The Ultimate Nursing Care Plan Database

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Provide education on smoking with COPD and the benefits of quitting. Hospitals and other healthcare facilities can upload the occupational injury data they already collect for analysis and benchmarking with other de-identified facilities, in order to identify and implement timely and targeted interventions. Clear, even, non-labored breathing while maintaining optimal oxygenation for patient. Emphysema Nursing Care Plan. Entrance exam to governmental universities and Azad University is held on separate basis. Journal of Christian Nursing.

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These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years program in Anesthesia, are in charge of performing profession duties in the operating room in the field of anesthesia including preparing the patients for anesthesia and necessary cooperation with anesthesiologists at the time of operation.

These persons by passing exam are eligible to continue uncontinuous bachelor's degree course in nursing. These persons after obtaining secondary school diploma and passing entrance exam of university and obtaining technician diploma are in change of performing affairs including rendering first aid services to the patients and emergency victims resulting from accidents with motor vehicles, explosion, debris, falling from height, fractures, burns, poisonings, cuts, drowning, industrial accidents cutting of limbs , patients with heart diseases and baby delivering.

Nurses after obtaining bachelor's degree and passing the entrance exam are eligible to continue their study in geriatric nursing, pediatric nursing, medical surgical nursing, community health nursing, psychiatric nursing and nursing education. These persons after graduation mainly become in charge of nurses' education or management of medical sections. Duration of this program is 2. At present annually persons are graduated in master's degree program in nursing. Nurses by holding master's degree after passing entrance exam, are eligible to continue their study in PhD in the field of Nursing.

Duration of this program is 4 years and the graduates mainly will work in educational and research sections. At present annually 20 persons are graduated in this program. According to the censes at present approximately , nurses are working in Iran in various sections. Also, nurses are working in the hospitals affiliated to social security organization, armed forces, private sector and charity sector. Within the last years of independence, nurses' activities are established in offices of consultancy and rendering nursing services at home.

Nurses by establishment these centers can render consultant and care services to the client. At present to work as a nurse only holding accredited academic degree is sufficient, but there are programs for nurses to take RN examination after graduation. Also, upon the approval and execution of continuous educational act, the Iranian nurses should obtain score of 15 every year in various educational courses held by the Ministry of Health of Universities, Scientific Associations and Nursing organization.

To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "Registered Nurse" can only be granted to those holding such registration. First-level nurses make up the bulk of the registered nurses in the UK.

Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse. Many have now either retired or undertaken conversion courses to become first-level nurses.

Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles see above , this has become a less attractive option.

Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons. Currently, this involves completing a degree , available from a range of universities offering these courses , in the chosen branch specialty see below , leading to both an academic award and professional registration as a 1st level registered nurse.

These courses are three occasionally four years' long. The first year is known as the common foundation program CFP , and teaches the basic knowledge and skills required of all nurses.

Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients.

The remainder of the program consists of training specific to the student's chosen branch of nursing. As of , the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification. Midwifery training is similar in length and structure, but is sufficiently different that it is not considered a branch of nursing. There are shortened 18 month programs to allow nurses already qualified in the adult branch to hold dual registration as a nurse and a midwife.

Shortened courses lasting 2 years also exist for graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation program. As of [update] student nurses in England and Wales can apply a bursary from the government to support them during their nurse training, and may also be eligible for a student loan, although there has been speculation that this will not be available in the future.

Before Project , nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.

After the point of initial registration, there is an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice PREP requirements. There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation , venipuncture , intravenous drug therapy and male catheterization are the most common, although there are many others such as advanced life support , which some nurses undertake.

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part-time. Many nurses prefer this option to gaining a degree initially, as there is often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it was also much more lucrative, as diploma students get the full bursary during their initial training, and employers often pay for the degree course as well as the nurse's salary.

To become specialist nurses such as nurse consultants, nurse practitioners etc. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards.

