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Managing Blood Loss

Describe about the Complex Nursing Care for Drug Alternatives .

All the blood spots on his clothes should be removed using detergent and it should be sterilized using disinfectant. Disinfectant used should be alcohol and formaldehyde. Don’t allow Mr Barber to wear clothes with blood stains. Discard immediately syringes and needle used for Mr. Barber. Surface of the floor should be disinfected, where Mr. Barber vomited. Bedding of Mr. Barber should be changed twice a day (Glen Mayhall, 2013).

List of PPE : Gloves, mask, eye protection, face shield, gown and linen.

Barber’s heart rate is little more than normal heart rate which is called tachycardia, he also has shallow breathing which is littler more than normal which is called tachypnea and his blood pressure is little less than the normal blood pressure. These all vital signs directly correlate with the blood loss in Barber which is called hypovolemic shock. As all these vital signs are slightly deviated from normal values with ADDS score of 1 (Talley & O’Connor, 2013).

Ondansetron is medication specifically used for the prevention of nausea and vomiting. This medication can be administered both by oral route and intravenous route. It exhibits its action by acting as antagonist of serotonin 5-HT3 receptor with less affinity for dopamine receptor. Occurrence of these 5-HT3 receptors is on vagal nerve terminals peripherally and in the chemoreceptor trigger zone of area postrema centrally.  Enterochromaffin cells of the small intestine release serotonin and this serotonin stimulates vagal afferents by acting on 5-HT3 receptors which stimulates vomiting reflex.  Thus antagonizing effect of ondansetron on 5-HT3 receptors results in the stimulation of vomiting reflex (Christofaki & Papaioannou, 2014).

Mr. Barber has rapid heart rate. Due to rapid heart rate, P waves are hidden in the preceding T wave and it produces camel hump appearance (Gertsch, 2013).   

3.

MRN: 0598371

Family Name: Barber

Given Name: Frederick

Date of Birth: 2/3/1931

S

I am EN Ms.A in Emergency ward.

I am mentioning about Mr. Barber.

I observed that Mr. Barber has haematemasis, epogastric pain, high pulse rate and respiratory rate, low blood pressure.

B

Mr. Barber was admitted to emergency department on 6/3/2013 at 8 p.m. with haematemasis, epigastric pain.

Mr. Barber had Diverticulitis, Emphysema, Ischaemic disease, osteoarthritis and morbid obesity.

There is no change in his condition.

A

I think his blood vomiting is still there. He is taking medication to stop vomiting, however it is not stopping.

I have given him IV fluids and analgesic drugs.

R

It is recommended that, he should undergo gastroscopy.

(Porche, 2008)

What do you think, who are the most suitable people to take your wife in your absence? Is she would be fine with neighbors or he would like to call upon his relatives who can better understand her feelings and her condition. Whether you required any trained personnel to take care of your wife because, with this nursing staff she would be holistic nursing care.

Is there any cultural hindrance in your community to share medical condition to the health care professionals? Because sharing exact medical condition is very important in nursing practice to make effective nursing care plan.

Administering Ondansetron Medication

Is there requirement to arrange prayer of God for his wife?. Because due to prayers there is the possibility she may get peace of mind and freedom from fear and anxiety (Yousefi & Abedi, 2011).

Nurse should take consent from Barber to give information to the neighbor about his condition. Nurse should inform neighbor that Mr. Barber is stable now and he is showing improvement in his condition. Frequency of his vomiting is also reduced and he is responding well to the medications. He will be discharged soon and he will with his wife soon. Nurse should inform neighbor that he is inquiring about his wife and asking them to take her of her in proper way. Nurse should tell neighbor that Barber informed that neighbor should consider her forgetfulness and assist her in all her activities (Holzeme & Klainberg, 2014).  

6. Written consent should be taken from Mr. Barber. Request/consent form should be there with information containing Mr Barber name, date of birth, age, full address, clinical history and medications. Consent form should contain information about nature of testing, complexity of examination, risk related to the procedure and Barber’s wish for testing (Daniels, 2014).

While transferring to the radiology department each one qualified person form the cardiology and respiratory department is there. Mr. Barber is having low blood pressure which is called hypotension and due to fear of radiological testing it can also affect further his blood pressure. His heart rate is also little more than normal which is called tachycardia and it can also get affected due to anxiety of testing. Hence, for continuous monitoring of his blood pressure and heart rate, expert form cardiology department is required. His respiratory rate is also little higher than normal respiratory rate which is called tachypnea and due to fear and anxiety of radiological testing there may be further shallowness in his respiratory rate. Mr. Barber has very high BMI. To assess and observe respiratory rate, expert form the respiratory department should be there at the time of radiology. Along with this radiology expert and radiographer or radiology technician required for Mr. Barber’s radiology testing. Radiology expert and radiographer well trained in manual handling of radiography machine without any discomfort to the patient. This radiography techniques is widely used for the patient with ostoarthritis (Talley & O’Connor, 2013).

