: 78 to 114
Diastolic: 46 to 78
10 years
Systolic: 90 to 132
Diastolic: 56 to 86
16 years
Systolic: 104 to 108
Diastolic: 60 to 92
Adult
Systolic: 90 to 130
Diastolic: 60 to 85
Older adult
Systolic: 140 to 160
Diastolic: 70 to 90

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USING A DOPPLER DEVICE

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USING A DOPPLER DEVICE
More sensitive than palpation for determining pulse rate, the Doppler ultrasound blood flow detector is especially useful when a pulse is faint or weak. Unlike palpation, which detects arterial wall expansion and retraction, this instrument detects the motion of red blood cells (RBCs).
  • Apply a small amount of coupling gel or transmission gel (not water-soluble lubricant) to the ultrasound probe.
  • Position the probe on the skin directly over the selected artery. In the illustration below left, the probe is over the posterior tibial artery.
  • When using a Doppler model like the one in the illustration below left, turn the instrument on and, moving counterclockwise, set the volume control to the lowest setting. If your model doesn't have a speaker, plug in the earphones and slowly raise the volume. The Doppler ultrasound stethoscope shown in the illustration below right is basically a stethoscope fitted with an audio unit, volume control, and transducer, which amplifies the movement of RBCs.
  • To obtain the best signals with either device, tilt the probe 45 degrees from the artery, being sure to put gel between the skin and the probe. Slowly move the probe in a circular motion to locate the center of the artery and the Doppler signal—a hissing noise at the heartbeat. Avoid moving the probe rapidly because this distorts the signal.
  • Count the signals for 60 seconds to determine the pulse rate.
  • After you've measured the pulse rate, clean the probe with a soft cloth soaked in antiseptic solution or soapy water. Don't immers the probe or bump it against a hard surface.



Doppler probe with amplifier

Doppler ultrasound stethoscope

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IDENTIFYING PULSE PATTERNS

Posted by Admin in Wednesday, December 16, 2009

IDENTIFYING PULSE PATTERNS
TYPE
RATE
RHYTHM (PER 3 SECONDS)
CAUSES AND INCIDENCE
NORMAL
60 to 80 beats/minute; in neonates, 120 to 140 beats/minute
o o o o
  • Varies with such factors as age, physical activity, and sex (men usually have lower pulse rates than women)
TACHYCARDIA
More than 100 beats/minute
o o o o o o o
  • Accompanies stimulation of the sympathetic nervous system by emotional stress, such as anger, fear, or anxiety, or by the use of certain drugs such as caffeine
  • May result from exercise and from certain health conditions, such as heart failure, anemia, and fever (which increases oxygen requirements and therefore pulse rate)
BRADYCARDIA
Less than 60 beats/minute
o o o
  • Accompanies stimulation of the parasympathetic nervous system by drug use, especially cardiac glycosides, and such conditions as cerebral hemorrhage and heart block
  • May also be present in fit athletes
IRREGULAR
Uneven time intervals between beats (for example, periods of regular rhythm interrupted by pauses or premature beats)
o o o o o o o
  • May indicate cardiac irritability, hypoxia, digoxin toxicity, potassium imbalance, or sometimes more serious arrhythmias if premature beats occur frequently
  • Occasional premature beats are normal

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TYPES OF THERMOMETERS

Posted by Admin


You can take an oral, rectal, or axillary temperature with such instruments as a mercury glass thermometer, a chemical-dot device, or various electronic digital thermometers. You may even have access to a tympanic thermometer.
You'll use the oral route most for adults who are awake, alert, oriented, and cooperative. For infants, young children, and confused or unconscious patients, you may need to take the temperature rectally.