District nurses and health visitors are also considered specialist nurses, and to become such they must undertake specialist training. This is a one-year full-time degree. All newly qualifying district nurses and health visitors are trained to prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings typically useful to those carrying out these roles.

Many of these and other nurses will also undertake training in independent and supplementary prescribing, which allows them as of 1 May to prescribe almost any drug in the British National Formulary.

This has been the cause of a great deal of debate in both medical and nursing circles. Canadian nursing dates back to in Quebec with the Augustine nuns.

The establishment of this mission created the first nursing apprenticeship training in North America. Most nurses were female and only had an occasional consultation with a physician.

Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In the first formal nursing training program was started at the General and Marine Hospital in St. All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses Association to continue their education to receive a baccalaureate degree.

They believe that this is the best degree to work towards because it results in better patient outcomes. In addition to helping patients, nurses that have a baccalaureate degree will be less likely to make small errors because they have a higher level of education.

A baccalaureate degree also gives a nurse a more critical opinion, which gives him or her more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian provinces and territories except for the Yukon and Quebec require that all nurses must have a baccalaureate degree.

However, Canada does have a condensed program that is two years long. Nursing specialty certification is available through the Canadian Nurses Association in nineteen practice areas. Canadian nurses hold a lot of responsibility in the medical field and are considered vital. According to the Canadian Nurses Association, "They expect RNs to develop and implement multi-faceted plans for managing chronic disease, treating complex health conditions and assisting them in the transition from the hospital to the community.

Canadians also look to RNs for health education and for strategies to improve their health. RNs assess the appropriateness of new research and technology for patients and adjust care plans accordingly". Nursing was not an established part of Japan's healthcare system until with the Midwives Ordinance.

This established a legal substantiation to registered nurses all over Japan. A new law geared towards nurses was created during World War II: There has been a continued effort to improve nursing in Japan.

In the Nursing Human Resource Law was passed. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public. This type of nursing is designed to help the public and is also driven by the public's needs. The goals of public health nurses are to monitor the spread of disease, keep vigilant watch for environmental hazards, educate the community on how to care for and treat themselves, and train for community disasters.

Nurses that are involved with midwifery are independent of any organization. A midwife takes care of a pregnant woman during labour and postpartum. They assist with things like breastfeeding and caring for the child. Individuals who are assistant nurses follow orders from a registered nurse.

They report back to the licensed nurse about a patient's condition. Assistant nurses are always supervised by a licensed registered nurse. In Japan established the first nursing university in the country. Soon people began to want nursing degrees at a higher level of education. Currently Japan offers doctorate level degrees of nursing in a good number of its universities. There are three ways that an individual could become a registered nurse in Japan.

After obtaining a high school degree the person could go to a nursing university for four years and earn a bachelor's degree, go to a junior nursing college for three years or go to a nursing school for three years. Those who attended a nursing university have a bit of an advantage over those who went to a nursing school.

They can take the national exam to be a registered nurse, public health nurse or midwife. In the cases of become a midwife or a public health nurse, the student must take a one-year course in their desired field after attending a nursing university and passing the national exam to become a registered nurse.

The nursing universities are the best route for someone who wants to become a nurse in Japan. These nursing universities train their students to be able to make critical and educated decisions when they are out in the field.

Physicians are the ones who are teaching the potential nurses because there are not enough available nurses to teach students. This increases the dominance that physicians have over nurses. Students that attend a nursing college or just a nursing school receive the same degree that one would who graduated from a nursing university, but they do not have the same educational background. The classes offered at nursing colleges and nursing schools are focused on more practical aspects of nursing.

These institutions do not offer many general education classes, so students who attend these schools will solely be focusing on their nursing educations while they are in school. Students who attend a nursing college or school do have the opportunity to become a midwife or a public health nurse.

They have to go through a training institute for their desired field after graduating from the nursing school or college. Once they have passed their exam, they have their license for life. Like the United States, Japan is in need of more nurses.

