Priorities in Nursing Practice and Nursing Standards of Care

 Establishing Nursing Priorities

1. Prioritizing - decisions of which needs or problems require immediate attention or action and which ones could be delayed until a later time since they are not urgent.
2. Needs that are life-threatening or could result in harm to the client if left untreated are high priorities.
3. Actual problems or needs have higher priority than potential problems or needs.
4. Problems or needs identified by the client are of a higher priority.
5. Principles of Maslow's Hierarchy of Needs or the ABCs may guide decisions.
6. Mutual decision-making for priorities may be made with the client based on the client's needs, desires and safety.

NURSE PRACTICE ACTS

• Definition: passed by each state legislature to regulate the practice of nursing in that state
• Nurse Practice Acts define:
• Scope of Practice
• Education
• Licensure
• Professional Misconduct:
• Negligence
• The 'Impaired Nurse'
• The nurse who violates boundaries
• Administered by the Board of Nursing in each state:
• The nurse must know how their state defines professional misconduct
• For Professional Misconduct, the State Board of Nursing imposes penalties (in order of severity):
• On Probation
• Censured
• Reprimanded
• License Suspended
• License Revoked

STANDARDS OF NURSING PRACTICE AND STANDARD OF CARE

Nursing Charting and Documentation

 EFFECTIVE DOCUMENTATION

• Legal Guidelines for Charting
1. Record the facts legibly, in ink
2. Never erase, scratch out or apply correction fluid. Cross through an error once, date and initial the change.
3. Do not leave black spaces in your nursing notes.
4. Never chart for another person
5. Avoid interpreting patient statements. Record exactly what the patient said in quotation marks.
6. Correct all errors in a timely manner.
7. Chart in a timely manner.
• Computerized Charting
1. Never lend access your ID to another person.
2. Maintain confidentiality of documented information printed from the computer.

TYPES OF DOCUMENTATION

Valve Disorders

MITRAL STENOSIS

 Definition

• Mitral valve thickens and gets narrower, blocking blood flow fro. the left atrium to left ventricle

Physiology

• Function of the heart is the transport of oxygen, carbon dioxide, nutrients and waste products
• Cardiac cycle consists of:
• Systole - the phase of contraction during which the chambers eject blood
• Diastole - the phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.
• Blood flow:
1. Deoxygenated blood enters the right atrium through the superior and inferior vena cava
2. Enters the right ventricle via the tricuspid valve
3. Travels through the pulmonic valve to pulmonary arteries and lungs
4. Oxygenated blood returns from the lungs through the pulmonary veins into the left atrium and enters the left ventricle via the bicuspid (mitral) valve
5. From the left ventricle, through the aortic valve through the aorta to the systemic cicrculation
• The heart itself is supplied with blood by the left and right coronary arteries
• The vascular system is a continuous network of blood vessels
• the arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues
• Oxygen, nutrients and metabolic waste are exchanged at the cellular level
• The venous system, veins and venules, returns the blood to the heart

Heart Infections: Rheumatic Heart Diseases (Rheumatic Endocarditis)

 Definition and Related Terms

• Rheumatic Heart Disease - damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
• Rheumatic Endocarditis - damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's chambers enlarge and walls thicken.

Epidemiology

• Worldwide, 15-20 million new cases of rheumatic fever are reported each year
• Rheumatic Fever - follows a Group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis
• Where malnutrition and crowded living are common, rheumatic fever is most common in children between ages 5 and 15.
• Rheumatic Fever strikes most often during cool, damp weather. In the US, it is most common in the Northern States.
• It is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies
• Damage depends on site of infection: most often the mitral valve in females and the aortic valve in males
• Malfunction of these valves leads to severe pericarditis, and sometimes pericardial effusion and fatal heart failure. Of those who survive this complication, about 20% die within ten (10) years.

Heart Infections: Endocarditis

 Definition and Related Terms

• An infection of the endocardium, heart valves,  or cardiac prosthesis resulting from bacterial or fungal invasion
• Endocarditis can be classified as:

1. Native valve endocarditis
2. Endocarditis in IV drug users
3. Prosthetic valve endocarditis

Epidemiology

• With proper treatment, about 70% of clients recover
• The prognosis is worse when endocarditis damages valve severely or involves a prosthetic valve
• Infective endocarditis occurs in 50-60% of clients with previous valvular disorders
• Systemic Lupus Erythematosus (SLE) often leads to nonbacterial endocarditis
• In 12-35% of clients, with subacute endocarditis, lesions produce clots that show the findings of splenic, renal, cerebral or pulmonary infarction, or peripheral vascular occlusion

Heart Infections: Myocarditis

Myocarditis

• an inflammatory condition of the myocardium that may be caused by
• viral infection
• bacterial infection
• fungal infection
• serum sickness
• rheumatic fever
• chemical agent
• as a complication of collagen disease (Systemic Lupus Erythematosus)

Epidemiology

• may be acute or chronic and may occur at any age
• usually an acute virus and self-limited, but it may lead to acute heart failure

