The Role of the Nurse - Essay Example

?Part A Discuss the role of the nurse when collecting a comprehensive nursing health assessment. In comprehensive nursing health assessment, the nurse’s role is to gather data on the patient’s physiological, psychological, sociological, spiritual health. Craig and colleagues (2006) discuss that assessment is a crucial first step in the delivery of health care, and often serves as the initial point of patient/nurse communication or contact. During the initial meeting with the patient, it is usually the nurse’s role to make a thorough evaluation of the patient (from head to toe) as a means of establishing baseline parameters for the patient’s general condition. This baseline is also the point of reference for nurses in order to monitor the patient’s progress from their point of admission to their point of discharge (Craig, et.al., 2006). The assessment as carried out by the nurse would also serve to guide the development of the nursing care plan. The role of the nurse in the assessment is to ensure a holistic evaluation of the patient, including the patient’s needs and the purpose of the medical consult (Rosdahl and Kowalski, 2011). As the assessment is carried out, the health issues of the patient – from the physiological to the psychological – would be established. During the assessment, it is also the nurse’s task to establish the patient’s medical history, which would include major and relevant health issues he has suffered in the past, including previous surgeries, allergies, and current medications (Rosdahl and Kowalski, 2011). The assessment process can also be awkward for patients and nurses. It is therefore the nurse’s role to build and maintain rapport with his client by respecting the patient’s boundaries, drawing drapes or closing doors, and presenting a calm and friendly manner (Rosdahl and Kowalski, 2011). By building rapport and a trusting relationship with the patient, better cooperation can be gained, and both parties can be more comfortable in the assessment process. 2. Based on the information provided in the case study, identify three key areas that the nurse should focus on during the interview with Erica. For each key area, identify two relevant questions you would ask Erica and provide a rationale to support each question you have identified. 1). Frequency of sunbathing without any sun block as well as frequency of tanning sessions Question 1: At what time of the day do you usually sunbathe without using sun block? Rationale: It is important to determine the time of day the patient has usually sunbathed because there are certain times of the day when the rays of the sun are strongest, and exposure to the sun during these times increases one’s risk for getting skin cancer (Leiter and Garb, 2008). There is a need to establish whether or not the patient has often sunbathed at 11 am to 4 am where the risk for exposure to UV rays is at its peak (Leiter and Garb, 2008). Question 2: How often do you get sunburns? Rationale: It is also important to establish how often the patient has suffered sunburns because the repeated healing and burning of the skin during sunburns have a cumulative effect (Qureshi, et.al., 2012). Every sunburn incident represents skin damage and repeated incidents of sunburn would cumulatively increase one’s risk for developing skin cancer (Qureshi, et.al., 2012). It is important to ask this of the patient in order to determine the level of risk she has already exposed herself to. 2) Mole is irregularly shaped two toned papule, with ill-defined light brown to pink medial and lower borders Question 1: Describe the changes which your mole has undergone? Rationale: Any irregularities in the shape of a mole often signify possible melanoma; more often than not, ill-defined moles signal skin cancer (Psaty, et.al., 2010). Question 2: Do you notice any pain in the area of the mole? Rationale: Pain on the moles may qualify the mole to be a suspicious mole which may also signal skin cancer or melanoma (Psaty, et.al., 2010). 3. Rapid change in the mole in the last few months Question 1: What is the exact period of time when you noticed your mole changing? Rationale: This can help establish the rate of development of the possible melanoma and to help ensure the early implementation of interventions, possible surgery for the patient (Psaty, et.al., 2010). 3. Discuss how the nurse may provide privacy and dignity for Erica during this consultation. (Expect approximately 150 words) The nurse can provide privacy and dignity for Erica during this consultation by: drawing the drapes/closing the doors of the examination room, ensuring that there would be no unnecessary disturbances, and making sure that total privacy is secured (Matiti and Baillie, 2011). Asking permission from Erica to examine the mole is also important. Touching a person’s skin is considered personal contact, one which much be handled professionally by the nurse. Asking the patient’s permission helps protect her dignity and her control over the situation (Matiti and Baillie, 2011). Moreover, exposing only the part of the body to be examined is an effective means of protecting the patient’s dignity and privacy (Matiti and Baillie, 2011). 