The driving force behind this need this is the fact that country is aging and needs more medical care for its people. The country needs a rapid increase of nurses however things do not seem to be turning around. Some of the reasons that there is a shortage are poor working conditions, an increase in the number of hospital beds, the low social status of nurses, and the cultural idea that married women quit their jobs for family responsibilities.

However, physicians make twice as much as nurses. They are considered lesser and oftentimes negative connotations are associated with nurses.

According to the American Nurses Association article on Japan, "nursing work has been described using negative terminology such as 'hard, dirty, dangerous, low salary, few holidays, minimal chance of marriage and family, and poor image'". Some nurses in Japan are trying to be advocates. They are promoting better nursing education as well as promoting the care of the elderly.

The JNA is not to be confused with a union, it is simply a professional organization for the nurses. Members of the JNA lobby politicians and produces publications about nursing. According to the American Nurses Association's article on Japan the JNA, "works toward the improvement in nursing practice through many activities including the development of a policy research group to influence policy development, a code of ethics for nurses, and standards of nursing practice".

The JNA also provides certification for specialists in mental health, oncology and community health. The [75] JNA is not the only nursing organization in Japan. There are other subgroups that are typically categorized by the nurses' specialty, like emergency nursing or disaster nursing.

One of the older unions that relates to nursing is the Japanese Federation of Medical Workers Union, which was created in This organization was involved with the Nursing Human Resource Law.

In the US, scope of practice is determined by the state or territory in which a nurse is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually the making of such rules and regulations is delegated to a state board of nursing , which performs day-to-day administration of these rules, licenses nurses and nursing assistants, and makes decisions on nursing issues.

In the hospital setting, registered nurses often delegate tasks to LPNs and unlicensed assistive personnel. RNs are not limited to employment as bedside nurses. Some registered nurses are independent consultants who work for themselves , while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation outcome and process in many areas such as biology, psychology, human development, and health care systems.

Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.

Nursing is the nation's largest health care profession, with more than 3. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care.

The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in Nursing BSN degree. Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam.

The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system. The oldest method of nursing education is the hospital-based diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy , physiology , microbiology , nutrition , chemistry , and other subjects at a college or university, then move on to intensive nursing classes.

And a word to the wise, have a backup plan. Meaning if you have a walkie talkie patient with functioning arms and a strong call light finger, I still would set up a bedside commode just. Diuretics work on different parts of the nephrons. There are three kinds of diuretics: Loop, Thiazide, and potassium sparing. Most commonly used diuretics in acute kidney failure: Furosemide is potassium wasting.

It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0. However, if patient is on a potassium wasting diuretic, educate about potassium bananas, sweet potatoes, etc.

When protein is broken down ammonia is formed. Ammonia is converted to urea in the liver and is eventually excreted in the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable. Anemia Nursing Care Plan. Etiology There are many causes of anemia, the most life threatening is massive hemorrhage, but other causes such as lack of iron, severe burns, cancers, bone marrow disorders like multiple myeloma or leukemia can be just as detrimental.

Some of the types of anemia: Usually caused by hemorrhage or lack of Iron or lack of ability to absorb iron. Due to Folic Acid vitamin B12 deficiency or lack of ability to absorb B Treated with B12 supplements and diet changes. The bone marrow is not producing enough RBCs.

Treated with blood transfusions and also bone marrow biopsies to diagnose specific issue with the bone marrow. Due to RBCs being destroyed. What is causing the lysing of the RBCs can be from a range of problems including infection, autoimmune disorders, etc. Treatment is dependant on the cause. If due to infection, treatment is antibiotics, if autoimmune treatment may be medications that suppress the autoimmune system.

Cardiac and vascular specialists should be consulted for this condition in case it is due to a mechanical factor like the heart valves. This is a genetic disorder where the blood cells become sickle shaped, causing clots, hemolysis, and poor perfusion. Treatment is focused on pain control, fluid resuscitation and sometimes blood transfusions. Give pantoprazole Protonix , potential surgical intervention to stop the bleeding. The provider will place a gloved finger into the rectum and needs to have feces on it when it comes out.

