Monday, December 6, 2021

Nursing Care Plan for Insomnia related to Anxiety

Nursing Care Plan for Insomnia related to Anxiety
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.


Causes of Insomnia

The most common causes are:

  • stress, anxiety or depression
  • noise
  • a room that's too hot or cold
  • uncomfortable beds
  • alcohol, caffeine or nicotine
  • recreational drugs like cocaine or ecstasy
  • jet lag
  • shift work


Types of Insomnia

Insomnia can come and go, or it may be an ongoing, longstanding issue. There is short term insomnia and chronic insomnia:

  • Short term insomnia tends to last for a few days or weeks and is often triggered by stress.
  • Chronic insomnia is when the sleep difficulties occur at least three times a week for three months or longer.


Symptoms of Insomnia

Insomnia symptoms may include:

  • Difficulty falling asleep at night
  • Waking up during the night
  • Waking up too early
  • Not feeling well-rested after a night's sleep
  • Daytime tiredness or sleepiness
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increased errors or accidents
  • Ongoing worries about sleep


Assessment

A brief sleep history incorporated into the routine review of systems can be helpful in detecting patients with insomnia. Direct inquiry is important because more than one half of patients who believe that they have chronic insomnia have never discussed the problem with a physician.

It is helpful for patients to keep a sleep diary for one to two weeks. Sleep diaries usually record bedtime, total sleep time, time until sleep onset, number of awakenings, use of sleep medications, time out of bed in the morning and a rating of quality of sleep and daytime symptoms. The sleep diary provides a night-to-night account of the patient's sleep schedule and perception of sleep. Moreover, it may serve as a baseline for assessment of treatment effects. Completing the diary each morning and using estimates rather than exact times should minimize the likelihood that the process itself will be disruptive to sleep. 

Assessment should include questions that address both sleep and daytime functioning, since sleep needs vary markedly from person to person. For example, one patient who sleeps six hours may feel totally unrefreshed, while another who sleeps six hours might have no sleep-related complaints during the day.

Although the ability to maintain sleep decreases with age, the need for sleep does not change significantly. A patient who complains of not sleeping “a full eight hours” but whose sleep is otherwise restorative is within the bounds of normal behavior, and reassurance may be all that is needed. However, a patient who complains of severe insomnia or excessive daytime sleepiness should be evaluated, regardless of age.


Nursing Diagnosis : Insomnia r.t Anxiety


Goals and Outcome 

NOC (p. 616)

  • Anxiety level
  • Stress level


After nursing actions for 3x 24 hours, insomnia is resolved with the following criteria:

  • Increased sleep time
  • Regular sleep pattern
  • Improved sleep quality
  • Nightmares are starting to disappear
  • It's not hard to sleep anymore


Nursing Intervention

Sleep Enhancement (NIC page 348)

  • Monitor/record the patient's sleep pattern and the number of hours of sleep
  • Instruct the patient to monitor sleep patterns
  • Monitor participation in tiring activities while awake to prevent excessive fatigue
  • Help to relieve stress before bed
  • Teach patient and loved ones about contributing factors
  • the occurrence of disturbances in sleep patterns (e.g., physiological, psychological,
  • life, frequent shifts of work, rapid time zone changes, long and excessive working hours, and other environmental factors).
  • Provide pamphlets with information on techniques to improve sleep. 


Source :

  • https://en.wikipedia.org/wiki/Insomnia
  • https://www.nhs.uk/conditions/insomnia/
  • https://my.clevelandclinic.org/health/diseases/12119-insomnia
  • https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
  • https://www.aafp.org/afp/1999/0601/p3029.html

Nanda Nursing Diagnosis List 2012

NANDA Nursing Diagnosis List 2012 – 2014 


Domain 1 – Health Promotion 

  • Deficient diversional activity 
  • Sedentary lifestyle 
  • Deficient community health 
  • Risk-prone health behavior 
  • Ineffective health maintenance 
  • Readiness for enhanced immunization status 
  • Ineffective protection Ineffective self-health management 
  • Readiness for enhanced self-health management 
  • Ineffective family therapeutic regimen management 


Domain 2 – Nutrition 

  • Insufficient breast milk 
  • Ineffective infant feeding pattern 
  • Imbalanced nutrition: less than body requirements 
  • Imbalanced nutrition: more than body requirements 
  • Risk for imbalanced nutrition: more than body requirements 
  • Readiness for enhanced nutrition 
  • Impaired swallowing 
  • Risk for unstable blood glucose level 
  • Neonatal jaundice 
  • Risk for neonatal jaundice 
  • Risk for impaired liver function 
  • Risk for electrolyte imbalance 
  • Readiness for enhanced fluid balance 
  • Deficient fluid volume 
  • Excess fluid volume 
  • Risk for deficient fluid volume 
  • Risk for imbalanced fluid volume


