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.
Nursing Care Plan for Retinal Detachment
Retinal detachment is the separation of the the retina from the choroid (the middle vascular coat of the eye between the retina and sclera). It occurs when the retina develops a hole or tear and the vitreous seeps between the retina and choroid. If left untreated, retinal detachment can lead vission loss.
The possible causes of retinal detachment are Trauma, Hemorrhage, Myopia, Tumor, Aging, Diabetic neovascularization, Inflammatory process and Familial tendency.
Assessment findings of retinal
detachment :
- Painless change in vision (floaters caused by blood cells in the vitreous and flashes of light as the vitreous humor pulls on the retina).
- Photopsia ( recurrent flashes of light).
- Blurred vision worsening as detachment increases.
- with progression of detachment, painless vision loss that may be described as veil, curtain or cobweb that eliminates part of the visual field.
- Indirect opthalmoscopy shows retinal tear or detachment.
- Slit-lamp examination reveals retinal tear or detachment.
- Ultrasound shows retinal tear or detachment in presence of cataract.
- Complete bed rest and restriction of eye movement to prevent further detachment.
- Laser theraphy, if there's a hole in the posterior portion of the retina
- Scleral buckling to reattach the retina, It is a surgical procedure, which a silicone band or sponge is sewn around the eyeball a little behind the visible portion or the eye. Exactly locates the hole and places the band and tightens it creating a buckle effect and then the outer coats of the eye are indented and in this way the hole in the retina approximates the outer scleral coat.
- Pneumatic Retinopexy, It is a short simple procedure, where a fixed amount of air is injected in the posterior part of the eye, which the air acts as an internal tamponade that helping to push and approximate the tear with the outer coat of the eye ball. Following the tear is sealed with cryo or laser therapy. Post-operatively the patient is advised rest in a specified position, in order to facilitate the air bubble to push the desired area of the retina with the tear against the sclera.
- Sub-retinal fluid drain : make seep the fluid out through the hole behind the retina that can be drained with a small slit made in the outer coats of the eye to flatten the retina. This procedure is usually done along with sclera bucking to flatten the retina.
- Vitrectomy: The procedure involves cutting and removal of the vitreous gel along with removal of all the fibrous tissue causing traction (pull) on the retina and detaching it, or sometimes the space is replaced with gas or silicon oil. ussually the procedure is done with the help of micro instruments and a fiberoptic light source. The procedure is combined with sclera buckling.
- Cyropexy, if there's a hole in the peripheral retina.
Nursing diagnoses for Retinal Detachment :
- Disturbed sensory perception (visual).
- Anxiety.
- Risk for injury.
- The client will remain free from injury.
- The client will be free from permanent visual impairment.
- The client will understand the treatment options.
- Asses visual status and functional vision in the unaffected eye to determine self care needs.
- Prepare the client for surgery by explaining possible surgical interventions and technique to alleviate some of the client's anxiety.
- Discourage straining during defecation, bending down and hard coughing, sneezing or vomiting to avoid activities that increase intraocular pressure.
- Assist with ambulation, as needed, to help the client remain independent.
- Approach the clients from the unaffected side to avoid startling him.
- Provide assistance with activities of daily living to minimize frustation adn strain.
- Orient the client to his environment to reduce the risk of injury.
- Posoperatively instruct the client to lie on his back or on his unoperated side to reduce intraocular pressure in the affected area.
- The client's vision is restored.
- The client will remains free from injury.
- The client will understands all discharge instructions.
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Management Nursing Care Plans @ 12:03 AM,
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Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease, also knwon as chronic airflow limitation (CAL), chronic obstructive lung disease (COLD), chronic obstructive respiratory disease (CORD), chronic obstructive airway disease(COAD) is a group of conditions that obstruct pulmonary airflow, resulting in air being trapped in the alveoli and then make difficult to breathe.
There are two main forms of COPD :
- Chronic obsturctive bronchitis, a productive cough that persisting for 3 months of the year for at least 2 consecutive years, causes inflamed airways that lead to increased mucus production and bronchospasms. Mucus plugs entrap air and result in alveolar hyperventilation. Patient will have severe hypoxemia and polycythemia, with hematrocit values from 50 % to 55 %.
