Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.
Five major types of anxiety disorders are:
• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder (OCD)
• Panic Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Social Phobia (or Social Anxiety Disorder)
Treatment
Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.
Oxygen therapy is just what it sounds like: concentrated oxygen is administered to raise the oxygen saturation of a patient’s blood to a normal, healthy level. This can be done via a nasal cannula, a mask, or a tent. Oxygen therapy can be given in the hospital or at home.
Often the respiratory therapist works closely with the doctor to decide what oxygen therapy the patient needs. Your job focuses on making certain the patient is comfortable, and closely monitoring their condition. Beyond Nursing School
The best information about oxygen therapy can be learned through hands-on training. Go beyond what you learned in nursing school with these tips from the experienced pros:
* Anxiety can make it even harder to breathe. Calming the patient can work wonders. * Sometimes a change in position can help. Sitting up or leaning forward can open up the lungs a bit. * A BiPap machine might look scary and feel frightening. Take the time to teach the patient exactly what it does, and why they need it. * Never use any kind of petroleum jelly or aerosol sprays around a patient receiving oxygen. * If a patient’s lips become dry or chapped while on oxygen, lip balm can help, but make certain it doesn’t have a petroleum base. * Cannulas can cause irritation. Tuck a bit of gauze under the tubing to prevent this. * When using a cannula, the patient might need to use a humidifier as well. Check with respiratory therapy about any discomfort the patient might experience. * Though a high oxygen saturation is good, anything 92 percent or above is acceptable for most patients. * Remember that oxygen stats might naturally drop a bit when someone is sleeping. * Instruct patients to inhale through their nose and exhale through their mouth. This may not only aid in breathing, but the focus required can help calm them as well.
A Final Word on Oxygen Therapy
Whether you opt to get your traditional or online nursing degree, you can learn about oxygen therapy–but you might not learn enough. Pay attention to your respiratory therapist when they show you the little “tricks of the trade” for patients under your care. Those little details can enhance your good nursing procedure, and can make your patient even more comfortable. source : medi-smar.com
Nursing Diagnosis Knowledge deficit of management of visual impairment
Knowledge deficit is a lack of cognitive information or psychomotor skills required for health recovery, maintenance, or health promotion. Teaching may take place in a hospital, ambulatory care, or home setting. The learner may be the patient, a family member, a significant other, or a caregiver unrelated to the patient. Learning may involve any of the three domains: cognitive domain (intellectual activities, problem solving, and others); affective domain (feelings, attitudes, beliefs); and psychomotor domain (physical skills or procedures). The nurse must decide with the learner what to teach, when to teach, and how to teach the mutually agreed-on content. Adult learning principles guide the teaching-learning process. Information should be made available when the patient wants and needs it, at the pace the patient determines, and using the teaching strategy the patient deems most effective. Many factors influence patient education, including age, cognitive level, developmental stage, physical limitations (e.g., visual, hearing, balance, hand coordination, strength), the primary disease process and other comorbidities, and sociocultural factors. Older patients need more time for teaching, and may have sensory-perceptual deficits and/or cognitive changes that may require a modification in teaching techniques. Certain ethnic and religious groups hold unique beliefs and health practices that must be considered when designing a teaching plan. These practices may vary from "home remedies" (e.g., special soups, poultices) and alternative therapies (e.g., massage, biofeedback, energy healing, macrobiotics, or megavitamins in place of prescribed medications) to reliance on an elder in the family to coordinate the plan of care. Patients with low literacy skills will require educational programs that include more simplified treatment regimens, simplified teaching tools (e.g., cartoons, lower readability levels), a slower presentation pace, and techniques for cueing patients to initiate certain behaviors (e.g., pill schedule posted on refrigerator, timer for taking medications).
Although the acute hospital setting provides challenges for patient education because of the high acuity and emotional stress inherent in this environment, the home setting can be similarly challenging because of the high expectations for patients or caregivers to self-manage complex procedures such as IV therapy, dialysis, or even ventilator care in the home. Caregivers are often overwhelmed by the responsibility delegated to them by the health care professionals. Many have their own health problems, and may be unable to perform all the behaviors assigned to them because of visual limitations, generalized weakness, or feelings of inadequacy or exhaustion.
