What are some of the cultural factors that you would need to consider when you are delivering care to Billy?
The cultural indicator that the nurse should consider is the person’s aborigine culture. Being an aborigine patient, the nurse should first consider the importance of family attachments and assess any manifestations of anxiety. Aborigine patients are sensitive to care handling especially those that do not belong on their same league. According to McGowan (1998), due to the racial discrimination against their indigenous tribe, aborigines have acquired a social implicated anxiety; hence, it is important to consider providing safe and comfortable atmosphere for the patient in order to reduce their anxiety (p.347).
List five factors that have contributed to the health status of Aboriginal people today
The five factors that are currently affecting the health status of Aboriginal people are (1) age (e.g. degenerating diseases, etc.), (2) poverty (e.g. unable to obtain health care needs due to financial constraints, etc.), (3) racism in their society (Aborigine versus White Australians), (4) feelings of societal rejection and discrimination, and (5) health policies implemented in their local health system.
Why it is important for you as a health professional to be aware of these factors and what can you do to reflect cultural safety in your workplace and professional relationships?
The age of the patient is an important consideration in the overall process of health care planning. According to McGowan (1998), older aborigine patients are prone to degenerative diseases related to their lifestyle and cultural practices (p.347). Meanwhile, poverty defines the capacity of the patient to correlate and apply the health care interventions (e.g. diet requisites, supplements, etc.). Lastly, the societal implications towards their race need to be considered by the nurse as well. Trust and collaborative actions in nursing care should be conducted in order to facilitate the patient’s ease towards the health care provider. These factors can greatly affect the response of the patient towards the health care interventions directed to his condition. Finalize
When you are assessing Billy’s wound, what signs and symptoms would you expect to see with an infected wound?
Considering the area of Billy’s wound, the large ulcer is expected to (1) contain minimal to moderate amount of pus, (2) release foul odor, (3) manifest redness in the areas surrounding the wound, (4) swelling in the area of the wound and (5) presence of warm temperature in the area.
You notice that the skin above the wound is inflamed and hot to touch almost up to his knee – what is the correct medical term for this?
Such condition relates to a chronic inflammation wherein a progressive shift of inflammation occurs from the injured area to the nearby sections of integument as evidenced by erythema, edema and warm temperature in surrounding pedal skin (Garner and Klintworth, 1994 p.87).
Using your knowledge of anatomy and physiology and pathophysiology, give a brief outline on diabetes and what organs or systems are affected
Diabetes is characterized by the cell’s impaired absorption of glucose due to faulty insulin receptors. Consequently, glucose in the body stacks in body fluids, such as lymph, blood and interstitial spaces. Hyperglycemic conditions among diabetic patients alter fluid consistency causing it to increase its viscosity. In such condition, Billy’s peripheral vascular disease may get worse due to the increased vascular pressure being exerted by the blood against arterial walls. Furthermore, even though increased thirst sensation is being triggered by the body to increase fluid intake, the effect is only nullified by diabetic polyuria, which consequently declines fluid content in the body and eventually contributing to the blood viscocity. Blood circulation is compromised, body oxygenation and healing are also impaired; hence, with the decreased circulation in pedal area of Billy, wound healing is unlikely to occur in its normal phase, which may eventually trigger wound gangrene or cellular necrosis (Edmonds and Foster, 2005 p.125).
The Dr has asked you to tae Billy’s pedal pulses. Where would you expect to find these?
In the foot, the pedal pulses to be palpated are the posterior and anterior tibial and dorsalis pedis. The dorsalis pedis pulse is palpated lateral to the extensor hallucis tendon at the base of the first metatarsal, while the anterior tibial is at the front of the ankle, and posterior tibial is located below and behind the medial malleolus (Lorimer, Neale and French, 2001 p.33).
You have difficulty locating the pedal pulses, what is the name of the machine that you could use to assist?
Another instrument that can be used to assess the pedal pulse is the Pedal Doppler, which is usually used to detect the shift in ultrasound frequency that results when the transmitted beam is reflected off moving particles within the vascular region (Lorimer, Neale and French, 2001 p.33).
Review Billy’s history – what condition has contributed to the difficulty in finding his pedal pulses?
Two possible conditions of Billy can contribute to Billy’s weak pedal pulse, specifically (1) the impaired pedal circulation due to increased blood viscosity and (2) the condition of peripheral vascular disease.
Using your knowledge of anatomy and physiology and pathophysiology, describe the condition above
Due to the increased solute (glucose) levels in the blood, the consistency becomes thick and viscous causing the slow phased circulation especially in the pedal region. In addition, his peripheral vascular occlusions further block the blood flow decreasing its net pressure. Eventually, by the time blood arrives in the pedal section, the pressure is not anymore that strong to be assessed by palpation.