Domain 3 – Elimination and Exchange 

  • Functional urinary incontinence 
  • Overflow urinary incontinence 
  • Reflex urinary incontinence 
  • Stress urinary incontinence 
  • Urge urinary incontinence 
  • Risk for urge urinary incontinence 
  • Impaired urinary elimination 
  • Readiness for enhanced urinary elimination 
  • Urinary retention 
  • Constipation 
  • Perceived constipation 
  • Risk for constipation 
  • Diarrhea 
  • Dysfunctional gastrointestinal motility 
  • Risk for dysfunctional gastrointestinal motility 
  • Bowel incontinence 
  • Impaired gas exchange  


Domain 4 – Activity/ Rest 

  • Insomnia 
  • Sleep deprivation 
  • Readiness for enhanced sleep 
  • Disturbed sleep pattern 
  • Risk for disuse syndrome 
  • Impaired bed mobility 
  • Impaired physical mobility 
  • Impaired wheelchair mobility 
  • Impaired transfer ability 
  • Impaired walking 
  • Disturbed energy field 
  • Fatigue
  • Wandering 
  • Activity intolerance 
  • Risk for activity intolerance 
  • Ineffective breathing pattern 
  • Decreased cardiac output 
  • Risk for ineffective gastrointestinal perfusion 
  • Risk for ineffective renal perfusion 
  • Impaired spontaneous ventilation 
  • Ineffective peripheral tissue perfusion 
  • Risk for decreased cardiac tissue perfusion 
  • Risk for ineffective cerebral tissue perfusion 
  • Risk for ineffective peripheral tissue perfusion 
  • Dysfunctional ventilatory weaning response 
  • Impaired home maintenance Readiness for enhanced self-care 
  • Bathing self-care deficit 
  • Dressing self-care deficit 
  • Feeding self-care deficit 
  • Toileting self-care deficit Self-neglect 


Domain 5 – Perception/ Cognition 

  • Unilateral neglect 
  • Impaired environmental interpretation syndrome 
  • Acute confusion 
  • Chronic confusion 
  • Risk for acute confusion 
  • Ineffective impulse control 
  • Deficient knowledge 
  • Readiness for enhanced knowledge 
  • Impaired memory 
  • Readiness for enhanced communication
  • Impaired verbal communication 


Domain 6 – Self-Perception 

  • Hopelessness 
  • Risk for compromised human dignity 
  • Risk for loneliness 
  • Disturbed personal identity 
  • Risk for disturbed personal identity 
  • Readiness for enhanced self-control 
  • Chronic low self-esteem 
  • Risk for chronic low self-esteem 
  • Risk for situational low self-esteem 
  • Situational low self-esteem 
  • Disturbed body image 
  • Stress overload 
  • Risk for disorganized infant behavior 
  • Autonomic dysreflexia 
  • Risk for autonomic dysreflexia 
  • Disorganized infant behavior 
  • Readiness for enhanced organized infant behavior 
  • Decreased intracranial adaptive capacity 


Domain 7 – Role Relationships 

  • Ineffective breastfeeding 
  • Interrupted breastfeeding 
  • Readiness for enhanced breastfeeding 
  • Caregiver role strain 
  • Risk for caregiver role strain 
  • Impaired parenting 
  • Readiness for enhanced parenting 
  • Risk for impaired parenting 
  • Risk for impaired attachment 
  • Dysfunctional family processes
  • Interrupted family processes 
  • Readiness for enhanced family processes 
  • Ineffective relationship 
  • Readiness for enhanced relationship 
  • Risk for ineffective relationship 
  • Parental role conflict 
  • Ineffective role performance 
  • Impaired social interaction 


Domain 8 – Sexuality 

  • Sexual dysfunction 
  • Ineffective sexuality pattern 
  • Ineffective childbearing process 
  • Readiness for enhanced childbearing process 
  • Risk for ineffective childbearing process 
  • Risk for disturbed maternal-fetal dyad 


Domain 9 – Coping/ Stress Tolerance 

  • Post-trauma syndrome 
  • Risk for post-trauma syndrome 
  • Rape-trauma syndrome 
  • Relocation stress syndrome 
  • Risk for relocation stress syndrome 
  • Ineffective activity planning 
  • Risk for ineffective activity planning 
  • Anxiety 
  • Compromised family coping 
  • Defensive coping 
  • Disabled family coping 
  • Ineffective coping 
  • Ineffective community coping 
  • Readiness for enhanced coping 
  • Readiness for enhanced family coping
  • Death anxiety 
  • Ineffective denial 
  • Adult failure to thrive 
  • Fear Grieving 
  • Complicated grieving 
  • Risk for complicated grieving 
  • Readiness for enhanced power 
  • Powerlessness 
  • Risk for powerlessness 
  • Impaired individual resilience 
  • Readiness for enhanced resilience 
  • Risk for compromised resilience 
  • Chronic sorrow 
  • Stress overload 
  • Risk for disorganized infant behavior 
  • Autonomic dysreflexia 
  • Risk for autonomic dysreflexia 
  • Disorganized infant behavior 
  • Readiness for enhanced organized infant behavior 
  • Decreased intracranial adaptive capacity 


