FINAL ADVANCE PRACTICE NURSING (Contents)

FROM THEORY TO PRAXIS ACKNOWLEDGMENT The researcher wish to express their profound gratitude and sincere appreciation to e er!
one who is in one wa! or another ga e their a"ua#"e he"p and guidance in the preparation of this wor$% His parents for &ora" support and ad ices To Ms% Ma% 'oren (o! Mana#at) for her up"ifting words during the hard ti&es% His c"ass&ates for the co&pan!) he"p and &a$ing each and e er!one rea"i*e the +o! of "earning the ad anced concepts of "earning To a"" the supporti e peop"e who unse"fish"! shared their $now"edge% The ad&inistration and facu"t! of Saint Pau" ,ni ersit! Phi"ippines for #ringing this progra& c"oser to us) continuous guidance) expert ad ices) teachings and patience% His practicu& ad iser) Ms% Sharon S% -a"i&ag for the encourage&ent) supporti e ad ices and super ision during the progra&% To Sister Ade"ina (a e""ana SP-) Sister -ora*on .unagan) SP-) the super isors) head nurses and staff of the /otre 0a&e de -hartres Hospita" .aguio -it! for their hospita"it! and $indness To the A"&ight! Father for gi ing this opportunit! as we"" as the strength and $now"edge &a$ing the author surpass o#stac"es and reach his goa"s in this aspect of his "ife%
FROM THEORY TO PRAXIS Ta#"e of -ontents
Ac$now"edge&ent 11111111111111111111
Hospita" Profi"e1111111111111111111111111 2 Executi e Su&&ar!11111111111111111111111% 3 0etai"ed -ase Ana"!ses -ardio"og! 1111111111111111111111111 4 0ia#etes 11111111111111111111111111 54 Onco"og! 111111111111111111111%1111 67
'earning Feed#ac$ 0iar! 111111111111111111111 289 .est Practices O#ser ed 111111111111111111111% 2:8 Reco&&endations and Suggestions 11111111111111111 2:7 References 111111111111111111111111111 2:5 Appendices111111111111111111111111111 2:;
FROM THEORY TO PRAXIS Hospita" Profi"e A. HISTORY A&idst the tur#u"ence in the #usiness en iron&ent where the econo&ic conditions ha e rendered patients in the hea"th care industr! power"ess) the RE.IRTH OF /OTRE 0AME 0E -HARTRES HOSPITA' </0-H= ca&e into #eing to fu"fi"" its raison d> etre% The +ourne! of /otre 0a&e started when the Sisters of Saint Pau" con erted their su&&er house into a 79 #ed hospita" on Octo#er 92)26:2 ser ing .enguet ? .a"atoc Mining -orp% 0uring @or"d @ar II) /otre 0a&e was not spared fro& the horrors of war% It was #o&#ed #! the (apanese so"diers #ecause it #eca&e a she"ter to the A&erican &i"itar!% On Octo#er 3)267;) /otre 0a&e rose fro& the ra ages of war% Another 79A#ed unit was #"essed and inaugurated% A decade "ater) /otre 0a&e 0e 'ourdes Hospita" was re#ui"t and #"essed on Apri" 26) 2656% It #eca&e a pro&inent institution in .aguio -it!) $nown for its caring and Bua"it! ser ice% ,nfortunate"!) on (u"! 2;) 2669) the hospita" was not spared of the wrath of the de astating earthBua$e that roc$ed .aguio -it!% The hospita" was dee&ed unsafe and tents were #ui"t to acco&&odate their patients% The sisters decided to c"ose the hospita" on March 2662% Thirteen !ears ha e passed) and the seed that "a! #uried in the ground has co&e to "ife) again%%% The RE.IRTH%%% The Sisters of Saint Pau" of -hartres ha e co&e #ac$ to fu"fi" their &ission%