4. Explain the patient teaching required for Erica, with appropriate rationales. (Expect approximately 250 words) Appropriate patient teaching for Erica would include: 1. Avoid tanning salons. Tanning salons also use ultraviolet rays and cause the same risk (as sunbathing) in terms of skin cancer (Brouse, et.al., 2011). 2. Always use sun screen, preferably with at least an SPF of 15 and above. Sun screen helps protect the skin from harmful ultraviolet rays (Leiter and Garbe, 2008). Sun screen acts to absorb and the reflect some of ultraviolet radiation on skin which is exposed to the sun, thereby also assisting in protection against sun burn (Leiter and Garbe, 2008). It has also been known to assist in the prevention of squamous cell carcinoma and basal cell carcinomas. 3. Avoid direct exposure to the sun from 11:00 in the morning to 4:00 in the afternoon because these are the times when the ultraviolet radiation is at its peak (Qureshi, et.al., 2012). When exposure cannot be avoided during these hours, the appropriate protective devices must be used, including wide-brimmed hats, sun screen, long sleeves, and long pants or dresses which can cover the feet (Qureshi, et.al., 2012). This would ensure minimal exposure to harmful ultraviolet rays and prevent sunburns. 4. Regular self-skin examinations. Carrying out regular self-skin examinations would help establish the presence of other unusual skin growth. This would help promote the early detection of melanoma and ensure early management of its symptoms (Qureshi, et.al., 2012). Melanoma can be treated and cured, especially when it is caught early, hence, it is important for the patient to carry out these regular self-examinations (Qureshi, et.al., 2012). 5. Eat healthy and exercise. One of the primary means by which any type of cancer and other diseases can be prevented and efficiently managed is on the implementation of a health regimen which includes a healthy diet and regular sustained exercise (Gogas, et.al., 2008). A healthy diet of fruits and vegetables can provide the patient with the right vitamins and minerals to prevent and manage disease (Gogas, et.al., 2008). Exercise can increase metabolism, prevent obesity, prevent diseases, and promote weight loss. Through a strong health regimen, most chronic illnesses, including cancer can be prevented. Part B Mr Tiko Lapa, 73-years-old, visits the Emergency Department complaining of abdominal discomfort. He states that he has had “vomiting and diarrhoea for the last 4 days”. He has been in hospital for 8 hours and received significant IV fluid therapy. His vital signs on admission at 2135 hours were: Temperature: 39.30C (tympanic) Pulse: 105 bpm Respirations: 26 bpm Blood pressure: 98/68 mmHg SpO2: 98% on room air At 0645hrs the next morning, Mr Lapa tells you he is having difficulty breathing and his chest feels “very heavy”. His observations are now: Temperature: 39.30C (tympanic) Pulse: 110 bpm Respirations: 36 bpm Blood pressure: 130/75 mmHg SpO2: 93% on room air The nurse asks you to assess Mr Lapa. Questions for Part B 5a) Identify three relevant physical assessments you should perform on Tiko in this situation. Provide a rationale for each assessment identified and explain what you expect to find from each assessment. 1. Volume of urine (intake-output volume) Rationale: The volume of urine needs to be determined in order to establish whether or not the patient is severely dehydrated and if his current symptoms, including difficulty of breathing and low SpO2 levels, is attributed to the dehydration (Endom and Somers, 2011). The volume of urine is low for patients with severe dehydration. The volume of input must be based on the water intake and the volume of IV fluids (Endom and Somers, 2011). 2. Capillary refill time. Capillary refill time can be evaluated by the nurse in order to establish whether or not the patient is severely dehydrated. Severely delayed capillary refill time is one of the primary signs for severe dehydration (Dugdale, 2011). Capillary refill time for this patient would likely be prolonged because of his dehydration. Even with the 8 hours of IV therapy, his 4 day bout with diarrhoea and vomiting still represents a voluminous loss of fluids and electrolytes. Hence, slow capillary refill may be expected. Moreover, his oxygen saturation is low, likely also contributing to the slow capillary refill (Wilmott, 2011). The supply of oxygen and hemoglobin into the capillaries is low as indicated by the oxygen saturation. The low oxygen saturation is actually contributing also to his difficulty in breathing (Lavi, et.al., 2009). 