Domain 10 – Life Principles 

  • Readiness for enhanced hope 
  • Readiness for enhanced spiritual well-being 
  • Readiness for enhanced decision-making 
  • Decisional conflict 
  • Moral distress 
  • Noncompliance 
  • Impaired religiosity 
  • Readiness for enhanced religiosity 
  • Risk for impaired religiosity
  • Spiritual distress 
  • Risk for spiritual distress 


Domain 11 – Safety/ Protection 

  • Risk for infection 
  • Ineffective airway clearance 
  • Risk for aspiration 
  • Risk for bleeding 
  • Impaired dentition 
  • Risk for dry eye 
  • Risk for falls 
  • Risk for injury 
  • Impaired oral mucous membrane 
  • Risk for perioperative positioning injury 
  • Risk for peripheral neurovascular dysfunction 
  • Risk for shock 
  • Impaired skin integrity 
  • Risk for impaired skin integrity 
  • Risk for sudden infant death syndrome 
  • Risk for suffocation 
  • Delayed surgical recovery 
  • Risk for thermal injury 
  • Impaired tissue integrity 
  • Risk for trauma Risk for vascular trauma 
  • Risk for other-directed violence 
  • Risk for self-directed violence 
  • Self-mutilation 
  • Risk for self-mutilation 
  • Risk for suicide 
  • Contamination 
  • Risk for contamination
  • Risk for poisoning 
  • Risk for adverse reaction to iodinated contrast media 
  • Risk for allergy response 
  • Latex allergy response 
  • Risk for latex allergy response 
  • Risk for imbalanced body temperature 
  • Hyperthermia 
  • Hypothermia 
  • Ineffective thermoregulation 


Domain 12 – Comfort 

  • Impaired comfort 
  • Readiness for enhanced comfort 
  • Nausea 
  • Acute pain 
  • Chronic pain 
  • Impaired comfort 
  • Readiness for enhanced comfort 
  • Social isolation

Nursing Intervention Classifications

Nursing Intervention Classifications

Esther K. AFOLABI

RN, MSc. FWACN


Introduction

  • We continue with the series of lectures on the SNLs by discussing the NIC.
  • The NIC was founded in the 1987 and it replaces the implementation used in the former format of the Nursing Process


Learning Objectives

  • At the end of this session, the learner will be able to ;
  • Define the NIC
  • Identify the format of writing the NIC
  • List out some examples of NIC
  • Link the NIC with other segments of the Nursing process



The Nursing Interventions Classification (NIC)

  • “is a comprehensive, research-based, standardized classification of interventions that nurses perform.

  • An intervention is defined as: “any treatment, based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes.”


Useful of NIC

  • for clinical documentation,
  • communication of care across settings,
  • integration of data across systems and settings,
  • effectiveness research,
  • productivity measurement,
  • competency evaluation,
  • reimbursement, and curricular design.


NIC Format

  • Label name
  • Definition
  • Activities
  • References


Nursing Intervention Domains

  • Physiological: Basic
  • Physiological: Complex
  • Behavioral
  • Safety
  • Family
  • Health System
  • Community


Diarrhea Management   0460

Definition: Management and Alleviation of diarrhea

Activities:

  • Determine history of diarrhea
  • Obtain stool for culture and sensitivity if diarrhea continues
  • Teach patient appropriate use of antidiarrheal medications
  • Instruct patient/family members to record color, volume, frequency, and consistency of stools.
  • Encourage frequent, small feeding, adding bulk gradually
  • Weigh patient regularly
  • Observe skin turgor regularly


Childbirth Preparation  6760

Definition: Providing information and support to facilitate childbirth and to enhance the ability of an individual to develop and perform the parental role

Activities

  • Teach the mother and partner about the physiology of labor
  • Educate mother and partner about signs of labor
  • Inform mother about when to come to the hospital in preparation for delivery
  • Discuss pain control options with mother
  • Inform mother about delivery options if complications arise
  • Promote parent’s self-efficacy in taking on parental role
  • Discuss arrangements for siblings care during hospitalization


Community Health Development   8500 

Definition: Assisting members of a community to identify community’s health concern, mobilize resources, and implement solution