What impact will this have on the healing time for Billy’s wound and why?
Considering the most important contents of the blood – Hemo and oxygen, which are responsible for promoting healing in the area as well as the delivery of cellular repair constituents (e.g. neutrophils, platelets, etc.), healing time is likely to decrease its phase. If this is not prevented, the tissue surrounding the wound may undergo necrosis or cellular death, and eventually precipitates the wound to gangrene conditions with chronic inflammation and infection (Edmonds and Foster, 2005 p.125).
The Dr has ordered 4/24 normal saline compresses for Billy’s wound. Describe the difference between a normal saline compress and a simple dressing
Normal saline compress contributes to the healing process by maintaining the wetness and moist in the wound area. In addition, saline compresses exert an appropriate pressure to the wound facilitating the absorption of lymph and other discharges that can induce infection. On the other hand, simple dressing only covers the wound area but does not prevent the wound from flaking and drying, which further blocks the portals of discharges and eventually increasing the risks of infection (Falanga, 2001 p.251).
What is the main reason for doing normal saline compresses and what outcome are you hoping to achieve?
The primary rationale for using saline compression is to promote wound healing and to prevent the portals of discharge from closing. In these conditions, the nurse expects improvement in the patient’s wound as manifested by the quick healing process, low risk of infection and establish comfort on the part of the patient.
The Dr has inserted an intravenous bung for IV antibiotics. One antibiotic has been ordered BR and one has been ordered 4/24. Using your knowledge of medications, explain why it is necessary for medications to be given at different frequencies
The administration of antibiotic medication depends on four considerations, specially (1) the generation of the antibiotic, (2) half-life, (3) dose requirement and (4) response of the body towards the medication. Physicians must accurately prescribe the dosage of medication in accordance to appropriate time frame to prevent the surge of drug complications, accumulation of medication in the body (overdose) and increase the drug efficacy.
You walk into the room not long after Billy has had his first dose of antibiotic commenced via the drip. He is experiencing difficulty in breathing and appears very unwell. What would you suspect?
Billy must be experiencing a drug complication called anaphylactic reaction, which implies that the drug – antibiotic – administered to him is causing an allergic response to his body.
What action would you take?
Such situation is considered risky and requires prompt nursing intervention, particularly (1) turn off the drip set or IV infusion, (2) report this to the nursing supervisor or the physician, (3) assess the patients for signs and symptoms associated to the condition and (4) document all the findings. If in case the doctor has prescribed STAT antidote for potential reaction, the nurse may immediately administer such medication. However, if there is no STAT antidote prescribed by the physician, the nurse should perform these interventions and check for the documented skin test result to compare.
Billy asks you what the antibiotic is for and how it works. How would you explain this to him?
The nurse must answer Billy using only the common and simple terms, “antibiotic is a type of drug usually prescribed for patients who have signs of infection. This is the condition wherein bacteria or microbes invade the body via a portal of entry such as wounds. During the course of the treatment, the patient needs to complete the prescribed frequency of administration in order to maintain the drug’s effectiveness.”
The Dr has ordered Billy strict RIB. Billy wants to go outside for a smoke. He is becoming quite anxious and is trying to get out of bed to go outside. He tells you that if he can’t he’s going back home. How would you deal with this situation and advocate for Billy?
Since smoking is not allowed in the hospital premises and not appropriate for Billy’s condition, the nurse can facilitate his/her advocacy by negotiating with Billy. The nurse may suggest to take Billy outside to relax and reduce is anxiety provided that he will refrain from smoking. It is important for the nurse explain the reason for preventing him from smoking. In addition, the nurse should help the patient to internalize the possible source of his anxiety.
A wound swab from Billy’s wound has come back as MRSA positive. What does MRSA stand for?
MRSA, stands for Methicillin-resistant Staphylococcus aureus, is a bacterium responsible for difficult-to-treat infections among humans.
What further action would need to be taken when caring for Billy with MRSA?
The nurse needs to consider utmost cleanliness and infection precautions to prevent the progression of Billy’s condition. The nurse needs to stress the importance of effective doctor-patient-nurse communication for possible concerns. The nurse should perform precautionary measures when assessing the patient (e.g. gloving, hand washing, etc.). If the wound is infected with MRSA, the nurse should keep the area covered to prevent dissemination of MRSA into the environment. Lastly, administer the MRSA protocol as prescribed (Brooker and Nicol, 2003 p.225).
As Billy is strict RIB the Dr has commenced him on SC Heparin. What complications are they hoping to prevent?
