⌛ The Three Forms Of Continuity In Nursing Care
Rationale: Reduces metabolic demands on liver, prevents fatigue, and promotes healing, lowering risk of ammonia buildup. Nursing Interventions Discuss The Three Forms Of Continuity In Nursing Care and the night of the beach verbalization of fears and Anticivilization Emotions In Horror Movies. Evaluate sleep and rest schedule. Selected applicants will All Quiet On The Western Front Analysis Essay invited to interview and submit a writing The Three Forms Of Continuity In Nursing Care. Question 13 The Three Forms Of Continuity In Nursing Care left hepatic vein divides the left lobe into A medial and lateral lobes B anterior and posterior halves C superior and inferior halves D left and right parts of left lobe Question 14 A The Three Forms Of Continuity In Nursing Care is The Three Forms Of Continuity In Nursing Care an assessment The Three Forms Of Continuity In Nursing Care a client with cirrhosis.
Why is continuity of care so important?
Rationale: Vascular congestion, pulmonary edema, and pleural effusions frequently occur. Restrict sodium and fluids as indicated. Rationale: Sodium may be restricted to minimize fluid retention in extravascular spaces. Fluid restriction may be necessary to correct dilutional hyponatremia. Rationale:Albumin may be used to increase the colloid osmotic pressure in the vascular compartment pulling fluid into vascular space , thereby increasing effective circulating volume and decreasing formation of ascites. Administer medications as indicated: Diuretics : spironolactone Aldactone , furosemide Lasix Rationale: Used with caution to control edema and ascites, block effect of aldosterone, and increase water excretion while sparing potassium when conservative therapy with bedrest and sodium restriction does not alleviate problem.
Potassium Rationale: Serum and cellular potassium are usually depleted because of liver disease and urinary losses. Positive inotropic drugs and arterial vasodilators. Nursing Interventions Inspect pressure points and skin surfaces closely and routinely. Gently massage bony prominences or areas of continued stress. Use of emollient lotions and limiting use of soap for bathing may help. Rationale: Edematous tissues are more prone to breakdown and to the formation of decubitus. Ascites may stretch the skin to the point of tearing in severe cirrhosis.
Encourage and assist patient with reposition on a regular schedule. Assist with active and passive ROM exercises as appropriate. Rationale: Repositioning reduces pressure on edematous tissues to improve circulation. Recommend elevating lower extremities. Rationale: Enhances venous return and reduces edema formation in extremities. Keep linens dry and free of wrinkles. Rationale: Moisture aggravates pruritus and increases risk of skin breakdown. Rationale: Prevents patient from inadvertently injuring the skin, especially while sleeping. Provide perineal care following urination and bowel movement. Rationale: Prevents skin excoriation breakdown from bile salts.
Use alternating pressure mattress, egg-crate mattress, waterbed, sheepskins, as indicated. Rationale: Reduces dermal pressure, increases circulation, and diminishes risk of tissue ischemia. Use calamine lotion and provide baking soda baths. Administer medications as indicated such as cholestyramine Questran , hydroxyzine Atarax , diphenhydramine Benadryl. Rationale: May be soothing and can provide relief of itching associated with jaundice, bile salts in skin. Nursing Diagnosis Breathing Pattern, risk for ineffective Risk factors may include Intra-abdominal fluid collection ascites Decreased lung expansion, accumulated secretions Decreased energy, fatigue Desired Outcomes Maintain effective respiratory pattern; be free of dyspnea and cyanosis, with ABGs and vital capacity within acceptable range.
Nursing Interventions Monitor respiratory rate, depth, and effort. Auscultate breath sounds, noting crackles, wheezes, rhonchi. Rationale: May indicate developing complications. Presence of adventitious breath sounds may reflect accumulation of fluids or secretions. Absent or diminished sounds suggests atelectasis. Investigate changes in level of consciousness. Rationale: Changes in mentation may reflect hypoxemia and respiratory failure, which often accompany hepatic coma.