The feces is placed on a hemoccult card where a developing solution is married with the stool giving the provider insight of whether or not there is blood in the stool. If the card turns blue it is positive for blood. This reduces the ulceration which could be and most likely is causing the GI bleed.

Apply pressure to any hemorrhage. Can be from a laceration to the liver or the spleen. Assess for abdominal pain and swelling. Here are the most important. This is the most commonly looked at lab value to assess need for a blood transfusion.

Every institution, Doctor, and person is different but as a general rule, a hemoglobin below 8 requires a blood transfusion. Red Blood Cells RBCs contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of days and are destroyed in the spleen and liver.

Folic acid is an essential water soluble B vitamin. Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.

Iron Fe is an element that is an important component of hemoglobin in red blood cells. Hemoglobin transports oxygen from the lungs to all the cells of the body. Most of the iron in the body is located in hemoglobin, but some iron is located in myoglobin as well as some iron is stored in the liver, bone marrow, and spleen.

The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin. Monitor for any changes in ECG, tell the patient to inform you of any new symptoms like chest pain or shortness of breath. Anemic patients are more likely to experience ST depression, QT prolongation, T wave depression, and R wave difference.

Fall Precautions High risk of syncope, especially if the patient is hemorrhaging. Keep the patient lying flat or in trendelenburg position if hypotensive. Oh and call your Respiratory Therapist because they are your best friends and need to monitor the patient too.

Iron supplements are likely to decrease absorption of Quinolone and Tetracycline Antibiotics as well as Levodopa, Levothyroxine, Methyldopa, CellCept, Penicillamine, and Bisphosphonates. Folic Acid supplements are likely to increase side effects of 5-Fluorouracil and Capecitabine.

It might also decrease the efficacy of Fosphenytoin, Methotrexate, Phenobarbital, Phenytoin, Primidone, and Pyrimethamine. Aspiration Nursing Care Plan. Pathophysiology Aspiration occurs when something enters into the lungs that is not air.

Desired Outcome Patent airway, oxygenation maintenance, prevention of further complications such as pneumonia. Everything else in this care plan is good too but this trumps it all when it comes to priorities. Prevention is key, but since this patient has already slipped substances past the epiglottis AKA royal lung guard everything that applies to prevention NPO, head of bed greater than 30 degrees, oral hygiene, etc.

Be prepared to intubate, not because the patient will for sure be intubated, but because not being prepared is costly like someones life kind of cost. Lastly have suction ready. Have all the stuff for oxygen ready. Monitor their oxygen levels. If they dip low Suction when necessary Have the suction ready to go to help keep the airway clear and increase the surface area for oxygen absorption.

Perform a Swallow Screen This is a simple, nurse initiated test that should really be performed on any patient that is not NPO. That fever they have, is not going to be treated via oral Tylenol if they cannot swallow. Then you will beg for IV Tylenol and get an order for rectal Tylenol because it is cheaper and the standard of care. After you and the patient cry it out for a minute, you will administer the Tylenol in the no go zone with the promise of blankets as a reward for breaking the fever.

If they do not pass the swallow screen the patient will be NPO, or they should be anyway. Acquire a chest X-ray A chest x-ray helps to differentiate the patient with aspiration as to whether they have acquired pneumonia or not. Antibiotics- if indicated Clindamycin or Metronidazole This may be used as prophylaxis, or because the patient developed pneumonia.

Auscultate lung sounds Monitor O2 saturation Assess skin color are they blue? Assess depth, rate, regularity of breathing as well as symmetry of chest rise and fall This should be done on every patient. But just like for a patient who has stroke like symptoms, you will be checking neuro function more frequently, a patient with aspiration needs to have their respiratory functions assess more frequently.

The frequency is based on each patient and the situation-use clinical judgement here. Asthma Nursing Care Plan. Pathophysiology Bronchoconstriction and increased mucus production decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange. Desired Outcome Decreased work of breathing and proper oxygenation to tissues. This is both a comfort measure as well as physiologically helpful.

