Order Now

Nursing diagnoses and patient education

Nursing diagnoses and patient education

Nursing diagnoses and patient education Length: 1500 words (+/- 10%) This is the first section of the written assignment for this unit. The assignment is divided into two parts. BOTH parts (A and B) must be attempted to gain a satisfactory result. Part A of the assignment focuses only on patient education and will be marked by teaching staff from Nursing faculty. Please do not discuss patho-physiology in Part A. You can, however, discuss what education Trevor may need regarding taking any medications. The Patient Education Plan should include the interdisciplinary team. Task You are the nurse organising Trevor’s care following the first episode of Trevor’s case study (Weeks 2/3). Using the nursing process, you need to present your assessment data and nursing diagnoses relating to Trevor’s need for education regarding his lifestyle, illness and treatment. You need to formulate an evidence-based care plan (see Structure and Presentation below) relating to these nursing diagnoses. Nursing Diagnoses are the problems you find on assessment. They are not medical diagnoses. The medical diagnoses are Trevor’s Ischemic (IHD) and Diabetes Mellitus. One example of a nursing diagnoses for Trevor is his breathlessness related to his smoking and obesity. You need to observe his subjective and objective data and analyse what is normal and what is not normal. Remember, the focus of this task is patient education ie. You diagnose his problems (there are several problems including physical, social and psychological) and set goals to improve his health. Referencing Your plan must be appropriately referenced. A minimum of 15 recent evidence-based resources is required for this section of the assignment. APA is the required referencing style for assignments in the School of Health. Follow the link at the top right of the page for information and examples. Please do not over depend on websites and avoid supporting your points using consumer sites such as Better Health Channel. You must use professional sources as much as possible. Diabetes Australia and the Heart Foundation are acceptable due to their significant research/evidence base. If you have text books should very helpful. Help-lines are acceptable to identify as Trevor needs to find information and get support. Structure and presentation This assignment should be briefly introduced. You are then required to provide a care plan. The main content of the assignment should be presented in a care plan (grid) format. The columns should be organised as follows: Nursing Diagnoses (based on your assessment findings), Nursing Interventions (what you will plan for Trevor), Goals/Outcomes (what he needs to achieve ie. reduce smoking/stop smoking by what time), Evaluation (what has or hasn’t been met) and Rationale (evidence based literature). A brief conclusion is also required. A Reference List should be provided as standard. CASE STUDY TREVOR Case Trevor; week 2: Trevor arrives at the ED Three months later, an interrupted morning walk. Trevor and Susan are concerned… Trevor has been trying to keep to a diet and exercise plan since his visit to the GP. He and Susan walk for an hour every morning in the local park. One morning during their walk Trevor begins to experience a dull, aching pain on the left side of his chest. The pain does not subside. As the pain continues, Susan and Trevor become more worried. Slowly and painfully Trevor manages to make his way home, with a number of stops and considerable assistance from Susan. Susan then drives Trevor immediately to the local hospital emergency department. You are on placement in the ED as a student nurse. Trevor is allocated to the Registered Nurse you are working with. Assessing Trevor You begin to assess Trevor. Here are details of some of the initial assessment data and management strategies: • Trevor has a patent airway, he is speaking in full sentences and has strong peripheral pulses. • His vital signs are: o BP 152/92mmHg o HR 127 beats/minute o RR 26 breaths/minute o SpO2 89% on room air, increases to 95% when the RN you are working with applies 8LO2 via a simple face mask o Temp 36.4oC The assessment continues The RN asks you to connect Trevor to the continuous cardiac monitor. You attach the electrodes and begin monitoring in lead II. The RN then asks you to complete a 12 lead ECG. Treatment for Trevor The RN asks Trevor how he is feeling. He says he still has the dull aching feeling. He is given the following medication: • sublingual 600micrograms glyceryl trinitrate (GTN) • oral 300mg aspirin Ten