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.