Activities

  • Identify health concerns, strengths, and priorities with community partners
  • Provide opportunities for community participation by all segments of the community
  • Assist community members in raising awareness of health problems and concerns
  • Enhance community support network
  • Develop strategies for managing conflict
  • Provide an environment, creating situations in which individuals and groups feel safe expressing their views


Self-Esteem Enhancement  5400

Definition: Assisting a patient to increase his or her personal judgement of self-worth

Activities

  • Monitor patient’s statement of self-worth
  • Determine patient’s locus of control
  • Determine patient’s confidence in own judgement
  • Encourage patient to identify strength
  • Facilitate an environment and activities that will increase self-esteem
  • Make positive statements about patient


NIC for Individuals 

Anxiety Reduction 5820 

Asthma Management 3210

Behaviour Management 4350

Bleeding Reduction: Post Partum Uterus 4026

Body Image Enhancement 5220

Fever treatment 3740


NIC for Families

Family Integrity Promotion 7100

Family Process Maintenance 7130

Family therapy 7150

Family Support 7140

Financial Resource Assistance 7380

Family Presence Facilitation 7170


NIC for Communities 

Community Disaster Preparedness. 8840

Community Health Development  8500

Culture Brokerage  7330

Immunization / Vaccination Management. 6530

Teaching: Safe sex. 5622

Environmental management: Community 6484

Surveillance: Community. 6652




The Nursing Process 

Assessing Diagnosing (NANDA-I)

Outcome Identification (NOC)

Planning

Implementing ( NIC)

Evaluating the Outcomes (NOC)


Conclusion

Using the three concepts will pave way for better understanding of Nursing and documentation of care.


Thank You For LISTENING


Any Question ???


Thursday, December 2, 2021

Nursing Assessment

Chapter 34 

Nursing Assessment


Nursing Assessment 

  • The systematic and continuous collection and analysis of information about a client
  • The nurse carefully collects this information, also called data, during the first step of the nursing process.
  • All steps of the nursing process depend on the nursing assessment.


Data Collection 

Sources of information about the client

  • The client and family
  • Other members of the healthcare team
  • The client’s previous and present health records, laboratory reports, and reference books
  • Physical examination


Objective Data 

  • All measurable and observable pieces of information about the client and his or her overall state of health.
  • Only precise, accurate measurements or clear descriptions are used.
  • Vital signs, height, weight, and urine volume
  • Measurements of body structure and function using instruments
  • Laboratory test results; radiologic diagnostic tools


Subjective Data 

  • The client’s opinions or feelings about what is happening
  • The client communicates through written words and body language.
  • This information cannot be confirmed through any other source.
  • The nurse needs sharp interviewing, listening, and observing skills.


Question 

Is the following statement true or false?

The client complains of a headache and fever; however, she has not recorded the temperature. This is an example of subjective data.


Answer

True

This data is subjective because it is based on the client's feelings. If the temperature is measured by a thermometer then, that data would be objective.


Data Collection 

Methods to collect data 

  • Observation 
  • Health interview
  • Physical examination


Observation

Assessment tool that relies on the use of the five senses to discover information about the client

  • Visual observation
  • Tactile observation
  • Auditory observation
  • Olfactory or gustatory observation

The Health Interview 

  • The health interview or nursing history
    • A way of soliciting information from the client
    • Uses combinations of open-ended questions, detailed questions, and observational and tactile skills
    • Clients have the right to refuse to answer questions that they believe are too personal.
  • Medical history
    • When a physician obtains information from the client


Question 

Is the following statement true or false?

A 15-year-old client who is experiencing lower abdominal cramps admits that she has had an abortion in the recent past, of which her family has no knowledge. The nurse is required to inform her parents as she is under age.


Answer

False

The nurse must protect the confidentiality of the client, never revealing any information previously unknown to the family without the client’s permission.


Components of the Nursing History

A complete health history helps develop an effective plan of care for the client. It includes:

  • Biographical data
  • Reason for coming to the healthcare facility
  • Recent health history
  • Important medical history
  • Pertinent psychosocial information
  • Activities of daily living (ADL)


Data Analysis

  • During and after data collection, critically examine each piece of information to determine its relevance to the client’s health problems and its relationship to other pieces of information.
  • Through systematic data analysis, draw conclusions about the client’s health problems.
  • During data analysis, use critical thinking skills.

  • Recognizing significant data
    • When preparing to analyze data, ask yourself which items are pertinent to client care and which are not.
  • Validating observations
    • Validate observations by checking if they agree with what the client is experiencing.
  • Recognizing patterns or clusters
    • Symptoms can be grouped together in clusters for further analysis.


Systematic Data Analysis

  • Identifying strengths and problems
    • While assessing the client, the nurse should look for strengths the client has that can be used in coping with problems.
  • Reaching conclusions
    • The client has no problem.
    • The client may have a problem.
    • The client is at risk for a problem.
    • The client has a clinical problem.


