In Britain, every nurse is on grade. The grade depends on experience and skill, and each grade has different responsibilities and pay. On the bottom grades are unqualified auxiliary nurses who do the routine work on hospital wards. On the top grades are nursing officer, who are usually administrators.
Auxiliary nurses are on the bottom grades, but student nurses get the lowest pay. However, student don't stay at the bottom of the scale forever. When they qualify, they start working on a middle grade. As they get experience, they can get promotion and move up the ranks to become staff nurse, then sister (charge nurse if a man), and perhaps eventually nursing officer.
Many Nurse work shift, and often they work overtime to earn more money. After basic training, many nurses choose to do further study and become specialists. Nurses can specialize in many different fields, there are triage nurses working in Casualty, and Psychiatric nurses who treat the mentally ill. There are health visitors who visit patients in their own home, practice nurses working in GPs' surgeries, and midwives who deliver babies.
Many of them say they don't get enough pay and respect for the work they do. They say that the work is physically and mentally hard, that they work long hours and get very tired. But they also say that there are many great rewards which have nothing to do with money.
Myocardial infarction (MI or AMI for acute myocardial infarction) is the rapid development of myocardial necrosis (die of heart cells) caused by a critical imbalance between oxygen supply and demand of the myocardium.
This is serious medical condition that sometimes called as a heart attack or a coronary thrombosis. The medical team should be take quickly action to give treatment and Nursing Care to prevent complication or die.
With myocardial infarction, reduce blood flow in one of the coronary arteries leads to myocardial ischemia, injury and necrosis. From the ECG result, with a Q-wave MI it's mean that the tissue damage extends through all myocardial layers. Non-Q-wave MI, ussually only the innermost layer is damage.
Possible causes of Myocardial infarction (MI) are : Coronary artery occlusion, Coronary spasm and Coronary stenosis. There are some risk factors to develop of Myocardial infarction such as :
- Decrease serum HDL levels
- Diabetes Mellitus
- Drug use, specifically use of amphetamines or cocaine
- Elevated serum Triglyceride, LDL and Cholesterol levels
- Excessive intake of saturated fats, carbohydrates, or salt
- Family history of CAD
- Post menopausal women
- Sedentary lifestyle
Nursing Care Plan For Myocardial Infarction (MI):
Assessment findings on the patient with myocardial infarction are : Dyspnea, Diaphoresis, Arrhythmias, Tachicardia, Anxiety, Pallor, Hypotension, Nausea and vomiting, Elevated temperature. The specific complain from the patient is crushing substernal chest pain (may radiate to the jaw, back and arms) that unrelieved by rest or nitroglycerin (NGT) tablet.
Diagnostic evaluation patient with myocardial infarction:
- ECG show deep, wide @ wave ; elevated or depressed ST segment; and T wave inversion or cardiac arrythmias.
- Blood chemistry test result show increased creatine kinase (CK), lactate dehydrogenase (LD), lipid, and troponin T levels; increased WBC count; positive CK_MB fraction; and flipped LD1.
Nursing diagnoses for patient myocardial infarction (MI) are:
- Chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply
- Potential Arrhythmias related to decrease cardiac output
- Respiratory difficulties (dyspnoea) due to decrease CO
- Anxiety & fear of death related to his condition
- Activity intolerance related to limitations imposed
- Potential for complications of thrombolytic therapy
- Discharge medications, follow up & Health teachings
Planing and goals of nursing care plan;
- The patient won't develop preventable complication
- The patient will understand the necessary treatment and lifestyle changes.
Nursing Intervention for myocardial infarction (MI):
- Monitor ECG result to detect ischemia, injury new or extended infarction, arrhythmia, and conduction defects
- Monitor, record vital signs and hemodynamic variables to monitor response to the therapy and detects complication
- Administer oxygen as prescribe to improve oxygen supply to the heart
- Obtain an ECG reading during acute pain to detect myocardial ischemia, injury or infarction
- Maintain the patient's prescribed diet to reduce fluid retention and cholesterol levels
- Provided postoperative care if necessary to avoid postoperative complications and help the patient achieve a full recovery
- Allay the patient's anxiety because the anxiety increase oxygen demands.