FROM THEORY TO PRAXIS B. BACKGROUND /otre 0a&e 0e -hartres is an 45A#ed Tertiar! care hospita" and TeachingCTraining Institution% The hospita" is "ocated at D85 Eenera" 'una Road) .aguio -it!% The hospita" is found within Eenera" 'una Road and intersects Assu&ption Road% It is surrounded #! nu&#er of schoo"s) two of which are the two #iggest uni ersities in the cit!% It is near the .aguio -athedra" and +ust across is the .aguioA.enguet P-AE) an e&ergenc! a"ert reporting s!ste&% /-0H is the sa&e icinit! with the Hospita" of the Sacred Heart a"ong Assu&ption Road% The hospita" is co&posed of co&p"ex #ui"dings and situated on a 25%83 hectares p"ain f"at "and with so&e portion on an e"e ated p"ain%
C. VISION AND MISSION STATEMENT VISION Pri i"eged to share in Eod>s sa ing and hea"ing action) we en ision /0-H as a -hristAcentered) d!na&ic and socia""! responsi#"e g"o#a" hea"thcare institution pro iding ho"istic Bua"it! hea"thcare ser ices%
MISSION Faithfu""! "i e and proc"ai& Eod>s "o e through co&passionate care% ,pho"d #ioAethica" princip"es and the teachings of the -atho"ic -hurch% 0e e"op co&petencies of hea"th care professiona"s for integra" growth and strengthen partnerships in education) training and research%
FROM THEORY TO PRAXIS Pursue a"ue inno ati e and socia""! responsi e hea"th care ser ices at par with g"o#a" standards for sustaina#i"it!% Assure that -hristian stewardship and good go ernance are practiced%
D. CORE VALUES Transfor&ing "i es through -hristAcentered hea"th care ser ices
E. ORGANIZATIONAL STRUCTURE .oard of Trustees F Medica" 0irectorAAAAAAAAAAAAAAAAAAAAAAd&inistrator AAAAAAAAAAAAGice President for Education F F F F F F
Finance
F
Pastora" -are
Hu&an Resource Anci""ar! S cs /ursing Ser ice Support S cs
F /urse Super isors F Head /urses F Staff /urses
FROM THEORY TO PRAXIS
F. DUTIES AND RESPONSIBILITIES OF KEY PEOPLE a% Hospita" Ad&inistrator The hospita" ad&inistrator responsi#"e for the da! to da! operationa" running of the hea"th care institution% In addition) the ad&inistrator participates in and coordinates the setting of strategic priorities for the direction of the hospita"% Specific duties inc"ude recruit&ent and retention of ph!sicians) o erseeing Bua"it!) i&pro e&ent of processes for efficient de"i er! of patient care) setting standards) o ersight of #udgets) creating financia" and #usiness strategies to assure fisca" ia#i"it! and hea"th% The hospita" ad&inistrators a"so #eco&e in o" ed in press re"ations) pu#"ic and co&&unit! affairs) grants &anage&ent) #i""ing) co""ections) purchasing of eBuip&ent and &eeting regu"ator! standards%
#% -hief /urse The chief nurse is the executi e head of the nursing ser ice% HeCShe carries fu"" ad&inistrati e responsi#i"it! and authorit! for the entire nursing ser ice of the hospita"% Participates in for&u"ating hospita" po"icies) in de e"oping and e a"uating progra&s and ser ices) assu&es fu"" authorit! and responsi#i"it! for de e"op&ent of nursing ser ice po"iciesH Organi*es) directs) coordinates) e a"uates acti ities of the /ursing Ser ice Staff which a""ow for satisfaction and professiona" growthH Pro ides &eans and &ethods #! which nursing personne" can interpret the goa"s and po"icies of hospita" and nursing
FROM THEORY TO PRAXIS ser ice to the patient and to the pu#"icH Initiates and directs studies) e a"uate procedures for the i&pro e&ent of nursing progra&s for different categories of nursing personne"H directs nursing personne" in functions re"ated to the c"inica" training progra& of nursing students and other affi"iatesH Prepares with her super isor! staff #udget proposa" for the nursing personne"H 0efines +o# description for each categor! of nursing personne"H Recruits and reco&&ends personne" for appoint&ent) pro&otion or dis&issa" depending on staffing needs of the ser ices%
