NUR 2102 Chronic Care Across The Lifespan B
Question:
She currently has an estimated Glomerular Filtration Rate (eGFR) of <15 mL/min/1.73m2 and is in end stage kidney stage disease. In consultation with her Nephrologist and family members she decided to commence on Continuous Ambulatory Peritoneal Dialysis (CAPD). She had surgery three months ago for the insertion of a Tenckhoff catheter. Her initial post-operative period was uneventful, with no reported complications. Her CAPD has been uneventful up to this point. Mrs Perkins was admitted through the emergency department yesterday with a 2 day history of vomiting and diarrhoea. She has been diagnosed with viral gastroenteritis
Mrs Perkins has been discharged home from USQ hospital following her recent admission for viral gastroenteritis. Her family continue to be very supportive, and assist with attending appointments, medication administration and diet. Until recently, Grace had been managing her fluid balance and weighing herself every morning at 6am. On a recent visit from the community nurse, Mrs Perkins discloses that her mother, who was 92 years old, has recently passed away. She reports this is causing her issues with her treatment. Conduct a focused assessment using the comprehensive health assessment documentation. Using the principles of motivational interviewing and selfmanagement, collaboratively develop a care plan including identification of concerns, goal setting using SMART goals, one short term and one long term goal including interventions to achieve the goals.
Answer:
Gibbs’ reflective cycle inspires one to think analytically about the stages of an activity or experience and one has to use all the headings to structure the reflection. I assessed all the six patients according to Gibbs cycle and found that they had different complication which are as a result of either inheritance or infections from the environment and what they were feeding on (Bassot, 2015). The complications for some patients were out of negligence while for others it is not their fault. According to the assessment the following factors were found to be of great assistance to the patients which helps them to change their health conditions are; getting care and assistance from their relatives, medications, taking meal as prescribed by doctors, body exercise and monitoring their body conditions using various machines. The barriers that inhibit the patient from changing their health status include; ignoring instructions of specialist, negligence or taking things for granted, not taking balanced diet, lack of knowledge about the disease and medication, and stress (Bassot, 2016).
Care and assistance given to the patient by the people they are associated with is of great assistance in assisting them to recover from their sickness. For instance, Mrs. Palmer gets assistance from her sister who stays in the nearby who assist her in her daily duties. In Brett case Josen takes care of her daily by ensuring that she takes the right meal and exercise as prescribed to help her regain her health. In Mr. Abba case, he is helped by his neighbors when he falls and taken to hospital for a specialized attention. The care and assistance given helps the patient to recover quickly. Medications given to the patients helps them to change their health conditions. In Mr. Morris case he takes palliative medication for the purpose of treatment and uses morphine and fentanyl patches to relieve pain. Ryan was given preventive and reliever inhalers to assist him better his health conditions (Davies, 2012).
Taking meals as per the prescription of the specialist assist the body to function properly and to avoid disorders that result from imbalanced diet. Upon treatment of patients they are advised accordingly on the meals to take and the meals to avoid at all cost in order to regain their normal body health. For instance, a patient with diabetes is advised to take food that contains high percentage of glucose to improve his body conditions. Body exercise is another important factor that assist patients with diabetes, obesity and other disorders to change their conditions. For example, Mrs. Palmer has a high weight of 87kgs which can be reduced to a reasonable level through exercise. Mrs. Perkins has obesity which is a disorder that can be eliminated through body exercise (Bevan, Keeley, & Brown, 2015).
There were various barriers that hindered the patients from changing their life regarding their well-being and their health. Some patients were not keen to follow the instructions of the specialist on administration of medicine for treatment purposes hence they cannot change their body health successfully. For example, in Mr. Morris scenario he chose not to take medications and let nature take its course which means he is not likely to get well any soon. Mr. Brett cannot remember the last time when he went for a tetanus injection. He also went for some antibiotics, but took only half and stopped immediately because he felt well and did not consider taking the medicine any more. Taking full dose is recommended because it ensures that the infection is eliminated completely from the body (Paterson, & Chapman, 2013).
Lack of knowledge on medication and negligence also were observed to be hindrances to the patients changing their health status. If a patient does not understand how to use the tablets and machine or neglect some guidelines they will not be able to change the body health status. For example, Ryan’s parents admit that they have a limited understanding of their son’s diagnosis with asthma and the use of the inhaled medications as prescribed. This is a hindrance to Ryan changing his body conditions (Dornan, Littlewood, Margolis, Scherpbier, Spencer & Ypinazar, 2006).
Lack of balanced diet and stress are also other factors that hinder the patient from changing their health status. If an individual take diet that lacks some nutrients he or she is likely to suffer from lack of such nutrients in the body. For instance, Mr. Brett has been able to control his blood glucose levels because he has not been testing his blood glucose level or taking his insulin. Mrs. Perkins has lost her mother and this is affecting her health status and she cannot change her well-being because of stress. I feel that the thing which contribute to patient being unable to change their health is lack of knowledge, ignorance, lack of support and personal preference. The ultimate solution is creation of awareness among the patients on how to manage their conditions (Husebø, ‘Regan, & Nestel, 2015).
The skills acquired include patient management, investigational skills, resuscitation techniques and procedures, health safety and manual handling and finally clinical reasoning and critical appraisal. These skills are of great importance to the nurse professional and will assist me in my line of duty in future. The will assist me in carrying out the necessary assessment for getting the appropriate feedback when approaching a patient (Herrmann-Werner et al 2013). Management of is one of the vital functions in the clinical setup hence requires an individual to have basic knowledge on it is carried out. The skills I have gained when participating in the lab activities will be of great importance when it comes to the management of patients in emergency department and other clinical setup. The skills wills also assist me in data collection and analysis to come up with conclusive result about the patient and the documentation of the information for future reference (Paterson, & Chapman, 2013).
References
Bassot, B. (2015). The reflective practice guide: An interdisciplinary approach to critical reflection. Routledge.
Bassot, B. (2016). The reflective journal. Macmillan International Higher Education.
Dornan, T., Littlewood, S., Margolis, S. A., Scherpbier, A. J. J. A., Spencer, J., & Ypinazar, V. (2006). How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Medical teacher, 28(1), 3-18.
Bevan, A. L., Joy, R., Keeley, S., & Brown, P. (2015). Learning to nurse: combining simulation with key theory. British Journal of Nursing, 24(15), 781-785.
Davies, S. (2012). Embracing reflective practice. Education for Primary Care, 23(1), 9-12.
Herrmann-Werner, A., Nikendei, C., Keifenheim, K., Bosse, H. M., Lund, F., Wagner, R., … & Weyrich, P. (2013). “Best practice” skills lab training vs. a “see one, do one” approach in undergraduate medical education: an RCT on students’ long-term ability to perform procedural clinical skills. PloS one, 8(9), e76354.
Husebø, S. E., O’Regan, S., & Nestel, D. (2015). Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Paterson, C., & Chapman, J. (2013). Enhancing skills of critical reflection to evidence learning in professional practice. Physical Therapy in Sport, 14(3), 133-138.
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