Feeding is a very important skill in nursing. Make sure you do these things with all patients.
1) Make sure the client is facing and mid line to the food
2) Do not tower over the patient for it is intimidating and makes them feel uncomfortable/violated.
3) Try to make the patient as independent as they can by getting them to feed themselves. It makes them develop confidence and feel empowered.
4) Tell the patient everything that your gonna do,
"now I'm going to raise the spoon to your mouth"
"please open your mouth, I will place the spoon inside your mouth"
"now please close your mouth and I will remove the spoon, alright"
5) Please do not continuously shove food in their mouth. You laugh now, but it is something that has happened time and time again in the work place. It is considered abuse and shall not be dealt with lightly as you greatly endanger the lives of those you treat with the possibility of choking, aspiration of foreign objects, pneumonia and infection. All of which can lead to death.
6) Patients are scared and vulnerable they will not complain and when faced with such abuse in fear that they will be left for dead as health care providers hold a lot of power (I am serious). You are playing with life and death in a matter such as this.
Overall. Get someone to feed you with your eyes blindfolded and you will feel how a patient feels when they are being fed. They feel uncomfortable, scared and timid. Understand their position and be patient.
Tuesday, January 22, 2013
Bleeding Walk Through (this won't be lame!)
Okay after my EPIC fail walk through that had little flow what so ever I have decided to try my hand at it again by request. I shall do my best, behold! This is a walk through on how to handle arteriole and venous bleeds.
Check this out for the first few steps in the tutorial.
http://ramblingsofanursingstudent.blogspot.ca/2013/01/basic-steps-before-i-post-any-tutorials.html
Check this out for the first few steps in the tutorial.
http://ramblingsofanursingstudent.blogspot.ca/2013/01/basic-steps-before-i-post-any-tutorials.html
These steps takes place during the ABCs or step 3 in the link above.
1) AVPU
The patient is currently Alert, meaning he consciously knows where he is and what is happening to him. This proves him to be mentally sane and means that he is unlikely to cause any intentional harm to himself and others.
2) Cervical Spinal Injury Consideration
It seems that he has not endangered his spine.
3) General Appearance of the Patient
He seems pale and in distress with rapid panicked breathing.
4) ABCs
Airway is fine since there is no obstruction
Breathing is compromised as he is taking inefficient rapid breaths, in addition his skin looks pale which suggests that he is going into shock or having hypoxia (which is basically shock). We give him non-rebreather mask (NRB) hooked up to an oxygen tank and feed him 10 to 15 L/Second of oxygen to combat shock.
Circulation is compromised as he is suffering a deep gash on his arm resulting in huge amounts of blood loss. Place some dressings on the wound and ask the patient to hold it there for you applying pressure onto the wound. Later wrap it in a bandage (in any way you can, though there is a proper way to do it) directly on TOP of the wound as much as possible. If there is bleeding through the bandage, add another layer of dressing and bandages on top of the previous wraps. Never remove a dressing or bandage once applied.
5) Now call for an ambulance. If you are working with a partner than this step should be done after the General Appearance of the Patient.
6) Take vitals and monitor the patient. Retake vitals periodically to make sure that your patient is getting better or worse as time goes by waiting for the ambulance. Save your vitals in a report and hand it off to the ambulance team.
7) Take history if you have time.
Finished!
Basic steps before I post any tutorials
Know these things whenever you go to a patient! Use the acronyms provided
1) Scene Survey
EMCAP-PE
E - Environment
M- Mechanism of injury
C- # of casualties
A - Additional Assistance (if necessary)
P-PE - Personal Protective Equipment (gloves, mask, hazmat)
2) Patient Communication and Consent
- Introduce yourself
- Obtain patient consent
- Obtain event history (you should always find an answer to, what happened?)
3) Primary Survey (the actions done in all acronyms happen simultaneously) and Treatment.
AVPU (level of consciousness/mental status)
A - Alert
V - Verbal
P - Pain
U - Unresponsive
Cervical Spinal Injury Considerations,
General Appearance of the Patient
ABC (are there vital parts compromised?)
A - Airway - Treat it as needed
B - Breathing - Treat it as needed
C - Circulation - Treat it as needed
CLAP-STICD (evidence supporting ABCs)
C - Contusions
L - Lacerations
A - Abrasions
P - Penetrating wounds
S - Subcutaneous Emphysema
T - Tenderness
C - Crepitus
D - Deformity
Head to Toe examination* see bottom of blog
4) Determine if Transport is needed. Is it too much for you to handle? Find a sufficient reason why and call the ambulance.