3. Quality of the vomitus and diarrhoea. It is also important to gain a general physical description of the vomitus and diarrhoea in order to help in diagnosing the cause of the patient’s symptoms. Watery mucoid stool may signal amoebiasis; and blood in the stool may indicate peptic ulcer or in some instances, colon cancer (Castro, 2010). The quality of the vomitus can also be assessed. Yellowish or greenish bile may contain bile; bright red vomitus may indicate peptic ulcer; for dark red blood in the vomitus, there may be gastric varices; if the vomitus has a coffee ground color, it may indicate a bleeding gastric or duodenal ulcer (Castro, 2010). The frequency, volume, and consistency of the vomitus and the diarrhoea are important elements which have to be recorded in order to help establish degree of dehydration, as well as to assist in making an accurate diagnosis of the patient’s condition (Castro, 2010). With the administration of medicines, assessing the frequency and volume of the vomitus and diarrhoea would also help determine if the medication is effective. 5b) Show how you would document this consultation/assessment in Tiko’s patient records. You are required to use a sheet of progress notes paper (available on DSO) to thoroughly document the assessment. Note that you will need to handwrite this section in the progress notes and should document it according to current medico-legal practices (as covered in your studies thus far). Progress notes: 1. Volume of urine – Patient has urinated two times in the past 8 hours and the total volume of the urine amounts up to 500 cc. The patient has completed about 750 cc of the IVF for the past 8 hours. No other fluids or solids have been taken by the patient. 2. Capillary refill time – 5 seconds. The capillary refill time of the patient is very slow, covering about 5 seconds. There is also a pale quality to his skin, and this pallor is also clearly apparent on his palm and his fingers. 3. Quality of vomitus and diarrhoea Vomitus: three times in 8 hours (frequency)/ non-bloody. The patient’s has vomited three times in the past 8 hours. The vomitus appearing to be stomach contents, mostly fluids, and some rice he ate before admission. No blood is apparent from the vomitus. Diarrhoea: two times in 8 hours/non-bloody. The patient had two incidents of diarrhoea. The stool appears watery and mucoid. No blood is also apparent from the vomitus. References Brouse, C., Basch, C., and Neugut, A., 2011. Warning signs observed in tanning salons in New York City: Implications for skin cancer prevention. Prev Chronic Dis., 8(4), A88. Castro, R., 2010. Assessment of digestive and gastrointestinal function [online]. Available at: http://rdcastro1.wordpress.com/2010/07/24/assessment-of-digestive-and-gastrointestinal-function/ [Accessed 10 September 2012]. Craig, P., Dolan, P., Drew, K., and Pejakovich, P., 2006. Nursing assessment, plan of care, and patient education: The foundation of patient care [online]. Available at: http://www.hcmarketplace.com/supplemental/732_browse.pdf [Accessed 10 September 2012]. Dugdale, D. (2011). Capillary nail refill test. Medline Plus [online]. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003394.htm [Accessed 09 September 2012]. Endom, E. and Somers, M., 2011. Clinical assessment and diagnosis of hypovolemia (dehydration) in children [online]. Available at: http://46.4.230.144/web/UpToDate.v19.2/contents/f26/17/27171.htm [Accessed 11 September 2012]. Gogas, H., Trakatelli, M., Dessypris, N., and Terzidis, A., 2010. Melanoma risk in association with serum leptin levels and lifestyle parameters: a case–control study. Ann Oncol, 19(2), 384-9. Lavi, R., Segal, D., and Ziser, A., 2009. Predicting difficult airways using the intubation difficulty scale: a study comparing obese and non-obese patients. Journal of Clinical Anesthesia, 21(4), 264-267. Leiter, U. and Garbe, C., 2008. Epidemiology of melanoma and nonmelanoma skin cancer—the role of sunlight. Advances in Experimental Medicine and Biology, 624, 89-103. Ouyang, P., Jiang, Y., Doan, H., and Xie, L., et.al., 2008. Weight Loss via Exercise with Controlled Dietary Intake May Affect Phospholipid Profile for Cancer Prevention in Murine Skin Tissues. Cancer Prevention Research, 3, 466 Psaty, E., Scope, A., Halpern, A., and Marghoob, A., 2010. Defining the patient at high risk for melanoma. The International Society of Dermatology, 49(4), 362-76. Qureshi, A., Wei-Passanese, E., Li, T., and Han, J., 2012. Host risk factors for the development of multiple non-melanoma skin cancers. Journal of the European Academy of Dermatology and Venereology. Rosdahl, C. and Kowalski, M., 2006. Textbook of basic nursing. London: Lippincott Williams & Wilkins. Wilmott, R., 2011. Prediction of oxygen saturation from the capillary refill time. The Journal of Pediatrics, 158(6), A1. Read More