Deficient Knowledge This care plan describes adult learning principles that can be incorporated into a teaching plan for use in any health care setting. Nursing Diagnosis : Knowledge deficit of management of visual impairment related to patient being unfamiliar with facial cellulitis as evidenced by the patient and spouse asking about what needs to be done to manage the cellulitis and what kind of assistance the patient may need
Expected Outcomes Patient and spouse will understand that patient will need assistance with ADLs (toileting, eating, walking, taking meds) by end of shift. Patient and spounse will state 3 techniques to manage cellulitis by discharge
Nursing Interventions/Rationale
1. Assess readiness to learn management techniques of cellulitis from the patient and spouse. It needs to be made sure that the patient and spouse are willing to learn these interventions so they can apply them. 2. Explain to spouse to clear obstructions along his path when ambulating. This reduces chance of falls (Harkreader and Hogan, 2004, p. 988) 3. Explain to spouse that rooms at home should be well or brightly lit. This prevents chance of pt. bumping into things and injuring self and falling. (Harkreader and Hogan, 2004, p. 988) 4. Explain to spouse that she needs to give medications to client. Since his vision is hindered, his wife is the only one who can read the label for the correct meds. 5. Collaborate with dermatologist or wound-care nurse to find ways to treat and manage symptoms of cellulitis (mainly the inflammation) that can be used to teach the patient and spouse. Dermatoligist and wound care nurse can find other methods of treamtent and possible medications. 6. Teach patient to moisturize skin to prevent cracking and peeling. Cracks and peels serve as portals of entry of bacteria and this can lead to complications such as cellulitis. (http://www.mayoclinic.com, 2007) 7. Tell patient, when resting, to try to sit at 90 degrees with head straight to promote maximum venous return to prevent venous stasis. Venous stasis is a risk factor for cellulitis. (Venes, 2005, p. 373) 8. Teach patient and spouse to apply cold (i.e.ice pack) if sympotms get worse (increase in swelling and pain) Cold is a local anesthetic and it reduces swelling. (http://merck.com, 2005)
Outcome Evaluation
Met. Patient and spouse understand that patient will need help with ADLs. Asked questions to clarify and backbriefed my teaching.
Met. Patient and spouse said they understand and stated at least 3 techniques in managing the cellulitis.
The systematic and continuous collection, validation, and communication of client data
During assessment, the care provider:
A. Establishes A Data Base B. Continuously Updates The Data Base C. Validates Data D. Communicates Data
Planning:
The establishment of client goals/outcomes by the provider, working with the client, that prevent, reduce, or resolve problems and the determination of related nursing interventions most likely to assist client in achieving goals
During planning, the provider:
A. Establishes Priorities
B. Writes Client Goals
C. Selects Nursing Interventions
D. Communicates The Plan
Implementing:
The provider carries out the plan of care
During implementing, the care provider:
A. Carries Out The Plan Of Nursing Care
B. Continues Data Collection And Modifies The Plan Of Care As Needed
C. Documents Care
Evaluating:
The measuring of the extent to which client goals have been met
During evaluating, the care provider:
A. Measures The Clients Achievement Of Desired Goals/Outcomes
B. Identifies Factors That Contribute To The Client's Success Or Failure
C. Modifies The Plan Of Care, If Indicated
Purpose of the nursing process:
1. To Achieve Scientifically- Based, Holistic, Individualized Care For The Client
2. To Achieve The Opportunity To Work Collaboratively With Clients, Others
3. To Achieve Continuity Of Care
Characteristics of the nursing process:
1. Systematic
The nursing process has an ordered sequence of activities and each activity depends on the accuracy of the activity that precedes it and influences the activity following it.
2. Dynamic
The nursing process has great interaction and overlapping among the activities and each activity is fluid and flows into the next activity.
3. Interpersonal
The nursing process ensures that nurses are client-centered rather than task-centered and encourages them to work to help clients use their strengths to meet human needs.
4. Goal-Directed
The nursing process is a means for nurses and clients to work together to identify specific goals related to wellness promotion, disease and illness prevention, health restoration, coping and altered functioning, which are most important to the client, and to match them with the appropriate nursing actions.
5. Universally Applicable
The nursing process allows nurses to practice nursing with well or ill people, young or old, in any type of practice setting.
Prostate cancer is the most common cancer in men in the UK. 37,000 men are diagnosed with prostate cancer every year. 250,000 men are currently living with the disease. Normally the growth of all cells is carefully controlled in the body. As cells die, they are replaced in an orderly fashion. Cancer can develop when cells start to grow in an uncontrolled way. If this happens in the prostate gland, prostate cancer can develop.
