What is Essential Nursing Care?
Integumentary -Pressure area care -Positioning -VTE Personal Care -Oral hygiene, eye care Diet and fluids Bowel/Urinary care Infection control considerations Discharge planning
What are the three types of Communication?
Nurse-Pt communication:
Body language, pictures, alphabetical boards, gestures, writing
Nurse-Family communication:
Honesty, given hope, competent correct care shown, transfer plans, speak to a dr daily, know progess/prognosis
Nurse-Multidisciplinary team:
ISOBAR
Precipitated Factors of Anxiety
- Concern about current illness/underlying chronic disease
- Current experiences and feelings
- Current care interventions
- Medication side effects
- Environmental considerations
- Concern about the ongoing impact of illness on recovery
Anxiety Occurs when?
- Patients are occupied with internal dialogue
- Patients are overly dependant on the nurse
- Patients have a long-term recovery ahead
- Patients perceive a threat to their well being
Anxiety contributing factors
- Duration and severity of illness
- Impact on learning ability and role function
- Loss of sense of control
- Impact of illness on family
- Foreign environment
- Overhearing discussion of condition
- Frequency and complexity of invasive interventions
- Pain
Anxiety Management
Pharmacological: -Treat pain and any other reversible physiological causes of anxiety and agitation Non-pharmacological -Massage -Aromatherapy -Music therapy -Natural light -Noise reduction -Sleep/rest
Sleep deprivation in patients who are critically ill is often attributed to
- Bed baths during the evening shift
- Untreated pain and anxiety
- Family visiting
- Altered melatonin levels
Nebulisers
- Compressed air/oxygen
- Fine mist in aerosol form from a solution
- Can deliver large doses of drug over long periods
Nebuliser considerations
- Lungs absorbent due to highly vascular pulmonary capillary system
- Rapid absorption of drug into systemic circulation
- Considerable proportion of the drug swallowed and can therefore metabolise rapidly
- Be aware – drug can irritate skin on face
Salbutamol
-Bronchodilator
-Beta2-adrenoreceptor agonist
-Acts quickly and directly on the smooth bronchial muscle
-Acts in 5-15 minutes
-Half life 2.7 – 5hrs
Contraindications
-Previous sensitivity, Reactions, Tremor, Tachycardia
Cardiac arrhythmias, Headaches, nausea, palpitations, feelings of warmth
Dosage
-Adults – 5mg, Children – 4-12yrs – 2.5mgs, Repeat 4-6hrs
-PRN – Emergency
Ipratopium Bromide
-Bronchodilator
-Inhibits bronchomotor tone
-Acts in 3-5 minutes
-Half life 6 hrs
Contraindications
-Hypersensitivity to atropine/atropine like drugs
Reactions, Tachycardia, arrythmias, SVT, AF, Nausea, Dry mouth/throat, Glaucoma (in direct contact with eye)
Dosage
-Adults – 250-500mcg with 2-3 mls saline (1ml if given with salbutamol), Children – Not given under 12yrs – 250mcg, Repeat 6 hrs
