ADMISSION OF A 93YEARS OLD FEMALE.
A 93years old female is brought in by ambulance due to mechanical falls at home while going to the bathroom. Primary diagnosis left hip dislocation .Secondary diagnosis: Hypertension hyperlipidemia, heart burn.Plans: Pain control ,use of incentive Spirometry 1hour while awake. Left hip fixation with DHS.( Dynamic Hip Screw) Dressing to the left hip intact. Physical therapy evaluation and treatment. Dangle feet at bedside. WBAT(Weight bearing as tolerated).SCD right lower Extremity. Physical therapy ambulate with patient. Discharge plan: Patient will be discharged to SNF with parameters. Keep wound clean and dry. Follow up with laboratory tests, procedures and treatment. Follow up with Orthopedic surgeon in ten days.Medication while in hospital are Coreg,Hydrochlothyzide, Lovenox 30mg, Rocephin 1gm,Ambien, morphine 2mg IV Q6hours,Norco 10/325mg Po Q4hours prn pain. Tylenol 650mg po Q6hours prn temperature.
August 22, 2021
DISCHARGE PLANNING/ INSTRUCTIONS.
Patient discharge starts upon admission. The patient will be informed early during their care process about their discharge to go home, or Skilled Nursing Facility or transfer to another hospital, or discharge to hospice. Patient discharge planning will include how patient can manage symptoms at home,pain medications, nausea/Vomiting medication, blood pressure medications. The emotional needs and support addressed. Transportation needs, family pick up or ambulance service pick up.Patient discharge to go home is done by the doctor atleast a day before the date of discharge and the nurse will initiate it a day early to make sure that patient discharge needs are met.Written instructions will be given to patient and family.No medical abbreviations on the discharge teaching.Medications reconciliation done. Do not tamper with medical records. Don't criticize other healthcare professionals in your charting.Enter all information in a complete relevant, accurate and factual manner. Avoid bias from written description of others. In discharging a patient with stroke for example educate patient on a healthier lifestyle. For example stop smoking( Recommend gums)reduce alcohol intake ( Give your patient phone number for AAA anonymous),reduce stress, take your medications as ordered, get 30minutes regular exercise every day. Take your medications as prescribed by the doctor. Check your blood pressure regularly document findings and take it to next doctor appointment. If patient is transferred to another hospital or Skilled Nursing Facility arrangement will be made for ambulance service to pick patient to the new facility or hospital at a specific time.Patient must must be cleaned and ready to go to the new facility with all patient belongings. Information about patient fax to the new facility. When ambulance arrive nurse will give report to the EMT team that came to pick up the patient. Case manager is the healthcare professional that made arrangements for the transfer according to the doctor orders.
August 05, 2021
ADMISSION THROUGH EMERGENCY ROOMS.(THREE CASE SCENARIOS. EIGHT YEARS OLD,69YEARS MALE AND 70YEARS)
Admissions of patients using three case scenarios. Eight years old boy is brought into Emergency room due to pain in left ear and fever.Upon arrival to Emergency room triage and place in room D.Vital signs done temperature 103.2.Saline lock started IV fluid given 0.9NS bolus 500ml,antibiotic IV given ,tylenol 15ml liquid suspension given po.Recheck temperature 97.6.Doctor gave prescription of Agumentin and tylenol. Patient and his mother receive a printed education materials through Krames upon discharge and is asked to follow up in two weeks with his Pediatrician but mother said that her son has no Pediatrician. The nurse gave her a list of Pediatricians and ask her to choose one,call and follow up in two weeks. So they left.He was not admitted. The next case SCENARIO is a 69years old man with facial tumors who went to surgery from Emergency room for Excision of tumors.The third case scenario is a 70years female with ejection fracture of 40%, came in due to left hip dislocation.(Fell at home) Patient will be admitted to Trauma Unit.