7.   

D - Danger

Danger due to osteoarthritis was checked and there is no danger of fall due to osteoarthritis.

R- Response

Response was checked by rubbing on his body parts and it is observed that he is conscious.

A-Airway

Airway was checked and it is observed that his airway is clear.

B-Breathing

Breathing was checked by keeping ear near to the mouth and chest. It is observed that he is having shallow breathing.

C-Circulation

Circulation was performed and it is observed that there are 40 chest compressions for every 2 breaths.

D- Defibrillator

Defibrillator is applied.

(Talley & O’Connor, 2013).


Form these assessments it is observed that Mr. Barber is having mild hypovolemic shock due to the loss of blood through vomiting. From the above assessment it is evident that there is increased heart rate per breaths in Mr. Barber. In case of blood loss there is the increased heart rate because to maintain supply of blood to the tissues which is reduced due to blood loss, heart pumps more blood and there is increased heart rate. Also, form the assessments it is evident that there is the increased respiratory rate. Due to blood loss, there is reduced oxygen saturation as compared to the carbon dioxide. To maintain oxygen saturation, lungs breaths at faster rate. Hence, these variations in heart rate and breathing rate are little more than normal values, there is little loss of blood through vomiting (Talley & O’Connor, 2013).

Taking Written Consent

8. Seretide Accuhaler is the combination of medications like fluticasone propionate and salmeterol xinafoate. Emphysema is a type of chronic obstructive lung disease which occurs due to the inflammation of the lung and due to which there the shortness of breath due to narrowing of airways due to inflammation and followed by structural changes in the airways. Fluticasone propionate is a corticosteroid and it is used as anti-inflammatory agent. Fluticasone propionate reduces inflammation in the respiratory tract by inhibiting recruitment of inflammatory cells. These inflammatory cells produce variety of markers which produces acute exacerbations of emphysema. Thus inhibiting inflammatory cells can reduce acute exacerbations of emphysema. Salmeterol xinafoate is a long-acting β? adrenergic receptor agonist which produces bronchodilator action. Due this bronchodilator action salmeterol xinafoate prevets or reverse narrowing of the airways and useful in preventing wheezing, coughing and shortness of breath which are the common symptoms of emphysema (Chen et al., 2013).

b. Hold accuhaler in one hand and open it by pushing thumb to the right so the mouthpiece is visible.    Hold the mouthpiece of acchaler directing towards you and push the lever away from you. Breathe out to the extent of maximum of your capacity and mouthpiece should be put on your lips. You should breathe through your accuhaler and not the nose and slowly breathe out. Silde the thumb grip back to original postion to close the accuhaler (Chen et al., 2013).      

Voltaren Emulgel is an external application used for relieving osteoarthritic pain in Mr. Barber. Voltaren Emulgel contains diclofenac sodium which is non-steroidal antiinflmmatory drug use dot reduce pain, swelling and inflammation. Diclofenac sodium exhibits its action by inhibiting prostaglandin synthesis through cyclooxygenase enzyme inhibition.

Oxucodone is a opioid pain medication used for reducing osteoarthritis pain of Mr. Barber. Oxycodone is available in the form of controlled release tablet and it produces pain relieving effect over the period of 12 hrs. Thus it helps to improve quality of life. Oxycodone acts a selective full agonist of μ-opioid receptor and lesser affinity for the other opioid receptors like δ-opioid and κ-opioid receptors. Once oxycodone binds to μ-opioid receptor, G-protein complex released which inhibits neurotransmitter release. As a result cAMP level reduced and it closes calcium channels and open potassium channels.

Naproxen in the orally administered nonsteroidal anti-inflammatory drug (NSAID) drug used for reducing pain due to osteoarthritis in Mr. Barber. Naproxen acts by inhibiting prostaglandin synthesis which is pain and inflammatory marker. Naproxen inhibits prostaglandin synthesis by inhibiting both Cox 1 and Cox2 enzymes.

Panadol Osteo is a sustained release tablet containing paracetamol. Paracetamol is useful for relieving mild to moderate pain and it acts specifically on the Cox 2 enzyme. Panadol Osteo has two layers of paracetamol. Out layer released within 30 minutes of its administration and second layer released over period of 8 hrs. to give relief  from pain to Mr. Barber.

Aspirin is also used for the management of pain in Mr. Barber. Aspirin acts by inhibiting Cox1 enzyme and modifying the action of Cox 2 enzyme (Balch, et al., 2011).