c% /urse Super isor /urse Super isors pro ide care for patients) #ut the! a"so o ersee the nursing staff% As a nurse super isor) !ou ensure that there is adeBuate staffing in !our unit) interact with patient and fa&i"ies) &anage issues that arise during !our shift) and direct and super ise a"" aspects of patient care%
d% ,nit Head /urse The head nurse sha"" direct the perfor&ance of nursing functions in hisCher units consistent with the phi"osoph!) goa"s) o#+ecti es and standards of care of the nursing ser ice% SheC He sha"" #e tas$ed with #ui"ding effecti e tea&wor$ of peop"e to effecti e and costAefficient uti"i*ation of faci"it! and other &ateria" resources% SheC He has contro" o er the functions of her unit and &a$es decisions
FROM THEORY TO PRAXIS regarding #oth patient care and staff situations as reBuired in these units% The head nurse is direct"! responsi#"e to the depart&ent head%
e% Staff /urse The staff nurse sha"" initiate and perfor& nursing care to &eet the needs of the patient within the scope of nursing practice pro ided #! the "aw within the context of the phi"osoph!) goa"s o#+ecti es and standards of care as esta#"ished #! the profession and the nursing ser ice% The staff nurse sha"" #e acti e"! in o" ed in teachingC continuing education progra&s designed to i&pro e Bua"it! of nursing care de"i er!%
f% Auxi"iar! Ser ice Staff The nurse auxi"iar! is a person who) ha ing #een regu"ar"! ad&itted to a progra& du"! recogni*ed and esta#"ished in the Phi"ippines) has successfu""! co&p"eted the prescri#ed course of studies and has acBuired the reBuisite Bua"ifications%
Executi e Su&&ar! This narrati e report is a co""ection of "earning insights acBuired during the Ad anced Re"ated /ursing Experience that too$ p"ace in /otre 0a&e de -hartres Hospita" in .aguio -it! fro& /o e&#er 5 to 88) 8928% The first part is the hospita" profi"e) histor!) ision and &ission state&ents and the $e! peop"e that run the organi*ation as one% Fo""owing this are the se"ected cases of patients with cancer) dia#etes and heart disease se"ected #! the author% The case studies inc"udes the #ac$ground of the case) profi"e of the patients) &edica" histor!) "a#orator! and diagnostic exa&inations done and the drug studies% The ita" part of the case studies are the nursing care p"ans for&u"ated for the& #! the author to &atch their nursing need% The "ast part of the report presents the dai"! acti it! of the author) the #est practices o#ser ed in the hospita" and the reco&&endations for the areas that need i&pro e&ent%
-ase Stud!I 0ia#etes This is a case of a 78 !ear o"d &arried wo&an diagnosed with dia#etes% She was diagnosed with T!pe II dia#etes Me""itus in the !ear 8929 and hospita"i*ed on"! once% Ora" antidia#etic &edication was prescri#ed #! her ph!sician #ut she on"! too$ it for ; &onths% ,nti" then) she did not #other to ta$e necessar! precautions and pre enti e practices to contro" her sugar "e e"% This case is a presentation of a possi#"e co&p"ication of dia#etes in the rena" s!ste&% Researches present strong e idence of this co&p"ication%
Patient Pr !i"e Sex Age Address Re"igion Occupation Ad&ission 0ate -hief -o&p"aint 0iagnosis I F I 78 I -a&p 3) .aguio -it! .enguet I .aptist I Hu&an Resource Officer I /o e&#er 22) 8928 I Fe er and H!pogastric Pain I T!pe 8 0ia#etes Me""itus