Prostate cancer can grow slowly or very quickly. Most prostate cancer is slow-growing to start with and may never cause any problems or symptoms in a man’s lifetime. However, some men will have cancer that is more aggressive or ‘high risk.’ This needs treatment to help prevent or delay it spreading outside the prostate gland.
source Prostate cancer is the most common cancer in men in the UK. 37,000 men Prostate cancer is the most common cancer in men in the UK. 37,000 men
Aseptic Technique Aseptic Technique Definition Aseptic technique is the effort taken to keep the service user as free from microorganisms as possible when undertaking any clinical procedure. It is a method used to prevent contamination of wounds and other susceptible sites by organisms that could cause infection. Indications Service Users have a right to be protected from preventable infection and all CNWL staff have a duty to safeguard the wellbeing of their patients.
An aseptic technique should be used during any invasive procedure that bypasses the body's natural defenses, e.g. the skin and mucous membranes or when handling equipment such as intravenous cannulae and urinary catheters. Whilst it is difficult to maintain sterility, it is important to prevent contamination of sterile equipment. Poor aseptic techniques can lead to contamination.
When should an aseptic technique be used. • When dressing wounds healing by primary intention, e.g. surgical wounds, burns, self harm injuries. • When dressing wounds healing by secondary intention, e.g. pressure sores, leg ulcers, simple grazes, removing drains or sutures.
• When inserting, re-siting or dressing an invasive device, e.g. intravenous line, urinary catheter, wound drain. • When the patient is immunocompromised Who should undertake an aseptic technique
• Only trained and assessed as competent staff should perform an aseptic technique. Note wound dressing should not be taken down for a ward rounds unless there is a clinical need to see the wound.
Aseptic Technique References:
Infection Control Nurses Association. Asepsis: Preventing Healthcare Associated Infection. 2003
National Institute for Clinical Excellence Infection Control Prevention of Healthcare Associated Infection in Primary and Community Care. June 2003
Essential steps to safe, clean care. Department of Health July 2006
The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 6th Edition, Chapter 4, Blackwell Publishing
Insufficient physiological or psychological energy to endure or complete required or desired daily activities
Defining Characteristics Abnormal blood pressure response to activity; abnormal heart rate response to activity; EKG changes reflecting arrhythmias; EKG changes reflecting ischemia; exertional discomfort; exertional dyspnea; verbal report of fatigue; verbal report of weakness
Related Factors (r/t) Bed rest; generalized weakness; imbalance between oxygen supply/demand; immobility; sedentary lifestyle Suggested NOC Outcomes
Activity Tolerance, Endurance, Energy Conservation, Self-Care: Instrumental Activities of Daily Living (IADLs)
Example NOC Outcome with Indicators
Endurance as evidenced by the following indicators: Performance of usual routine/Activity/Concentration/Muscle endurance/Eating pattern/Libido/Energy restored after rest/Blood oxygen level (Rate the outcome and indicators of Endurance: 1 severely compromised, 2 substantially compromised, 3 moderately compromised, 4 mildly compromised, 5 not compromised see Section I.) Suggested NIC Interventions
Activity Therapy, Energy Management Example NIC ActivitiesEnergy Management
Monitor cardiorespiratory response to activity; Monitor location and nature of discomfort or pain during movement/activity source Nursing Diagnosis Activity intolerance
Most Nursing Assistants work very hard to ensure the safety of patients as well as provide them with quality care. However, consumer complaints happen often, resulting in the profession not getting a fair look. Too often the focus is on the negative that takes place during interactions with Nursing Assistants than reporting good staff to the proper people.
One of the biggest complaints about Nursing Assistants by consumers is that they are too rushed. They often have to hurry through bathing and dressing because they have too many demands on their time in a given shift. This often results in patients getting cared for, but quickly and robotically. The personal touch is often smothered in an effort to get it all done.
For patients, simple requests are on of the few perks they have in a medical facility. It also allows they to still exercise some control over their decisions. This is very important to someone who no longer is able to be at home or do basic tasks for themselves without assistance. These requests can be as simple as helping them from the bed to a chair or bringing them a pen and paper to write a letter. It is easy for Nursing Assistants to get side tracked or forget. However, since these simply requests are important to the patient, it is very important that Nursing Assistants follow through with them. Carrying a pen and notepad to jot down requests is a great way to remember them.