August 03, 2021
People enter the hospital settings to become a patient for various reasons. The first place of contact is Emergency department or nursing unit where they will be screened. Patients will be triage.All parients(clients)require care but the will not have the same kind of care.Here are some examples: A lady came in with high blood pressure. Her blood pressure was stabilized and she got her blood pressure medication and discharged home. A 35years old man is brought in by ambulance due to motorcycle accident, he has brain injury. He was rushed to surgery. Craniotomy done ,he is transferred to ICU.In ICU after few days he started to recover from the acute phase of the accident. He was then transferred to trauma floor. He worked slowly with physical therapist and occupational therapist. He will be transferred to special rehabilitation center to fully recover. When patients come to the emergency room the staff will gather information from patients such as Your full name ,address, date of birth, name of the admitting doctor, gender,marital status, occupation, insurance, employer, religion preferred, date and time of admission, identification number, admitting diagnosis. Print out the information which will become patient permanent records. After the paperwork and stabilization of patient .The patient will be taken to the assigned floor.The nurse should establish nurse patient relationship. The nurse must act not only as a professional but as a person that cares about patient and their family. The admission period is the orientation phase.
August 01, 2021
CRITERIA FOR ADMISSION AND APPROPRIATE UNIT TO BE ADMITTED TO.
When someone is sick and comes to the hospital ,their first contact with the hospital is the Emergency room or Nursing unit.There patient will be screened and determined what unit that he/ she will go to.The hospital unit have criteria that will define the scope of care and the appropriate population for admission. The decision to admit a patient is based on patient needs and the hospital ability to provide those needs. If the hospital cannot provide those needs then patient will be transferred to another facility. And information about patient will be shared with that facility. These will include reasons for transfer.And summary of care already provided. We must provide privacy. Access only the medical information that you will need to do your job. Do not share password, shut computer after use.Do not share information of patient in a nonworking area such as the elevator. To take good care of our patients, it is important to recognize the communication needs. What language does patient speak. Do we need interpreters or the blue phone( Cyracom International- commercial telephone interpretation services).
July 31, 2021
HOW TO PROVIDE EXCELLENCE SERVICE.
Provide excellence service.Dress up in your nursing uniforms, looking professional. Use AIDET: Acknowledge, Introduce, Duration, Explanation, Thank you.Acknowledge your patients and families. Make eye contact. Offer services of what you will be doing before they are asked.Be positive and take time to show common courtesy. Be the solution and not the problem. Be respectful and totally present with your patients. Turn off phone when you are with your patients. Go above and beyond. Collaborate and cooperate the other healthcare workers. Show concerns about patients and their families. Provide updates to patients and families. Be able to answer simple questions. Manage each other well.Provide patients with using the rest room, urinal or bedpan, pain medications and personal belongings. Be respectful and non-judgmental about age,race,sexual orientation, ethnicity or health problems. Always thank the patient before leaving the room and let them know when you will return.
July 30, 2021
LOVE IS PATIENT, LOVE IS KINDNESS- MAKING UNHEALTHY RELATIONSHIP HEALTHY.
Love is patient, love is kindness, it does not envy, it does not boast, it's not proud.It does not dishonor others, it is not self seeking, it is not easily angered. It keeps no records of wrongs- 1Corinthians 13:4 - 5.Do you have these numbers: Alignment of communication. That is communicating in agreement. Caring .Compassion and Respect. What are men obsessed about?.What are men thoughts that are hidden away from women. What are women thinking. TEN FACTORS THAT CAN AFFECT A RELATIONSHIP. 1.Poor Communication 2.Lack of respect and disregard. 3.Lack of trust. 4.Age difference. 5.Emotiomal Manipulation. 6.No motivation or Support. 7.Selfisness.8.Postponement of intimacy. 9.No support in your toughest time.That is he/ she does not support your thick and thin.He/ she has a lukewarm attitude towards you. 10. Suppression of your initiatives.
July 27, 2021
MAKING UNHEALTHY RELATIONSHIPS HEALTHY.