Eliminate hypoxia, move up by 1L if not improving after re-checking every few minutes, call respiratory therapy if they require more than 6L NC. Make sure the patient knows about their asthma triggers and help them problem solve how to eliminate the trigger from their life. Auscultate lung sounds If wheezy they may need a breathing treatment If you hear crackles they may have pneumonia and potentially could use suctioning.

Positioning patient in an upright position Opens lung bases and airway Have the patient perform a peak flow meter Peak flow meters tell us how much air that patient can exhale. The smaller the number the less amount of air they are moving. Breathing treatments and medication therapy Beta-Agonists: Such as albuterol work as bronchodilators Anticholinergics: Such as Ipratropium work to relax bronchospasms Corticosteroids: Such as Fluticasone work as an anti-inflammatory If the patient is a child or the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart.

And for the love of the airway, have your respiratory therapist aware of the patient Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway.

Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis. Pathophysiology An electrical activity disturbance in the heart that causes an irregular and often rapid heartbeat.

Etiology The specific cause of atrial fibrillation is unknown but there are risk factors that put someone at higher risk of developing afib. Desired Outcome Decreasing risks of clot formation, a heart rate within normal limits and rhythm control. Objective Data Irregular heartbeat Tachycardia. Nursing Interventions and Rationales Obtain a 12 lead ECG Used to diagnose atrial fibrillation The waves are more chaotic and random The beat is irregular You can see the atria quivering between the QRS ventricles pumping No discernible P waves The ventricular rate is often bpm and the QRS complexes is usually less than ms.

Electrocardioversion, Ablation, Pacemaker -Electrocardioversion: The patient will be shocked on the outside of the chest wall. This treatment is used for patients who have infrequent episodes of atrial fibrillation because if the patient has it frequently, they have a high probability of the afib returning after being cardioverted. This is placed under the skin and is a device that sends electrical signals to the heart to help it beat with the right rhythm and pace.

Using beta blockers, calcium channel blockers and cardiac glycosides will help control the rate of the heart beat. They block beta 1 receptors from being stimulated.

Stimulation of Beta 1 causes positive inotropic force of contraction and chronotropic pace of heart beat effects. If you block beta 1 you will have decreased force of contraction and decreased heart rate.

They block calcium channels… Duh. When calcium enters the cell in causes the cell to contract, thus when the channels are blocked, it decreases the production of electrical activity innately decreasing the heart rate. This medication stimulates the Vagus nerve, which when stimulated slows the heart rate down.

When it is blocked it causes increased contractility of the heart. If your heart is beating stronger it will inherently slow down. Coumadin Aspirin Lovenox Plavix Eliquis Thinning the blood helps to disintegrate and break up the clot as well as increasing flow of blood.

The most common are listed to the left. Fall education Being on a blood thinner, the patient needs to be informed of their risk of bleeding out especially if they fall and hit their head. Make sure to go over environmental hazards such as good lighting and eliminating throw rugs.

If a patient does fall and hit their head they need to go to the ER immediately, even if they are not experiencing any adverse effects. Time to call The risk of a blood clot forming and moving to the brain is fairly high. It is important to teach the patient and their family members the signs and symptoms of stroke. Teach the patient that if they feel confused or feel weakness on one side to call for help.

Troponin I Creatine Kinase MB Initial measurement of the cardiac enzymes is important because it helps with any trending information, the sooner you get this information the better. Also getting trending results over specific periods of time is helpful.

Is an enzyme that helps the interaction of myosin and actin in the cardiac muscle. When necrosis of the myocyte happens, the contents of the cell eventually will be released into the bloodstream.

Troponin can become elevated hours after in ischemic cardiac event and can stay elevated for up to 14 days. This enzyme is found in the cardiac muscle cells and catalyses the conversion of ATP into ADP giving your cells energy to contract.