PAST MEDICAL HISTORY The patient is $nown dia#etic since 8929 #ut ad&its nonco&p"iance to treat&ent regi&en% She was ad ised to ta$e ora" h!pog"!ce&ic agent and referred to a dietitian for diet &odification #ut fai"ed to co&p"!% She has no $nown histor! of asth&a and heart attac$ and has not #een hospita"i*ed due to 0ia#etes% Her #"ood pressure is within nor&a" &easure&ents% On an a erage of twice e er! !ear in the past three !ears) c"ient experiences cough and co"ds #ut did not see$ &edica" attention regarding this% Se era" &onths after #eing diagnosed with T!pe 8 0ia#etes) it was found out that she has nephro"ithiasis and undergone &edica" &anage&ent% /o surgica" operation has #een done%
HISTORY OF PRESENT ILLNESS Four da!s prior to ad&ission) the c"ient experienced undocu&ented fe er which she &edicated with paraceta&o") #od! wea$ness) "oose #owe" &o e&ent and &ucoid stoo"% Three da!s prior to ad&ission) she experienced h!pogastric pain% Se era" hours prior to ad&ission) s!&pto&s are sti"" present and fe er did not su#side% The c"ient experienced co"d c"a&&! s$in% This is when the! ha e decided to see$ &edica" attention% After thorough exa&ination) the attending ph!sician diagnosed her with P!e"onephritis%
FAMILY MEDICAL HISTORY The patientJs &other is a $nown dia#etic and has a histor! of congesti e heart fai"ure% Her father has asth&a and died of &!ocardia" infarction%
She has no $nown food and drug a""ergies%
HEALTH ASSESSMENT A. Hea"t# Per$e%ti n an& Hea"t# Mana'e(ent .efore ad&ission) patient descri#es her "ife as good% She was satisfied with it e en though she is aware of her condition% She is a nonAs&o$er and drin$ wine in &oderation and +ust at "east two occasions in a &onth% She had a $idne! stone diagnosed &onths after she was diagnosed with dia#etes% She consu"ted a ph!sician regarding her dia#etes twice in 8929 and se era" ti&es for her $idne! stones which was &anaged on"! #! &edications% She descri#es her current wor$ing condition in San RoBue Power -orporation as good% Since she and her hus#and are wor$ing) she does not pa! &uch attention to the nutritiona" contents of the food the! eat for the! prefer those that cou"d #e easi"! prepared and accessi#"e which is in her case) &eat) pou"tr! and co&&on egeta#"es so"d in the &ar$et near#! their ho&e% Hea"thcare faci"it! is accessi#"e fro& 25 to :9 &inutes awa! fro& their ho&e% In cases of &i"d headache) she on"! ta$es paraceta&o" and ne er too$ an! other &edications%
FROM THEORY TO PRAXIS She was prescri#ed with Metfor&in #ut stopped ta$ing it after se era" wee$s for she fee"s as if she is nor&a" without it% According to her) she percei es no noticea#"e s!&pto& of dia#etic after her consu"tation%
B. N)triti n an& Meta* "i$ The patientJs s$in is pa"e "oo$ing) dr! and co"d with supp"e turgor% She has no noticea#"e s$in "esion% She has an artificia" denture and her gu&s are nor&a" with pin$ish co"or% The patient experienced a weight gain of 29 $i"ogra&s in the past six &onths% Her appetite #eca&e fair se era" da!s after her ad&ission #ut she sti"" a#"e to to"erate so"id foods #eing ser ed #! the hospita" dietar! depart&ent <dia#etic diet=% She has no nausea) does not o&it) no difficu"t! of swa""owing) chewing and indigestion%
