Four Aspects Of Fundamental Nursing Care: Wound Care, Oxygen Therapy, Neurovascular Evaluation, And Medication Management

The Importance of Nursing Education and Values in Providing Fundamental Nursing Care

Question:

Discuss about the Exmples Of Fundamental Nursing Care.

The prime aim of the fundamental nursing care is to ensure patient safety and care. This is directly connected to the nursing education, their communication and their adherence to the values and knowledge they acquire during their nursing education. Such nursing education teach them the basic values and principles of the nursing. As future healthcare providers, they get to learn all the nuances with chosen patients and provide them with wide-ranging nursing care. It is important as the quality of care provided to the patient determines the duration of his stay in the healthcare setting and the pace of his recovery as well (Darbyshire and McKenna 2013).

This assignment is going to discuss about the four aspects of the fundamental nursing care as observed on placement in the cardiac and Geriatric Evaluation Management ward. Further, these four aspects will be critically supported with recent researches. First aspect will be wound care in the cardiac ward and a discussion will be done on every aspect of it, and then will move to the oxygen therapy. Furthermore, neurovascular evaluation of a patient of Geriatric Evaluation Management ward and medication management will be discussed.

Wound care is the prime component of the wound management process, where the data about the patient and his/her wound is been collected before recommending a treatment plan for it. The steps of wound care includes observation, collecting data from the patient and identifying clinical data from the physical examination of the patient and his/her health history (Dorai 2012). The wounds that are generally observed in the cardiac wards are generally of three types, type 1, type 2 and type 3. Type 1 infection is the wound within the first month of the operation. This is very crucial as the patient has chances to acquire infection in his/her wound. Therefore, wound management has to be precise and effective. There are different steps to assess the wound. These are- sizes of the wound, depth, surrounding skin of the wound, Edge of the wound, presence of exudate and pain score. After completion of the pain assessment through these steps, medication plan will be provided to the patient to treat his/her wound (Hosseinrezaei, Rafiei and Amiri 2012).

While assessing the wound of the patient, it is also important to maintain aseptic environment in the ward so that the open wound is not infected with the bacteria or virus present in the environment. According to Daeschlein (2013), the maximum number of wound infections are acquired from the nosocomial infection present in the environment of the hospitals. Therefore, the cardiac ward should be free from any microorganism and steps need to be taken to kill or remove microorganisms from different objects and hands of the staff, patient and all the people who enters the ward. Secondly, all the instruments present in the ward should be sterile and free from infections. Finally, to reduce the patient’s risk of exposure to different microorganisms, limited people should be allowed to enter the ward. Nurses should also follow the aseptic techniques prior and after the wound analysis and treatment. the aseptic technique procedure include hand wash, surgical scrub, using personal protective equipment, patient prep, maintaining sterile and safe environment within the ward and applying safe operative technique (Kubota et al. 2013).

Wound Care: A Critical Component of Wound Management Process

The third point that should be in the focus of wound management is dressing techniques and factors that increases or decreases the pace of wound healing procedure. There are different type of wound dressing techniques such as hydrocolloid, hydrogel, alginate, collagen, foam, transparent and cloth dressing technique. However, the cardiac surgery wound surface is generally bigger, the dressing should be impermeable to bacteria, and viruses so that infection can be avoided (Anjum et al. 2016). Hence, hydrocolloid dressing will be used as it helps to keep the wound clean and protects from environmental infections. At the time of dressing, it is important to provide the patient with analgesia to manage the pain. Further, several other factors contribute in the pace of healing of the wound such as the age, nutritional preference, diabetic and level of infection of the patient. Depending on these, the healthcare experts will be able to calculate the time needed for the healing of the wound (Thu, Zulfakar and NG 2012).

During the placement in the cardiac ward, different techniques to assess the wound was observed. Knowledge about the state of the wound was perceived and different measures that need to be recorded, such as secretion of pus, exudates, any odour and appearance was noted. The nursing assistance in that ward helped to observe the procedures and showed the process of cotton swab technique. They all were following ethical ways to complete the wound assessment and were maintaining sterile condition in the ward so that infection did not occur. However, in the presence of any infection, the wound swab process was applied to collect the infectious fluid from the wound. overall there were so many things to learn from a practical experience and all the nursing staff helped to perceive those knowledge.