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RESPIRATION - Assessment

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RESPIRATION
Controlled by the respiratory center in the lateral medulla oblongata, respiration is the exchange of oxygen and carbon dioxide between the atmosphere and body cells. External respiration, or breathing, is accomplished by the diaphragm and chest muscles and delivers oxygen to the lower respiratory tract and alveoli.
Four measures of respiration—rate, rhythm, depth, and sound—reflect the body's metabolic state, diaphragm and chest-muscle condition, and airway patency. Respiratory rate is recorded as the number of cycles (with inspiration and expiration comprising one cycle) per minute; rhythm, as the regularity of these cycles; depth, as the volume of air inhaled and exhaled with each respiration; and sound, as the audible digression from normal, effortless breathing.
Equipment
Watch with second hand.
Implementation
  • The best time to assess the patient's respirations is immediately after taking his pulse rate. Keep your fingertips over the radial artery, and don't tell the patient you're counting respirations. If you tell him, he'll become conscious of his respirations and the rate may change.
  • Count respirations by observing the rise and fall of the patient's chest as he breathes. Alternatively, position the patient's opposite arm across his chest and count respirations by feeling its rise and fall. Consider one rise and one fall as one respiration.
  • Count respirations for 30 seconds and multiply by 2 or count for 60 seconds if respirations are irregular to account for variations in respiratory rate and pattern.
  • As you count respirations, be alert for and record such breath sounds as stertor, stridor, wheezing, and an expiratory grunt. Stertor is a snoring sound resulting from secretions in the trachea and large bronchi. Listen for it in patients with neurologic disorders and in those who are comatose. Stridor is an inspiratory crowing sound that occurs with upper airway obstruction in laryngitis, croup, or the presence of a foreign body.
  • PEDIATRIC ALERT When listening for stridor in infants and children with croup, also observe for sternal, substernal, or intercostal retractions.
  • Wheezing is caused by partial obstruction in the smaller bronchi and bronchioles. This high-pitched, musical sound is common in patients with emphysema or asthma.
    P.18

  • PEDIATRIC ALERT In infants, an expiratory grunt indicates imminent respiratory distress.
  • ELDER ALERT In older patients, an expiratory grunt may result from partial airway obstruction or neuromuscular reflex.
  • Watch the patient's chest movements and listen to his breathing to determine the rhythm and sound of respirations. (See Identifying respiratory patterns.)
  • To detect other breath sounds—such as crackles and rhonchi—or the lack of sound in the lungs, you'll need a stethoscope.
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  • Observe chest movements for depth of respirations. If the patient inhales a small volume of air, record this as shallow; if he inhales a large volume, record this as deep.
  • Observe the patient for use of accessory muscles, such as the scalene, sternocleidomastoid, trapezius, and latissimus dorsi. Using these muscles reflects weakness of the diaphragm and the external intercostal muscles—the major muscles of respiration.

Special considerations
  • Respiratory rates of less than 8 or more than 40 breaths per minute are usually considered abnormal; report the sudden onset of such rates promptly. Observe the patient for signs of dyspnea, such as an anxious facial expression, flaring nostrils, a heaving chest wall, and cyanosis. To detect cyanosis, look for characteristic bluish discoloration in the nail beds or the lips, under the tongue, in the buccal mucosa, or in the conjunctiva.
  • In assessing the patient's respiratory status, consider his personal and family history. Ask whether he smokes and, if so, for how many years and how many packs per day.
  • PEDIATRIC ALERT A child's respiratory rate may double in response to exercise, illness, or emotion. Normally, the rate for neonates is 30 to 80 breaths/minute; for toddlers, 20 to 40; and for children of school age and older, 15 to 25. Children usually reach the adult rate (12 to 20) at about age 15.
Documentation
Record the rate, depth, rhythm, and sound of the patient's respirations.

