Fluid Management

Being a student in the UW nursing school, I can not only take advantage of the special classroom settings, but also the advanced technology. With classroom settings designed for active learning, it gives me opportunities to share my thoughts and ideas with other students. Instead of listening passively, we would work as a team to find out the best solution for patients. Besides, the unique state-of-the-art technology allows me to practice and apply my knowledge in a simulated hospital setting. Since every practice is recorded, I can take a look at those videos several times and self-reflect. Thus, I can correct my mistakes and improve.

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last

During the transitioning process to the new hemodialysis unit, Ms. Conlon anticipated the challenges acquired by learning to set up and use new water equipment in an acute situation. In response to this, Ms. Conlon created and implemented a reverse osmosis flow sheet to assist her colleagues with the quick set-up of the portable RO in the ICU care setting. This tool resulted in a smoother transition for her colleagues, improvement in the delivery of care to the acute dialysis patient, and a decrease in the possibility of staffing overtime.

A long standing tradition is highly valued but compromises may need to be implemented in order to keep up with the proceeding changes in the medical field. Johnson proposes that the current

I have been fortunate enough to gain experiences that have effectively taught me how to be a leader and work together with a team and I am confident I will be able to apply this to my nursing career more

Tammy, I would agree there is a major difference between knowing how to perform a specific skill and knowing how to perform that skill effectively. I think it is great that you offer new nurses to your department an extensive orientation and training. Wound vac care can be tedious, depending on the wound, requiring much training and then follow-up training to ensure it is being performed correctly. The surrounding skin appearance of a wound bed is a good indicator of correct wound vac application. Your expertise in wound care with precise skin barrier methods prevented further complications with this already painful wound. When patients get, frustrated or are having a lot of pain related to a treatment or procedure, many times they will refuse

Nurses should take care to select the proper outcomes to ensure optimum care is provided to patients with CHF. The plan of care is dependent on the nursing diagnosis and the desired nurse-sensitive outcomes. The priority NOC outcome for the diagnosis of CHF is Fluid Balance and Fluid Overload Severity. Other related NOC outcomes are Knowledge: Cardiac Disease Management, Knowledge: Energy conservation, Knowledge: Medication, Knowledge: Prescribed Activity, Knowledge: Treatment, and Knowledge: Weight Management (Johnson et al., 2012). These are only a select few of the multiple outcomes available; care should be modified as the disease progresses through the problems which evolves over the lifetime of patients diagnoses with CHF. Once all these determinants are established, the nurse will be prepared to determine which level of NOC is essential to effectively manage the disease.

As a dialysis nurse I am tasked with providing pre and post treatment assessments for each patient and through these assessments I identify if there are any patient problems that must be managed. These problems can include access issues, such as clotting or infection, fluid related problems and many others. If a patient is short of breath or complains of chest pain prior to

In Kidney failure cases urea, creatine, uric acids and electrolytes move from the blood to the dialysate with the net effect of lowering their concentration in the blood. RBC s WBC s and plasma proteins are too large to diffuse through the pores of the membrane. Hemodialysis patient are exposed to 120 to 130 L of water during each dialysis treatment. Small molecular weight substances can pass from the dialysate in to patient’s blood. So the purity of water used for dialysis is monitored and controlled.

In year 2000 and 2010, an estimated 1 million hospitalizations for Congestive Heart Failure (CHF), of which most of these hospitalizations were for those aged 65 and over, the share of CHF hospitalizations for those under age 65 increased from 23% to 29% over this time period (Hall, Levant, & DeFrances, 2012). According to Held (2009), acute decompensated heart failure (ADHF) ensues when cardiac output fails to meet the demand of the body’s metabolic needs. The fluid volume overload makes the unstable condition necessitates instant treatment for the reason that it impairs perfusion to systemic organs, endangering their function.

Consider a fluid restriction to prevent possible fluid overloading due to his decreased renal function (Vera, 2011).

The nurse should act as a facilitator, creating an environment conducive to learning that motivates individuals to want to learn and makes it possible for them to learn (Musinski, 1999). The assessment of learning needs, the designing of a teaching plan, the implementation of instructional methods and materials, and the evaluation of teaching and learning should include participation by both the educator and the learner. Thus, the emphasis should be on the facilitation of learning from a nondirective rather than a didactic teaching approach (Knowles, Holton, & Swanson, 1998; Musinski, 1999; Mangena & Chabeli, 2005; Donner et al., 2005).

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.

This option has great potential for generating patient retention and referrals due to DHC paying attention to patient’s requests increasing their loyalty and people willing to attend DHC opposed to the new clinic. Although this alternative would increase patient’s visits, profitability is not a guarantee. This option would also require an increase of 33 percent in personnel costs and cost of the other physician.