Question 

Is the following statement true or false?

A medical diagnosis falls in the domain of nursing, and nursing staff may treat it without consulting a physician.


Answer

False

A medical diagnosis is a collaborative problem; the nursing staff must consult a physician and work together to resolve the problem.

A nursing diagnosis falls in the domain of nursing, and nursing staff may treat it without consulting a physician.


Source : https://slideplayer.com/slide/13034948/

Sunday, November 28, 2021

Fundamental of Nursing 9th Edition

Fundamental of Nursing 9th Edition



by

Patricia A. Potter RN PhD FAAN (Author),
Anne Griffin Perry RN MSN EdD FAAN (Author),
Patricia A. Stockert RN BSN MS PhD (Author),
Amy Hall RN BSN MS PhD CNE (Author)


It’s your complete guide to nursing ― from basic concepts to essential skills! Fundamentals of Nursing, 9th Edition prepares you to succeed as a nurse by providing a solid foundation in critical thinking, evidence-based practice, nursing theory, and safe clinical care in all settings. With illustrated, step-by-step guidelines, this book makes it easy to learn important skills and procedures. Care plans are presented within a nursing process framework, and case studies show how to apply concepts to nursing practice. From an expert author team led by Patricia Potter and Anne Griffin Perry, this bestselling nursing textbook helps you develop the understanding and clinical reasoning you need to provide excellent patient care.

  • 51 skills demonstrations provide illustrated, step-by-step instructions for safe nursing care ― and include rationales for each step.
  • 29 procedural guidelines provide streamlined, step-by-step instructions for performing basic skills.
  • UNIQUE! Critical Thinking Models in each clinical chapter show how to apply the nursing process and critical thinking to achieve successful clinical outcomes.
  • Evidence-Based Practice chapter shows how nursing research helps in determining best practices.
  • UNIQUE! Caring for the Cancer Survivor chapter prepares nurses to care for cancer patients who may still face physical and emotional issues.
  • Case studies include unique clinical application questions and exercises, allowing you to practice using care plans and concept maps.
  • The 5-step nursing process provides a consistent framework for care, and is demonstrated in more than 20 care plans.
  • 15 review questions in every chapter test your retention of key concepts, with answers available in the book and on the Evolve companion website.
  • Practical study tools on Evolve include video clips of skills, skills checklists, printable key points, a fluid & electrolytes tutorial, a concept map creator, an audio glossary, and more.
  • UNIQUE! Clear, streamlined writing style makes complex material more approachable.
  • More than 20 concept maps show care planning for clients with multiple nursing diagnoses.
  • Key points and key terms in each chapter summarize important content for more efficient review and study.
  • Unexpected Outcomes and Related Interventions for each skill alert you to potential problems and appropriate nursing actions.
  • Delegation coverage clarifies which tasks can and cannot be delegated.
  • A glossary provides quick access to definitions for all key terms.
  • UPDATED! Patient Safety and Quality chapter describes how quality and safety apply to the nurse, and includes a new skill on fall prevention in healthcare settings.
  • NEW content addresses the Affordable Care Act, patients’ perspectives on hospital care as measured by HCAHPS surveys, health disparities and vulnerable populations, compassion fatigue, pain assessment, patient education techniques like teach-back, new equipment, Healthy People 2020, and more.
  • NEW! Additional alternate-item review questions include at least four alternate-item questions ― multiple select, sequencing/priority, delegation, hot-spot images, and fill-in-the blank for medications ― for every chapter.
  • Expanded Building Competency boxes help you apply QSEN (Quality & Safety Education for Nurses) competencies to realistic clinical situations.
  • UPDATED! Unique Evidence-Based Practice boxes in every chapter include a PICO question ― the Problem, Intervention, Comparison, and Outcome ― and summarize a research study along with its application to nursing practice.
  • Over 100 NEW photos clarify procedures and familiarize you with the latest clinical equipment.

History of Nursing in the world

Nursing in Ancient Times

Ancient history shows records of nursing. What we know about the care of the sick in ancient times has been discovered through songs and findings of archaeologists. People were interested in the mysteries of life, birth, disease and death. Men lived very close to nature; life was very simple; people made few changes except when men were compelled to do so. Men attributed spiritual value to all natural objects, believing that objects in nature such as trees or rivers had spirit or soul. Objects in nature became friends such as water and trees, while storms and poisonous plants became enemies. Attitudes changed according to man's ability to control nature. They thanked friendly harmless objects for their help and tried to cooperate with the unfriendly, threatening situations.

Disease was believed to be caused by evil spirits within the body. The body had to undergo unpleasant experiences to get rid of these evil spirits. Men thought disease was caused by their failure to satisfy the gods, or was punishment for their sins. These ideas are still prevalent today even among highly civilized and intelligent people.

