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Pediatric Shock

admin — Wed, 01 Feb 2012 05:28:07 +0000

It has been noted that shock in children can be easily managed if early recognition of the condition is achieved and if timely intervention and treatment is initiated. Nurses have a big role in such through proper patient assessment, family education, and proper management.

Assessment

It is crucial for the health team to come up with the most detailed and frequent assessment of a child with shock. It is in this stage that the prognosis and survival can be projected to either a positive or a negative outcome.

Parameters that greatly matters in assessing a child with shock are the following:

Pulses (proximal and peripheral pulses)
Perfusion
Skin color
Skin temperature
Vital signs
Urine output
Level of consciousness
Respiratory functions

Ongoing assessment is also critical; therefore as the disease progresses or improves, indicators to predict survival have been noted:

Heart rate
Arterial blood pressure
Serum lactate levels
Degree of acidosis

Nursing Diagnosis

Decreased cardiac output related to inadequate intravascular volume
- As evidenced by:
  - Hypotension
  - Deprived perfusion
  - Lethargy
  - Increased Cardiac rate
  - Deficient urine output
  - Ineffective peripheral tissue perfusion related to vasodilation and coagulopathy
    - As evidenced by:
      - Decreased urine output
      - Metabolic acidosis
      - Altered neurologic status
      - Decreased cardiac output related to decreased cardiac function
        
        As evidenced by:
        
        Decreased blood pressure
        
        Poor perfusion
        
        Lethargy
        
        Tachycardia
        
        Lesser urine output

Outcome Identification

Patient will be able to restore normal volume status, heart rate, urine output, blood pressure, and level of consciousness within twenty four to forty eight (24 – 48) hours.
Patient will be able to exhibit restoration of normal vascular tone (septic – induced distributive shock).
Patient will be able to obtain normal blood cultures and without indication of any bleeding alterations and disorders.
Patient will be able to obtain blood cultures negative of sepsis.

Planning and Implementation

Vital signs monitoring
Perfusion assessment and monitoring
Carrying out orders for administration of both intravenous fluids and medications (such as inotropics and antibiotics)
Strict monitoring of intake and output (diarrhea, vomiting, etc.)
Respiratory status monitoring (includes assessment, oxygen supplementation and if indicated, endotracheal intubation)
On-going neurological assessment noting consciousness and lethargic episodes (airway support should be ready at hand)
If coagulopathies are present, blood transfusions (fresh frozen plasmas) might be indicated, or Vitamin K is administered as ordered.
Antibiotics are given as ordered foe septic induced shocks.
Febrile episodes may be common which can be treated with antipyretics.

Evaluation

After proper and adequate interventions, the child will be stable with good respiratory, circulatory, cardiac and neurologic functions.
There will be no more evidence of sepsis and coagulopathies, all laboratory works will be normal.
Fever will subside and white blood count will be within normal limits.

Newborn Procedures

admin — Wed, 11 Jan 2012 07:49:07 +0000

An impending birth of a child can be exciting and yet crucial. Being one of the health care workers witnessing the birth of a child is a unique role. You will be able to witness life as it unfolds. With the responsibility placed upon nurses during the delivery of a baby, baby care is an important part of making sure that the infant is clinically stable. In the long run, the steps instituted in the first hours of life can be detrimental for the normal growth and development of the infant.

1. Suctioning Secretions – As the head of the infant comes out, the nurse or medical intern responsible for the baby care must be able to establish the basic ABC’s – Airway, Breathing and Circulation. A rubber bulb syringe is used to clear out the nasal openings as well as the buccal area of the baby. Secretions should be gently taken out of these areas in order to give a patent airway. The baby is placed on his or her side in order to prevent aspiration. Suctioning of the oral secretions can be further being done after that. Circulation must also be assessed especially when there is a cord coil. It is essential to untangle the cord first so that the baby won’t be strangled.

2. Cord Cutting and Clamping – Cutting and clamping the cord is the official end of the support of the mother’s blood circulation, the neonate is on its own in terms of the circulatory system. Some agencies would also allow the father to cut the cord for memorable reasons. This procedure must be done aseptically by the nurse. In this part, it is important to assess the completeness of the two veins and one artery. Any anomalies must be reported to the paediatrician.