Oxygen therapy is a process, which is applied by physicians to deliver the extra demand of oxygen of the patient. Several health disorders in which, people need oxygen therapy to survive, such as Chronic Obstructive Pulmonary Disease (COPD), pneumonia, cystic fibrosis, asthma and so on. This section will discuss the oxygen therapy for patients suffering from COPD as placement was in Cardiac ward. As the patient observation policy, each patient admitted in the cardiac ward need to be assessed and analyzed thrice per day for vital signs and symptoms (McDonald 2014). Signs and symptoms of the first analysis will be considered as the baseline analysis and further signs will be recorded and evaluated based on that. The frequency of the assessment depends on the vitality of the patient situation. After collecting the vital signs and symptoms, the SpO2 level is determined. SpO2 is the peripheral Capillary Oxygen Saturation level that estimates the amount of oxygen present in the blood. It is basically the ratio between Oxygenated haemoglobin and total oxygen present in the body. Good level of SpO2 in the blood helps to energize the muscles and keeps the cells fresh and active whereas, lower level of oxygen creates situations like hypoxia. Hence, the level of SpO2 is very important to be analyzed (Vestbo et al. 2013).

Oxygen Therapy: Ensuring Oxygen Supply to Patients with Chronic Obstructive Pulmonary Disease

Respiratory rate is also an important factor to determine the care for a patient suffering from COPD. Respiratory rate is termed as the rate of breathe per minute. The normal rate of respiration is 12 to 18 breathes per minute, however, due to COPD and reactive airway disease, people feels air trapping and cannot empty their lungs. Therefore the respiratory rate becomes 20 to 25 breathes per minute. Hence, detection of the respiratory rate can be helpful to identify the vitality of COPD. The patient should be assessed every now and then, as the risk of being unconscious is very high in case of chronic obstructive pulmonary disorder. As pain is one of the prime symptom of the COPD, characterization of pain is very important to analyze and provide care to the patient. As per the Australian statistical data, 45 percent of people affected with COPD suffers from severe pain (Lenglet et al. 2012). The prime reason behind the pain is associated with the blown up lungs. In such condition, lungs puts pressure on chest wall, diaphragm and the spine. Another reason can be Osteoporosis, as 20 percent of people affected with COPD, suffers from thinning of bones or osteoporosis.

During placement in the ward, different procedures for assessment was observed including a number of procedures, tests and questionnaires for research and clinical purposes. Each nursing staff were following the procedure as proper assessment is necessary as it helps to make accurate diagnosis, provides information about prognosis and helps to apply appropriate therapeutic intervention. Oxygen therapy is an integral part of this intervention. The nursing staff were checking the state of the patient four-times a day to observe his condition and were implementing the oxygen therapy according to his need. The knowledge acquired was long term oxygen therapy can harm the patient hence short-term therapy was applied.

While working in the geriatric management ward, it was observed that people who are suffering from multiple complex disorders are admitted in the geriatric ward of the hospital. As they have multidimensional needs, for their cognitive, medical and functional requirement, carers are appointed in the geriatric management ward. In the hospital’s geriatric ward, a 92-year-old woman has been admitted after a fall. As per her medical history, she has a history of epilepsy, which is a neurological disorder and associated with abnormal electrical activity in the brain. She also had a fracture in her left medial malleolus. She is been unresponsive after the fall hence, code blue was applied to perform resuscitation efforts as her heart was stopped beating. Several members of the code blue responded quickly to manage the situation in which code team leader, primary RN, respiratory therapist, critical care physician nursing supervisor and nursing assistant was there (Boddaert et al. 2014). They help to detect the problem and revived the patient from the unresponsive state. After that, they stabilized her, and assessed her condition to provide her interventions. Critical care physician then asked to conduct some of the tests such as CT scan and ECG to understand the reason behind the unresponsiveness. Primary intervention that was applied to the woman was blood donation and application of knee slab below her left leg to support her past injury. CT scan done will help to understand the electrical imbalance of her brain and the reason for her epilepsy related disorder (Claassen et al. 2013).

Neurovascular Evaluation: Key to Assessing Complex Disorders in Geriatric Management