People were ignorant of the laws of nature. People were beaten to get rid of evil spirits; sudden fright, loud noises and magic ceremonies were also used to get rid of evil spirit. Holes on the bodies were made for the evil spirits to escape. Sacrifices were offered as a treatment. Care was given by the man who knew the signs and symptoms of evil spirits and knew what to do in certain conditions. He wore a strange dress and used magic words. He took his role as a priest. He attempted to understand and control the forces of health and disease. The skill of primitive men in fighting disease has given us many medical and surgical treatments. Massage, fomentation, triphining, bone setting, amputations, hot and cold baths, abdominal sections and heat to control haemorrhage are some of the skills gained from primitive men.


Nursing in India

The earliest Indian medicine was Ayur Veda Medicine found in Veda 5000 B.C. About 1400 B.C. Charaka,the father of medicine, wrote a book on internal medicine. From these books we learn the hospitals were large and well equipped. Surgery had advanced to a high level. Doctors and attendants or nurses had to be people of high moral character. King Ashoka B.C.226-250, built monasteries and houses for travellers; hospitals for men and animals were founded. Hygienic practise was adapted; cleanliness of body was a religious duty. First importance was given to prevention of diseases. Doctors and nurses were expected to be skillful and trustworthy. They had to keep their nails short. Nurses were usually men or old women.


Nursing in China

China was quite advanced in medicine. Before 2000 B.C., medical professionals were allowed to practice dissection. They knew about circulation of blood. They had good description of internal organs. Sen-Lung was known as the father of medicine. The doctors used systematic method of diagnosis. Their slogan was Look, Listen, Ask and Feel. By 100B.C. they used vaccination. They recognized syphilis, gonorrhoea,used liver diets for anaemia,seaweed or iodine for thyroid conditions and chaulmoogra oil for leprosy by 3000 A.D.

Bathing and wearing clean clothes were advised and practised. Importance was given to hygiene. But nursing was not practised as they believed that disease was due to evil spirits in the patient and they might enter anyone who touched the sick person. Medical progress was therefore hindered by this belief in common people.


Nursing in Egypt

During 1500 B.C. Egyptians used Castor oil and lead and copper salts as remedies for diseases. There were well specialised doctors for eyes and tooth. They had good knowledge of community health. There were planned cities and public baths. They had underground drains and midwives for deliveries.


Nursing in Greek and Roman Medicine

People in Greece believed that medicine was of divine origin and was represented by many gods. Apollo, the sun god, represented health and medicine, his son Aesculapius, was the god of healing and his daughter, Hygeia, was the goddess of health. Temples were built for gods. A priest physician was in charge of it. People came to the temple and believed that during their sleep god would appear and prescribe them treatment. They used special diets and massage bath.

Hippocrates gave scientific views to medicine. He was known as the father of medicine. He taught doctors signs and symptoms of diseases. The treatment was based on diagnosis. He developed ways of doing physical examination and taking histories. Stress was given on good health by giving good diet, fresh air and maintaining cleanliness. He gave instructions in hot applications, poultices, cold sponge for fever, fluid for kidney diseases and mouth washes. Rome learnt a lot from Greece about medicine. Rome built good sanitation, good roads and bridges. There were pubic baths for men and women; drinking water was brought by channel or large pipes. Drainage system and sewage were made. They built market places and hospitals.

Old women and men of good character did nursing in those days.



History of Nursing in the world

Nursing in ancient times

Ancient history shows records of nursing.What we know about the care of the sick in ancient times has been discovered through songs and findings of archaeologists.People were interested in the mysteries of life,birth,disease and death.Men lived very close to nature;life was very simple;people made few changes except when men were compelled to do so.Men attributed spiritual value to all natural objects,believing that objects in nature such as trees or rivers had spirit or soul.Objects in nature became friends such as water and trees,while storms and poisonous plants became enemies.Attitudes changed according to man's ability to control nature.They thanked friendly harmless objects for their help and tried to cooperate with the unfriendly,threatening situations.

Disease was believed to be caused by evil spirits within the body.The body had to undergo unpleasant experiences to get rid of these evil spirits.Men thought disease was caused by their failure to satisfy the gods, or was punishment for their sins.These ideas are still prevalent today even among highly civilized and intelligent people.

People were ignorant of the laws of nature.People were beaten to get rid of evil spirits;sudden fright,loud noises and magic ceremonies were also used to get rid of evil spirit.Holes on the bodies were made for the evil spirits to escape.Sacrifices were offered as a treatment.Care was given by the man who knew the signs and symptoms of evil spirits and knew what to do in certain conditions.He wore a strange dress and used magic words.He took his role as a priest.He attempted to understand and control the forces of health and disease.The skill of primitive men in fighting disease has given us many medical and surgical treatments.Massage,fomentation,triphining,bone setting,amputations,hot and cold baths,abdominal sections and heat to control haemorrhage are some of the skills gained from primitive men.