3. APGAR Score – As the baby is taken out of the womb, the doctor will examine the baby in the first minute of life as well as on the next five minutes. The APGAR score has been widely used in order to assess the infant in its first hours of life. Developed by Dr. Virgina Apgar in 1952, it measures the heart rate, breathing, muscle tone, skin colour and reflex irritability of the infant. A perfect score of 10 means that the baby is normal while a score of zero to 3 may mean resuscitation measures. Assisting during the scoring may mean being present during the resuscitation of the baby.

4. Immunization – Initial dose of vitamin K is given in order to avoid bleeding after the birth. Antibiotic ointment is applied to both eyes of the baby also.

Keeping the baby warm is a very important part of the initial management. Since babies have less fat, it is a must to thermoregulate them. The first hour is also an important to give a chance for the mother to see her child when everything is stabilized.

Nursing Management for Guillain-Barre Syndrome

admin — Wed, 11 Jan 2012 07:39:37 +0000

Guillain-Barre Syndrome is also known as Infectious Ployneuritis as well as Polyradiculitis. It characterized by paresthesias of the extremities and muscle weakness or paralysis. It is a rare disorder that the cause was thought to be of allergic or immunologic reaction. Another theory would state that it is preceded by an infection. The most common cause of this paralysis can due to the effect of polio, although polio is controlled already worldwide.

Medically known to be called as GBS, its rarity may account 2 in 100,000 people. The prognosis is good but despite that, GBS is still a life-alternating event. Many patients suffer from fast loss of control of their muscular function, vital functions may also breathing and swallowing. These symptoms can make patients feel that they are terminal. A patient with GBS will complain of sudden feeling of weakness in the legs and progresses up to the body.

Stages of GBS:

Acute – the symptoms show between one to three weeks.
Plateau – the symptoms show between several days to 2 weeks.
Recovery – This is the stage wherein there is remyelination which may last up to 2 years.

Signs and Symptoms:

Paresthesia – tingling and numbness of the lower extremities
Muscle weakness of legs – progress rapidly ascending paralysis involving the trunk, upper extremities and facial muscles which may mean complete paralysis.
Difficulty in chewing, swallowing and talking. The cranial nerves are now involved.
Loss of sensation and sphincter disturbances of bladder and rectum.
Areflexia or absence of reflexes is also observed.
Respiratory failure is the respiratory muscle function is affected.

Diagnosis

The clinical manifestation is the basis of the diagnosis. The viral infection as well as motor and sensory deficits is used in determining the severity.

Nursing Management:

It is important to prevent complication such as immobility as well as infection. Placing the patient in a comfortable and clean environment is a must.
Plasmapheresis or exchanging plasma through a machine can also decrease the severity of GBS.
For patients that have difficulty in breathing due to the involvement of respiratory muscle function, ventilator support is needed. Proper turning from time to time must be done in order to prevent accumulation of moisture on the back of the patient.
Surgically, some patients must undergo tracheostomy along with mechanical ventilation.
Encourage to comply with steroids such as adrenocorticotropic hormone (ACTH) and prednisone. Cytoxan or cyclophosphamide can also slow down the progress of GBS. At times, anticoagulants are given in times of thrombophlebitis.
Food intake is also necessary to support the patient. A balanced diet must also be served in order to prevent tissue and muscle breakdown. Some of the patients may require gastrostomy tube in order to by support nutritionally.

Nursing Interventions for Guillain-Barre Syndrome
Nursing Interventions: Guillain-Barre Syndrome Turn and reposition the patient, and encoura...