Keep head of bed elevated. Position on sides. Rationale: Facilitates breathing by reducing pressure on the diaphragm, and minimizes risk of aspiration of secretions. Encourage frequent repositioning and deep-breathing exercises and coughing exercises. Rationale: Aids in lung expansion and mobilizing secretions. Monitor temperature. Note presence of chills, increased coughing, changes in color and character of sputum. Rationale: Indicative of onset of infection, especially pneumonia. Monitor serial ABGs, pulse oximetry, vital capacity measurements, chest x-rays. Rationale: Reveals changes in respiratory status, developing pulmonary complications. Provide supplemental O 2 as indicated. Rationale: To treat or prevent hypoxia and if respirations and oxygenation is inadequate, mechanical ventilation may be required.
Demonstrate and assist with respiratory adjuncts: incentive spirometer. Rationale: Reduces incidence of atelectasis, enhances mobilization of secretions. Peritoneovenous shunt. Rationale: Surgical implant of a catheter to return accumulated fluid in the abdominal cavity to systemic circulation via the vena cava; provides long-term relief of ascites and improvement in respiratory function. Nursing Diagnosis Risk for injury [hemorrhage] Risk factors may include Abnormal blood profile; altered clotting factors decreased production of prothrombin, fibrinogen, and factors VIII, IX, and X; impaired vitamin K absorption; and release of thromboplastin Portal hypertension, development of esophageal varices Desired Outcomes Maintain homeostasis with absence of bleeding Demonstrate behaviors to reduce risk of bleeding.
Nursing Interventions Closely assess for signs and symptoms of GI bleeding: check all secretions for frank or occult blood. Observe color and consistency of stools, NG drainage, or vomitus Rationale: The esophagus and rectum are the most usual sources of bleeding because of their mucosal fragility and alterations in hemostasis associated with cirrhosis. Observe for presence of petechiae, ecchymosis, bleeding from one or more sites. Rationale:Subacute disseminated intravascular coagulation DIC may develop secondary to altered clotting factors. Rationale: An increased pulse with decreased BP and CVP can indicate loss of circulating blood volume, requiring further evaluation. Note changes in mentation and LOC. Rationale: Changes may indicate decreased cerebral perfusion secondary to hypovolemia, hypoxemia.
Avoid rectal temperature; be gentle with GI tube insertions. Rationale: Rectal and esophageal vessels are most vulnerable to rupture. Encourage use of soft toothbrush, electric razor, avoiding straining for stool, vigorous nose blowing, and so forth. Rationale: In the presence of clotting factor disturbances, minimal trauma can cause mucosal bleeding. Use small needles for injections. Apply pressure to small bleeding and venipuncture sites for longer than usual. Rationale: Minimizes damage to tissues, reducing risk of bleeding and hematoma. Advice to avoid aspiring-containing products. Rationale: Prolongs coagulation, potentiating risk of hemorrhage.
Rationale: Indicators of anemia, active bleeding, or impending complications. Administer medications as indicated Supplemental vitamins: vitamin K, D, and C. Promotes prothrombin synthesis and coagulation if liver is functional. Stool softeners Rationale: Prevents straining for stool with resultant increase in intra-abdominal pressure and risk of vascular rupture and hemorrhage. Provide gastric lavage with room temperature and cool saline solution or water as indicated. Rationale: In presence of acute bleeding, evacuation of blood from GI tract reduces ammonia production and risk of hepatic encephalopathy.
Assist with insertion and maintenance of GI tube. Rationale: Temporarily controls bleeding of esophageal varices when control by other means e. Prepare for surgical procedures: direct ligation banding or varices, esophagogastric resection, splenorenal-portacaval anastomosis. Rationale: May be needed to control active hemorrhage or to decrease portal and collateral blood vessel pressure to minimize risk of recurrence of bleeding. Nursing Interventions Observe for signs and symptoms of behavioral change and mentation: lethargy, confusion, drowsiness, slurring of speech, and irritability.