C. E"i(inati n The patient has nor&a" #owe" sound% She has tenderness in the h!pogastric area radiating to her "eft and right f"an$ with pain sca"e of ;C29% There is no o erf"ow of urine when #"adder is pa"pated% The patient has one #owe" &o e&ent e er! da! and it does not change e en during hospita" ad&ission% There is a histor! of diarrhea that "asted for one da! <: rd da! of hospita"i*ation=% The oiding freBuenc! of the patient is increased #ut there is no histor! of
difficu"t!) retention) pain or #"adder spas&%
FROM THEORY TO PRAXIS D. A$ti+it,-E.er$i/e In the wor$p"ace) the patientJs acti it! is reduced due to the nature of her +o#% He tries to wa"$ herse"f when needs to go fro& one p"ace to another as her on"! for& of exercise% In the hospita") when fee"ing we"" and wa"$ing is to"era#"e) she wa"$s herse"f around the roo& or around the garden near#! the ward% She experiences no difficu"t! &o ing and difficu"t! of #reathing during acti ities% The patient needs "itt"e assistance in A0'Js due to &o e&ent restrictions of her hands with IG "ine% -"ient has nor&a" pu"se rate and respirator! rate upon assess&ent%
E. S"ee% Re/t Pattern The c"ient usua""! s"eeps ; to 4 hours at night and has an afternoon nap% She a"wa!s fee"s rested afterwards% She has no difficu"t! s"eeping and does not awa$en at night except when fee"ing the urge to oid%
F. C 'niti+e- Per$e%t)a" Patient co&p"ains an on and off h!pogastric pain% ,pon assess&ent) it was identified as f"an$ pain radiating to the h!pogastric area with pain sca"e of ;C29 with no pattern of occurrence and "asts fro& 2 hour to ha"f a da!% At ho&e) she tried to &edicate it with paraceta&o" which according to her ga e a "itt"e re"ief% The pain #egan : da!s prior to her ad&ission%
FROM THEORY TO PRAXIS G. Se"!- Per$e%ti n an& Se"!-C n$e%t 0uring assess&ent) patient is re"axed and ca"& and spea$s in a soft toned oice that hasnJt changed throughout the inter iew%
The patientJs &a+or concern at the &o&ent is the changes that she needs to undergo to a oid such situation for the doctor a"read! exp"ained to her that her current condition is possi#"! a co&p"ication of her 0ia#etes% @ith regards to "ifest!"e &odification) she er#a"i*e that she #e"ie e it wou"d not #e a pro#"e& for her as "ong as she wi"" #e guided #! her hea"th care pro iders%
H. R "e Re"ati n/#i% The patient is "i ing in their residence with her hus#and and 7 chi"dren and as she er#a"i*ed) the changes that she needs to undergo wou"d not affect her ro"e as a hus#and and &other%
I. Se.)a"it, The patient uses contracepti e pi""s as &ethod of #irth contro" since 8995% She had : pregnancies and a"" of which are #orn a"i e% She is not !et into &enopausa" stage and satisfied with her sexua" re"ationship with her hus#and%
FROM THEORY TO PRAXIS 0. C %in'-Stre// There are no o ert sign of stress that can #e o#ser ed during inter iew and the patient rates her stress hand"ing as good% She dea"t with e er!da! stressor #! confronting it with the he"p of her support s!ste&%
K. Va")e/-Be"ie! The patient is a de oted .aptist and is satisfied with the de e"op&ent of her "ife #esides her condition% Her ad&ission &ade her c"oser to the Supre&e .eing and it does not interfere with her re"igious practices%
LABORATORY AND DIAGNOSTIC E1AMINATIONS URINALYSIS RESULTS A&#er Tur#id ;%92 <Acidic= 2%985 Positi eKKK Positi e KKK Positi e KKK Positi eKKK Positi eK /egati e /egati e /egati e Too /u&erous to -ount 7A; Few Few Few COMPLETE BLOOD COUNT RESULTS NORMAL VALUES 25%6 7%9A29%9 5%79 :%5A5%9
PARAMETERS -o"or Transparenc! pH Specific Era it! E"ucose Protein 'eu$oc!tes Er!throc!tes Letones /itrates ,ro#i"inogen .i"iru#in @.R.A&orphous ,rates Mucuous Thread .acteria PARAMETERS @hite ."ood -e""s Red ."ood -e""s