When the cardiac muscle cells are damaged the enzyme is eventually released into the bloodstream. CKMB levels should be checked at admission, and then every 8 hours afterwards. Etiology Any issue with the cardiovascular system could potentially cause CHF or put the patient at a much higher risk for CHF , such as myocardial infarction, coronary artery disease, hypertension, cardiomyopathy, heart arrhythmias, etc.

Desired Outcome maximized cardiac functionality as well as decreased stress on the cardiovascular system. Restrict sodium intake Water follows salt! The patient has too much fluid on board and needs to get rid of it, restricting the sodium helps with this. This means educating the patient on dietary changes that need to happen and be adhered to. Try to stay between mg of salt in a serving. Monitor BNP Normal range: Brain natriuretic peptide BNP: When the heart is stressed or working hard to pump blood, it releases BNP.

Listen to breath sounds Monitor O2 saturation Fluid can back up into the lungs and cause shortness of breath, especially upon exertion. Be careful about laying these patients flat as you can put them in respiratory distress.

Place the patient on O2 as needed to help them keep their O2 levels adequate. Furosemide Lasix Bumetanide Bumex Hydrochlorothiazide Microzide Spironolactone Aldactone We need to get all this fluid out of the patient… The best way to do this is administer diuretics.

Most commonly used diuretics in congestive heart failure are loop and sometimes thiazides are used with loop diuretics: This can change per patient and per doctor recommendation, so make sure to get a goal from the physician. Cirrhosis Nursing Care Plan. Pathophysiology Liver cirrhosis is a chronic, irreversible liver disease.

Desired Outcome Minimize continued liver damage, optimize nutrition, maximize hepatic circulation, minimize and prevent respiratory complications. Nursing Interventions and Rationales Promote nutrition Many who suffer from cirrhosis have impaired nutrition and require nutritional support with specific vitamins and minerals; enteral or parenteral feedings may be ordered Assist with paracentesis, if needed Patients may require the abdominal fluid that has built up ascites to be drained. Assist in set-up, positioning, and post-procedure site assessments, and monitoring as needed.

Daily weights This indicates if fluid has been accumulating, or if patient is losing weight Dietary adjustments: Monitor for excess fluid volume assess daily weight, JVD, blood pressure Increasing values indicate vascular congestion Note and address electrolyte imbalances Fluid and electrolyte imbalances are common and can result in dysrhythmias Promote oral care Patients are at a higher risk for bleeding gums and mouth sores, which can cause a decreased appetite in an already malnourished individual Complete a careful and comprehensive respiratory assessment vitals, labs, auscultation Essential to note impaired gas exchange and compromised respiratory function early.

Pathophysiology Less air flow is able to flow into and out of the alveoli both trapping CO2 as well as restricting O2 entering. Desired Outcome Clear, even, non-labored breathing while maintaining optimal oxygenation for patient. Nursing Interventions and Rationales Avoid irritants: Quit smoking or being around smoke Be mindful of the weather very cold can aggravate the bronchi Allergens like dust or pollen The key to avoiding a flare up of COPD is to avoid things that make it worse.

If the patient is smoking still this is a priority, they need to quit smoking. Provide education on smoking with COPD and the benefits of quitting. If the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient! Breathing Treatments and medications Beta-Agonists: Plan the oxygen monitoring with the physician.

Give oxygen as ordered and needed. Obtain an ECG The lungs and the heart are in the same general area, if someone is having problems breathing, make sure their heart is ok.

Encourage a healthy weight Can be either overweight or underweight Having access weight on the patient decreases the space for the lungs to expand. Plus, generally those who lose weight are also moving more to lose the weight, double win. Some patients especially those with emphysema can be very thin barrel chested and it is important to make sure they are getting the proper nutrition so their body is at optimal performance for that patient.