Fetal Blood Circulation

admin — Wed, 11 Jan 2012 07:34:01 +0000

Importance

It is necessary in serving the fetus and to prepare the circulatory system to function after birth

Three Important Parts of the Fetal Circulation

Ductus Venosus
- shunts a significant majority (80%) of the blood flow of the umbilical vein directly to the inferior vena cava
- it allows oxygenated blood from the placenta to bypass the liver
- in conjunction with the other fetal shunts, tit plays a critical role in preferentially shunting oxygenated blood to the fetal brain
- Foramen Ovale
  - it is one of two fetal cardiac shunts
  - allows blood to enter the left atrium from the right atrium, thereby allowing oxygenated blood to bypass the pulmonary system
  - Ductus Arteriosus
    - is a cardiac shunt connecting the pulmonary artery to the aortic arch
    - it allows most of the blood from the right ventricle to bypass the fetus’ fluid-filled lungs, protecting the lungs from being overworked and allowing the left ventricle to strengthen

The Fetal Circulation

Oxygen from the placenta travels to the umbilical vein bringing oxygen and nutrients.
Some of the blood flows to the hepatic circulation, others bypass the liver and pass through the ductus venosus.
The blood from the lower parts of the body together with the blood in the ductus venosus flows towards the inferior vena cava.
Then it goes to the right atrium
Some of the blood from the right atrium goes to the right ventricle via the tricuspid valve while others pass the foramen ovale leading to the left atrium.
From the left atrium, it goes towards the left ventricle, mixing with the poorly oxygenated blood from the lungs and then pumped towards the ascending aorta.
From the ascending aorta, the blood is pumped to the upper parts of the body like the heart, neck, head and upper limbs.
Then perfuse to the placenta via the two umbilical arteries.
Meanwhile the blood that enters the right ventricle (from No. 5) together with the poorly oxygenated blood from the head and upper extremities returns to the right side of the heart by the way of the superior venacava then, passes through the pulmonary artery wherein 10% enters the lungs, most of the blood bypasses the lungs which is then pumped to the ductus arteriosus going to the descending aorta.
The blood is the pumped and perfused to other parts of the fetus.
The blood then returns to the placenta via the two umbilical arteries.

Transition after Birth

The infant takes first breath, causing the mechanical expansion of the lungs. (Increasing uptake of oxygen by lungs induces a vasoconstriction of ductus venosus and ductus arteriosis.)
Rapid decrease in pulmonary vascular resistance (pulmonary vasodilation that is produced by initiation of ventilation) occurs.
The pressure in the pulmonary circulation and the right side of the heart fall as the fetal lung fluid is replaced by air and as lung expansion decreases the pressure transmitted to the pulmonary blood vessels.
With lung inflation, the alveolar oxygen tension increases, causing reversal of the hypoxemia-induced pulmonary vasoconstriction of the fetal circulation.
Clamping of the umbilical cord causes removal of the low-resistance placental circulation and produces an increase in systemic vascular resistance and left ventrical pressure, which further closes the ductus venosus.
The resultant decrease in right atrial pressure and increase in left atrial pressure produce closure of the foramen ovale.
A decrease in pulmonary vascular resistance and an increase in systemic vascular resistance causes a left to right shunting and increasing PO2 (constricts ductal smooth muscle) which further closes the ductus arteriosus.

Adult Derivatives of Fetal Vascular Structures

Because of certain changes in the cardiovascular system at birth, certain vessels and structures are no longer required.
Over a period of months these fetal vessels form nonfunctional ligaments, and fetal structures such as the foramen ovale persist as anatomic vestiges of the prenatal circulatory system.

Fetal Structure	Adult Structure
Foramen Ovale	Fossa Ovalis
Umbilical Vein	Ligamentum teres
Ductus Venosus	Ligamentum venosum
Umbilical Arteries and abdominal ligaments	Medial umbilical ligaments, superior vesicular artery (supplies bladder)
Ductus Arteriosum	Ligamentum arteriosum

Nursing Management of the Child with a Congenital Heart Defect

admin — Wed, 11 Jan 2012 07:24:55 +0000

I. Nursing Assessment

A. Become informed about the child’s symptomatology and plan of medical care

Obtain thorough nursing history to become familiar with the child and his family to recognize normal and abnormal patterns
Discuss with the physician the plan for medical care

B. Make a baseline Nursing Assessment of the child’s condition

Observe and record information relevant to the child’s growth and development
Observe and record child’s level of exercise tolerance
Observe child’s skin and mucous membranes for color and temperature changes
Observe for clubbing of the fingers, especially the thumb nails, with thickening and shininess of the terminal phalanges-may occur in cyanotic children by 2-3 months of age.
Observe for chest deformities
Observe for respiratory pattern
Palpate the child’s pulses in all extremities
Auscultate the child’s heart
Record vital signs

