As a nurse who is looking into the future of her career, I have many options to look into as I apply for a graduate degree program that would advance my skills and expertise in that field. There are two degree programs which in my opinion are very valuable and competitive while at the same time fulfilling to those with passion for caring and patience with the sick and incapacitated.
As I narrow down to what graduate program I would choose, I want a program that is self-satisfactory and in line with my vision and expertise too. A graduated program that is accommodating and will provide me with a larger base to operate and expand my research in nursing as a medical field. That's is what the Hit the Ground Running program is to me. It entails dedication to work, helping me reach the required approvals in the medical system that I need for my future career. The program is flexible and detailed in giving the standard requirements for success in the medical field.
I am a passionate and self-dedicated person who has a big heart. The fact that I cannot stand sewing so much suffering in hospital coercion has driven me to dedicating myself to being part of their hope. Offering them a shoulder to lean on and know that they can put their trust in medicine and doctors to provide a solution to their problems. One such approach is through the use of a computer matching program (Postgraduate Medical Council of Victoria, 2017). This makes it easier to match an individual with a hospital. This leads to improved efficiency.
Even though a solution may not always be there but giving the patients hope that there is more to hospitals that deaths and morgues but an advancing technology that will zero in on the most complicated cases is soothing. I want to be part of the solution in providing the neat healthcare facilities and services to this great nation.
For proper nursing management especially in conditions that require immediate care, a nurse should follow the nursing process; a systematic method of assessment, diagnosis, planning, implementation and evaluation. This is important to direct a nurse in planning patient and enable him/her organize and deliver nursing care. Moreover, the steps are dependent on the accuracy of each of the preceding steps.
As a nurse, a quick assessment of the signs of chest pain and shortness of breath point to respiratory distress in the patient. My hypothesis is a case of pulmonary embolism considering the presenting complains (Andrews & Massive, 2010) and the fact that the patient had experienced trauma which is a risk factor in pulmonary embolism (Emde & Rush, 2001). Pulmonary embolism is a medical emergency that will require proper management for a good outcome (Shaughnessy, 2007).
The first priority nursing diagnosis in this case is ineffective tissue perfusion related to obstructed pulmonary circulation. The goal of management is to attain acceptable gas conversation and respirational function by maintaining a respirational rate of 12-20 breaths per minute, oxygen saturation of >95% and a P.H between 7.35-7.45.
I will place the patient in semi-Fowler’s position. This involves elevating the head of the bed to between 450- 600 to allow for improved breathing since this locus allows amplified thoracic capacity, full pedigree of diaphragm and full lung growth (Smeltzer & Bare, 2008). Moreover, this position is comfortable for breathing thus alleviating pain. I will administer humidified oxygen 12 liters per minute via a non-rebreather face mask. Deteriorating respiratory rate and pattern in a patient is a major indicator for oxygen therapy (Smeltzer & Bare, 2008). The mask is ideal because it offers high oxygen concentration since the patient does not get to inhale exhaled air and humidified oxygen is preferred so as not to dry mucosal membranes.
Supplemental oxygen will help raise and maintain oxygen saturation levels. This in the long run will help improve tissue perfusion. While administering oxygen, I will observe for dyspnea, monitor oxygen saturation levels using pulse oximeter to ensure they are above the ideal 90%. I will also monitor other vital signs such as respirations assessing rate and depth, pulse, temperature and blood pressure. Monitoring these vital signs is important in evaluating any improvement in the patient’s condition as they assess if interventions undertaken are effective (B?lohl?vek, Dytrych, & Linhart, 2013). Additionally, I will auscultate for lung sounds and heart sounds. It is also important to perform pain assessment to assess if repositioning has helped alleviate pain.
While monitoring the patient, I will delegate another nurse to call a physician who will assess the patient further. I will ensure patent intravenous access and administer normal saline slowly to correct hypotension in patient. Fluid overload is likely to compromise further right-ventricle function (Belohlavek & Linhart, 2013). It will be important in administration of thrombolytic medications that will need to be administered as per physician orders.
The patient in such a situation is often anxious because they do not understand the nature of what is happening or are scared of unclear outcomes. I will reassure the patient and family members if present. It is important to alleviate anxiety especially in the patient since anxiety tends to increased dyspnea, respiratory rate and work of breathing. Reducing anxiety may also help alleviate pain since the patient relaxes subsequently increasing tolerance and threshold for pain.
Prioritization is an important skill that is needed by any professional nurse. Usually comes hand in hand with time management as well as saving of lives and patients in pain. As per my judgement, prioritization will depend on the acuteness of the patient's conditions and also my response reflex.
With patients’ conditions, I would first go for the one with acute asthma. This is mainly because anything that affects the breathing should be dealt with much seriousness. Falling short of breath could be a possible cause of collapsing of vital organs in the body that may lead to death. Fast short breaths and sitting upright means lack of oxygen in the system and therefore attending to the patient would stabilize the oxygen flow thereafter pulling the patient out of the danger zone.
I would then visit Mrs. Walter whose blood glucose level was not checked during the routine check. Increase or decrease in blood glucose level could be a dangerous sign. I know that insulin administration should be around 15 minutes prior to eating or we wait for around 15-30 minutes after eating. In this case the patient needs the administration beforewals and therefore I will administer the drug according to the usual prescription. I would indicate on my chart that I have provided the patient with the insulin so that whoever is providing the breakfast meal should be careful.