FROM THEORY TO PRAXIS He&og"o#in He&atocrit P"ate"et -ount @.- 0ifferentia" /eutrophi"s '!&phoc!tes Monoc!tes Eosinophi"s ."ood -he&istr! Potassiu& Sodiu& -h"oride SPE-IME/ Throat Swa# 27%: 9%7: 8:2 9%3; 9%87 9%99 9%99 :%25 2:5 292%8 KOH Te/t 22%9A25%9 9%:39A9%:49 279A759 9%7A9%3 9%89%9%79 9%99A9%9; 9%99A9%97 :%5A5%: 2:5A274 64A293
RES,'T Positi e for Funga" Spores On"! GRAM STAIN Speci&enI Throat Swa#
Resu"tI S&ear shows a &ixture of few gra& negati e <A= cocci occurring sing"! and in pairs and few negati e cocco#aci""i% Pus ce""s and few epithe"ia" ce""s are noted% GLYCOSILATED HEMOGLOBIN Resu"tI 4%8M Reference Ga"ueI 7%:A ;%7M ABDOMINAL ULTRASOUND I&pressionI o Medu""ar! nephroca"cinosis) #i"atera" with aca"!cea" stones o Sonographica""! nor&a" "i er) pancreas) sp"een and urinar! #"adder o /or&a" si*e ante erted uterus with thin endo&etriu& o /egati e for adrena" &asses
PATHOPHYSIOLOGY Eenetic predisposition and age are the two distinct predisposing factor the patient ha e% She is 78 !ear o"d with a dia#etic &other% T!pe 8 0ia#etes affects 69M to 65M of peop"e with disease% It occurs &ore co&&on"! in peop"e who are o"der than :9 !ears of age and o#ese% The two &ain pro#"e&s re"ated to insu"in in t!pe 8 0M are insu"in resistance and i&paired insu"in secretion% Insu"in resistance refers to a decrease tissue sensiti it! to insu"in% The exact &echanis& that resu"ts to insu"in resistance and i&paired insu"in secretion in t!pe 8 dia#etes are un$nown% To o erco&e insu"in resistance) and to pre ent the g"ucose in the #"ood) increased a&ounts of insu"in &ust #e secreted to &aintain the g"ucose "e e" at a nor&a" or s"ight"! e"e ated "e e"% This is ca""ed &eta#o"ic s!ndro&e% Howe er) if the #eta ce""s cannot $eep up with the increased de&and for insu"in) the g"ucose "e e" rises and t!pe 8 dia#etes de e"ops% .ecause t!pe 8 dia#etes is associated with a s"ow progressi e g"ucose into"erance) its onset &a! go undetected for &an! !ears% If the patient experiences s!&pto&s) the! are freBuent"! &i"d and &a! inc"ude fatigue) po"!uria <which the patient encountered wee$s #efore her diagnosis and se era" ti&es #efore ad&ission=) po"!dipsia) poor"! hea"ing s$in wounds) agina" infections or #"urred ision% .ecause of the extra g"ucose in the urine it pro ides an exce""ent source of food for an! pathogenic &icroorganis&% This increases the ris$ of getting #"adder or $idne!
FROM THEORY TO PRAXIS infections which is in the case of the patient) we &a! assu&e that the dia#etes contri#uted to the de e"op&ent of p!e"onephritis%
DRUG STUDY Le+ !" .a$in -"ass Therapeutic Action 0osage Indications I I I I Anti#iotic) F"ouroBuino"one .actericida" 599&g ta#"et once a da! Acute P!e"onephritis) -o&&unit! AcBuired Pneu&onia) .acteria" Sinusitis) -hronic .ronchitis) -hronic .acteria" Prostatitis) PostAexposure inha"ationa" Anthrax
/ursing Responsi#i"ities I Arrange for cu"ture and sensiti it! tests #efore #eginning of the therap! -ontinue therap! as indicated for condition #eing treated <3 to 27 da!s for p!e"onephritis= Ad&inister ora" drugs without regards to &ea"s with a g"ass of water% Separate ora" drug fro& other cation ad&inistration inc"uding antacids) #! at "east 8 hours% Monitor drug response% If no i&pro e&ent is seen or re"apse occurs) repeat cu"ture and sensiti it! test Ce!tria. ne S &i)( -"ass I Anti#iotic) Third Eeneration -epha"osphorin