minutes after the medication is administered, Trevor states he is now comfortable and pain free. Here is his ECG after administration of the medication: The continuing story Blood is taken from Troponin I and T. Results are within normal limits. Trevor spends the next 24 hours in the short stay area being monitored for any further complications. He is discharged thereafter without having experienced any further symptoms and his ECG remains unchanged from the “pain free” ECG he had in the emergency department. Trevor is discharged Next day Trevor undergoes a “stress test” ECG. This shows ischemic ECG changes on exertion. Upon discharge he is prescribed GTN 600 micrograms to be taken PRN when he experiences pain in his chest. Case Trevor; Module 3: A more serious emergency ‘We just went for a walk to the beach…’ The walk to the beach It is six months since Trevor’s visit to the ED. Trevor and Susan decide to take a few weeks of holiday, including a visit to the city to catch up with their children. Trevor has been feeling quite well since his short hospital stay. He has had two episodes of chest pain, both occurring after he has walked for more than 30 minutes. Both were relieved with one dose of his GTN. He has been trying to quit smoking and has managed to cut back to about 6 cigarettes a day. Staying with their son in the city, Trevor and Susan are determined to keep up their daily walk, both to keep Trevor’s new healthy regime on track and to explore the sights around their son’s new home in the Eastern suburbs of Sydney. Today, Trevor and Susan decide to follow the road around Coogee headland, then take the walking track down the hill to the beach. They stroll along the beach, then they start the long steep climb up Coogee Bay Road on their way back home. They have been walking for about an hour. As they push up the hill, suddenly Trevor collapses. He is pale and beads of sweat are starting to form on his forehead. Susan grabs his arm and supports him as he doubles over. ‘What’s the matter?’ she cries. Trevor gasps in reply that he has intense crushing pain in the middle of his chest. ‘Quick, where’s your drops?’ Susan asks as she anxiously starts looking through Trevor’s pockets. ‘You need to take some of your drops.’ ‘Home,’ gasps Trevor. ‘Didn’t think…Forgot… them…’ Susan hurriedly reaches in her bag for her mobile phone and calls an ambulance. Then she makes Trevor sit down on the nearest fence while they wait. Fortunately they are very close to Prince of Wales Hospital and the paramedics arrive five minutes after Susan’s call. Initial assessment & treatment Here is some of the initial assessment and treatment carried out by the paramedics: o Trevor is conscious but anxious and confused. He has a patent airway, he is speaking in short bursts, one or two words at a time and has weak peripheral pulses. o His vital signs are:  BP 102/71mmHg  HR 134 beats/minute  RR 28 breaths/minute  SpO2 86% on room air, increases to 92% when the paramedic applies 15LO2 via a simple face mask  Temp 36.4oC o 600 micrograms of GTN is administered. o A peripheral IV line is inserted on the way to hospital and 5mg morphine is administered. At the hospital Trevor arrives in the Emergency Department, where you are on placement as a student nurse. He is still very distressed with what he describes as 5/10 central chest pain, radiating down his left arm and up into his neck. He states that the GTN and morphine helped reduce the severity from 10/10 when it started. Here is the some of the assessment and initial treatment upon arrival to the ED:  Trevor is conscious and still anxious. He has a patent airway, he is speaking in short sentences and has strong peripheral pulses.  His vital signs are:  BP 108/83mmHg  HR 102 beats/minute  RR 26 breaths/minute  SpO2 94% on 15LO2 via a simple face mask  Temp 36.4oC Your supervising RN directs you to connect Trevor to a continuous cardiac monitor, and you begin monitoring in lead II. The next steps Following the ECGs, the following blood tests are taken for Trevor. The results are available 30 mins later:  Sodium: 148mmol/L  Potassium: 2.8mmol/L  Troponin I and T: elevated Trevor is given the following medications:  Aspirin 500mg oral  Clopidogrel 75mg oral  GTN IV infusion at 5micrograms/minute initially.  Metoprolol 5mg IV- 3 doses at 5 minute intervals  Heparin IV infusion is established based on weight and titrated to APTT results. Diagnosis & treatment Trevor is diagnosed with an Inferior Acute Myocardial Infarction and taken to the catheter laboratory for an immediate percutaneous coronary intervention (PCI) and coronary stent placement.
]]>

Open chat