Two are better than one,because they have good return for their labor. If either of them falls down one can pick up the other. TWELVE QUALITIES OF A GOOD RELATIONSHIP. Open snd frequent communication. Don't hide anything from your partner. Alignment in communication is very important. Make unhealthy environment healthy by been compassionate, show affection. Learn to trust your partner. If there is no trust there is no relationship. Be interested in what your partner is doing. Limit time apart. Playfulness and lightheartedness are important condiments in a relationship. Physical intimacy. Find your partner attractive. Teamwork. Your partner is your teammate. Separation anxiety is normal. Comfortable with your partner. Caring and willing to provide tender loving care. Do not be emotional drainer in the relationship. There is no problem until someone creates problem then there is a problem.
July 27, 2021
WHEN IS NUTRITION ASSESSMENT DONE?.
All patients should be screened during admission. Nutrition assessment should be done upon admission during nursing assessment. All patients that are identified as high risk are assessed by the Registered Dietitian within 24hours to 48hours. These include patients with chewing and swallowing problems, skin problem, CHF,Decubitus ulcers, Diabetes.
July 25, 2021
ISOLATION PRECAUTIONS OF BODY SUBSTANCES.
It is the responsibilities of the nurse to assess, plan, implement the appropriate Isolation precautions. So be proactive. First and foremost you must assume that every patient is infected no matter their diagnosis. This precautionary measures should be everyone responsiblity. These are as follows. Handwashing and avoid long fingernails which can harbor infection. Wear gloves when coming in contact with body fluids, mucous membranes, open wound, saliva, blood, vagina secretions and faces.Wear mask and eye protective gears. Uncapped needles, capped needles and all sharp instrument should be placed in a punctured proof container. Isolation gowns. It is important to wear Isolation gown when coming in contact with body substances. Gown should be worn once and discarded .Soiled linens properly secured and transported to laundry room for washing. There are soiled utility room in each unit and in every hospital. Trash are secured and properly disposed of.
July 25, 2021
WHAT ARE STANDARD PRECAUTIONS?.(UNIVERSAL PRECAUTIONS)
Standard precautions:This is the minimum or the least or smallest infection prevention practices that apply to all patient care regardless of if infection is suspected or confirmed. Standard precautions protocols are applied to every patient interaction. Perform hand hygiene each time before touching your patient.Follow your facility policy and procedures on Standard precautions.
July 23, 2021
NURSES WITH DISABILITIES. (MY PERSONAL EXPERIENCES PERSPECTIVE )
Www.NATIONALNURSESUNITED.ORG Nurses are human beings and should be treated like human beings. They cry,laugh, hurt and develop health problems just like any other human being.
July 22, 2021
IMPORTANCE OF NURSING PROCESS.
There are five steps in the nursing process. These at assessment,Diagnosis, Planning,Implementation and Evaluation. Nursing process is a series of steps, procedures or actions that you (Registered Nurse)will take to reach a particular end result. Without using the nursing process to take care of patients, evidenced based practice will become difficult to achieve. The main purpose of nursing process is to help the nurse manage the patients physically, emotionally and holistically. So you will need to follow the five criteria of nursing process to do a good job in taking care of your patients. These five criteria of Nursing process are Assessment, Diagnosis, Planning, Implementation and Evaluation. Nursing process achieve for the patient evidenced based practice, individualized plan of care, holistic care and continuity of care.
July 20, 2021
PATIENTS BELONGINGS. WHO IS RESPONSIBLE. (IN MY PERSPECTIVE)
When you the nurse admit a patient. Patient belongings are very important to address. Some items might need special care.You have to itemize everything that patient brings to the hospital. If a reliable family member is there encourage them to take the items home.There is a place in the patient Checklist to enter date of admission and department after checking all belongings that correspond to what the patient brings in. Patient belongings does not go to ICU,call famiily to pick up items. Follow your facility policy and procedures. When patient is transferred to another floor,patient belongings goes with them.Read about save keeping. Please listen to my Podcasts for details. Thank you for your time and cooperation.
July 19, 2021
NURSES RESPONSIBILITIES WITH MEDICATION ADMINISTRATION.
The first action will be to gather equipment such as medication KARDEX or review in the Meditech,medication Cart or tray,medication cups,water, ice water, applesauce, pill crusher ,applesauce, pill crusher and straws. Check doctor orders. Assess patient for understanding the purpose of medication. Education patient on medication administration. Prepare the medication to be administered as ordered.