II. Nursing Diagnoses

Impaired gas exchange related to altered pulmonary blood flow or oxygen deprivation
Altered cardiac output related to specific anatomic defect
Activity intolerance related to decreased oxygenation in blood and tissues
Altered Nutrition: less than body requirements related to the excessive energy demands required by increased cardiac workload
Increased potential for infection related to poor nutritional status
Anxiety related to diagnostic procedures and hospitalization
Developmental delay related to decreased energy, inadequate nutrition, physical limitations and social isolation
Alteration in parenting related to parental perception of the child as vulnerable

III. Nursing Interventions

A. Provide adequate nutritional and fluid intake to maintain the growth and developmental needs of the child

Feed in semi-erect position
Provide small frequent feedings
Provide foods with high nutritional value
Determine child’s likes and dislikes
Strict input and output
Daily weight

B. Prevent infection

Prevent exposure to communicable diseases
Immunizations should be up-to-date
Handwashing should be observed
Be certain that the child receives prophylactic medication for infective endocarditis

C. Reduce the workload of the heart since decreased activity and expenditure of energy will decrease oxygen requirements

Uninterrupted rest
Avoid unnecessary activities
Prevent excessive crying
Provide diversional activities
Prevent constipation
Relieve the respiratory distress associated with increased pulmonary blood flow or oxygen deprivation

Determine degree of respiratory distress
Include specific information in nursing record
Position child at 45 degree angle to decrease pressure of the viscera on the diaphragm and increase lung volume
Pin diapers loosely and provide loose-fitting pajamas for older children
Feed slowly
Tilt infant’s head slightly
Suction the nose and throat if unable to cough out secretions
Provide oxygen therapy as needed
Improve oxygenation o that the body functions may be maintained
Provide effective oxygen environment
Observe response to oxygen therapy
Observe response to oxygen weaning therapy

Relieve Hypoxic spells associated with cyanotic types of Congenital heart disease
Observe for “tet” spells
Encourage fluid intake
Obtain vital signs

D. Observe child for symptoms of Congestive Heart Failure that occur frequently as a complication of Congenital Heart Disease

E. Observe for the development of symptoms of infective endocarditis that may occur as a complication of congenital heart disease

F. Observe for the development of thrombosis that may occur as a complication of congenital heart disease

G. Prepare the child for diagnostic and treatment procedures

H. Explain cardiac problems to child and parents

IV. Health Education

A. Instruct the family in necessary measures to maintain the child’s health

B. Teach the family about the defect and its treatment

C. Encourage the parents and other persons to treat child in a normal manner as possible

Nursing Management of Deep Vein Thrombosis

admin — Mon, 09 Jan 2012 06:18:58 +0000

Assessment and Diagnosis

Venous disorders warrant careful assessment and history taking. High risk patients are those who have undergone a major surgery; those who have history of cardiovascular disease, hypercoagulation, varicose veins, neoplastic disease; or amongst the elderly, pregnant women who takes contraceptive pills and obese individuals.
Assessment of signs and symptoms would require the following key points:
- Limb pain
- Ankle engorgement
- Edema
- Functional impairment
- Differences in leg circumference bilaterally from thigh to ankle
- Increase in surface temperature of the leg
- A feeling of heaviness
- Homan’s sign

Prevention

To prevent deep venous thrombosis and its possible complications, the following should be observed:

Patients should wear elastic compression stockings.
Patients should observe special body positioning and perform indicated exercise.
Patients should use intermittent pneumatic compression.
In surgical patients, subcutaneous unfractioned or low molecular weight heparin is administered.