Helping the patient move more often helps improve breathing abilities. Pathophysiology Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow. Etiology Narrowing or occlusion of the vessels in an extremity. Desired Outcome Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots. Subjective and Objective Data Subjective Data Painful extremity Numbness and tingling on affected extremity Potential subjective data to be concerned about and monitor for: Chest Pain CP Stroke: Objective Data Warm, red, firm and swollen leg Decreased peripheral pulse on affected extremity.

Nursing Interventions and Rationales Assess a full neuro exam, assess breathing-Pulse oximetry, difficulty in breathing, chest pain, obtain an EKG. Heparin- initial therapy to break up clot. Transition into a SubQ or oral anticoagulant to prevent future clots. This is an anticoagulant that breaks up blood clots as well as prevents them. Patient will need to have frequent blood draws to monitor their INR. Therapeutic range is between 2 and 3.

Educate about avoiding vitamin K both supplements as well as food Vitamin K works to help increase clotting, this is opposite of what we are trying to do for this patient, unless of course they are bleeding out, in which case the treatment may be vitamin K with Fresh Frozen Plasma FFP Continuous monitoring: This monitors for changes in oxygenation if the clot moves to the lungs.

Nosebleeds are obvious, however, inform the patient that if they bleed through nasal packing for longer than 15 minutes they should go to the ER. Also they they feel dizzy, faint, or are losing color in their face they should go to the ER. Diabetes Nursing Care Plan. Etiology The cause for Type I diabetes is unknown, but hypothesized to be potentially genetic or triggered by a virus. Desired Outcome Blood sugar control with minimal side effects. Nursing Interventions and Rationales Blood sugar monitoring: The physician will make a target blood glucose level.

Teach the patient that they need to monitor their blood glucose. Teach the patient how to use their glucometer and record their results. Insulin administration -Rapid Acting: Each institution has guidelines and each insulin has guidelines.

Following the guidelines, make sure you know the onset, peak and duration of each type of insulin. Up to 12 hours -Intermediate Action Onset: Up to 24 hours -Long Acting Onset: Up to 24 hours To administer insulin, teach the patient to rotate injection sites and to clean the site with alcohol prior to inserting needle.

Educate about nutritional changes and monitoring This would be a good time to get the dietician involved. The patient needs to learn at a minimum, how to count carbs and which foods to avoid such as beer. If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter. Increase water intake if the patient has hyperglycemia Monitor feet and educate about monitoring feet Both decreased blood flow to the feet as well as neuropathy occur to make the feet something the patient really needs to watch.

Wounds are hard to heal so if they are having a hard time feeling their feet and they become injured, the wounds will be worse than with someone without diabetes.

Teach the patient to check their feet everyday. Washing their feet, cutting their toenails straight across, and scrubbing off calluses gently are a couple of points to make with the patient.

The patient may have a podiatrist involved in their care as well. Placing strain on the cardiovascular system wrecks havoc on other organ systems. Being diabetic makes the chances of that system having issues worse. A patient can lose their vision, kidney function, have a stroke or heart attack. Educate about maintaining a healthy weight and keeping active With a healthy weight, the patient is likely also implementing a healthy diet as well as implementing more movement.

These three things weight, diet, exercise can help to manage or even reverse diabetes. Healthy weights are calculated based on height and sex of the patient. Other ways to monitor the size of the patient is to use a BMI calculator or measure waist circumference.

Etiology Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections UTI, etc , prolonged vomiting, surgery or when they miss doses of insulin. Desired Outcome Maintain blood glucose level within the target range, maintain normal fluid balance.

Blurry vision Excessive urination. Monitor glucose and intervene with prescribed insulin as appropriate to reduce glucose levels and prevent further ketone production. Monitor fluid and electrolyte balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium Excess blood glucose can cause nausea and vomiting resulting in electrolyte imbalances.

These electrolyte deficiencies can lead to further complications and cardiac arrhythmias. Assess for fever and other symptoms of infection and administer antibiotics as necessary. Administer medications as appropriate Medications may be given to lower the blood glucose level in order to prevent further production of ketones or to manage symptoms of vomiting and underlying infection. This will be evident by low blood pressure and tachycardia Prevent injury and falls; assist with ambulation Fatigue and weakness are common due to the cells inability to use glucose to produce energy, also following vomiting, and in cases of dehydration.