July 18, 2021
QUESTIONS AND ANSWERS ON MEDICATION SAFETY.
(1)How do you explain high alert drugs?.The drugs that are most likely to harm (injury)or kill the patient if given wrongly. There are five questions and answers. (2) Which of the following can lead to errors among health care professionals when administering medications?.(a)A look alike and sound alike medication.For example Clonidine, Klonopin. )b)Availability of high concentration of medication. (c)Medication with similar package color,shape and size.(d)Above of the above is correct. The correct answer is D.
July 16, 2021
Improve the authenticity of patient identification. Use two identifier and and date of birth.(Don't use room number. What is medication errors?.It is a preventable event that can cause or lead to harm or death of someone due to inappropriate use of the medication by health care professionals. List of medication errors. Prescription errors. Unauthorized use.Omission errors. Wrong time and wrong dosage. Giving of expires drugs. Improper drug storage. Noncompliance and Adverse reactions should be reported. Medication errors should be reported to the risk management department, your manager and your Nursing Supervisor. Follow your facility policy and procedures.
July 16, 2021
COMPLETION OF QUESTIONS AND ANSWERS ON MEDICATION ADMINISTRATION FROM NUMBER 23 TO 33.
Questions and answers on medications administration and rationales from number 23 to number 33.
July 16, 2021
CONTINUATION OF QUESTIONS AND ANSWERS ON MEDICATION ADMINISTRATION.
Questions and answers from 11 to 22.Question (11) Before administering Doxorubicin hydrochloride (Adriamyycin)IVP to a patient with breast cancer. The nurse will identify. Answer: The patient using her ID and also asking patient her name.Rationale: Appropriate identification of the patient is the first priority after the doctor orders has been verified.
July 15, 2021
QUESTIONS AND ANSWERS ON MEDICATION ADMINISTRATION.
Patient is discharged from the hospital on oral ferrous sulfate therapy. When see in the clinic two weeks later.Which of the following information is important for the nurse to obtain?. Answer: What is the characteristic of your stool?.Because constipation is the common side effects of ferrous sulfate.The nurse will also encourage patient to take medication with orange juice orange juice for better absorption
July 15, 2021
CASE SCENARIO (NURSING)MEDICATION ADMINISTRATION QUESTIONS.
There are ten GOLDEN RULES of medication administration safety. There has to be doctor's orders. First,administration of the right medication. Remember that some medications look alike and sound alike. So administer the right medication to the right patients. Make sure that medication is not labeled with another patient name. Check the ID band.Third right dosage. Fourth Administration through the right route. Fifth the right time.Sixth Education on what they are receiving. Seventh get a complete patient medication history. Know all the medications that that your patient is taking and provide safety. Eight find out if patient is allergic to any medication.As a nurse know the DIFFERENCE BETWEEN ALLERGIC REACTIONS AND ADVERSE REACTIONS. Adverse reaction is Pharmaceutical, controllable even though problematic. Allergic reaction is not pharmacological rather a Chemical reaction. Nine,medication and food interactions. For example Dilantin will increase liver metabolism. So it can lower the drug levels of other medications. Seniors are at a greater risk for drug interactions. Tenth.The right documentation of the medications is very important. If it is not documented it is not given.So document properly.
July 15, 2021
THE RULE OF 15.
Have you heard of the rule of 15 as a Registered Nurse or as a diabetic patient?. The rule of 15 is for low blood sugar. The blood sugar is less than 60.Give 15gram of rapid carbohydrate. Three tablespoonfuls of mix sugar in water, or 3 hard candies if patient is awake or give 4 glucose tablets ,soda or milk.In the hospitals the doctors will have a standing orders of 50% Dextrose. Wait for 15minutes, recheck blood sugar, if result is between 60 and 90.Give snacks consisting of protein, carbohydrates and fat.If it is still below 60 repeat the 15gram carbohydrate and recheck sugar in 15minutes. Take care of your blood sugar levels don't let it be a pattern.