Patients don't like to be kept waiting. It is very hard to adjust to. They may forget they are not the only patient. Nursing Assistants do the best they can to stay on schedule. However, working short staffed and medical emergencies can quickly put them behind schedule. Nursing Assistants have to prioritize, so sometimes helping someone who has fallen is more important than giving the patient a shower on time. Since confidentiality is so important, the Nursing Assistant can't tell the patient why they are running late.
Never discuss a patient with another staff member or family member in a manner that makes the patient feel as if they are not in the room. Speak with them in mind. It is important to carefully choose your words, even when you think they are asleep or in a coma. Many patients have filed complaints regarding conversations they overheard while Nursing Assistants thought they were sleeping or unresponsive.
One huge area of controversy is that many consumers are uneasy with who quickly a Nursing Assistant can obtain a license. They do not feel there is adequate training time to do an effective job. Federal guidelines require all Nursing Assistant programs to have a minimum of 75 hours of training. The actual amount will depend on the program coordinator and the state requirements for a particular program. However, it is often debated that to be certified as a manicurist, it takes over 1000 hours of training, but so little to become a Nursing Assistant.
Medical facilities and program developers defend the hours required to earn a certificate as a Nursing Assistant. They feel the training builds on an individuals basic concepts of feeding, bathing, and dressing individuals. It is routine tasks we have all done at some point in our lives. They also stress that the clinical hours are hands on training in a medical facility with close observation. This type of training is more effective than just classroom curriculums of other programs. In addition, Nursing Assistants are closely supervised by Nursing staff on a regular basis.
Nursing Assistants work hard to do an effective job of meeting the needs of consumers. Complaints will continue to be file as long as Nursing Assistants maintain such high workloads. With the demand of this field continuing to grow, it is not likely that the workloads will get anything but larger over time.
If you enjoy helping other people, a career in the medical field might be for you. The field is always in demand of qualified compassionate individuals who are willing to put forth their best efforts to help others. A Nurse Assistant is an entry level position that will allow you the opportunity to help others and gain experience in the medical field.
Since Nurse Assistants are needed throughout the Nation, you will be able to secure employment opportunities most anywhere. Job security is very high in most areas of the medical field. The training programs to earn your certificate all vary depending on state regulations. However, most can be completed in four to six weeks on average. The cost of such programs is very low.
If you need assistance with the cost of the course, many programs offer scholarships or financial aid. In addition, many community agencies such as Human Services will assist you with the cost of completing such a training course. Some employers in the medical field will agree to either pay for your Nurse Assistant training or reimburse you upon successful completion of the program.
Most Nurse Assistant programs start every six to eight weeks. It will depend on the length of the course and the interest in your particular area. This is different than most certificate programs where you have to wait until a full semester ends before you can enroll. Sometimes that can mean a three or four month waiting period.
During your Nurse Assistant training, you will attend a classroom learning environment as well as receive hands on training. The hands on training requires you to complete a certain number of hours, called clinicals, working at a medical facility with actual patients. All of your work will be overseen by trained professionals who with assist you with the proper procedures and medical understanding.
The combination of classroom learning and clinicals will result in you being well prepared to enter the job market as a Nursing Assistant. Often, the medical site that oversees the clinicals will offer employment to those students who are learning well, following procedures for their facility, and who have a positive attitude.
Working as a Nurse Assistant can be very exciting and rewarding for the right person. The work is challenging and you may find yourself over extended at times. Things in a medical setting will change all the time, so the job definitely isn't predictable. There are so many variables including the patients, then number of patients, other staff, and the medical needs of the patients that you work day with never be predictable.
While being a Nurse Assistant is an entry level position, it is also a very important position. You will be responsible for many daily living tasks for each patient. These tasks include bathing, grooming feeding, and checking their vital signs. You will also be responsible for assisting with medical equipment and moving patients as needed. The exact requirements of the position will vary depending on the facility you work for. Becoming a Nurse Assistant generally does not take very long. You will continue to learn about your role as a Nurse Assistant once you secure employment. You will be exposed to medical information and procedures by the rest of the staff. This information will be very valuable. Many people choose to use the role of Nursing Assistance as a foundation to continue their education and become a Nurse or to explore other types of employment in the medical field.