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BLOOD PRESSURE - Assessment

Posted by Admin

BLOOD PRESSURE
Defined as the lateral force exerted by blood on the arterial walls, blood pressure depends on the force of ventricular contractions, arterial wall elasticity, peripheral vascular resistance, and blood volume and viscosity. Systolic, or maximum, pressure occurs during left ventricular contraction and reflects the integrity of the heart, arteries, and arterioles. Diastolic, or minimum, pressure occurs during left ventricular relaxation and directly indicates blood vessel resistance.
Pulse pressure—the difference between systolic and diastolic pressures—varies inversely with arterial elasticity. Rigid vessels, incapable of distention and recoil, produce high systolic pressure and low diastolic pressure. Normally, systolic pressure exceeds diastolic pressure by about 40 mm Hg. Narrowed pulse pressure—a difference of less than 30 mm Hg—occurs when systolic pressure falls and diastolic rises. These changes reflect reduced stroke volume, increased peripheral resistance, or both. Widened pulse pressure—a difference of more than 50 mm Hg between systolic and diastolic pressures—occurs when systolic pressure rises and diastolic pressure remains constant, or when systolic pressure rises and diastolic pressure falls. These changes reflect increased stroke volume, decreased peripheral resistance, or both.
Blood pressure is measured in millimeters of mercury with a sphygmomanometer and a stethoscope, usually at the brachial artery (less often at the popliteal or radial artery). Lowest in the neonate, blood pressure rises with age, weight gain, prolonged stress, and anxiety. (See Effects of age on blood pressure.)
Frequent blood pressure measurement is critical after serious injury, surgery, or anesthesia, and during any illness or condition that threatens cardiovascular stability. (Frequent measurement may be done with an automated vital signs monitor.) Regular measurement is indicated for patients with a history of hypertension or hypotension, and yearly screening is recommended for all adults.
Equipment
Mercury or aneroid sphygmomanometer • stethoscope • alcohol pad • automated vital signs monitor (if available).
The sphygmomanometer consists of an inflatable compression cuff linked to a manual air pump and a mercury manometer or an aneroid gauge. The mercury sphygmomanometer is more accurate and requires calibration less frequently than the aneroid model but is larger and heavier. To obtain an accurate reading, you must rest its gauge on a level surface and view the meniscus at eye level; you can rest an aneroid gauge in any position but must view it directly from the front.
Hook, bandage, snap, or Velcro cuffs come in six standard sizes ranging from neonate to extra-large adult. Disposable cuffs are available.
The automated vital signs monitor is a noninvasive device that measures pulse rate, systolic and diastolic pressures, and mean arterial pressure at preset intervals. (See Using an electronic vital signs monitor.)
Preparation of equipment
Carefully choose a cuff of appropriate size for the patient. An excessively narrow cuff may cause a false-high pressure reading; an excessively wide one, a false-low reading. If you aren't using your own stethoscope, disinfect the earpieces with an alcohol pad before placing them in your ears to avoid cross-contamination.
To use an automated vital signs monitor, collect the monitor, dual air hose, and pressure cuff. Then make sure the monitor unit is firmly positioned near the patient's bed.
Implementation
  • Tell the patient that you're going to take his blood pressure.
  • The patient can lie supine or sit erect during blood pressure measurement. His arm should be extended at heart level and be well supported. If the artery is below heart level, you may get a false-high reading. Make sure the patient is relaxed and comfortable when you take his blood pressure so it stays at its normal level.
  • Wrap the deflated cuff snugly around the upper arm.
  • If necessary, connect the appropriate tube to the rubber bulb of the air pump and the other tube to the manometer. Then insert the stethoscope earpieces into your ears.
  • Locate the brachial artery by palpation. Center the bell of the stethoscope over the part of the artery where you detect the strongest beats, and hold it in place with one hand. The bell of the stethoscope transmits low-pitched arterial blood sounds more effectively than does the diaphragm. (See Positioning the blood pressure cuff.)
  • Using the thumb and index finger of your other hand, turn the thumbscrew on the rubber bulb of the air pump clockwise to close the valve.
  • Then pump air into the cuff while auscultating for the sound over the brachial artery to compress and, eventually, occlude arterial blood flow. Continue pumping air until the mercury column or aneroid gauge registers 160 mm Hg or at least 10 mm Hg above the level of the last audible sound.
  • Carefully open the valve of the air pump, and then slowly deflate the cuff—no faster than 5 mm Hg per second. While releasing air, watch the mercury column or aneroid gauge and auscultate for the sound over the artery.
  • When you hear the first beat or clear tapping sound, note the pressure on the column or gauge. This is the systolic pressure. (The beat or tapping sound is the first of five Korotkoff
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    sounds. The second sound resembles a murmur or swish; the third sound, crisp tapping; the fourth sound, a soft, muffled tone; and the fifth, the last sound heard.)
  • Continue to release air gradually while auscultating for the sound over the artery.
  • Note the diastolic pressure—the fourth Korotkoff sound. If you continue to hear sounds as the column or gauge falls to zero (common in children), record the pressure at the beginning of the fourth sound. This is important because, in some patients, a distinct fifth sound is absent.
  • Rapidly deflate the cuff. Record the pressure, wait 15 to 30 seconds, and then repeat the procedure and record the pressures to confirm your original findings. After doing so, remove and fold the cuff, and return it to storage.

