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 Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder is characterized by recurrrent obsession (intruitive images,impulses and though) and compulsion (repetitive behaviour in response to an obsession.
The obsession and compulsion can cause intense stress and impairement of functioning. Fear of losing control, fear of losing the self esteem, overly conscientious, perfectionistic, have trouble to being spontaneously and filled with self-doubt are common experiences by client. Frequently the client will use defence mechanisms of denial, reaction formation, isolation and undoing.
Contributing factors client with obsessive compulsive are
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Management Nursing Care Plans @ 12:48 AM,
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Nursing Care Plan for Bipolar Disorder
Also known as manic-depression is a severe disturbance in affect, manifested by episodes of extreme sadness alternating with episode euphoria. There are two common patterns of bipolar disorder;
bipolar I, in which depressive episode alternate with full manic episodes.
bipolar II, characterized by recurrent depressive episodes and occasional with manic episodes.
Assesment findings for bipolar disorder
Treatment for bipolar disorder
bipolar I, in which depressive episode alternate with full manic episodes.
bipolar II, characterized by recurrent depressive episodes and occasional with manic episodes.
Assesment findings for bipolar disorder
- During periods of mania;
- bizarre and eccentric appereance
- difficulty concentration, flight of idea, delusion of grandeur and impaired judgment
- decreased sleep
- motor agitation
- feeling of grandiosity
- rapid jumbled speech
- deteriorated physical appearance
- euphoria, hostility
- dry mouth, tremors, tachycardia, labored respirations
- inflated sense of self-worth
- increased social contact
- increased libido
- lack of inhibition, recklessness
- anorexia and weight loss, constipation
- altered sleep patterns
- decreased alertness, difficulty thinking logically
- confusion and indecisiveness
- guilt, helplessness, sadness and crying
- amenorrhea
- lack of motivation, low self-esteem, poor self-hygiene
- irritability, pessimism
- impotence and lack of interest in sex
- inability to experience pleasure
During periods of depression;
Treatment for bipolar disorder
- Anticonvulsant agent : carbamazepine (tegretol), divalproex sodium.
- Selective serotonin reuptake inhibitor : paroxetine
- Antimanic agent : lithium carbonate(eskalith), lithium citrate(cibalith-S)
- Individual therapy and family therapy
- Electroconvulsive therapy if drug therapy fails
- Disturbed thought processes
- Impaired social interaction
- Risk for injury
- Disturbed sleep pattern
- demonstrate a stable mood and practice self-care activities
- control thought processes
- demonstrate a normal sleep pattern
- interact adequately with others
- not harm himself
- During manic phase;
- decrease environmental stimuli, to promote relaxation and enable to sleep
- monitor drug level, especially lithium
- ensure safe environment to protect the client
- define and explain acceptable behaviors and then set limits
- if a mood swing to depression, implement suicide precaution for client
- channel the client's energy in one direction and pace activities, to decrease client's energy expenditure, prevent overstimulation and have soothing effect
- assess the risk of suicide and formulate a safety contract with client
- assess the level and intensity if client's depression to obtain baseline information
- ensure a safe environment to client to protect from self-inflicted harm
- encourage the client to identify current problems and stressors, so that can begin with therapeutic treatment
- select activities that ensure success and accomplishment to increase self esteem
- spend time with the client, evens if he's too depressed to talk, in order to enhance therapeutic relationship
- help the client to modify negative expectations and think more positively
- promote opportunities for increased involvement in activities through a structures and daily program
- observe the client for medication compliance and adverse effect
During depressive phase;
- doesn't harm himself or others
- maintains adequate on medication and nutrition
- sleeps throught the night
- expresses understanding of the illness and states how to obtain assistance or support from others
- engages in goal-directed activity and no longer exhibits disturbed thinking
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Management Nursing Care Plans @ 2:05 AM,
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