5) Take Vitals (if possible)
- Heart rate
- Respiratory rate
- Blood pressure
- Blood glucose
- SPO2%
- Temperature
- Pupils
- Skin
- Glasgow Coma Score
*This is when Medications can be administered or assisted with after pronouncing the 5 rights.
The 5 Rights to medication is in the acronym TRAMP, however I'll teach you TRAMP-E.
T-Timing (is it taken as needed, interval between dosages, can it be taken at this time?)
R-Route (is it by oral, spray, injection?
A-Amount (is it the right amount?)
M-Medication (is it the right medication?)
P-Patient (is it the right person?)
E-Expiration date
If you cannot find answers to ALL of the 5 rights above than you cannot administer or assist someone with their medication.
6) Take History
SAMPLE and OPQRSTU
S - Signs and Symptoms
A - Allergies
M - Medications
P - Past medical history
L - Last meal (this is not a joke)
E - Events leading up to
As part of Signs and Symptoms
O - Onset of sign/symptom
P - Palliative/provocative (what makes it better/worse?)
Q - Quality/Quantity
R - Region/Radiating
S - Severity (on a scale of 0-10)
T - Timing
U - Understanding of what is happening
You're done!
*The head to toe examination may be placed at the very end here since it is unnecessary most of the time and yields little information for most patients. Use it to provide supporting evidence for what you already know.
*Update Jan 25, 2013. Added 5 rights to medication. Grammar fixes in head to toe disclaimer.
1) Scene Survey
EMCAP-PE
E - Environment
M- Mechanism of injury
C- # of casualties
A - Additional Assistance (if necessary)
P-PE - Personal Protective Equipment (gloves, mask, hazmat)
2) Patient Communication and Consent
- Introduce yourself
- Obtain patient consent
- Obtain event history (you should always find an answer to, what happened?)
3) Primary Survey (the actions done in all acronyms happen simultaneously) and Treatment.
AVPU (level of consciousness/mental status)
A - Alert
V - Verbal
P - Pain
U - Unresponsive
Cervical Spinal Injury Considerations,
General Appearance of the Patient
ABC (are there vital parts compromised?)
A - Airway - Treat it as needed
B - Breathing - Treat it as needed
C - Circulation - Treat it as needed
CLAP-STICD (evidence supporting ABCs)
C - Contusions
L - Lacerations
A - Abrasions
P - Penetrating wounds
S - Subcutaneous Emphysema
T - Tenderness
C - Crepitus
D - Deformity
Head to Toe examination* see bottom of blog
4) Determine if Transport is needed. Is it too much for you to handle? Find a sufficient reason why and call the ambulance.
5) Take Vitals (if possible)
- Heart rate
- Respiratory rate
- Blood pressure
- Blood glucose
- SPO2%
- Temperature
- Pupils
- Skin
- Glasgow Coma Score
*This is when Medications can be administered or assisted with after pronouncing the 5 rights.
The 5 Rights to medication is in the acronym TRAMP, however I'll teach you TRAMP-E.
T-Timing (is it taken as needed, interval between dosages, can it be taken at this time?)
R-Route (is it by oral, spray, injection?
A-Amount (is it the right amount?)
M-Medication (is it the right medication?)
P-Patient (is it the right person?)
E-Expiration date
If you cannot find answers to ALL of the 5 rights above than you cannot administer or assist someone with their medication.
6) Take History
SAMPLE and OPQRSTU
S - Signs and Symptoms
A - Allergies
M - Medications
P - Past medical history
L - Last meal (this is not a joke)
E - Events leading up to
As part of Signs and Symptoms
O - Onset of sign/symptom
P - Palliative/provocative (what makes it better/worse?)
Q - Quality/Quantity
R - Region/Radiating
S - Severity (on a scale of 0-10)
T - Timing
U - Understanding of what is happening
You're done!
*The head to toe examination may be placed at the very end here since it is unnecessary most of the time and yields little information for most patients. Use it to provide supporting evidence for what you already know.
*Update Jan 25, 2013. Added 5 rights to medication. Grammar fixes in head to toe disclaimer.
Wednesday, January 9, 2013
On Using Defibrillators
The following content specifically applies to the use of AED (Automated External Defibrillators) which are highly accessible for public use, both for trained and untrained civilians; and health care providers in the event of someone in cardiac arrest.
Frankly that is not possible.
An ECG or electrocardiogram gives enough information for any health care professional to know, (well I'm not assuming everybody, but Physicians, Nurses, and EMRs should definitely know), the hearts current electrical and mechanical activity.
--------------------------------------------------
How does the AED work?