Management

Medical Management

Anti – coagulation Therapy
- Anti – coagulation therapy is indicated for patients with thrombophlebitis or DVT, recurrent embolus formation and leg edema (from heart failure) in order to prevent and reduce blood clotting. This therapy is also indicated for the elderly population with hip fractures (requires prolonged immobilization)
  - Unfractioned Heparin – administered subcutaneously to prevent foomation of DVT or by IV. Given adjuct with oral anti – coagulant like warfarin. While under this treatment course, International Normalized Ratio or INR, partial thromboplastin time and platelet count is continuously monitored.
  - Thrombolytic Therapy – if heparins prevent DVT formation, thrombolytics on the other hand dissolves clots and thrombus. It has a lesser damage on the venous valves and reduced incidence of chronic venous insufficiency. However, use of thrombolytics could make the patient prone to bleeding, and so, if bleeding becomes uncontrolled, the therapy is immediately stopped.
Surgical management – there are cases where anti – cougulant and thrombolytic therapy are contraindicated so the goal of treatment will be surgery.
- Thrombectomy –removal of the thrombosis
- Placement of a thrombi filter after the thrombectomy to sift emboli and thrombus.

Nursing Management

Assessing and monitoring anti – coagulant therapy
- To prevent overdose of heparin, nurses should be able to calculate the dosage of the medications and administer them accurately. Laboratories should be monitored and referred if within outside the normal limits.
- Monitoring and managing potential complications
  - Bleeding – bleeding is the prime complication of patients undergoing anti- coagulant therapy. Nurses should be keen to monitor and detect signs of bleeding like bruises and nose bleeds. If bleeding occurs, fresh frozen plasma transfusion is initiated and Vitamin K is administered as ordered.
  - Drug interactions
  - Thrombocytopenia – taking in heparin for five days or more could cause decrease in platelet count. Regular and close monitoring is recommended.
  - Provide rest and comfort
    - Bed rest
    - Analgesics
    - Warm compress to affected area
    - Elastic compression stockings (evenly distributes pressure over the entire calf areas)
    - Elevation of affected extremity

Men in Nursing Profession Pushing Ways to Make a Difference

admin — Sat, 07 Jan 2012 05:52:37 +0000

Along with the rising population of men in nursing is the drive for those who are already in the field to find ways that they can influence healthcare. The American Assembly for Men in Nursing (AAMN), bearing this in mind, received members to the celebration of its 36^th annual conference in Lexington, KY on Oct. 19-21.

The host for the week was the University of Kentucky College of Nursing using the Robert Wood Johnson Foundation/IOM Future of Nursing report for its theme, concentrating on the ways men could pilot change and move forward health.

A Fresh Tomorrow

In general, men who are in nursing, particularly AAMN, shall be concerned in coming up with a fresh future of nursing, influencing the delivery of healthcare globally.

With that purpose, the AAMN suggested techniques in taking in more men to get into nursing, incorporating the production of a male-nurse teacher role for practice to encourage the employment as well as preservation of men in nursing, inventing schemes that will make the most out of the role of men in most professional nursing organizations and unfolding ideas created to move forward health issues and matters that men have.

Nurses, hailing from throughout the U.S. and Canada, who were there, and also nursing students, even one student from high school, were egged on to look at approaches where they can go into the roles of leadership, which provides other opportunities to influence practice and impart the vocation to other men.

During AAMN’s yearly business assembly, a gender unbiased language position paper was tackled, and a new head, secretary, as well as three board members were chosen. These were:

President: William T. Lecher, MBA, MS, RN, NE-BC
Vice President: Edward J. Halloran, PhD, MPH, RN
Secretary: Philip Julian, MSN, RN, NE-BC
Board Members: Michael Gailbraith, PhD, RN and Bob Patterson, MSN, RN
First time elected for Board: Susan LaRocco, PhD, RN

Talking about Health

To talk about men’s health along with its impact on public guidelines was the vice president of the Men’s Health Network Scott Williams. He brought in the “Blue Ribbon Campaign” of the Network. This acted as aid to provide support and add to awareness on the topic of prostate cancer. Before that, he gave an overview of the mission of the Network. The mission is to get to men as well as their families with messages about health prevention and tools, educational materials, screening programs, advocacy chances, and patient navigation. He urged everyone to be dynamic both at the state as well as federal levels, assisting in promoting the health needs and the well-being on the whole of men and their families.

Dean of the Oregon Health and Science University School of Nursing Michael Bleich, PhD, RN FAAN, talked about healthcare reform and what is jeopardized should men not react to the Future of Nursing report. He persuaded all to raise their voices and let the public be clarified about the contributions that nurses create every single day. Moreover, he said that each nurse should function with optimum competency, and emphasized the significance of about 80% of the entire nursing population being trained at the baccalaureate level.