Special considerations
  • If you can't auscultate blood pressure, you may estimate systolic pressure. To do this, first palpate the brachial or radial pulse. Then inflate the cuff until you no longer detect the pulse. Slowly deflate the cuff and, when you detect the pulse again, record the pressure as the palpated systolic pressure. When measuring blood pressure in the popliteal artery, position the patient so that you can assess the area, wrap a cuff around the middle of his thigh, and proceed with blood pressure measurement.
  • Palpation of systolic blood pressure may also be important to avoid underestimating blood pressure in patients with an auscultatory gap. This gap is a loss of sound between the first and second Korotkoff sounds that may be as great as
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    40 mm Hg. You may find this in patients with venous congestion or hypotension.
  • Another alternative to auscultating with a stethoscope is to use Doppler ultrasound to hear Korotkoff sounds. This is useful when the blood pressure is diminished or when the pulse is nonpalpable.
  • If the patient is crying or anxious, delay blood pressure measurement, if possible, until he becomes calm to avoid falsely elevated readings.
  • If your facility considers the fourth and fifth Korotkoff sounds as the first and second diastolic pressures, record both pressures.
  • Remember that malfunction in an aneroid sphygmomanometer can be identified only by checking it against a mercury manometer of known accuracy. Be sure to check your aneroid manometer this way periodically. Malfunction in a mercury manometer is evident in abnormal behavior of the mercury column. Don't attempt to repair either type yourself; instead, send it to the appropriate service department. (For information on other situations that can cause false-high or false-low readings, see Correcting problems of blood pressure measurement.)
  • Occasionally, blood pressure must be measured in both arms or with the patient in two different positions (such as lying and standing or sitting and standing). In such cases, observe and record any significant difference between the two readings and record the blood pressure and the extremity and position used.
  • Measure the blood pressure of a patient taking antihypertensive medication while he's in a sitting position to ensure accurate measurements.
Complications
Don't take a blood pressure in the arm on the affected side of a mastectomy patient because it may decrease already compromised lymphatic circulation, worsen edema, and damage the arm. Likewise, don't take a blood pressure on an arm with an arteriovenous fistula or hemodialysis shunt because blood flow through the vascular device may be compromised.
Documentation
On the patient's chart, record blood pressure as systolic over diastolic pressures, such as 120/78 mm Hg; if necessary, record systolic pressure over the two diastolic pressures such as 120/78/20 mm Hg. Chart an auscultatory gap if present. If required by your facility, chart blood pressures on a graph, using dots or checkmarks. Document the extremity used and the patient's position. If the blood pressure was palpated or auscultated using a Doppler device, record this as well.