Nursing Evaluation for myocardial infarction (MI):
- The patient explains how and when to take medicine and state reportable adverse reaction
- The patient describes appropriate lifestyle changes to reduce the risk of future cardiac event
- The patient experiences no complication after heart attack (myocardial infarction)
Labels: NCP Heart Disease
Management Nursing Care Plans @ 3:01 AM, ,
Hypertension or High blood pressure (HBP) is a medical condition in which the blood pressure is chronically elevated in the arteries or blood vessels. Hypertension is also categorized according to etiology: as primary/essential (approximately 95% of all cases), when it has no identifiable cause; or secondary, which occurs as a result of an identifiable, sometimes correctable, pathologic condition.
1. Hypertension (Blood pressure) of 160/100 mmHg or above
This is definitely high, In this level the patient should be treat with medication to lower it. Otherwise, Persistent hypertension can make serious problem such as strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure.
2. Hypertension (Blood pressure) of 140/90 mmHg to 160/100 mmHg
This level called as 'mild' high blood pressure. For many people the risk from mild high blood pressure is small, and drug treatment is not indicated. Anyway, in this range they will get advised medication to lower it. Hypertension increases with age and is one of the major risk factors in the development of cardiovascular disease.
3. Hypertension (Blood pressure) between 130/80 and 140/90 mmHg
For most people this level is fine, But in some group of people this level is too high for them. Treatment to lower the blood pressure if it is 130/80 mmHg or higher may be considered if some one :
- Have developed a complication of diabetes, especially kidney problems.
- Have had a serious cardiovascular event such as a heart attack, transient ischaemic attack (TIA) or stroke.
- Have certain chronic (ongoing) kidney diseases.
Risk factors to get hypertension are ; Aging, Atherosclerosis, Diet (sodium and caffein), Family history, Obesity, Race (insidence is higher in blacks), Sex (incidence is higher in males older than age 40), Smoking and Strees.
Nursing Care Plan For Hypertension :
The Nurses must collect some data during assessment ; Asymptomatic, Elevated blood pressure, Dizziness, Headache, Left ventricular hypertrophy, Heart failure, Cerebral ischemia, Renal Failure, Papilledema, Vsual disturbance (including blindness).
See the diagnostic evaluation ;
- ECG: Ventricular or atrial hypertrophy, axis deviation, ischemia, and damage patterns may be present. Dysrhythmias; e.g., tachycardia, atrial fibrillation, conduction delays, especially left bundle branch block, frequent premature ventricular contractions (PVCs), may be present. Persistent ST-T segment abnormalities and decreased QRS amplitude may be present.
- Chest x-ray: May show enlarged cardiac shadow, reflecting chamber dilatation/hypertrophy, or changes in blood vessels, reflecting increased pulmonary pressure. Abnormal contour; e.g., bulging of left cardiac border, may suggest ventricular aneurysm.
- Sonograms (echocardiogram, Doppler and transesophageal echocardiogram): May reveal enlarged chamber dimensions, alterations in valvular function/structure, the degrees of ventricular dilation and dysfunction.
- Heart scans: Technetium-99m (99mTc) pyrophosphate scaning (also known as hot spot myocardial imaging and infarct avid imaging): Used to detect recent myocardial infaction and its extent.
- Multigated acquisition (MUGA): Measures cardiac volume during both systole and diastole, measures ejection fraction, and estimates wall motion.
- Exercise or pharmacologic stress myocardial perfusion (e.g., dipyridamole [Persantine] or thallium scan): Evaluates blood flow, determines presence of myocardial ischemia and wall motion abnormalities.
- Positron emission tomography (PET) scan: Sensitive test for evaluation of myocardial ischemia/detecting viable myocardium.
- Cardiac magnetic resonance imaging (MRI): Helps detect congenital heart disease, valvular heart disease, and vascular disorders such as thoracic aneurysm. It also helps detect cardiac tumors and structural anomalies.
- Cardiac catheterization: Abnormal pressures are indicative of and help differentiate right-sided versus left-sided heart failure, as well as valve stenosis or insufficiency. Also assesses patency of coronary arteries. Contrast injected
- into the ventricles reveals abnormal size and ejection fraction/altered contractility. Transvenous endomyocardial biopsy may be useful in some clients to determine the underlying disorder, such as myocarditis or amylodosis.
- BNP (Beta-type natruiretic peptide): Affects cardiac function and vascular tone and renal function. Low levels indicate worsening heart failure.
- Liver enzymes: Elevated in liver congestion/failure.
- Digoxin and other cardiac drug levels: Monitored to determine therapeutic range and correlate expected response with client response.