Nursing in India

The earliest Indian medicine was Ayur Veda Medicine found in Veda 5000 B.C.About 1400 B.C. Charaka,the father of medicine,wrote a book on internal medicine.From these books we learn the hospitals were large and well equipped.Surgery had advanced to a high level.Doctors and attendants or nurses had to be people of high moral character.King Ashoka B.C.226-250,built monasteries and houses for travellers;hospitals for men and animals were founded.Hygienic practise was adapted;cleanliness of body was a religious duty.First importance was given to prevention of diseases.Doctors and nurses were expected to be skillful and trustworthy.They had to keep their nails short.Nurses were usually men or old women.


Nursing in China

China was quite advanced in medicine.Before 2000 B.C.,medical professionals were allowed to practice dissection.They knew about circulation of blood.They had good description of internal organs.Sen-Lung was known as the father of medicine.The doctors used systematic method of diagnosis.Their slogan was Look,Listen,Ask and Feel.By 100B.C. they used vaccination.They recognized syphilis,gonorrhoea,used liver diets for anaemia,seaweed or iodine for thyroid conditions and chaulmoogra oil for leprosy by 3000 A.D.

Bathing and wearing clean clothes were advised and practised.Importance was given to hygiene.But nursing was not practised as they believed that disease was due to evil spirits in the patient and they might enter anyone who touched the sick person.Medical progress was therefore hindered by this belief in common people.


Nursing in Egypt

During 1500 B.C. Egyptians used Castor oil and lead and copper salts as remedies for diseases.There were well specialised doctors for eyes and tooth.They had good knowledge of community health.There were planned cities and public baths.They had underground drains and midwives for deliveries.


Nursing in Greek and Roman Medicine

People in Greece believed that medicine was of divine origin and was represented by many gods.Apollo,the sun god,represented health and medicine,his son Aesculapius, was the god of healing and his daughter, Hygeia, was the goddess of health.Temples were built for gods.A priest physician was in charge of it.People came to the temple and believed that during their sleep god would appear and prescribe them treatment.They used special diets and massage bath.

Hippocrates gave scientific views to medicine.He was known as the father of medicine.He taught doctors signs and symptoms of diseases.The treatment was based on diagnosis.He developed ways of doing physical examination and taking histories.Stress was given on good health by giving good diet, fresh air and maintaining cleanliness.He gave instructions in hot applications,poultices,cold sponge for fever,fluid for kidney diseases and mouth washes.Rome learnt a lot from Greece about medicine.Rome built good sanitation,good roads and bridges.There were pubic baths for men and women;drinking water was brought by channel or large pipes.Drainage system and sewage were made.They built market places and hospitals.

Old women and men of good character did nursing in those days.


Nursing in Modern Times

The modern form of nursing was started by Florence Nightingale. Before that, it was influenced by religious groups. In the 15th and 16th centuries, nursing was dominated in Europe by religious bodies including Benedictine and Augustinian sisters, Franciscan brothers and sisters of charity. Original motivation for caring for the sick was in order to ensure one's salvation by engaging in self-sacrificing work. That is why nursing was considered as a noble work. Today,the salvation has been replaced by a desire to serve people, nation and the world with the help of scientific technology.

Actually, Florence Nightingale (1820-1910) revived nursing during her life time. She said,"Nursing is to help the patient to live."

She was one of the most influential reformers of her time. Even today, her writings remain as relevant as they were 120 years ago. Her own practical experiences combined with her own aims for the nursing profession gave her a greater insight into problems of hospital administration than her contemporaries. Her social position enabled her to give ideas to the committees, which controlled the voluntary hospitals in those days. But above all, she had the determination to use every weapon she possessed including charm and social pressure to achieve the objective she had in mind, thus becoming the greatest publicist the profession has ever had. After the Crimean War of 1854, nursing could never be the same again. Florence Nightingale's adventure in Crimea, drew public attention on an enormous scale to the problems of nursing role in transforming the recruitment,training and practice of the new profession.

Source : http://nursingnepal.blogspot.com/2010/02/history-of-nursing_08.html

Friday, November 26, 2021

Pre and Post Operative Nursing Management

Pre and Post Operative Nursing Management


LEARNING OBJECTIVES 

On completion of this chapter, the learner will be able to: 

  1. Define the three phases of the perioperative period. 
  2. Describe a comprehensive preoperative assessment to identify surgical risk factors. 
  3. Identify the causes of preoperative anxiety and describe nursing measures to alleviate it. 
  4. Identify legal and ethical considerations related to informed consent. 
  5. Describe preoperative nursing measures that decrease the risk for infection and other postoperative complications. 
  6. Describe the immediate preoperative preparation of the patient. 
  7. Develop a preoperative teaching plan designed to promote the patient’s recovery from anesthesia and surgery, thus preventing postoperative complications.


