Patient Y Having Pain

P in the PICOT is patients with Foley catheter inserted at admission causing patients catheter-associated urinary tract infections (CAUTI). The aim is to build a nurse-driven protocol to remove Foley catheters early on will help reduce additional days of having the use of an unnecessary indwelling urinary catheter. For every extra day, a Foley catheter increases the risk to develop hospital-acquired catheter-associated infections in our patients ("AACN Competencies and Curricular Expectations for CNL Education & Practice,"

The interventions will be aimed at reducing as far as possible all factors that decrease the threshold and promote those that increase it. It is of no use to judge the pain of others. Nursing care should recognize the presence of the painful experience of the patient, listen carefully and evaluate the factors that condition. Assess the response to analgesics as important as identifying the intensity of pain at the start of the intervention, it is reassessing its evolution time and under the treatment plan is implemented. In hospitalized patients should ask about pain at frequent intervals, every four hours or at least once per shift, and always after administration extra to check their adequacy and effectiveness dose. What drug it was effective and what dose is information that should not be left to memory for later transmission. Its systematic registration history is essential for inter-coordination. Moreover, the patient transmits real interest on the part of professionals and reinforces the therapeutic relationship and

Summary: Prevention of transmissible infections is an important role of perioperative nurses and requires an understanding of the recommended practices to break the chain of infection. There are standard precautions to follow by the healthcare team as well as specific precautions in relation to how the infection is transmitted such as: contact precautions, droplet precautions, and airborne precautions. Healthcare workers must protect themselves

exposed catheter is cleaned in a downward motion away from the insertion site without touching the mucus membranes, to reduce the risk of infection. These CHG Wipes were also utilized when a patient has a bowel movement. The outcomes reported by the article showed significant decrease in the amount of catheter associated UTI occurring on the unit. It is reported that in the first quarter of the trial, only four CAUTI incidents occurred on the unit, in the second quarter, only three CAUTI incidents were reported on the unit, and these were identified in patients who were transferred from another facility with Foley insertions. A revision was done to remove catheters past three weeks. By the 4th and last quarter, there were no CAUTI attributed to the unit (Carter et al, 2014).

Nurses have a unique role in alleviating the pain experienced by their patients. With their professional knowledge and regular close contacts with patients, they are ideally placed to listen and respond to any concerns. Taking time to assess the individual will allow for the development of a thrusting relationship between the nurse and patient. Accurate assessment and documentation can help to chart the multi- dimensional nature of the pain, aiding decision making and patient care planning (Mcguie 1992).

Catheters may be inserted when a patient is having a specific type of surgery, such as repair of hip fracture (Johansson et al, 2002). The EPIC Project guidelines, recommend four interventions related to reducing urinary catheter-associated infection (Pratt et al, 2001): Assessing the need for catheterization, selecting the catheter type, Aseptic catheter insertion, Catheter maintenance. Tsuchida and colleagues (2008) found that the use of a ‘pre-connected closed system’ and ‘daily cleansing of the perineal area’ could reduce the incidence of CAUTIs by nearly 50%. Also following guidelines is essential for preventing urinary tract infections some guidelines are; Perform hand hygiene before and after all handling of the catheter, tubing, and drainage bag. Empty the drainage bag when it becomes full or at least once every 8 hours to prevent migration of bacteria. Lastly, keep the drainage bag lower than the level of the patient’s bladder to prevent backflow of urine in the bladder; verify that the bag does not rest on the floor (Caple,

At my facility, 34 units are inpatient units and five critical care units. Initial surveys can be given out to assess the staff’s understanding of CAUTIs, experience with Foley insertion and the rate of nurse driven discontinuation. This will give vital information on how different units use and manage Foley catheters for educational purposes. Additional education needs are reported to the clinical educators to confer on per department and online educational material can be assigned to staff members. Collaborating with the physicians, unit managers, nurse practitioners will be important because they have influence on early Foley discontinuation. They can ask the question of whether the patient’s Foley is still needed or can be discontinued? In addition, collaborating with the nursing research team will be essential in gaining more information on evidence-base practice on latest research on Foley catheters. Volunteers to serve on the Foley rounding teams will need to make daily rounds through the facility and track the occurrences of CAUTIs that is reported to unit managers. At the next meet, managers can discuss with the staff the progression of the project, encourage efforts toward a zero occurrence of CAUTI and give credit to staff member that continuously