FROM THEORY TO PRAXIS Therapeutic Action 0osage Indications I .actericida" I 2g e er! 4 hours I ,rinar! Tract Infection) "ower respiratot! infection) gonorrhoea) intraAa#do&ina" infection) pe" ic inf"a&&ator! disease) septici&ea) #one and +oint infections and &eningitis
/ursing Responsi#i"it! I -u"ture infection and arrange for sensiti it! tests #efore and during therap!%
Instruct patient to report diarrhea) difficu"t! of #reathing) unusua" tiredness or fatigue) pain at in+ection site% Pr '"ita2 ne -"ass Therapeutic Action I Antidia#etic I Resensiti*es tissues to insu"inH sti&u"ates insu"in receptor sites to "ower #"ood g"ucose and i&pro e the action of increases 0osage Indications insu"in) decreases hepatic g"uconeogenesis and insu"inAdependent &usc"e g"ucose upta$e% I :9&g ta#"et once a da! I Monotherap! as an ad+unct to diet and exercise to i&pro e g"ucose contro" in patients with t!pe 8 &e""itus As a part of co&#ination with a su"fon!"urea) &etfor&in and insu"in when diet) exercise) p"us a sing"e agent
FROM THEORY TO PRAXIS a"one dia#etes /ursing Responsi#i"it! I Monitor "i er function tests #efore therap! and during the therap! to &onitor effecti eness of drug Ad&inister without regards to &ea"s Arrange consu"tation with dietitian to esta#"ish weight "oss progra& and dietar! contro" as appropriate Patient Education I 0o not discontinue this &edication without consu"ting !our hea"th care pro iderH continue with diet and exercise progra& for dia#etes contro" Ta$e this drug without regards to &ea"s% If a dose is &issed) it &a! #e ta$en on the next schedu"ed ti&e% If the dose dose is &issed on the entire da!) do not ta$e dou#"e the fo""owing date Monitor urine and #"ood er! c"ose"! for g"ucose and $etones whi"e ad+usting to drugs ,se #arrier contracepti es if current"! using with hor&ona" contracepti e does not resu"t in g"!ce&ic contro" in t!pe 8
Met! r(in -"ass Therapeutic Action I Antidia#etic I Exact &echanis& is not understoodH possi#"! increases periphera" uti"i*ation of g"ucose) decreases hepatic
FROM THEORY TO PRAXIS g"ucose production) and a"ters intestina" a#sorption of 0osage Indications g"ucose% I 459 &g ta#"et twice a da! I Ad+unct to diet to "ower #"ood g"ucose with t!pe 8 dia#etes &e""itus in patients who are 29 !ears o"d or o"der o"der As part of co&#ination therap! with su"fon!"ureas or insu"in when either drug a"one cannot contro" g"ucose &e""itus /ursing Responsi#i"ities I Monitor urine and seru& g"ucose "e e" to deter&ine effecti eness of drug and dosage Arrange for transfer to insu"in therap! during periods of high stress Patient Teaching I 0o not discontinue this &edication without consu"ting hea"th care pro ider Swa""ow extended re"ease ta#"et as who"e) do not crush ) #rea$ or chew% "e e"s in patient with t!pe 8 dia#etes and extended re"ease in patients 23 !ears o"d and
Ket r "a$ -"ass I /SAI0) /onopioid Ana"gesic) Antip!retic
FROM THEORY TO PRAXIS Therapeutic Action I AntiAinf"a&&ator! and ana"gesic acti it!H inhi#its prostag"andins and "eu$otriene s!nthesis% 0osage Indications I :9 &g a&pu"e e er! 4 hours dai"! intra enous"! I Short ter& &anage&ent of pain <up to 5 da!s=
/ursing Responsi#i"ities I .e aware that patient &a! #e at ris$ for -G e ents) EI #"eeding) rena" toxicit!) &onitor according"!% Leep e&ergenc! eBuip&ent readi"! a ai"a#"e at ti&e of initia" dose reaction% in case of se er h!persensiti it!
