ALRIGHT. CLIENT REPORTED
FATIGUE, HEAT RACING
AFTER ACTIVITY,

DIFFICULTY WITH BREATHING
AND WE SELECTED OUTCOMES.

WALK FOR FIVE MINUTES,
THREE TIMES A DAY.

SO, OUR INDIVIDUALIZED
OUTCOME WOULD BE.

ACTIVITY INTOLERANCE IMPROVED,
THAT'S THE GOAL,

AS EVIDENCED BY, AND THESE
ARE OUR MEASURABLE OUTCOMES.

THAT'S WHAT YOU'LL BE WRITING IN
EXPECTED OUTCOMES END COLUMN.

CLIENT WILL WALK IN THE HALL
THREE TIMES A DAY
FOR FIVE MINUTES.

CLIENT'S HEART RATE WILL
BE LESS THAN 100.

AND RESPIRATION IS LESS
THAN 20 AFTER ACTIVITY.

AND CLIENT WILL STATE POSITIVE,
SUBJECTIVE FEELINGS
AFTER ACTIVITY.

THAT'S OUR GOAL.

AND THEN WE'RE GOING TO DOCUMENT
THAT IN THE CHART.

THIS IS WHAT WE WANT
TO ACCOMPLISH.

SO THAT IF YOU WRITE
UP THIS PLAN,

YOU'VE TALKED TO THE CLIENT,
YOU'VE WORKED IT ALL OUT,

I COME ON THE NEXT SHIFT AND GO,
"WHAT ARE WE DOING
WITH THIS GUY?"

AND I READ IT AND I GO,
"OH, GREAT.

WALKING HIM FOR 5 MINUTES.
I GOT TO DO IT TWICE." I'M NOW
GOING TO REPORT THAT TIME.

WE'LL MEASURE HIS RESPIRATIONS
BEFORE AND AFTER.

I'LL TELL HIM IF HE FEELS
HIS HEART RACING, STOP AND
CHECK HIS PULSE

AND SEE HOW WELL HE'S DOING. AND
I HAVE A PLAN NOW OF WHAT TO DO
FOR THIS CLIENT,

INSTEAD OF HAVING TO START FROM
SCRATCH, IN THE BEGINNING.

NOW, WE'VE GOT TO EVALUATE
THE EFFECTIVENESS.

AND THIS IS HOW WE
WOULD CHART IT.

ACTIVITY TOLERANCE IS IMPROVED.

HOW DID THAT HAPPEN? IMPROVED IS
WHAT? IS THAT MEASURABLE? NO.

CLIENT STATES, "I DO NOT FEEL
TIRED ALL THE TIME ANYMORE,

HEART RATE OF 90 AFTER WALKING
IN THE HALL FOR FIVE MINUTES.

CLIENT STATES, "MY HEART
ISN'T RACING ANYMORE,

RESPIRATION 18 AFTER WALKING
IN THE HALL FOR 5 MINUTES.

CLIENT STATES,
"MY BREATHING IS EASIER."

YEAH. OUR JOB IS DONE. RIGHT?

NO, BECAUSE THE NURSING
PROCESS IS CONTINUAL.

DO YOU SUPPOSE HE MIGHT WANT
TO WALK FOR TEN MINUTES?

NOW THAT WE'VE GOT UP
TO FIVE MINUTES,

LET'S SEE IF WE CAN DO SEVEN
AND BUILD UP HIS STAMINA

AND BUILD UP HIS STRENGTH
AND HIS INDEPENDENCE.

SO WE'RE GOING TO
CONTINUE TO ASSESS

AND WE'RE GOING TO CONTINUE TO
ADAPT OUR NURSING CARE PLAN

TO MOVE THAT CLIENT ON TO BETTER
HEALTH AND BETTER STAMINA.

SUMMARY. WE'RE GOING TO WRITE
OUR OUTCOMES, SUBMIT,

FORMULATE A DIAGNOSIS
FOR A FOCUSED OUTCOME

THAT'S MEASURABLE
AND ATTAINABLE.

DO KNOW HOW TO WRITE A NURSING
CARE PLAN?

- NO.
- ALRIGHT.

THIS RIGHT? LET'S GET THESE OUT.

OH, DON'T LET ME FORGET,
I HAVE QUESTIONS FOR YOU.

I DIDN'T KNOW WE WERE
ON THIS STUFF, BUT I HAVE
A COUPLE QUESTIONS.

ALRIGHT, LET'S JUST START FROM
THE BEGINNING.

WHAT IS ISCHEMIA?

THE PRESSURE ON THOSE LITTLE
CAPILLARIES SO THAT THE SKIN
DOESN'T BREAK DOWN.

SOME PEOPLE NEED TO BE
TURNED MORE.

THEY'VE GOT TO CHANGE THEIR
POSITION EVERY 10, 15
MINUTES.

ADAPT MENTALLY
BECAUSE THEY CAN'T FEEL.

RIGHT? OTHERWISE THEY'RE GOING
TO GET ISCHEMIA.

AND THEY'RE GOING TO GET RIGHT
THERE ON THESE BUTTOCK
MUSCLES AND SO FORTH.