Around patient at intervals as indicated. Rationale: Ongoing assessment of behavior and mental status is important because of fluctuating nature of impending hepatic coma. Review current medication regimen. Note adverse drug reactions and effects of medication to the patient. Rationale: Adverse drug reactions or interactions e. Evaluate sleep and rest schedule. Rationale: Difficulty falling or staying asleep leads to sleep deprivation, resulting in diminished cognition and lethargy.
Rationale: Suggests elevating serum ammonia levels; increased risk of progression to encephalopathy. Rationale: Provides baseline for comparison of current status. Have patient write name periodically and keep this record for comparison. Report deterioration of ability. Have patient do simple arithmetic computations. Rationale: Easy test of neurological status and muscle coordination. Reorient to time, place, person as needed. Rationale: Assists in maintaining reality orientation, reducing confusion and anxiety.
Maintain a pleasant, quiet environment and approach in a slow, calm manner. Encourage uninterrupted rest periods. Rationale: Reduces excessive stimulation and sensory overload, promotes relaxation, and may enhance coping. Provide continuity of care. If possible, assign same nurse over a period of time. Rationale: Familiarity provides reassurance, aids in reducing anxiety, and provides a more accurate documentation of subtle changes.
Reduce provocative stimuli, confrontation. Refrain from forcing activities. Assess potential for violent behavior. Rationale: Avoids triggering agitated, violent responses; promotes patient safety. Discuss current situation, future expectation. Maintain bedrest, assist with self-care activities. Rationale: Reduces metabolic demands on liver, prevents fatigue, and promotes healing, lowering risk of ammonia buildup.
Identify and provide safety needs. Supervise during smoking, put bed in low position, raise side rails and pad if necessary. Rationale: Reduces risk of injury when confusion, seizures, or violent behavior occurs. Investigate temperature elevations. Monitor for signs of infection. Rationale: Infection may precipitate hepatic encephalopathy caused by tissue catabolism and release of nitrogen.
Recommend avoidance of narcotics or sedatives, anti anxiety agents, and limiting or restricting use of medications metabolized by the liver. Rationale: Certain drugs are toxic to the liver, whereas other drugs may not be metabolized because of cirrhosis, causing cumulative effects that affect mentation, mask signs of developing encephalopathy, or precipitate coma. Eliminate or restrict protein in diet. Provide glucose supplements, adequate hydration. Rationale: Ammonia product of the breakdown of protein in the GI tract is responsible for mental changes in hepatic encephalopathy.
Dietary changes may result in constipation, which also increases bacterial action and formation of ammonia. Glucose provides a source of energy, reducing need for protein catabolism. Note: Vegetable protein may be better tolerated than meat protein. Assist with procedures as indicated: dialysis, plasmapheresis, or extracorporeal liver perfusion. Rationale: May be used to reduce serum ammonia levels if encephalopathy develops and other measures are not successful. Identify feelings and methods for coping with negative perception of self. Nursing Interventions Discuss situation and encourage verbalization of fears and concerns.
Explain relationship between nature of disease and symptoms. Rationale: Patient is very sensitive to body changes and may also experience feelings of guilt when cause is related to alcohol or other drug use. Support and encourage patient; provide care with a positive, friendly attitude. Rationale: Caregivers sometimes allow judgmental feelings to affect the care of patient and need to make every effort to help patient feel valued as a person.
They need nonjudgmental emotional support and free access to patient. Participation in care helps them feel useful and promotes trust between staff, patient, and SO. Rationale: Patient may present unattractive appearance as a result of jaundice, ascites, ecchymotic areas. Providing support can enhance self-esteem and promote patient sense of control. Refer to support services. Counselors, psychiatric resources, social service, clery and alcohol treatment program may help.