Nutrition and lifestyle education Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educate patients on healthy diet and lifestyle to prevent DKA.

Emphysema Nursing Care Plan. Pathophysiology Destruction of the alveoli shapes and functionality. Etiology Exposure to lung irritants in the air: Nursing Interventions and Rationales Auscultate lung sounds If wheezy they may need a breathing treatment If you hear crackles they may have pneumonia and potentially could use suctioning.

Monitor ABGs Blood gases help to determine if the patient is in respiratory acidosis. Encourage a healthy weight Early stages of emphysema: Plus, generally those who lose weight are also moving more to lose the wieght, double win.

In later stages of emphysema, the patient can be very thin barrel chested and it is important to make sure they are getting the proper nutrition so their body is at optimal performance for that patient. Prepare for the worst: Breathing treatments and medications Beta-Agonists: Gerd Nursing Care Plan.

Pathophysiology The repeated assault of stomach acid and bile into the esophagus. Etiology A weakened esophageal sphincter allowing the acid or bile up into the esophagus from the stomach. Desired Outcome Maintain a normal amount of acid in the stomach, eliminate or decrease burning in the esophagus from acid splashing up and protect the GI tract from bleeding. Nursing Interventions and Rationales Educate on the benefits of lifestyle changes: Quitting smoking Wear loose fitting clothing Keeping active Quitting smoking: Nicotine relaxes the esophageal sphincter.

Teaching the patients about the connection helps give them another reason to quit. Wear loose fitting clothing: Having the midsection squeezed puts pressure on the stomach-this is the same concept as being overweight. Helps the patient lose weight, which is important since excess weight pushes on the stomach. Esomeprazole Lansoprazole Omeprazole Pantoprazole Antacids: Maalox Mylanta Rolaids H2 Blockers: Cimetidine Famotidine Nizatidine Ranitidine Prokinetics: Erythromycin Proton Pump Inhibitors: Neutralizes stomach acid H2 Blockers: Decreases the amount of acid made in the stomach -Inhibits action of histamine leading to inhibition of gastric acid secretion Prokinetics: Helps to empty the stomach faster.

Helps to empty the stomach faster watch out for diarrhea though! Educate on nutritional changes Nutritional changes such as not over eating, avoiding acidic foods like orange juice or spicy foods such as salsa. Also after eating, be sure to have the patient sitting in an upright position for at least hours. Also, having a patient sleep with their HOB greater than 30 degrees helps. Prepare the patient for a Barium Swallow Test An X-Ray tech will perform this test, your job as a nurse is to prepare the patient for this appointment.

Generally the patient has been NPO but check with the hospital policy or through the X-Ray tech as to how long they would like the patient to be NPO prior to the test.

Assist with Endoscopy This procedure allows the visualization of the esophagus and the esophageal sphincter. The nurse will be administering sedative medications, maintaining the airway and monitoring vital signs.

Obtain an ECG The symptoms of chest burning and pain are similar to that of a heart attack. It is always important to eliminate the heart as a problem, and not to just assume that the patient is experiencing GERD symptoms.

Encourage a healthy weight Access fat on a patient usually shows up in their abdomen and the displaces their stomach, increasing the risk of acid or bile deviously sneaking into the supposed off limits zones. Pathophysiology Bleeding along the lining of the Gastrointestinal Tract is hard to recognize because it is not something you can see immediately, or necessarily get imaging or laboratory test work to discover the cause of bleeding right away.

Etiology The bleeding along the GI tract is from a perforation somewhere in the intestines or stomach. Sign in or Create an account. Home Supplements Thyroid IodoRx. See 1 more picture. Buy in bulk and save. Product Description Same formula as Iodoral! New and less expensive! The benefits of a high potency Iodine supplement do not end there.

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