Dean and professor at the School of Nursing and assistant director of the UCLA Health System University of California in Los Angeles Courtney Lyder, ND, GNP, FAAN, tackled on the future of nursing. She is the first African-American to function as dean at the UCLA and the first ever male minority dean of nursing in the United States. His research enabled to fashion the U.S. government’s position on assessing 16,000 of its skilled nursing facilities. His piece in pressure ulcers helped the U.S. government’s choice to end shelling out cash for pressure ulcers acquired in hospitals, supplying the platform to view healthcare reform as well as its effect on nursing practice.

Luther Christman, PhD, RN, FAAN, co-founder of AAMN, was praised at the assembly. He pass away last June. He received honor for several important contributions to nursing, which includes the “Rush Model” development.

To distinguish and commemorate this highlight for men in nursing, the board of AAMN set up the Luther Christman Awards Fellows program. Bleich was given the 2011 award at the assembly. Additionally, award winners for 2011 consisted of Best School: Excelsior College, Albany, New York; Lee Cohen Award for AAMN Member of the Year: Lavoy Bray, Jr, Med, BSN, RN. Lavoy is dean of quality enhancement services at Southside Regional Medical Center Professional Schools in Petersburg, VA.

Aged Care Terrifies Student Nurses

admin — Fri, 06 Jan 2012 06:08:01 +0000

Two nursing schools claim that far-reaching modification is required as to how aged care nursing is being taught in universities, if aged care should draw in nurses needed to care for the raising population of the elderly for the next few years.

Even though it has been more than ten years of concentrated efforts to boost nursing undergraduates’ experience with aged care nursing, student awareness of gerontic nursing career still stay very negative. A research revealed this finding, delivered last week during the 9^th Asian Oceana Gerontology and Geriatrics Congress in Melbourne.

The research, carried out by Southern Cross University Associate Professor John Stevens, was a follow-up investigation which mirrors the research project that Professor Stevens had begun in 1995 for his PhD.

Professor Stevens followed the opinions of students in six nursing degree courses, in the 1995, research in New South Wales. The research asked students, depending on their learning as well as personal experience of placements, to provide rankings, in the order of their inclination, to ten various nursing practice areas where they would like to work. The rankings were calculated throughout the 3-year degree course to determine if and in what manner the nursing students’ opinion and awareness regarding aged care nursing differed over the time.

The 1995 study discovered that students who are in their first year had fairly low eagerness of a career in aged care nursing but their views are not yet formed strongly, giving aged care a ranking of seventh in a list containing ten nursing practice areas. But, come their second year and after being exposed to practical placements in care of the aged, the students’ primary opinions only got stronger, ranking aged care ninth. By their third year, the students have given aged care a ranking of tenth, or the last, on their list of ideal nursing career areas.

During the 2010 survey, although the mentioned reasons have altered, the rankings for aged care that were given by nursing students who are in first, second and third year, as opposed to all the other nine areas, stay the same.

Professor Stevens stated he was very disappointed personally with the outcomes of the study.

He said that after every effort that he and his colleagues have included in order to boost both the image and experience of aged nursing for the past ten years, he expected that things would be better, but he was proven wrong, and said he was disappointed. He continued to say that included in the efforts that were carried out to boost the image of aged care nursing included an improved training to supervisors, diminished student ratios, acquiring more aged care specialist as part of the teaching program, and lessons for nursing home staff in order to allow the students to feel welcome.

He stated that they have attempted to deal with the balance of weight that was assigned to aged care as opposed to acute care and the other areas. However, there exists a touch connection between the amount of time allotted in practical placements and outlook to aged care. It was mainly that the more time spent on working with the elderly, the less that they want to work with them, he stated. The only difference between the two surveys pertained to the causes the students provided for the low rankings. In 1995, it revealed that the basic variation was that the nurses mentioned that they did not like the areas that they had to go to. According to the nurses, nursing home were unpleasant places to be employed. By 2010, they claimed that it would give their career a negative effect.