WE NEED TO KEEP THE SKIN CLEAN

BECAUSE IF EXCREMENTS STAY ON
THE SKIN, THAT'LL BREAK DOWN
THE SKIN.

THE SKIN'S ALREADY AT RISK
BECAUSE OF THE DECREASE
IN PROTEIN

AND METABOLIC ISSUES.

AND SO WE WANT TO BE WATCHING
THAT THEY'RE NICE AND CLEAN.

AND WE WANT TO PROTECT
THEIR SKIN WITH --

IF YOU WANT TO PROTECT
THE HEELS, WE PUT
LAMB'S WOOL SOMETIMES

ON THEIR HEELS TO KEEP THEM
FROM SCRAPING ON THE BED.

WE PUT PRESSURE RELIEF
MATTRESSES ON THE BED SO THAT --

THIS MATTRESS IS ALL FULL OF AIR
AND THEN THIS PIECE
OF THE MATTRESS

WILL LET GO OF ITS AIR
SO THERE'S NO PRESSURE.

THE BODY'S JUST KIND OF HANGING
IN THE MIDDLE RIGHT THERE

AND THEN IT'LL FILL UP AND THEN
THIS PART WILL GO OUT
OF AIR.

SO IT'S ALL PRESSURE RELIEF.

SO THAT THE CLIENT DOESN'T
HAVE...

HYDRATION. WE WANT TO MAKE SURE
THEY'RE GETTING THEIR 2000
MILLILITERS PER DAY.

WE'RE CHECKING I&O AND THEY'RE
GETTING ADEQUATE FIBER
IN THEIR DIETS.

WHEN WE TALK ABOUT -- OH, MY
GOSH! I NEED TWO MORE MINUTES.

WHEN WE TALK ABOUT FOOT ROTS

FOOTBOARDS ARE ON THE BED AND
THAT'S AT THE END OF THE BED.

THOSE ARE GOOD PICTURE
IN YOUR BOOK. AND THE FOOT
ACTUALLY GOES UP

PART OF IT RESTS ON THE BOARD
AND KEEPS IT FROM FALLING.

SOMETIMES PATIENTS ARE SHORT AND
THEY DON'T REACH UP TO THE BOARD
VERY WELL

AND THAT'S A PROBLEM, SO WE
FOUND THAT HIGH-TOP TENNIS SHOES

WORK SO THAT
WILL ALLOW YOU TO PULL UP.

SO IT'S NOT FLOPPING DOWN. WE
PUT SHEET CRADLES
ON THE BED

SO THE SHEETS AREN'T
PUTTING THE WEIGHT

ON TO THE EXTREMITY ITSELF AND
THAT LEAVES THE TOES TO STAY UP.

HAND ROLLS AND SPLINTS
ARE IN YOUR BOOK

BUT I DO WANT TO MENTION
TROCHANTER ROLLS.

THAT WAS TO KEEP THE LEGS.
WHEN SOMEONE'S AT REST

THEIR LEGS KIND OF WILL
FALL OUT A LITTLE BIT.

AND IF YOU PUT A TROCHANTER ROLL
IN THAT HOLDS THESE KNEES IN

OR THE HIP JOINT IN

SO YOU DON'T GET THAT ROTATION
IN. AND THE KNEES SHOULD THEN

BE STRAIGHT UP INSTEAD OF
FALLING OUT OF JOINT.

AND THEN ANOTHER SPLINT THAT WE
USE THAT'S REAL IMPORTANT
IS FOR HIP INJURIES.

WHEN THEY HAVE SURGERY

WE HAVE TO KEEP THE LEGS
ABDUCTED BECAUSE IF THEY ABDUCT,

THEY'LL POP OUT OF JOINT AND
THAT WILL DESTROY THE SURGERY
THAT WAS DONE

AND THAT'LL BE BAD SHAPE
THAN THEY WERE TO START WITH.

SO WE PUT AN ABDUCTION
PILLOW OR SPLINT IN

TO KEEP THE LEGS APART
SO THEY DON'T TURN.

BED POSITIONS, REVIEW THOSE
AND THAT'LL HELP YOU.

INSTRUMENTAL ACTIVITIES
OF DAILY LIVING.
I JUST WANTED TO MAKE SURE

THAT YOU KNEW WHAT ADLS WERE.
BATHING, AMBULATION, TOILETING,
TRANSFER, EATING AND DRESSING.

BUT INSTRUMENTAL ACTIVITIES
OF DAILY LIVING

ARE THOSE THINGS THAT YOU HAVE
TO BE ABLE TO DO
TO LIVE INDEPENDENTLY.

AND THAT IS, YOU HAVE TO BE
ABLE TO SHOP, COOK AND CLEAN,

USE YOUR TELEPHONE AND
TRANSPORTATION,
MANAGE MONEY AND MEDICATION.

AND THAT'S THE DIFFERENCE
BETWEEN ACTIVITIES
OF DAILY LIVING

AND INSTRUMENTAL ACTIVITIES
OF DAILY LIVING.