The goal is partially met because pain control is not achieved. However, the patient was able to verbalize how to make a heat pack to control pain in the hospital. The nurse will continue interventions and re-evaluate goal in 24 hours.

In 1992, the Agency for Health Care Policy and Research provided guidelines for the management of acute postoperative pain. “The goals of the pain management guidelines are to reduce pain, complications, and length of hospital stay, to educate patients in communicating unrelieved pain; and to enhance patient satisfaction with pain management practices” (Good, 1998). From these guidelines, Marion Good, PhD, RN, helped develop a middle-range theory for Acute Pain Management for adults who can learn, set goals, and communicate symptoms. The theory does not pertain to individuals such as elderly,

According to the Surviving Sepsis Campaign, careful infection control practices should be reviewed in nursing considerations, should be established during care delivery of septic patients. Infection control measures include: hand washing, urinary and venous catheter care, protective skin barrier, airway management, head of the bed elevated greater than 30°, and subglottic suctioning (Dellinger, et al., 2013, p. 595). [continue with preventative measures, i.e. handwashing

Another important nursing recommendation regarding PD training is to guide patients or caregivers perform appropriate assessment and cleaning skills of the PD catheter exit site. According to Mudge et al. (2016), early detection of exit site infections and initiate related management are essential to promote timely interventions and minimise potential progress to peritonitis. The signs and symptoms of exit site infections include pain, redness, crusting, oedema and drainage, normally caused by using inappropriate technique or omitting procedural steps (Schreiber, 2016). Rosendo da Silva et al. (2016) stated technical and behaviour measures such as hand hygiene affect the quality of health and the outcomes which aimed at the decrease of infection, related complications and costs. Therefore, nurses must provide ongoing educations to patients or caregivers regarding the importance of hand hygiene as an integral part of PD process.

Urinary catheters have been directly linked to infection. Catheter are inserted in 25% of patients who are hospitalized (Center for Disease Control and Prevention (CDC), 2014). Fifty percent of these catheters are unnecessary. (CDC, 2014) Patients with urinary catheters are at risk for infection, including blood stream infections. Each day a catheter remains in place it increases the patient’s mortality rate by 3-7 %.Complications from urinary catheters, which can lead to death. In addition, catheters are source of discomfort to patients. Urinary tract infection caused by urinary catheters prolongs patient length of stay, which prevents patients returning home to their love ones or the comforts of their own home. A nurse driven indwelling

Pain is one of the major reasons people seek for health care. Millions of people suffer from acute and chronic pain such as arthritis, migraine headache, and back pain. Pain can affect not only the individual experiencing it, but also every person around them (Lewis, Dirksen, Heitkemper, & Bucher, 2014). Many people are seeking medical procedure and medications to decrease the pain. Pain can be managed by both pharmacologic and non-pharmacologic methods based on pain assessment. Patients with pain often dissatisfied with pharmacological methods and turn to non-pharmacological method to manage their symptoms (Lizhou, Skinner, McDonough, Mabire, & Baxter, 2015), therefore, nurse should have basic knowledge

Sterile conditions is important when working in patients rooms or using the instruments when caring for wounds or surgery. The Aseptic technique is used to keep patients free from hospital micro-organisms as much as possible. While working in patients rooms with open wounds make sure that you are using good hygienic practice. Hand washing, the use of PPE, and sterile instruments are a must to reduce the spread of infections. Autoclaving is used to sterilize the instruments, but if they are disposable discard after one use in the proper manner.

In critically ill surgical patients, pain can be complex and needs integrated multidisciplinary approach. Proper