Among the things they said included: forgetting how to inject, inability to utilize every skill, or what are the chances for becoming a CNC. They stated that they would like a career that would allow them to create a difference, but with aged care nursing, they only view it as handling slow death.

Professor Stevens said that the subjects said they wanted to get a job where people are able to go somewhere. They say that intensive care is where the action is. The biggest problem is status. They think that aged care is “low tech”. Despite them getting the pay disparity correct, issues regarding status needs to be examined. It is something that the profession holds little to no value, Professor Stevens continued.

Professor of Aged Care Nursing Andrew Robinson, head of the Wicking Dementia Research and Education Centre teaching aged care facility course at the University of Tasmania, stated that his own study reveals the same outcomes.

He claimed that the lessons about aged care nursing must have an incorporated, well-planned approached founded on proof, as rather than gradual efforts.

Professor Robinson went on to say that student outlook to aged care worsens over time mainly because in most curricula, ageing is not addressed in an important way, not addressing the entire matter of the elderly in a manner that is important for these young professionals in the health care field.

Professor Robinson said that in their aged care facility, the students claimed that they understood and appreciated the significance of viewing the elderly in a non-acute phase. Because if not, how else will they know how an older person might appear or what they will be like regularly if they are never seen outside an acute phase?

If the nurses are exposed to a person with dementia then they could get scared. But provided with training as well as experience in research about those with dementia, then it turns into something interesting. It has to be approached with the right strategy, not only reactive, as well as the fact that it has to be founded on evidence.

Scrutinizing the Changing Roles of Nurses

admin — Thu, 05 Jan 2012 06:13:14 +0000

The top three most common topics during the Nursing Management Congress last week included the changing role of nurses, changing care delivery, and which show to watch later that night.

Despite the place being Las Vegas, the almost 1,000 nurse managers as well as leaders came together for some networking and education and grabbed the opportunity to talk about the more pressing matters regarding health care reform and also the role of nursing that thrilled the lot more than the place itself.

Tim Porter-O Grady, the keynote speaker, spoke to the audience saying that it was high time that nurses choose what it will not do anymore in order for nurses to be able to concentrate on the more significant matters in the ever transforming façade of care delivery. He said that nurses have been too hooked both on protocols and rituals. Nursing simply cannot go on with its usual old deeds in the innovative field of healthcare reform along with purchasing that’s based on value. On the other hand, it’s about time to grip important changes.

Modify the fresh graduate nurse practice.

Whenever we set those nurses who have been around for too long, those who are the oldest and probably with the most experience, as preceptors to the fresh graduates, we kill the young ones in a way, Porter-O Grady said. Most of the time, these old preceptors can barely connect to the younger fresh grads. Instead of precepting them, he continued, mentoring should be started. As opposed to preceptorships, mentoring interactions is aware that new nurses can teach us as much as we can teach them, he said.

Show the way for the subsequent generation of nurses

The present group of nurse leaders has been assigned with heading the next generation towards a future that isn’t yet understood and that will never be fully occupied, according to Porter-O Grady. Clinging to the past makes it a barrier to living in the future.

Nurse leaders ought to grip on to technology along with its ability to modernize healthcare, instead of seeing it as something that has been imposed by others on nursing.

Gauge value instead of volume

Porter-O Grady said that we are not staying any longer to an age of volume but are moving towards that of value. Nursing should end gauging itself in relation to volume and begin viewing at the value that it offers. It is the outcomes that they create, and this should be stressed, that makes nurses important to their organizations and not just because of the numerous tasks that they perform.

The role of nurse leaders is to distinguish the portions of the work that nurses perform that holds value and creates a difference and also those portions that do not fit in the RN role. This can be done by asking what effect the job has or if it has changed anything, said Porter-O Grady.

He continued to say that work in itself should have meaning, and not solely because one does it. Healthcare, and everyone should be aware, is more and more complex, and the only way to make the most of what nurses perform is by doing a smaller amount of the work that does not put in value, thus allowing for more time to the more complicated work that has value.

The forefront nursing leaders who were at last week’s conference are those who can aid organizations attain this vital distinction.