YOU CAN BE COMFORTABLE DOING
YOUR OWN PERSONAL CARE,

BUT IF YOU WANT TO LIVE
INDEPENDENTLY, YOU HAVE
TO BE ABLE TO DO THIS.

ALRIGHT, NOW I'M ONE MINUTE
OVERDUE. ANY QUESTIONS, OR DO
YOU WANT TO READ THEM ON-LINE?

ALRIGHT, THE CLIENT ON BED
REST MAY HAVE COMPLICATIONS
RELATED TO IMMOBILITY.

TO ASSESS FOR METABOLIC CHANGES
THE NURSE SHOULD ASSESS FOR ALL
OF THE FOLLOWING EXCEPT...

SO OUR QUESTIONS --
THE QUESTION IS WE'RE LOOKING
FOR METABOLIC CHANGES.

SO ANYTHING THAT'S NOT
METABOLIC IS OUR ANSWER.

ALRIGHT, NEGATIVE
NITROGEN IMBALANCE.

THAT'S METABOLIC. LUNG SOUNDS.

THAT'S NOT METABOLIC,
THAT'S LUNGS.

HYPOCALCAEMIA. THAT'S METABOLIC.
CONSTIPATION.

YES. OK. SO THE ANSWER IS B.

LUNGS SOUNDS WOULD NOT BE AN
ASSESSMENT FOR METABOLIC.

THE NURSE HAS AN ORDER
TO PLACE THE CLIENT WITH
A HERNIATED LUMBAR

INVERTEBRAL DISC ON BED REST
IN WILLIAM'S POSITION
TO MINIMIZE THE PAIN.

THE NURSE PLANS TO PUT THE BED
-- I DIDN'T TALK ABOUT
WILLIAM'S POSITION, HUH?

BECAUSE I WAS RUNNING OUT OF
TIME. LET'S SEE IF YOU CAN
FIGURE IT OUT.

WILLIAM'S. LOOK AT THE WORD
WILLIAM'S. THE W IS YOUR KEY.

IN A HIGH-FOWLER POSITION WITH
THE FOOT OF THE BED FLAT.

WHENEVER YOU GET THESE,
ALWAYS TRY TO SEE WHAT
THEY'RE DESCRIBING

AND THINK BACK PAIN. WHAT WOULD
MINIMIZE BACK PAIN?

IN A SEMI-FOWLER POSITION,
THAT'S 45 DEGREES,

WITH THE KNEES SLIGHTLY RAISED.

IT SHOULD BE LIKE THIS, YOU CAN
SEE. THAT LOOKS LIKE IT WOULD BE
EASIER.

IN A SEMI-FOWLER POSITION WITH
THE FOOT OF THE BED

FLAT WITH THE KNEES RAISED.

THE ANSWER IS B, WILLIAM'S
POSITION IS LIKE THE W.

AND THAT IS THE MOST
COMFORTABLE POSITION FOR
BACK INJURY PATIENTS.

IT TAKES THE STRAIN OFF THE BACK
AND THE STOMACH.

ANSWER B, AND THIS IS A HEAVILY
TESTED AREA.

OKAY, SO THAT WAS AN
APPLICATION QUESTION.

THE NURSE IS EVALUATING GOAL
ACHIEVEMENT FOR THE CLIENT
IN TRACTION

WITH IMPAIRED PHYSICAL MOBILITY.

THE NURSE DETERMINES THAT
THE CLIENT HAS NOT SUCCESSFULLY
MET ALL OF THE GOALS FORMULATED

IF WHICH OF THE FOLLOWING
OUTCOMES WAS NOTED? OK.

WE'RE LOOKING FOR
SOMETHING NEGATIVE

RELATED TO GOAL ACHIEVEMENT.
SO, IS THE NEGATIVE
HOMAN'S SIGN NEGATIVE?

NO. THAT'S GOOD.

B, IS ACTIVE RANGE OF MOTION OF
UNINVOLVED JOINTS NEGATIVE?

NO. WE WANT THEM TO MOVE THEIR
UNINVOLVED JOINTS.

IS INTACT SKIN SURFACE NEGATIVE?

NO. THAT'S GOOD. SO WE'RE LEFT
WITH ONE. D'S OUR ANSWER.

BOWEL MOVEMENTS EVERY FOUR DAYS.
HOW OFTEN ARE YOU SUPPOSED TO
HAVE THEM?

ONE OR TWO. THAT'S OUR PROBLEM.
ANSWER'S D.

TEST ONE ON FRIDAY.
I'LL POST YOUR QUIZ SCORES
ON THE BLACKBOARD

SO HAUL IN TOMORROW SOMETIME,
SO YOU CAN SEE THOSE.
BRING A SCANTRON.

WE'LL DO THE TEST FOR THE FIRST
HOUR AND FIFTEEN MINUTES.

THEN WE'LL COME BACK AT ONE
THIRTY AND WE'LL GO OVER MATH.

BECAUSE WE GOT TO
ADDRESS THAT. IT'S A TIMED EXAM.

IF YOU HAVE ANY QUESTIONS,
AN HOUR AND 15 MINUTES.

OVER EVERYTHING
WE JUST REVIEWED.