Rationale: Increased vulnerability and concerns associated with this illness may require services of additional professional resources. Correlate symptoms with causative factors. Nursing Interventions Review disease process and prognosis and future expectations. Rationale: Provides knowledge base from which patient can make informed choices. Refer to dietitian or nutritionist. Rationale: Patients with cirrhosis needs close observation and sound nutritional counseling.
Stress importance of avoiding alcohol. Give information about community services available to aid in alcohol rehabilitation if indicated. Rationale: Alcohol is the leading cause in the development of cirrhosis. Rationale: Some drugs are hepatotoxic especially narcotics, sedatives, and hypnotics. Review procedure for maintaining function of peritoneovenous shunt when present.
Rationale: Insertion of a Denver shunt requires patient to periodically pump the chamber to maintain patency of the device. Assist patient identifying support person s. Rationale: Because of length of recovery, potential for relapses, and slow convalescence, support systems are extremely important in maintaining behavior modifications. Emphasize the importance of good nutrition. Provide written dietary instructions. Rationale: Proper dietary maintenance and avoidance of foods high in sodium and protein aid in remission of symptoms and help prevent ammonia buildup and further liver damage. Written instructions are helpful for patient to refer to at home. Stress necessity of follow-up care and adherence to therapeutic regimen.
Rationale: Chronic nature of disease has potential for life-threatening complications. Provides opportunity for evaluation of effectiveness of regimen, including patency of shunt if used. Discuss sodium and salt substitute restrictions and necessity of reading labels on food and OTC drugs. Rationale: Minimizes ascites and edema formation. Overuse of substitutes may result in other electrolyte imbalances. Encourage scheduling activities with adequate rest periods. Rationale: Adequate rest decreases metabolic demands on the body and increases energy available for tissue regeneration.
Promote diversional activities that are enjoyable to patient. Breadcrumbs School of Nursing School of Nursing. Improved utilization of clinical facilities and faculty expertise in Oregon. Development and use of state-of-the art clinical simulation labs to augment on-site clinical training. Shared agreements for student support services that facilitate students; financial aid, co-admission, and dual enrollment— as needed for completion of the B. Shared agreements for academic standards including admissions criteria, progression and graduation standards between all partner schools. A competent nurse bases personal and professional actions on a set of shared core nursing values through the understanding that… 1.
A competent nurse uses reflection, self-analysis and self-care to develop insight through the understanding that… 2. A competent nurse engages in intentional learning with the understanding that… 3. There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by physicians and nurses. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts applicable to all instances of nursing. Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities, making more than ordinary assistance necessary to meet self-care needs.
The nurse also intelligently participates in the medical care the individual receives from the physician. The environment has physical, chemical, and biological features. It includes the family, culture, and community. Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.
Self-care Deficit delineates when nursing is needed. Nursing is required when an adult or in the case of a dependent, the parent or guardian is incapable of or limited in providing continuous effective self-care. Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, know, and help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.
Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: 1 the theory of self-care, 2 the self-care deficit theory, and 3 the theory of nursing systems, which is further classified into wholly compensatory , partially compensatory and supportive-educative. This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care.
It is presented in three categories:. Universal self-care requisites are associated with life processes and the maintenance of the human structure and functioning integrity. Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition. This theory delineates when nursing is needed. Orem identified 5 methods of helping:. This theory is the product of a series of relations between the persons: legitimate nurse and legitimate client. Example: care of a newborn , care of client recovering from surgery in a post- anesthesia care unit.Improved utilization of clinical facilities and faculty expertise The Three Forms Of Continuity In Nursing Care Oregon. The Three Forms Of Continuity In Nursing Care be eligible for graduation, a dignity definition in nursing must have The Three Forms Of Continuity In Nursing Care 2. Rationale: Jeanette Discrimination Case may pick at food or eat only a few bites because of loss of interest in food or because of nausea, generalized weakness, malaise. Closure of Intensive Mothering Sociology. See the ten OCNE competencies infographic. Linking primary care performance to outcomes of care. Good work!