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PULSE - Assessment

Posted by Admin in Tuesday, December 15, 2009

PULSE
Blood pumped into an already-full aorta during ventricular contraction creates a fluid wave that travels from the heart to the peripheral arteries. This recurring wave—called a pulse—can be palpated at locations on the body where an artery crosses over bone on firm tissue. In adults and children over age 3, the radial artery in the wrist is the most common palpation site. (See Pulse points.) In infants and children under age 3, a stethoscope is used to listen to the heart itself rather than palpating a pulse. Because auscultation is done at the heart's apex, this is called the apical pulse.
An apical-radial pulse is taken by simultaneously counting apical and radial beats—the first by auscultation at the apex of the heart, the second by palpation at the radial artery. Some heartbeats detected at the apex can't be detected at peripheral sites. When this occurs, the apical pulse rate is higher than the radial; the difference is the pulse deficit.
Pulse taking involves determining the rate (number of beats per minute), rhythm (pattern or regularity of the beats), and volume (amount of blood pumped with each beat). If the pulse is faint or weak, use a Doppler ultrasound blood flow detector if available. (See Using a Doppler device.)
Equipment
Watch with a second hand • stethoscope (for auscultating an apical pulse) • Doppler ultrasound blood flow detector if necessary.
Preparation of equipment
If you aren't using your own stethoscope, disinfect the earpieces with an alcohol pad before and after use to prevent cross-contamination.
Implementation
  • Wash your hands, and tell the patient that you intend to take his pulse.
  • Make sure the patient is comfortable and relaxed because an awkward, uncomfortable position may affect the heart rate.
Taking a radial pulse
  • Place the patient in a sitting or supine position, with his arm at his side or across his chest.
  • Gently press your index, middle, and ring fingers on the radial artery, inside the patient's wrist. You should feel a pulse with only moderate pressure; excessive pressure may obstruct blood flow distal to the pulse site. Don't use your thumb to take the patient's pulse because your thumb's own strong pulse may be confused with the patient's pulse.
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  • After locating the pulse, count the beats for 60 seconds, or count for 30 seconds and multiply by 2. Counting for a full minute provides a more accurate picture of irregularities. While counting the rate, assess pulse rhythm and volume by noting the pattern and strength of the beats. If you detect an irregularity, repeat the count, and note whether it occurs in a pattern or randomly. If you're still in doubt, take an apical pulse. (See Identifying pulse patterns.)

Taking an apical pulse
  • Help the patient to a supine position, and drape him if necessary.
  • Warm the diaphragm or bell of the stethoscope in your hand. Placing a cold stethoscope against the skin may startle the patient and momentarily increase the heart rate. Keep in mind that the bell transmits low-pitched sounds more effectively than the diaphragm.
  • Place the diaphragm or bell of the stethoscope over the apex of the heart (normally located at the fifth intercostal
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    space left of the midclavicular line). Then insert the earpieces into your ears. Count the beats for 60 seconds (or count for 30 seconds and multiply by 2) and note their rhythm, volume, and intensity (loudness).
  • Remove the stethoscope and make the patient comfortable.
Taking an apical-radial pulse
  • Two nurses work together to obtain the apical-radial pulse; one palpates the radial pulse while the other auscultates the apical pulse with a stethoscope. Both must use the same watch when counting beats.
  • Help the patient to a supine position and drape him if necessary.
  • Locate the apical and radial pulses.
  • Determine a time to begin counting. Then each nurse should count beats for 60 seconds.