Quadriplegic Patient Not Given Life Support

admin — Thu, 05 Jan 2012 06:02:32 +0000

A nurse in an Intensive Care Unit (ICU) denied getting orders for not to resuscitate a quadriplegic patient from physicians who have been accused of planned killing of the patient.

She said to the Court headed by Judge Maher Salama Al Mahdi that she worked with the Emergency Assistance division of the ICU and frequently helped revive the quadriplegic patient.

She testified that when the patient flipped over from side to side, his heart would always stop, there was no direct instruction about lifting life support. She also said that a lot of doctors had discussed regarding the matter.

Based on the records, physicians at Rashid hospital known as MOK, 49, Indian, and EE, 50, Austrian are charged with planned killing of a quadriplegic patient as a result of not giving him the CPR that was needed when he went through a heart attack last February 21, 2009.

As leader of the Intensive Care Unit, EE is charged of handing out order on not giving CPR to the patient should he have a heart attack, thereby planning to kill him as an unavoidable outcome to his orders and deeds.

The Prosecution likewise charged the leader of the ICU for insisting to attain his goal with every means in spite of the opposition of the medical team. He was able to take away the devices that were connected to the patient required to rescue him, along with the oxygen monitor and the alarm. He is also charged of raising the morphine rate that was given to the patient and decreasing the oxygen rate given to him.

The ICU physician on duty, MOK, agreed with EE, and avoided providing CPR to the patient who experienced a heart attack, based on the records.

The two physicians refused the allegations when showing up before the Court.

The records state that the heartbeat of the patient slowed down slowly until it stopped so that he died, as revealed in his medical file.

50-year-old Syrian doctor Yaser Ahmad Masri bore witness that EE had set verbal instructions to the nursing team to not give CPR or medical assistance to Ghulam Mohammed, the patient, should he have a heart attack, thereby planning to kill him.

According to Masri, one day before the incident, the patient underwent a heart attack and the physician on duty MOK avoided providing him CPR according to the order of EE. He said that he was adamant that the patient should be rescued if he goes through a heart attack, so he was given all the required equipment and medication. However, EE got there a day prior to the patient’s death and took away all the equipment, and MOK, on duty that time, did not give him the needed CPR.

50-year-old Egyptian Intensive Care Consultant Ashraf Mahmoud Al Hofi testified that he was a leader of a medical committee that was set to examine the patient’s death.

The committee arrived at EE giving verbal directive as well as indirect orders to not provide the patient CPR or any other medical measure of support, going against the medical regulations.

According to Al Hofi, there were some notes in the file of the deceased that backed this. The patient was not dead clinically, but was in fact conscious, and the death resulted from him not receiving any CPR when he underwent a heart attack according to the instructions given by EE, and MOK was accountable as well since he implemented the orders, he continued.

40-year-old Pakistani ICU nurse Amin Najmi, testified that on the date of the event, he received the shift from another nurse who said to him that the physicians committee have decided not to provide the patient with CPR in the event of a heart attack.

Najmi testitfied that the patient did have a heart attack, and that he notified the doctor on duty, MOK, who said to him that giving the patient CPR is not allowed, and when asking why this was, the doctor replied that it was their decision and then got out of the nursing room.

30-year-old Indian nurse Marline Shakoshan gave the same testimonies and further supplied that EE gave orders to take away the oxygen monitor device at the time when the patient’s status needed monitoring of the oxygen rate in his blood. This device is likewise connected to the alarm, which was not active also.

She testified that she has written on the file of the patient that CPR was not given according to the order of EE, and that doctor MOK denied the patient CPR in accordance with those orders.

The trial supplied the court with technical proofs which includes choices taken by EE which were a breach of procedural, administrative, and clinical terms, as well as immoral, despite of the justification given by the accused.

MOK confessed that the order of not providing CPR to the patient was set by EE and were made known to the nursing team. EE was ready to kill the patient, he went on.

The files cited that EE got into the patient’s room at the last part of the working day prior to the weekend and took away all the devices that were connected to the patient. By doubling the speed of the morphine provided to the patient, it aimed to keep from revealing the worsening status of the patient.

EE was eager to take away the alarm that was connected to the patient to ensure that no alarm will be there in case of an emergency and so that no one would give the required support, based on the prosecution notes.

NursingFile.com

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