- Bleeding and clotting times: Determine therapeutic range for anticoagulant therapy and/or identify those at risk for excessive clot formation.
- Electrolytes: May be altered because of fluid shifts/decreased renal function and medications (e.g., diuretics, ACE inhibitors).
- Arterial blood gases (ABGs): Left ventricular failure is characterized by mild respiratory alkalosis (early) or hypoxemia with an increased PCO2 (late).
- BUN/creatinine: Elevated BUN suggests decreased renal perfusion as may occur with HF and/or as a side effect of prescribed medications (e.g., diuretics and ACE inhibitors). Elevation of both BUN and creatinine is indicative of renal failure.
- Serum albumin/transferrin: May be decreased as a result of reduced protein intake or reduced protein synthesis in congested liver.
- Complete blood count (CBC): May reveal anemia (major contributor/exacerbating factor in HF), polycythemia, or dilutional changes indicating water retention. Levels of white blood cells (WBCs) may be elevated, reflecting recent/acute MI, pericarditis, or other inflammatory or infectious states.
- ESR: May be elevated, indicating acute inflammatory reaction (especially if viral infection is cause of HF).
- Thyroid studies: Increased thyroid activity suggests thyroid hyperactivity as precipitator of HF. Hypothroydism can also cause or exacerbate HF.
- Pulse oximetry: Oxygen saturation may be low, especially when acute HF is imposed on chronic obstructive pulmonary disease (COPD) or chronic HF.
- Improve myocardial contractility/systemic perfusion.
- Reduce fluid volume overload.
- Prevent complications.
- Provide information about disease/prognosis, therapy needs, and prevention of recurrences.
- Assess Cardiovascular status including vital signs to detect cardiac compromise.
- Take an average of two or more blood pressure readings to establish hypertension.
- Check the client's blood pressure in lying, sitting, and standing position to determine if orthostatic hypotension is present. Also check for pallor, diaphoresis, and vertigo.
- Assess neurologic static and observe the client for changes that may indicated an alteration in cerebral perfussion (CVA or hemorrhage).
- Monitor and record intake and output and daily weight to detect fluid volume overload.
- Administer medications as prescribed to lower blood pressure.
- Make sure the client maintains a low-sodium, low-cholesterol diet to help minimize hypertention.
- Encourage the client to express feelings about daily stress to reduce anxity.
- Maintain a quiet environment to reduce stress.
- The client will exhibit a reduction in blood pressure
- The client will express understanding and acceptance of necessary lifestyle changes.
- Complications prevented/resolved.
- Optimum level of activity/functioning attained.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Labels: NCP Cardiovascular Disease
Management Nursing Care Plans @ 5:11 PM, ,
To decide what kind of nursing intervention or nursing management for the anxiety's patient, the Nurses should make an assessment in two point ; Actual or Potential before they make their nursing care plan (NCP) note. Then the nurses collect some information, why the patient become anxiety.
May be related to :
- Anesthesia intervention
- Anticipated or actual pain
- Him or Her condition (Disease)
- Invasive/noninvasive procedure during treatment
- Loss of significant other
- Threat to self-concept
- Other may appear on Him/Her self
To help and support the assessment's data, look and check on :
- Physiological; Elevated Blood Pressure , Pulls and Respiration. Insomnia, Restlessnes, Dry mouth, Dilated pupils, Frequent urination, Diarrhea.
- Emotional; Patient complains of apprehension, nervousness, tension
- Cognitive; Inability to concentrate. Orientation to past. Blocking of thoughts, hyper-attentiveness
Plan and Outcome data :
The patient will :
- Demonstrate a decrease in anxiety A.E.B.:
- A reduction in presenting physiological, emotional, and/or cognitive manifestations of anxiety.
- Verbalization of relief of anxiety.
- Discuss/demonstrate effective coping mechanisms for dealing with anxiety.
Nursing Interventions :
- Assist patient to reduce present level of anxiety by:
- Provide reassurance and comfort.
- Stay with person.
- Don't make demands or request any decisions.
- Speak slowly and calmly.
- Attend to physical symptoms. Describe symptoms: Give clear, concise explanations regarding impending procedures.
- Focus on present situation.
- Identify and reinforce coping strategies patient has used in the past.
- Discuss advantages and disadvantages of existing coping methods.
- Discuss alternate strategies for handling anxiety. (Eg.: exercise, relaxation techniques and exercises, stress management classes, directed conversation (by nurse), assertiveness training)
- Set limits on manipulation or irrational demands.