Her history of fracture and casting of her medial malleolus has increased the level of neurovascular problems in her body. Hence, the five P’s of the neurovascular assessment will be applied in her assessment. The first P is Pain, for the assessment of pain the patient will be asked to describe the severity. The pain can be aching or dull however, manipulating, or helping the patient to reduce the pain can weaken the patients and affect her tolerance power. The second P is Pallor, in which, the nurses need to observe the color of the tissue distal to the cast. different color determines different level of pain, such as pink color determines arterial pressure is normal hence, blood blow is normal. Whereas, whitish color determines reduced arterial pressure or the blood is flowing with less pressure within the artery. however, the concern is blue or violet color of the skin distal to cast, which determines that the arteries are static and blood is not been able to flow from it. The third P is Pulselessness. It can be assessed by checking capillary fill. For that, the toe finger need to be pressed and the time needed to refill the finger and make the finger pink is the pace of the capillary blood. Weakness in pulse can lead to slower blood flow within capillaries which is a serious concern for the patient who are recovering form fall in geriatric ward. The fourth P is Paresthesia, which is associated with assessment of numbness, tingling and different abnormal sensation in the place of casting. Presence of such sensation in the place of cast can be sign of nerve damage development of compartment syndrome; hence, it is important to check the presence of such sensation. Finally, the last P, which is Paraplegia need to be checked for assessment of motion.

During placement in the geriatric ward, it was observed that, nurses were focusing on the issue according to the priority of the patient. Pain management was their first priority. After that, nurses focused on the epilepsy and other severe conditions. The most important experience was Code blue operation that was to revive the patient after she was unresponsive. This experience will help to overcome the forthcoming challenges in nursing life. Patients drug dose Phenytoin for her epilepsy syndrome was reduced to half to understand the abnormality of her brain. this is important as, it enhanced the skills to understand about the disease. my overall experience in this ward was exceptional.

Medication Management: Critical in Ensuring Patient Safety

Medication management therapy or MTM is known as a treatment system used by doctors and pharmacists to ensure that the patients are having optimal profits of the medication. It covers a broad array of professional activities that includes patient assessment, formulating long-term and short-term medication care, assessing the efficacy and safety of the drug provided and patient education. This processes help to manage a proper communication and documentation to maintain a higher standard of care between medical professionals (Johnson, Lehmann and Council on Clinical Information Technology, 2013). There are eight rights of medication administration. All these right protects the patient to have quality healthcare, quality medication through correct route as these aspects can enhance his/her chances of recovery (Marcum, Zachary and Sevick 2013). The first right is Right Dose, which is done by checking the order and then checking the dose against the drug reference standards. Further to crosscheck the dose, one more nurse need to be employed to calculate the dose for a specific patient. The second right is Right Route in which the assigned nurse checks the order given by the doctor to confirm the route of drug administration. However, the patient’s ability to take the drug from that route is analyzed. Right Time is the third right which determines the frequency of the drug. The nurses need to be alert at the time of administration as right timing can enhance the chances of survival. Sixth and seventh rights are right documentation and right reason. Documentation of drug administration is very important as it may help the physician or other nurses to understand the last given medicine, route, dose and timing. Vital signs prior or after the drug administration should also be recorded in the medication chart. On the other hand, right reason provides the rationale of the medication applied for the patient regarding his medical history, current health status and signs symptoms. This portion is necessary, as long-term medication needs the medication history to assess the duration of care and medication needed. Right response is the eighth right that talk about right response. In this section, the healthcare expert or nurses need to record the after effect of drug administration. Nurses need to record the blood pressure change; pulse and other positive effects are assessed in this case (Kim and Bates 2013).

Other than oral medication, there are two different route of medication, intramuscular and subcutaneous. These routes of medication are applied when the patient is unable to take the medication from oral route. Subcutaneous medication is administered inside the cutaneous layer of the skin, whereas in intramuscular medication, the medicine is administered in the deep muscles of the destined area (Jin et al. 2015).

However, on appointment in the cardiac ward, the observed scenario was subtle different from what actually needed to be flowed. Few of the nurses were unaware of the 8 rights of the drug administration and they were just following the prescribing route. Some of the staff were not following the hand hygiene practice before administrating the drug. However, some of the veteran nurses were following all the regulations that is inspirational for the future nurses to understand the workflow in the cardiac ward.

Conclusion

During the placement in the geriatric ward and cardiac ward, different observation was made that helped to understand the fundamental nursing care of a patient. Wound management of a patient recovering from cardiac surgery helped to understand the different aspects needed for assessing the type, depth and level of wound. Further, the dressing technique of the wound was discussed with other important factors that are necessary to calculate the healing time of the wound. The second thing discussed was oxygen therapy, in which, need of the therapy for a patient suffering from COPD was discussed. Third aspect was observed while placement in geriatric ward, where a 92 year old patient was going through cold process. The five P’s of the neurovascular assessment was observed. Finally, the medication management was observed and the eight rights of the medication administration was discussed with relation to the patient observed in the wards. As there are a number of flaws in the practice of these fundamental care processes are observed, a continuous updates to practical practice are required and strengthening is essential to confirm that nursing care is not negotiated by risky or out of date practice.

References

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