An AED works by placing two paddles, or sticky pads, on the patients chest with the hearts location between the two pads. A 'shock' is delivered and the hearts rhythm is stopped. Yes, stopped. So that the SN (sinus node), the hearts natural pace maker, can restart it and bring the person back to life.
If a patient is 'flatlined' or in Asystole, that means the heart is already stopped. Both electrically (nerve impulses) and mechanically (the actual pumping action). If you shock the patient to make their heart stop when their heart is already stopped, guess what? Nothing happens. Sad truth but it is true.
The only two heart rhythms that can be shocked is ventricular tachycardia (heart beating too fast) and ventricular fibrillation. Both cannot be found without the use of an ECG because they are both identical to Asystole to an untrained person because they do not produce a pulse.
Ventricular tachycardia is when the heart is beating so fast and inefficiently that no blood is being pumped (hence no pulse).
Ventricular fibrillation is when the heart is, this is the easiest I can describe it, is having a spasm attack. Like muscle twitching, but it pumps no blood what so ever (hence no pulse).
An AED will stop the heart and give it a chance to 'reboot' thus saving a persons life.
*Side note, the heart reboots so easily because it kinda has a mind of its own. As long as there is warm fluid present it just starts beating until it dies. That' how heart transplants work. They don't even connect the heart back to the brain, they just connect it to the circulatory system and the patient is A Okay!
If a patient is 'flatlined' or in Asystole, that means the heart is already stopped. Both electrically (nerve impulses) and mechanically (the actual pumping action). If you shock the patient to make their heart stop when their heart is already stopped, guess what? Nothing happens. Sad truth but it is true.
The only two heart rhythms that can be shocked is ventricular tachycardia (heart beating too fast) and ventricular fibrillation. Both cannot be found without the use of an ECG because they are both identical to Asystole to an untrained person because they do not produce a pulse.
Ventricular tachycardia is when the heart is beating so fast and inefficiently that no blood is being pumped (hence no pulse).
Ventricular fibrillation is when the heart is, this is the easiest I can describe it, is having a spasm attack. Like muscle twitching, but it pumps no blood what so ever (hence no pulse).
An AED will stop the heart and give it a chance to 'reboot' thus saving a persons life.
*Side note, the heart reboots so easily because it kinda has a mind of its own. As long as there is warm fluid present it just starts beating until it dies. That' how heart transplants work. They don't even connect the heart back to the brain, they just connect it to the circulatory system and the patient is A Okay!
Tuesday, January 8, 2013
How to make a peanut butter sandwich.
How to make a peanut butter sandwich? If your a patient with Alzheimer'r or Dementia this may be harder than you think.
I saw a wonderful presentation about the disease and its affect on patients. If you wish to view it than view it here http://cleo.uwindsor.ca/uview/pp/D029C8FE11621493/
It's up for public viewing! You may not be able to view it since you may need a student account at the university to access it.
So how many steps does it take to make a peanut butter sandwich? Scroll down to find out!
More than 30 steps! Who would've thunk it? This is how it can be more than 30 steps.
1) Walk down the stairs
2) Turn left
3) Open the door to the room on your left
4) Turn on the lights, by flicking the switch up
5) Walk to the cupboards
6) Get a plate
7) Place the plate down on a table
8) Walk to the refrigerator
9) Grab the bread
10) Put it in the toaster
and etc!!!!!!
If you have Alzheimer's disease or Dementia than missing any of these steps may be confusing to the patient. There are many steps that you don't think of and take for granted. Remember when communicating with these patients always explain the in between steps, a person who agrees to a bath may not make the connection that their clothes need to be taken off before doing so.
I saw a wonderful presentation about the disease and its affect on patients. If you wish to view it than view it here http://cleo.uwindsor.ca/uview/pp/D029C8FE11621493/
It's up for public viewing! You may not be able to view it since you may need a student account at the university to access it.
So how many steps does it take to make a peanut butter sandwich? Scroll down to find out!
More than 30 steps! Who would've thunk it? This is how it can be more than 30 steps.
1) Walk down the stairs
2) Turn left
3) Open the door to the room on your left
4) Turn on the lights, by flicking the switch up
5) Walk to the cupboards
6) Get a plate
7) Place the plate down on a table
8) Walk to the refrigerator
9) Grab the bread
10) Put it in the toaster
and etc!!!!!!
If you have Alzheimer's disease or Dementia than missing any of these steps may be confusing to the patient. There are many steps that you don't think of and take for granted. Remember when communicating with these patients always explain the in between steps, a person who agrees to a bath may not make the connection that their clothes need to be taken off before doing so.
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