For patient 3, Mr. Young, he is a nil by mouth patient who requires an IV therapy. The situation leading to him being on IV means that he is either onto or out of surgery or he is a patient with a chronic disease that needs the administration. If it’s the first case, I would review the administration and make sure the fluid content in his body is stable and if need be for more I would administer the IV therapy. Patients going into surgery need a lot of fluid to compensate for the loss during the surgery and after. If it’s the latter, then I would review administer the right amount as prescribed on his medical chart.
I would then attend to Mr. Nguyen and administer the right amount of endone to reduce the amount of pain he is in. This is after I review my fellow nurse's report on him and see the intensity of pain he is in which I really doubt is so chronic as the nurse would have already attended to him
Lastly I would consider patient 1 whose condition is a call of nature. Nor to say that her condition is not serious but because she needs quite the attention and that requires enough time. As a nurse, I know that the left hemiplegia has left her quite incapacitated and therefore I will need to support her all through the process. Being a high risk fall patient makes her prone to falls that may cause further damage to her body tissues and can attain a physical injury that may affect her condition and recovery too.
Most of my selection and priority is strongly based on the essence of survival first, then time management also came up. I attended to the patients bearing in mind the need to act first and on a definitive time limit as well as ensuring the stability of all of the patients I had to attend to.
Sutures are devices used in medicine to hold parts or sections of the skin or flesh that are apart due to a surgery or an accident. They are of different forms in materials ranging from threads to small stainless steel metal pieces. These are used in accordance with the flesh being stitched together and where the parts are located for example the internal body parts, external skin, the eyes, the mouth etcetera (Glynda and Jodie, n.d.). Their application involves the use of needles with the attached thread and are held in place at their end by use of knots. Sutures are generally classified as being absorbable or non-absorbable; depending on whether the body can degenerate and absorb the suture material or not. The absorbable sutures are usually made of polymers whereas the non-absorbable sutures are usually made of special silk. The non-absorbable sutures are the commonly used sutures in stitching skin wounds since they can be retrieved easily due to their proximity the surface.
The length of period the seams remain in place hinge on upon the percentage of healing and the countryside of the looped (David, n.d). The process of removing sutures requires great care to protect the healing wound from reinfection. To approach the scenario of the removal of sutures, I as a nurse, has to apprehend the highest degree of hygiene; hand hygiene, sterile surgical instruments among others are the measures I must practice to ensure the lowest risk of infection of the wound. Before I assist my colleague handle the patient, I must first wash my hands thoroughly. This practice is recommended since it “is the most important part of practice for health care workers and is the single most effective way to stop the spread of infections; catastrophe to properly accomplish hand sanitation is the leading reason of HAIs and the binge of multi-drug-resistant organisms (MDROs)” (Glynda and Jodie, n.d.). An additional measure that I have to ensure before I handle the patient are wearing a pair of non-sterile gloves.
At the stage that the suture is being removed, the wound has reached its third healing phase-the tissue remodeling phase. It’s at this stage that the wound is gaining tensile strength and its ends are closing in (The Royal Children’s Hospital Melbourne, n.d.). Moisture at this stage should be cleaned by patting dry the wound section that is wet. This is because wetness of the wound could be as a result of some wound discharge which could lead to infection. I would pat dry the wound and take a closer examination of the same to ensure that the wound is not infected. I would also speak with the patient to know whether he is feeling excessive pain on the wound. I would also recommend a highly absorbent dressing for the wound.
Melonin is a widely used wound dresser which can be used for after operation and fatality, in precise of light so as to abstemiously radiating wounds, counting Fresh and sewn lesions (Medisave, 2016). It’s known for being highly absorbent, allowing the drainage of exudate, plummeting shock to healing tissue, remarkable strike through; therefore, requires fewer dressing changes (Medisave, 2016). Despite Melonin’s remarkable quality, it’s advisable to note that Melolin Dressings should be recycled with carefulness in the conduct of leg ulcers that produce abundant quantities of very viscous exudates that can become trapped under the dressing; the incidence of alteration depends entirely upon the countryside and disorder of the wound (Safety First Aid, 2017). I therefore would advise the patient to ensure fluids don’t come into contact with the dressing. To the nurse, my colleague, I would advise her to ensure that she checks the patient frequently and change the dressing at short time intervals to ensure the bet condition or the promotion of the healing of the wound.
Proper clinical hygienic practices dictate that no contaminated material should be allowed to come into contact with the ailing part-a broken part of the skin. These practices ensure that the risk of contamination of the wound, at any stage of its healing process, is minimized to boost its healing rate. The part of melonin that came to contact with the bed definitely got contaminated and if it were to come in contact with the wound, it would most probably infect the wound thus leading to the deteriorating of the condition of the wound. I would therefore instruct the nurse against the use of the same on the healing wound. Flesh uncontaminated dressing should be used instead.
Andrews, P. L., & Massive, P. E. (2010). Detecting, managing, and preventing pulmonary embolism. American Nurse Today, 21-25.
B?lohl?vek, J., Dytrych, V., & Linhart, A. (2013). Pulmonary embolism, part II: Management. Experimental & Clinical Cardiology, 18(2), 139.
Emde, K., & Rush, C. (2001). Suspecting pulmonary embolism. American Journal of Nursing, 19-24.
Shaughnessy, K. (2007). Massive pulmonary embolism. Critical Care Nurse, 39-53.
Smeltzer, S. C., & Bare, B. (2008). Brunner and Suddarth's textbook of Medical Surgical Nursing. Williams & Wilkins.
The Royal Children’s Hospital Melbourne (n.d.). A great children's hospital, leading the way; Suture line care.
Victoria, P. M. (2017). PMCV. Retrieved from PMCV: