PACU Nursing Care Plan Essay

For my seventh clinical shift at the Loma Linda Veterans Affairs Medical Center, my assigned preceptor Filipina Gumangan assigned me three patients on the 4NW unit. The unit where I precept is an intensive care step down unit. Filipina’s objective for giving me three patients this shift was to give me an opportunity to continue exercising my time management skills and to practice my reporting and charting skills, and wound care. This shift I was responsible for many clinical duties corresponding to the care of these patients. My patients this shift were Mr. B, a 72 year-old Vietnam War veteran newly diagnosed with colon cancer, Mr. S, a 65 year-old Vietnam War veteran in the hospital for complicated urinary tract infection, Mr. R, a 90 year-old Korean and Vietnam War veteran. Caring for these patients taught me more about the humanbecoming perspective of nursing and showed me about multidisciplinary coordination with peers, colleagues, and more.

This assignment will critically discuss the nurse’s role in assessment and care planning for a patient in a case study. Confidentiality which is required by the NMC (Nursing Midwifery Council, 2008) and the Data protection Act (1998) will not be broken through out the assignment because the case study used is a scenario not a fictional character. The care plan will focus on Jean’s incontinence needs using The Roper, Logan and Tierney model (2000).

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

The ICU should be equipped with a recliner in every patient room, therefore 12 more recliners need to be purchased. Signage inside the patient’s room can be made by printing and laminating the AACN Early Progressive Mobility Protocol from their website with minimal cost. Total estimated cost including 12 recliners and staff education time: $ 10,200. Re-teaching will be implemented at staff meetings on a quarter-yearly basis and the ICU nurses will have the opportunity to provide constructive feedback. HCAP statistics will provide data regarding length of stay in the ICU, Ventilator and Health-care Acquired Pneumonias and Wound care will contribute the data for Decubitus occurrence.

This assignment will reflect on the effectiveness of my clinical and interpersonal skills in relation to my position as a nurse in a busy critical care unit. It will primarily focus on one particular patient and the care they received by myself in their immediate post operative period. In accordance with the NMC’s code of professional conduct names will not be used to protect the patient’s confidentiality. NMC (2008).

Jane’s asthma was acute severe. Initially to alleviate some of Jane’s breathlessness she was sat up right in the bed and supported with pillows to improve air entry. Due to her low oxygen saturations she was placed on 40% oxygen via Hudson mask (BTS 2006), as Jane was mouth breathing the mask was the appropriate device to use to ensure adequate oxygenation (Walsh 2002). According to Inwald et al (2001) hypoxemia is frequently a primary cause in numerous asthma related deaths. By administering oxygen promptly, for acute severe asthma, serious hypoxemia

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

The key concept underpinning the role of the anaesthetic nurse in an unanticipated difficult intubation as part of the multidisciplinary theatre team is essential; as a lead provider of compassionate anaesthetic care (Fynes et al, 2014), as a communicator, have the courage to advocate, be competent and committed (DOH, 2012). These are very important for enhancing patient anaesthetic care and improving patient safety (NPSA, 2010). And above, to improve the knowledge and skills by continuous training is vital in the event of a difficult intubation in adults, pregnant women and children (Brien and Conlon, 2013; Clark and Nolan, 2010). The incident confirms that to improve airway management, especially in the event of a difficult intubation planning, training and practising (such as in simulation centres) for the unanticipated difficult airway for the anaesthetist, anaesthetic nurse and theatre staff as a whole, is vital and it highlighted that our practice around managing the airway needs to be improved and constantly updated (Mellanby, Podmore and McNarry, 2014), and that is why I have applied to take part in the new airway simulation training

As a clinical facilitator, I provide learning opportunities to staff and nursing students at St Vincent’s Private Hospital Brisbane (SVPHB). Not long after I joined St Vincent’s, I encountered a patient who was receiving high flow oxygen (7 litres/min) via high flow nasal prongs without any humidification device running with it. The scene surprised me. Supplemental oxygen is

The main priority for all the pediatric patient was to make sure they are getting enough air. They needed an open airway. Without an open airway nothing else matters. To help with the patients airways we monitored their O2 sats and if they were low we made sure to apply oxygen, and continue to monitor their sats. Once oxygen was applied we worked on

I stayed close to the patient during this whole period, but I was not paying enough attention to her low oxygen level. The patient was a healthcare aid and she kept telling me that, “It’s ok, I am always a shallow breather”. However, I should have my own judgement ability and provide more competent care with timely evaluation of the effectiveness of the interventions.

One of the most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

I woke up in the recovery room after the surgery. They had me on antibiotics because of my weakened physical condition. My body’s immune system just wasn’t strong enough to fight off infection. Having a low, or weak immune system is serious condition. If you catch a contagious or communicable disease you could easily die. Things like stress can weaken your immune system. Somehow psychological stress weakens your bodies ability to fight infections. Exercise helps strengthen your immune system. When your in the hospital they get you up and moving around as soon as they can, because you recover faster and your immune system works better because of the physical movement.