- Emphysema, characterized by enlargment of the alveoli distal to the terminal bronchioles, leads to alveolar wall destruction. obstructed expiratory airflow and irreversible loss of the lung elasticity. It is causes less hypoxemia and hematrocit values commonly normal.
- Allergens.
- Smoking.
- Alpha-1 antitrypsin deficiency.
- Chronic respiratory tract infection.
- Airborne irritants and pollutants, like certain gases or fume in the workplace and using cooking fire without proper ventilation.
Assesment findings in COPD :
- Anatomic changes (such as barrel chest and clubbing) in late disease.
- Cough (evaluate characther, frequency and time of day).
- Decreased breath sounds, hyperresonant breath sounds on percussion and wheezing.
- Cor pulmonale (right-sided heart failure).
- Prolonged expiration.
- Dyspena.
- Jugular vein distention.
- Peripheral edema.
- Use of accessory muscles.
- Pursed-lip breathing.
- Sputum (amount, color and consistency).
- Use of accessory muscles.
- Risk factors.
- ABG levels show hypercapnia and hypoxemia. Bicarbonate levels may increase to compensate for chronic hypercapnia and the resultant respiratory acidosis.
- Pulmonary function test, especially spirometry, reveal diminished lung function.
- Pulse oximetry may show a decrease in arterial oxygen saturation, which indicates impending hypoxia.
- Complete blood count shows elevated hemoglobin level and hematocrit.
- Chest X-ray provides baselines norms; in late disease, the patient's diaphragms appears flat.
- ECG shows signs of right ventricular hyperthrophy in late disease.
- O2 therapy at 2 to 3 L per minute and transtracheal therapy for home O2 therapy.
- Fluid intake up to 3 L per day if not contraindicated by heart failure.
- Chest physiotherapy, postural drainage and incentive spirometry.
- Diet high in protein, vitamin C. calories and nitrogen. Patients with advanced disease may require a diet thats's low in carbohydrates and higher in fats.
- Antibiotic : infecting organism determines which drugs is used.
- Bronchodilator : aminophylline, terbutaline, theophylline; by nebulizer: albuteral (proventil), ipratropium bromide (atrovent), metaproterenol sulfate (alupent).
- Expectorant : guaifenesin.
- Steroid : hydrocortisone, methylprednisolone sodium succcinate; by nebulizer : beclomethasone, triamcinolone.
- Antacid : aluminum hydroxide gel.
- Diuretic : furosemide (lasix).
- Alpha-1 antitrypsin.
- Vaccine : influenza, pneumovax.
- 1.Ineffective airways clearance.
2.Impaired gas exchange.
3.Fatigue.
4.Chronic low self esteem.
- The client will have an adequately clear airway.
- The client will establish an effective breathing pattern.
- The client will maintain adequate gas exchange.
- The client will remain free from infection.
- The client will understand why he should avoid respiratory irritants.
- Assess respiratory status and ABG and pulse oximetry studies to evaluate oxygenation.
- Administer low-flow oxygen, if indicated, ussually 1 to 2 L per minute in 24 % to 28 % concentrations (Client with emphysema respond only to low oxygen tension, if it too much oxygen reduces the drive to breathe and contributes to respiratory failure)
- Monitor cardiovascular status to detect arrhythmias related to hypoxia or adverse response to medications.
- Monitor and record amount, color and consistency of sputum.
- Encourage the cllient to drink plenty of fluids and weight patient daily to monitor for fluid overload and right -sided heart failure.
- Monitor electrolytes levels, blood counts and drug levels for indications of possible toxic reaction.
- Encourage activity as tolerated to help the client to avoid fatigue.
- Provide chest physiotherapy, including postural drainage and percussion, incentive spirometry and suction as needed- to aide in removal of secretions.
- Administer medications as prescribed to relieve symptoms and prevent complications.
- The patient remain free from respiratory tract infection.
- The patient will regularly practices breathing exercises and his breathing efficiency increases.
- The patient will stop smoking and obtains a job with little or no exposure to respiratory irritants.
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Management Nursing Care Plans @ 4:02 AM,
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