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TEMPERATURE - Assessment

Posted by Admin in Sunday, December 13, 2009

TEMPERATURE
Body temperature represents the balance between heat produced by metabolism, muscular activity, and other factors and heat lost through the skin, lungs, and body wastes. A stable temperature pattern promotes proper function of cells, tissues, and organs; a change in this pattern usually signals the onset of illness.
Temperature can be measured with a mercury, an electronic digital, or a chemical-dot thermometer. Oral temperature in adults normally ranges from 97° to 99.5° F (36.1° to 37.5° C); rectal temperature, the most accurate reading, is usually 1° F (0.6° C) higher; axillary temperature, the least accurate, reads 1° to 2° F (0.6° to 1.1° C) lower; and tympanic temperature reads 0.5° to 1° (0.3° to 0.6° C) higher.
Temperature normally fluctuates with rest and activity. Lowest readings typically occur between 4 and 5 a.m.; the highest readings occur between 4 and 8 p.m. Other factors
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also influence temperature, including gender, age, emotional conditions, and environment. Keep the following principles in mind. Women normally have higher temperatures than men, especially during ovulation. Normal temperature is highest in neonates and lowest in elderly persons. Heightened emotions raise temperature; depressed emotions lower it. A hot external environment can raise temperature; a cold environment lowers it.
Equipment
Thermometer (mercury, electronic, chemical-dot, or tympanic) • water-soluble lubricant or petroleum jelly (for rectal temperature) • facial tissue • disposable thermometer sheath or probe cover (except for chemical thermometer) • alcohol pad.
Preparation of equipment
If a thermometer is included in the admission pack, keep it at the patient's bedside and, on discharge, allow him to take it home. Otherwise, obtain a thermometer from the nurses' station or central supply department. If you use an electronic thermometer, make sure it's been recharged. (See Types of thermometers.)
Implementation
  • Explain the procedure to the patient, and wash your hands. If the patient has had hot or cold liquids, chewed gum, or smoked, wait 15 minutes before taking an oral temperature.
Using a mercury thermometer
  • Hold the thermometer between your thumb and index finger at the end opposite the bulb.
  • If the thermometer has been soaking in a disinfectant, rinse it in cold water. Rinsing removes chemicals that may irritate oral or rectal mucous membranes or axillary skin. Avoid using hot water because it expands the mercury, which could break the thermometer. Using a twisting motion, wipe the thermometer from the bulb upward.
  • Then quickly snap your wrist several times while holding the thermometer to shake it down to below 98° F (36.7° C). Shaking causes the mercury to descend into the bulb. The mercury will then expand in response to the patient's body temperature and be forced upward.
  • To use a disposable sheath, disinfect the thermometer with an alcohol pad. Insert it into the disposable sheath opening; then twist to tear the seal at the dotted line. Pull it apart.
Using an electronic thermometer
  • Insert the probe into a disposable probe cover. If taking a rectal temperature, lubricate the probe cover to reduce friction and ease insertion. Leave the probe in place until the maximum temperature appears on the digital display.
Using a chemical-dot thermometer
  • Remove the thermometer from its protective dispenser case by grasping the handle end with your thumb and forefinger, moving the handle up and down to break the seal, and pulling the handle straight out. Keep the thermometer sealed until use.
Using a tympanic thermometer
  • Make sure the lens under the probe is clean and shiny. Attach a disposable probe cover.
  • Stabilize the patient's head; then gently pull the ear straight back (for children up to age 1) or up and back (for children age 1 and older to adults).
  • Insert the thermometer until the entire ear canal is sealed. The thermometer should be inserted toward the tympanic membrane in the same way that an otoscope is inserted. Then press the activation button and hold it for 1 second. The temperature will appear on the display.
  • PEDIATRIC ALERT For infants younger than age 3 months, take three readings and use the highest.
Taking an oral temperature
  • Position the tip of the thermometer under the patient's tongue, as far back as possible on either side of the frenulum linguae. Placing the tip in this area promotes contact with superficial blood vessels and contributes to an accurate reading.
  • Instruct the patient to close his lips but to avoid biting down with his teeth. Biting can break the thermometer, cutting the mouth or lips or causing ingestion of broken glass or mercury.
  • Leave a mercury thermometer in place for at least 2 minutes or a chemical-dot thermometer in place for 45 seconds to register temperature; for an electronic thermometer, wait until the maximum temperature is displayed.
  • For a mercury thermometer, remove and discard the disposable sheath; then read the temperature at eye level, noting it before shaking down the thermometer. For an electronic thermometer, note the temperature; then remove and discard the probe cover. For the chemical-dot thermometer, read the temperature as the last dye dot that has changed color, or fired; then discard the thermometer and its dispenser case.
Taking a rectal temperature
  • Position the patient on his side with his top leg flexed, and drape him to provide privacy. Then fold back the bed linens to expose the anus.
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  • Squeeze the lubricant onto a facial tissue to prevent contamination of the lubricant supply.
  • Lubricate about ½″ (1.3 cm) of the thermometer tip for an infant, 1″ (2.5 cm) for a child, or about 1½″ (3.8 cm) for an adult. Lubrication reduces friction and thus eases insertion. This step may be unnecessary when using disposable rectal sheaths because they're prelubricated.
  • Lift the patient's upper buttock, and insert the thermometer about ½″ (1.3 cm) for an infant or 1½″ (3.8 cm) for an adult. Gently direct the thermometer along the rectal wall toward the umbilicus. This will avoid perforating the anus or rectum or breaking the thermometer. It will also help ensure an accurate reading because the thermometer will register hemorrhoidal artery temperature instead of fecal temperature.
  • Hold the mercury thermometer in place for 2 to 3 minutes, or the electronic thermometer until the maximum temperature is displayed. Holding the thermometer prevents damage to rectal tissues caused by displacement or loss of the thermometer into the rectum.
  • Carefully remove the thermometer, wiping it as necessary. Then wipe the patient's anal area to remove any lubricant or feces.