July 10, 2021
HYPOGLYCEMIA AND HYPERGLYCEMIA. THIS SIMPLY MEAN LOW BLOOD SUGAR AND HIGH BLOOD SUGAR.
Hypoglycemia symptoms are low blood sugar, shaking, sweating, hungry, dizziness, impaired vision,irritability, fast heart beat, weakness. What causes hypoglycemia. 1.Taking insulin injection or pills without food.2.Too much diabetes medications. What is the solution?.Make sure that you have enough food ready on your table before taking insulin injection or diabetes pills. If you find yourself in this situation drink a glass of milk or orange juice or sweet candy. Recheck blood sugar in 30minutes. Follow the 15minutes rules of low blood sugar. Hyperglycemia (High blood sugar)is the opposite of hypoglycemia. It is eating too much too much food with little insulin or diabetes pills. Because your pancreas does not produce enough insulin so that the sugar in your blood will be chased to your cells. So the sugar stays in your blood. Little insulin will not be enough. Stress or sickness can ma kn e your blood sugar levels to be high.So you need insulin to move the sugar into your cells to give you energy. So that you will feel better or really good. The signs and symptoms will start gradually and might lead into Diabetic coma.Here are what you will experience extremely thirsty, hunger, frequent urination,decrease wound healing, blurred vision, drowsiness. If your sugar remains high like over 200mg/dL. Call and follow up with your doctor. Don't allow your diabetes to be an Emergency situation. Hip,hip hooray. You can manage your blood sugar.
July 09, 2021
WHAT IS DIABETES?.
Diabetes is a disease in which the body lacks the ability to produce insulin or use insulin properly. What is insulin?.Insulin is a hormone that is needed by the body to convert glucose, sugar or starches into energy. So this glucose or sugar sits in the blood and does not go to the cells for energy. So your blood sugar levels remain high but you are weak and lack energy. The cause of diabetes remains unknown. But according to research the major causes of diabetes are genetic factors, lack of exercise, obesity, and environmental factors. There are four types of diabetes. Type 1( IDDM),Type 11 (NIDDM)Gestational diabetes and Prediabetic.
July 09, 2021
I AM A DIABETIC. SHOULD I LOVE ALCOHOL.
Should I love alcohol. No you don't have to love alcohol. Because alcohol don't love you. Your question should be can you drink alcohol. Yes you can drink in moderation. Is your diabetes under control. Everything is always good with moderation. Talk to your doctor about how many to drink and what to drink. If you can do not drink alcohol. If you must MODERATION is the KEY.Follow your doctor orders.
July 08, 2021
I AM DIABETIC CAN I STILL SMOKE?.
I know that you wanna be cool. Smoking is not good for diabetes. Smoking will make your sugar higher. Bad idea for diabetes. Not good for legs and feet. Smoking is not good for the nerves. So if you wanna be cool do something else.Not good for your vision. I know that you wanna be cool. I am sure that it is not good for your libido. Check with your doctor.Reach your A1C target and maintain it.How cool are you when you worsen your kidney disease.
July 08, 2021
AS A DIABETIC CAN YOU DANCE.
Episodes with music are only available on Spotify.
Yes you can dance .Eat three balanced meals a day. What music do you love to dance?.Rocky, country music. I love them all.If you cannot dance ,sit down move your head,your hands and legs.Yes you can do it.Manage yourself and I will manage myself.
July 08, 2021
AS A DIABETIC CAN I DANCE.
Yes you can dance.What music do you like?.I like some slow music, country music like Dolly Parton. Dancing is exercise. Any music is great. Check your blood sugar. Smile and be happy. It is not bad.Eat a balanced meals three times a day.Give your insulin in your lower abdomen or outer thigh. Maintain good blood sugar. Are you ready to dance.Move your hands and your legs. Dance only if you can dance.If you cannot dance just sit down and shake your head, move your hands. It is not a must but a choice. Manage yourself and I will manage myself.
July 08, 2021
May 12, 2021
May 12, 2021