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.
Assesment finding for reye's syndrome:
- Stage 1 : lethargy, vomiting and hepatic dysfunction
- Stage 2 : hypervetilation, hyperactive reflexes, delirium and hepatic dysfunction.
- Stage 3 : coma, decorticate rigidity, hyperventilation and hepatic dysfunction.
- Stage 4 : deepening coma, large fixed pupils, decerebrate rigidity and minimal hepatic dysfunction.
- Stage 5 : seizures, flaccidity, loss of deep tendon reflexes and respiratory arrest (death is usually a result of cerebral edema or cardiac arrest).
Diagnostic evaluation for reye's syndrome :
- CSF analysis shows a WBC count less than 10/ul; with coma. there's increased CSF pressure.
- Blood test results show elevated serum ammonia levels; serum fatty acid and lactate levels are also increased.
- Liver biopsy show fatty droplets uniformly distributed throughout cells.
- Liver function studies show aspartate aminotransferase and alanine aminotransferase are elevated twice from normal levels.
- Coagulation studies reveal prolonged PT and PTT.
Treatment for reye's syndrome :
- Endotracheal intubation and mechanical ventilation to control partial pressure of arterial carbon dioxide levels.
- Induced hypothermia.
- Exchange transfusion.
- Decompressive craniotomy.
- Enteral or parenteral nutrition as needed.
- Transfusion of fresh frozen plasma.
Nursing diagnosis for reye's syndrome :
- Ineffective thermoregulation.
- Decreased intracranial adaptive capacity.
- Impaired physical mobility.
- Impaired gas exchange.
- Risk for fluid volume deficit.
- Risk for impaired skin integrity.
Nursing planning and goals for reye's syndrome :
- The patient will maintain adequate ventilation.
- The patient will maintain a normal respiratory status, as evidenced by normal respiratory rate.
- The patient will maintain orientation to environment without evidence of deficit.
- The patient will maintain skin integrity.
- The patient will maintain joint mobility and range of motion.
Nursing implementation for reye's syndrome :
- Monitor vital signs and pulse oximetry to determine oxygenation status.
- Monitor ICP with a subarachnoid screw or other invasive device to closely assess for increased ICP.
- Monitor blood glucose levels to detect hyperglycemia or hypoglycemia and to prevent complications.
- Monitor fluid intake and output to prevent fluid overload.
- Assess cardiac, respiratory and neurologic status to evaluate the effectiveness of interventions and monitor for complications such as seizures.
- Assess pulmonary artery catheter pressures to assess cardiopulmonary status.
- Keep the head of the bed at a 30 degree angle to decrease ICP and promotes venous return.
- Maintain seizures precautions to prevent injury.
- Maintain oxygen therapy, which may include intubation and mechanical ventilation, to promote oxygenation and maintain thermoregulation.
- Administer medications as ordered and monitor for adverse effects to detect complications.
- Administer blood products as necessary to increase oxygen-carrying of blood and to prevent hypovolemia.
- Check for loss of reflexes and signs of flaccidity to determine degree of neurologic involvement.
- Provide a hypothermia blanket as needed and monitor the client's temperature every 15 to 30 minute while the blanket is in use to prevent injury and maintain thermoregulation.
- Provide postoperative craniotomy care in necessary to promote wound healing and to prevent complications.
- Provide good skin and mouth care and perform ROM exercise to prevent alteration in skin integrity and to promote joint motility.
- Be supportive of the family and keep them informed of the patient status to decrease anxiety.
Evaluation for reye's syndrome :
- The patient returns to normal respiratory state without sign of respiratory distress.
- The patient will maintain joint mobility and range of motion as well as skin integrity during hospital course.
- The patient has minimal neurologic complication as ICP decreases, as evidenced by reflexes, LOC and orientation.
- The parent verbalize an understanding of avoiding this syndrome by using nonsalicylate analgesic and antypiretic.
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