Taking an axillary temperature
  • Position the patient with the axilla exposed.
  • Gently pat the axilla dry with a facial tissue because moisture conducts heat. Avoid harsh rubbing, which generates heat.
  • Ask the patient to reach across his chest and grasp his opposite shoulder, lifting his elbow.
  • Position the thermometer in the center of the axilla, with the tip pointing toward the patient's head.
  • Tell him to keep grasping his shoulder and to lower his elbow and hold it against his chest. This promotes skin contact with the thermometer.
  • Remove a mercury thermometer after 10 minutes; remove an electronic thermometer when it displays the maximum temperature. Axillary temperature takes longer to register than oral or rectal temperature because the thermometer isn't enclosed in a body cavity.
  • Grasp the end of the thermometer and remove it from the axilla.

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TRANSFER - Fundamental Procedures

Posted by Admin in Monday, December 7, 2009

TRANSFER
Patient transfer—either within your facility or to another one—requires thorough preparation and careful documentation. Preparation includes an explanation of the transfer to the patient and his family, discussion of the patient's condition and care plan with the staff at the receiving unit
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or facility, and arrangements for transportation if necessary. Documentation of the patient's condition before and during transfer and adequate communication between nursing staffs ensure continuity of nursing care and provide legal protection for the transferring facility and its staff.
Equipment
Admission inventory of belongings • patient's chart, medication record, and nursing Kardex • medications • bag or suitcase • wheelchair or stretcher, as necessary.
Implementation
  • Explain the transfer to the patient and his family. If the patient is anxious about the transfer or his condition precludes patient teaching, be sure to explain the reason for the transfer to his family members, especially if the transfer is the result of a serious change in the patient's condition. Assess his physical condition to determine the means of transfer, such as a wheelchair or a stretcher.
  • Using the admissions inventory of belongings as a checklist, collect the patient's property. Be sure to check the entire room, including the closet, bedside stand, overbed table, and bathroom. If the patient is being transferred to another facility, don't forget valuables or personal medications that have been stored.
  • Gather the patient's medications from the cart and the refrigerator. If the patient is being transferred to another unit, send the medications to the receiving unit; if he's being transferred to another facility, return them to the pharmacy.
  • Notify the business office and other appropriate departments of the transfer.
  • Have a staff person notify the dietary department, the pharmacy, and the facility telephone operator about the transfer (if within the facility).
  • Contact the nursing staff on the receiving unit about the patient's condition and drug regimen and review the patient's nursing care plan with them to ensure continuity of care.

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Admitting the pediatric patient

Posted by Admin in Friday, December 4, 2009

Admitting the pediatric patient
  • Your initial goal will be to establish a friendly, trusting relationship with the child and his parents to help relieve fears and anxiety, which can hinder treatment. Remember that a child under age 3 may fear separation from his parents; an older child may worry about what will happen to him.
  • Speak directly to the child, and allow him to answer questions before obtaining more information from his parents.
  • While orienting the parents and child to the unit, describe the layout of the room and bathroom, and tell them the location of the playroom, television room, and snack room, if available.
  • Teach the child how to call the nurse. Stress that she'll always be available to take care of his needs, such as helping him to the bathroom.
  • Explain the facility's rooming-in and visiting policies so the parents can take every opportunity to be with their child.
  • Inquire about the child's usual routine so that favorite foods, bedtime rituals, toileting, and adequate rest can be incorporated into the routine.
  • Encourage the parents to bring some of their child's favorite toys, blankets, or other items to make the child feel more at home amid unfamiliar surroundings.

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USING PATIENT CARE REMINDERS

Posted by Admin in Wednesday, December 2, 2009

USING PATIENT CARE REMINDERS
When placed at the head of the patient's bed, care reminders call attention to the patient's special needs and help ensure consistent care by communicating these needs to the hospital staff, the patient's family, and other visitors.
You can use a specially designed card or a plain piece of paper to post important information about the patient, such as:
  • allergies
  • dietary restrictions
  • fluid restrictions
  • specimen collection
  • patient deaf or hearing-impaired in right ear
  • foreign-language speaker.
You can also use care reminders to post special instructions, such as:
  • complete bed rest
  • no blood pressure on right arm
  • turn every 1 hour
  • nothing by mouth.
Never violate the patient's privacy by posting his diagnosis, details about surgery, or any information he might find embarrassing.