- Help establish short term goals that can be attained.
- Reinforce positive responses.
- Initiate health teaching and referrals as indicated:
Labels: NCP Psychology - Anxiety
Management Nursing Care Plans @ 12:18 AM, ,
When the doctor decided that the patient already in the good condition, The nurses have to prepare what they must do or see what is the patient needs after discharge from hospital.
Nursing care pan for the discharge patient do not important for the patient only, but to the family also the nurses should explain what they can do related to patient's needs.
Plan and Outcome data :
- The patient or family's discharge planning will begin on day of admission including preparation for the education and or equipment.
- On the day of discharge, patient / family will receive verbal and written instructions concerning: Medications, Diet, Activity, Treatments, Follow up appointments, Signs and symptoms to observe for (when to contact the doctor), Care of incisions, wounds, etc.
- Other data may can help.
Nursing Interventions :
- Assess needs of patient/family beginning on the day of admission and continue assessment during hospitalization.
- Anticipated needs/services:
- Respiratory equipment,
- Hospital bed,
- Wheel chair, Walker,
- Home health nurse,
- Home PT/OT/ST
- Involve the patient/family in the discharge process.
- Discuss with physician the discharge plan and obtain orders if needed.
- Contact appropraite personnel with orders.
- Provide written and verbal instructions at the patient/family's level of understanding.
- Verbally explain instructions to patient/family prior to discharge and provide patient/family with a written copy.
- Ascertain that patient has follow-up care arranged at discharge.
- Provide verbal and written information on what signs and symptoms to observe and when to contact the physician.
- Assess if any community resources should be utilized (i.e.: Home Health Nurse), and contact appropriate personnel.
- Document all discharge teaching on Discharge Instruction Sheet and Nursing notes.
- Other: ...
Labels: NCP Discharge Patient
Management Nursing Care Plans @ 11:42 PM, ,
Nursing Management is the leading monthly source for practical, educational, cutting-edge information for nurse leaders. The Nursing management will perform a leadership functions of governance and decision-making within organizations employing nurses. A good nurse manager should be open to anything in the environment and be sensitive to the needs of the staff under her/his management.
In this website, we do not talking about some one who has profession as a Nurse manager. But we try to give many information what the nurses can do with his profession, especially how to manage health care delivery across the continuum of care.
In the other word, we write how the nurses make the Nursing Care Plan (NCP) and do the Nursing Intervention to the patient when they are admission, during treatment and discharge from hospital (Implementation of nursing care plan ).
Labels: Nursing Management
Management Nursing Care Plans @ 11:04 PM, ,
Nursing Care Plan (NCP) is an essential part of nursing practice that provides a written means of planning patient care and discharge planning based upon nursing diagnosis using some guide to meet the patient's needs.
Care planning provides a "road map" of sorts, to guide all who are involved with a patient or resident's care. The care plan has long been associated with nursing, and many people believe (inaccurately, in my opinion) that is the sole domain of nurses.
Nursing Care Plan is a set of actions from the nurses, They will implement care plan to resolve nursing problems which happened to the patient during treatment. The Nurses identified all of patient's problem by accurate and comprehensive assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.
To decided of Nursing Care Plan, For the first step the nurse collects subjective data and objective data, and then organizes the data into a systematic pattern as standard plans of care such as Marjory Gordon's functional health patterns. This step helps identify the areas in which the client needs nursing care.
Once the initial assessment is completed, a problem list should be generated. The nurse have to look at each problem and put the question "Can we make this problem better?" or "Can we keep this from getting any worse, or developing complications?".
After that, the nurse will put timing (review period) when the problem resolve or show signs of improvement. In the acute setting, the review period may be as short as next shift, next day or next week. In the long-term or home health setting, the review period will likely be longer.
When the problem is not getting better or not likely to improve, and deterioration is inevitable, then the nurse will decided last question "What can we do to provide optimal quality of life, comfort and dignity for this person?"
To make a better Nursing Care Plan, the Nurses must follow the steps of the nursing process bellow :
- Assessment (collect data from medical record, do a physical assessment of the patient, assess ADL's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- Determination of the patient's problem(s)/Nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- Planning (write measurable goals/outcomes and nursing interventions)
- Implementation (initiate the care plan)
- Evaluation (determine if goals/outcomes have been met)
Labels: Nursing Care Plan
Management Nursing Care Plans @ 12:38 AM, ,