Since Billy is under RIB and possess diabetes as well as Peripheral Vascular disease, the chances of forming blood clots are increased tremendously. Heparin is an anti-coagulant drug that prevents the formation of blood clots that can occlude in Billy’s peripheral and central vessels.
What group of medications would Heparin is classified under?
Heparin is classified as a highly- sulfated glycosaminoglycan drug that belongs to the family of injectable anticoagulant.
Whilst you are on the ward a nurse has come to you and asked you to administer IMI Morphine to one of her patients. What would you do in this situation and why?
If such situations occur, the nurse should first consider the principles of medication administration. Such scenario illustrates a very delicate example of nursing ethics that involve potential liabilities towards both nurses if the administration of drugs has been compromised. American Nursing Association (ANA) and the standard guidelines for medication administration impose that the nurse who prepared the drug should also administer the said preparations towards the patient. This is to prevent potential liabilities and professional breach of tasks towards the alternate drug administrator especially if the drug preparation is proven to be incorrect or problematic (White, 2001 p.471).
Billy’s blood results have come back and show he has a low potassium level. What is the correct medical term for this?
The correct term for such condition is hypokalemia wherein an electrolyte disturbance on the body’s potassium level occurs causing it to decline lower than 3.5 mEq.
The Dr has ordered 1 Liter of Normal Saline with potassium chloride as an additive. What special precautions need to be taken when administering potassium intravenously and why?
Four important considerations and precautions need to be assessed prior and during the administration of potassium IV, particularly (1) consider the administration if urine output is at least 40 to 50 ml/hr; (2) never provide potassium chloride in its undiluted form since it can induce arrhythmia and cardiac arrest, (3) do not administer more than 40 mEq of potassium in any one hour or more than 200 mEq in 24 hours; and (4) the concentration of potassium in IV administration should not exceed to 40 mEq/L (Chand, 2000 p.353).
Two days after admission when you are checking the insertion site for the intravenous cannula, you notice the area is reddened and Billy states that it is very sore. What action would you take?
Such condition of the patient is likely associated to phlebitis or inflammation of the IV insertion site. If inflammatory signs and symptoms appear, the first action that the nurse should consider is (1) stop the IV drip to prevent further inflammatory response, (2) assess the area for pain, discomfort and temperature, (3) inform or endorse the physician or nurse supervisor about the disconnection of IV set, and (4) documents the entire procedure done. In addition, the nurse may relocate the IV insertion site depending on the most appropriate site available.
When you are doing Billy’s dressing, you notice he appears very uncomfortable and appears to be in a lot of pain. How would you assess Billy’s pain?
The nurse should first conduct a prompt and critical assessment on the patient’s wound site. It is important for the nurse to note possible presence of (1) inflammation, (2) erythema, (3) pus and/or discharges, (4) odor and (5) feeling of warmth. If these conditions are present, the nurse should assess the surrounding area for edema, extent of redness and the surrounding tissue. Afterwards, the nurse should check the start for possible STAT pain relievers prescribed by the physician. If none, the nurse should utilize every possible nursing interventions aiming to promote the comfort of the patient, reduce anxiety, etc. After the series of interventions and assessment, the nurse should report the incident to the appropriate nursing head and/or the physician.
What strategies could be implemented to ensure Billy’s comfort whilst doing his dressing?
Strategies that the nurse can implement during dressing procedure include (1) applying sterile swabs on the plasters of the old dressing to facilitate its quick removal, (2) promote communication between the self (nurse) and the patient, (3) provide diversional activities that will redirect the focus of the patient, and (4) provide prescribed local anesthesia or pain reliever depending on the severity of pain and jurisdiction of the physician.
References
Brooker, C., & Nicol, M. (2003). Nursing Adults: The Practice of Caring. New York, U.S.A: Elsevier Health Sciences.
Chang, D. W. (2000). Clinical Application of Mechanical Ventilation. New York, U.S.A: Thomson Delmar Learning.
Edmonds, M. E., & Foster, A. V. (2005). Managing the Diabetic Foot. New York, U.S.A: Blackwell Publishing.
Falanga, V. (2001). Cutaneous wound healing. London, New York: Informa Health Care.
Garner, A., & Klintworth, G. K. (1994). Pathobiology of Ocular Disease: A Dynamic Approach. New York, U.S.A: Informa Health Care.
Lorimer, D. L., Neale, D., & French, G. J. (2001). Neale’s Disorders of the Foot: Diagnosis and Management. New York, U.S.A: Elsevier Health Sciences.
McGowan, K. (1998). The Year’s Work in Critical and Cultural Theory: 1995. New York, U.S.A: Blackwell Publishing.
White, L. (2000). Foundations of Nursing: Caring for the Whole Person. New York, U.S.A: Thomson Delmar Learning.