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Admitting the adult patient

Posted by Admin in Tuesday, November 24, 2009

Admitting the adult patient
  • Speak slowly and clearly, greet the patient by his proper name, and introduce yourself and any staff present.
  • Compare the name and number on the patient's identification bracelet with that listed on the admission form. Verify the name and its spelling with the patient. Notify the admission office of any corrections.
  • Quickly review the admission form and the physician's orders. Note the reason for admission, any restrictions on activity or diet, and any orders for diagnostic tests requiring specimen collection.
  • Escort the patient to his room and, if he isn't in great distress, introduce him to his roommate. Then wash your hands, and help him change into a gown or pajamas; if the patient is sharing a room, provide privacy. Itemize all valuables, clothing, and prostheses on the nursing assessment form or in your notes if your facility doesn't use such a form. Encourage the patient to store valuables or money in the safe or, preferably, to send them home along with any medications he may have brought with him. Show the ambulatory patient where the bathroom and closets are located.
  • Take and record the patient's vital signs, and collect specimens if ordered. Measure his height and weight if possible. If he can't stand, use a chair or bed scale and ask him his height. Knowing the patient's height and weight is important for planning treatment and diet and for calculating medication and anesthetic dosages.
  • Show the patient how to use the equipment in his room. Be sure to include the call system, bed controls, TV controls, telephone, and lights.
  • Explain the routine at your health care facility. Mention when to expect meals, vital sign checks, and medications. Review visiting hours and any restrictions.
  • Take a complete patient history. Include all previous hospitalizations, illnesses, and surgeries; current drug therapy; and food or drug allergies. Ask the patient to tell you why he came to the facility. Record the answers (in the patient's own words) as the chief complaint. Follow up with a physical assessment, emphasizing complaints. Record any wounds, marks, bruises, or discoloration on the nursing assessment form.
  • After assessing the patient, inform him of any tests that have been ordered and when they're scheduled. Describe what he should expect.
  • Before leaving the patient's room, make sure he's comfortable and safe. Adjust his bed, and place the call button and other equipment (such as water pitcher and cup, emesis basin, and facial tissues) within easy reach. Raise the side rails.

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Admission - Fundamental Procedures

Posted by Admin in Monday, November 23, 2009

Admission
Admission to the nursing unit prepares the patient for his stay in the health care facility. Whether the admission is scheduled or follows emergency treatment, effective admission procedures should accomplish the following goals: verify the patient's identity and assess his clinical status, make him as comfortable as possible, introduce him to his roommates and the staff, orient him to the environment and routine, and provide supplies and special equipment needed for daily care.
Because admission procedures can color the patient's perception of the environment, they have a significant impact on subsequent treatment. Admission routines that are efficient and show appropriate concern for the patient can ease his anxiety and promote cooperation and receptivity to treatment. Conversely, admission routines that the patient perceives as careless or excessively impersonal can heighten anxiety, reduce cooperation, impair his response to treatment, and perhaps aggravate symptoms.
Equipment
Gown • personal property form • valuables envelope • admission form • nursing assessment form, if appropriate • thermometer • emesis basin • bedpan or urinal • bath basin • water pitcher, cup, and tray • urine specimen container, if needed.
An admission pack usually contains soap, comb, toothbrush, toothpaste, mouthwash, water pitcher, cup, tray, lotion, facial tissues, and thermometer. Because the patient's pack is included in his bill, he can take it home with him. An admission pack helps prevent cross-contamination and increases nursing efficiency.
Preparation of equipment
Obtain a gown and an admission pack.
Position the bed as the patient's condition requires. If the patient is ambulatory, place the bed in the low position; if he's arriving on a stretcher, place the bed in the high position. Fold down the top linens.
Prepare any emergency or special equipment, such as oxygen or suction, as needed.
Implementation
  • Adjust the room lights, temperature, and ventilation.
  • Make sure all equipment is in working order prior to the patient's admission.

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