Findings

• depends on the type of infection, degree of myocardial damage, capacity of myocardium to recover, and host resistance
• may be minor or unnoticed - fatigue and dyspnea, palpitations, occasional precordial discomfort manifestations such as mild chest soreness and persistent fever
• recent upper respiration with fever, viral pharyngitis or tonsillitis
• cardiac enlargement
• abnormal heart sounds - murmur, S3 or S4 or friction rub

Levine's Grading of Heart Murmurs

H.A.B.I.T.s to Break to Build a Better YOU

Health Hints by Alexandra Nicole Torres (HealthCare Magazine)

PhotoCredit: Dreamstime.com

Breaking free from an unhealthy routine to build a good one requires time, patience and commitment - it's a process. Let's face it, we all have our guilty pleasures that are really difficult to depart from.

To Guide us on our Journey, let's remember the acronym H-A-B-I-T:

1. (H)AVE A GOAL. In order for you to be successful, you must learn to KNOW WHAT YOU WANT. The key to building a solid plan is knowing yourself and knowing what you really want to do and what you want to achieve.

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A Treat for Nursing Students

I remember as a Nursing student that what I dreaded most is making Nursing care plans. What I remember is that it needs your focus and attention in order to make it really good. You think it sounds easy? Well it's not...Just imagine having your 8 hour duty and after that you have to make 4-5 NCPs, what makes its worse is that our CIs usually want all of them handwritten. Can you believe that? About 30-50 pages of agonizing written reports about your patient. You're lucky if you can finish it all before midnight. Well for my case, 3 a.m. is usually early. Yeah, you guessed it, you'll be lucky to have an hour or two for sleep. That's why I value my sleep so much today that I almost don't want to leave my bed.

I remember also that when I am doing reports, NCPs and other research works, it is always gruesome to find all the data in the World Wide Web. I hoped before that someone would compile all the data in just one website. Boy I got a treat for you.

Visit and explore this site...Register as well for your convenience...

http://nursingcrib.com/

Dilemma of the Insane

When I had my duty in the pSyche Ward, I have met all kinds of people that you never thought that would end up there. There are sons of prominent families, some are even working already and in fact they are professionals. One patient is an optometrist, another is an engineer. When you talk to them, they are very sane and the things they say are so logical that you question the fact that they are admitted there.

I recount that a particular patient told me that he is forced to be there and once inside, you don't know what to do to get out. you are faced with the dilemma of behaving in order to be called sane or you lose your patience and release your outburst but you really can't afford to do the latter since you will be considered as manic or having "craziness episodes". But you really can't say that you can behave and not be angry since the condition of the place is not worth living for that you really would get mad if people will keep you in there......

It's ironic that you cannot do something once you're inside because the doctors may misinterpret you actions as insane whereas you're just expressing your frustrations. That particular patient that i was talking about is an optometrist and he is of legal age and he is already earning for himself but he was admitted by his family in the psychiatric ward saying that he is insane. What is the right of anyone, even your family, to tell that you are insane? It's your life and you should decide whether you like to seek consultation or not. of course I am telling this because I feel the situation of the patients.

I agree that the other patients really need to seek medical help but instances like him are very worrying. of course I may be just having "counter-transference" so I cannot really conclude that these people are sane.

Thin Line of Sanity

It's been a while since I have posted my last blog, I have been very busy and I was finally assigned to have my duty in the Psyche Ward ....

WHooah! It's a very tense moment when I first entered the ward. I thought I was gonna die before I leave the place. The patients are all looking at us and they do not look normally. Their stare feels like they're dissecting every bit and every part of your body. It feels as if they know your deepest secrets. It's a good thing that I am not the only one who will have my duty in the Psyche Ward for the first time. I have my three other classmates with me who are first timers. The ironic thing is I was assigned to two patients...Imagine!!!??? Not one patient but TWO!!! GRRRR..At that moment, I thought I want to kill my C.I. but I can't do anything, I have to go through this.

So after minutes of preparation, which feels like years..heheheh... I went to my patient and introduced myself. At first, he seems like a normal person. "Is this a crazy person I'm talking to? He seems pretty ok to me...." That eased my anxiety as I get to know the person more. His name is Mr. Ferdinand ******( let's give him privacy, ok?) he's a seaman and he's ok for a guy. We talked and we talked like crazy. As I talk to him, I remebered my bestfriend who took BSMT too and he is currently having internship in inter-island shipping. That thought made me closer to my patient and we talked the day away....

As the day came to a close, my anxiety in having my duty in the pSyche Ward is still there but at least I am a bit relaxed as I come to know that Psyche patients or the "crazy" or the "mentally ill" as others would call them are very much other person that we come to talk to everyday. Sometimes, the people that we know are worse than those who are in the Psyche Ward. Maybe the difference is just they are undiagnosed to be having such illness or they still have support persons who help them through their problems....

It came to me that the thin line that separates the sane from the insane is indeed veryvery very thin...