Nurse should ask him about the pain in the knees, hips and wrists. During what type of activities Mr. Barber is facing problem. Is he having problem in flexion and extension movements of joints?   Nurse should ask him to grade his pain score during different activities on a scale of 1-10. Also, nurse should ask him, according to him how bad is his arthritis and ask him to designate either of the mild, moderate and severe. Due to this osteoarthritis his daily activities affected are clothing and putting buttons, washing hair, getting up from chair, getting up from the bed after completion of sleep, taking bath and use of toilet (Sadosky eta l., 2010).

Nurse should remove the bandage check the severity of wound due to cut. Nurse should remove the bandage and clean the wound with the help of antiseptic and apply antiseptic lotion on it and apply new bandage. Nurse should advise Mr. Barber not to put water on the leg. Because wound is not properly filled currently and due to water, there may be possibility of infection on the wound. Nurse should daily check the severity of wound, clean it properly and apply new bandage on the daily basis. Nurse also should advise Mr. Barber not to remove bandage on his own, until he gets instructions from the nurse or other medical staff (Peate & Glencross, 2015).

Nurse should try to convince him about the importance of gastroscopy in his current condition. Nurse should give him confidence that, his wife is going to be taken care nicely by his neighbors. He should be perfectly fine to take his wife. For this purpose, he needs to get recovered completely. Until and unless he performs gastrocopy, it would be difficult to know the exact reason behind his blood vomiting and planning for the concerned intervention. If Mr. Barber is not ready undertake gastroscopy, even after all these efforts, nurse should try to manage blood vomiting with medications for few days and ask him to come back for gastrosopy (Yao, 2013).

Mr. Barber is having osteoarthritis problem. So, physiotherapist is the most suitable allied health worker for Mr. Barber. Physiotherapist is associated with the hospital since long time and this physiotherapist is skilled enough to take care of osteoarthritis patients. Physiotherapist is beneficial for Mr. Barber because he can promote moderate exercise in Mr. Barber which helps to reduce pain and improve functioning. Physiotherapist teach Mr. Barber stretching and strengthening exercise which helps to improve free joint motion and make stronger the muscles around the affected joint. Physiotherapist applies cold packs to the affected joints after exercise to relax it and to reduce pain. Also there should be interaction with psychologist who can give moral boost to Mr. Barber in his disease condition. Nurse should assist Mr. Barber in his all daily activities. There should be coordination between physiotherapist, psychologist and nurse for providing holistic community care to Mr. Barber (Page & Hinman, 2011).

References:

Balch, J. F., Stengler, M., Young-Balch, R. (2011). AARP Osteoarthritis and Osteoporosis Drug Alternatives. John Wiley & Sons.

Chen, L., Heng, R.L., Delele, M.A., Cai, J., Du, DZ., & Opara, U.L. (2013). Investigation of dry powder aerosolization mechanisms in different channel designs. International Journal of Pharmaceutics, 457(1):143-9. 

Christofaki, M., & Papaioannou, A. (2014). Ondansetron: a review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opinion on Drug Metabolism & Toxicology, 10(3), 437-44.

Daniels, R. (2014).  Delmar's Guide to Laboratory and Diagnostic Tests. Cengage Learning.

Gertsch, M. (2013). The ECG: A Two-Step Approach to Diagnosis. Springer Science & Business Media.

Glen Mayhall, C. (2013). Hospital Epidemiology and Infection Control. Lippincott Williams & Wilkins.

Holzemer, S. P. & Klainberg, M. (2014). Community Health Nursing. Jones & Bartlett Publishers.

Page, C.J., Hinman, R.S., & Bennell, K.L. (2011). Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, 14(2), 145-51.

Peate, I., & Glencross, W.  (2015). Wound Care at a Glance. John Wiley & Sons.

Porché, R. A. (2008). High-Alert Medications: Strategies for Improving Safety. Joint Commission Resources.

Sadosky, A. B., Bushmakin, A. G., Cappelleri, J. C., & Lionberger, D.R. (2010). Relationship between patient-reported disease severity in osteoarthritis and self-reported pain, function and work productivity. Arthritis Research & Therapy, 12(4), R162.

Talley, N. J, & O’Connor, S. (2013).  Clinical Examination: A Systematic Guide to Physical Diagnosis. Elsevier Health Sciences.

Yousefi, H. & Abedi, H. A. (2011). Spiritual care in hospitalized patients. Iranian Journal of Nursing and Midwifery Research, 16(1), 125–132.

Yao, K. (2013).  Zoom Gastroscopy: Magnifying Endoscopy in the Stomach. Springer Science & Business Media.

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