Pre and Post Operative Nursing Management

  • Preoperative Phase: The period of time from when decision for surgical intervention is made to when the patient is transferred to the operating room table. 
  • Intaroperative Phase: Period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit. 
  • Postoperative Phase: Period of time that begins with the admission of the patient to the postanesthesia care unit and ends after follow-up evaluation in the clinical setting or home. 
  • Perioperative Period: Period of the time that constitute the surgical experience, include the preoperative, intraoperative, postoperative phases.


Preoperative Phase 

  • Begins with decision to proceed with surgical intervention 
  • Baseline evaluation 
  • Preparatory education

Intraoperative Phase 

  • Begins when patient is transferred to operating room table 
  • Provide for patient safety 
  • Maintain aseptic environment 
  • Provide surgeon with supplies and instruments 
  • Documentation

Postoperative Phase 

  • Admission to PACU 
  • Maintain airway
  • Monitor vital signs 
  • Assess effects of anesthesia 
  • Assess for complications of surgery 
  • Provide comfort and pain relief 
  • Ends with follow-up evaluation in clinical setting or home


Preoperative Nursing Management:

I- Patient Education: 

  • Teaching deep breathing and coughing exercises. 
  • Encouraging mobility and active body movement. e.g Turning(change position),foot and leg exercise. 
  • Explaining pain management. 
  • Teaching cognitive coping strategies.

  • Managing nutrition and fluids. − The major purpose of withholding food and fluid before surgery is to prevent aspiration. − A fasting period of 8hours or more is recommended for a meal that includes fried or fatty foods or meat 
  • Preparing the bowel for surgery. − Enema is not commonly ordered, unless the patient is undergoing abdomen or pelvic surgery.e.g (cleansing enema, laxative). 
  • Preparing the skin. −The goal of preoperative skin preparation is to decrease bacteria without injuring the skin.

III- Immediate preoperative nursing intervention: 

  • Administering preanesthetic medication. 
  • Maintaining the preoperative record. e.g. Final checklist, consent form, identification.


11 Nursing management in the post anesthesia care unit:


I - Assessing the patient: Frequent assessment of the patient oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness. 

II - Maintaining a patent airway: 

  • The primary objectives are to maintain pulmonary ventilation and prevent hypoxia and hypercapenia. 
  • The nurse applies oxygen, and assesses respiratory rate and depth, oxygen saturation.

III- Maintaining cardiovascular stability: 

  • The nurse assesses the patient’s mental status, vital signs, cardiac rhythm, skin temperature, color and urine output. 
  • Central venous pressure, arterial lines and pulmonary artery pressure. − The primary cardiovascular complications include hypotension, shock, hemorrhage, hypertension and dysarrythmias.

IV - Relieving pain and anxiety: 

  • analgesic. 

V - Assessing and managing the surgical site: 

  • The surgical site is observed for bleeding, type and integrity of dressing and drains. 

VI - Assessing and managing gastrointestinal function: 

  • Nausea and vomiting are common after anesthesia. 
  • Check of peristalsis movement.

VII - Assessing and managing voluntary voiding: 

  • Urine retention after surgery can occur for a verity of reasons. Anesthesia interfere with the perception of bladder fullness. 
  • Abdominal, pelvic ,hip may increase the like hood of retention secondary to pain. 

VIII - Encourage activity: 

  • Most surgical are encouraged to be out of bed as soon as possible. Early ambulation reduces the incidence of post operative complication as, atelectasis ,pneumonia, gastrointestinal discomfort and circulatory problem.


Post Operative Complication:

  • Shock: Is the response of the body to a decrease in the circulating volume of blood, tissue perfusion impaired, cellular hypoxia and death. Hemorrhage: Is the escape of blood from a blood vessel. 
  • Deep vein thrombosis. (DVT). Occur in pelvic vein or in lower extremities, and it’s common after hip surgery.
  • Pulmonary embolism. It’s the obstruction of one or more pulmonary arterioles by an embolus originating some where in the venous system or in the right side of heart. 
  • Urinary Retention. 
  • Intestinal obstruction.  Result in partial or complete impairment to the forward flow of intestinal content.


Potential Intraoperative complication:

  • Nausea and vomiting 
  • Anaphylaxis 
  • Hypoxia and other respiratory complication 
  • Hypothermia


Source : https://slideplayer.com/slide/6002032/

Nanda Nurse

Nurses Books