Fro& Theor! to Praxis NURSING CARE PLANS Assess&ent NMa! &ga pag$a$ataon "ang na &ada"as a$ong &auhaw at &ada"as &aihi $atu"ad nga!on%O As stated #! the patient% E"!cos!"ated He&og"o#in P 4%8M /ursing 0iagnosis I&#a"anced /utritionI More Than .od! ReBuire&ents re"ated to insu"in deficienc! with ina#i"it! to uti"i*e nutrients as e idenced #! freBuent urination) increased thirst and e"e ated #"ood g"ucose "e e" Eoa" of -are Short ter& goa"I After 5 da!s of nursing inter entions) c"ient wi"" &aintain adeBuate ca"oric and nutritiona" inta$e as e idenced #! reso" ing s!&pto&s of h!perg"!ce&ia /ursing Inter ention Ongoing assess&entI @eigh the patient on initia" and su#seBuent contact
8;
Rationa"e
E a"uation After 5 da!s of nursing inter entions) c"ient ha e &aintained adeBuate ca"oric and nutritiona" inta$e as e idenced #! reso" ing s!&pto&s of h!perg"!ce&ia Eoa" &et%
To esta#"ish #ase"ine and co&parison for future reassess&ent H!perg"!ce&i a resu"ts when there is inadeBuate insu"in% To esta#"ish #ase"ine of #"ood g"ucose "e e" To identif! the foundation for de e"oping an indi idua"i*ed diet
Assess for signs of h!perg"!ce&ia
Re iew #"ood g"ucose histor! Assess current eating ha#its
FROM THEORY TO PRAXIS p"an% Therapeutic inter entionsI Esta#"ish goa"s with patient% Re iew progress towards goa"s on each su#seBuent isit% Patient in o" e&ent in the treat&ent p"an enhances adherence to treat&ent regi&ens% To pro ide the #asis for indi idua"i*ed diet p"an An indi idua"i*ed &ea" p"an #ased on weight) #"ood g"ucose and "ipid pattern shou"d #e de e"oped for each patient Each
Assist patient to identif! eating pattern that needs changing Refer to a registered dietitian for an indi idua"i*ed instruction
Instruct patient to ta$e
FROM THEORY TO PRAXIS Ora" Hpog"!ce&ic Agent as directed &edication acts on different site of g"ucose &eta#o"is&% The patient &ust #e infor&ed regarding this to &axi&i*e each &edicationJs effects% Exercise i&pro es "ipid pattern and assists with weight "oss%
Instruct the patient to exercise% Refer to the Pg!sica" therap! depart&ent for appropriate exercise%

Assess&ent NSa#i ng doctor $ai"angan $o na daw &agsa$sa$ ng insu"in pag"a#as $o ng ospita")hindi $o pa nga a"a& $ung pano eO) as er#a"i*ed #! the patient% -o&p"ex &edica" regi&en Insufficient $now"edge a#out dia#etes and its treat&ent /ursing 0iagnosis Ris$ for ineffecti e therapeutic regi&en &anage&ent re"ated to co&p"ex &edica" regi&en and $now"edge deficits Eoa" of -are After : da!s of nursing inter ention) the c"ient wi""I 0e&onstrate a#i"it! to &aintain #"ood g"ucose "e e" within defined target range 0e&onstrate $now"edge of dia#etes se"fA care &easures /ursing Inter ention 0eter&ine patient "earning needs% E a"uate se"fA &anage&ent s$i""s) inc"uding a#i"it! to perfor& procedures for #"ood g"ucose &onitoring Assess financia" resources for hea"th care Rationa"e This dictates the a&ount and t!pe of infor&ation necessar!% This deter&ines the a&ount of education necessar! The cost of &edication &a! #eco&e #arrier to &anage&ent of 0ia#etes% E"e ated g"ucose "e e"s in patients with pre ious"! diagnosed dia#etes indicate the need to e a"uate dia#etes &anage&ent% FreBuent episode of h!pog"!ce&ia in indi idua"s with pre ious"! diagnosed dia#etes indicate the need to E a"uation After : da!s of nursing inter entions) the c"ientI 0e&onstrated the a#i"it! to &aintain #"ood g"ucose "e e" within defined target range 0e&onstrated $now"edge of 0ia#etes and its treat&ent
Ensure that the patient has $now"edge a#out s!&pto&s) causes) treat&ent) and pre ention of h!perg"!ce&ia Ensure that the patient has $now"edge a#out the s!&pto&s) causes) treat&ent and pre ention of h!perg"!ce&ia%

e a"uate dia#etes &anage&ent% Teach re"ationship #etween &edication &anage&ent and #"ood g"ucose contro" Approxi&ate"! 69M of persons with 0ia#etes wi"" reBuire ora" antidia#etes &edications) insu"in) or #oth Instruction a""ows the patient to identif! when therap! ad+ust&ent need to #e &ade in dia#etes treat&ent E a"uation pro ides opportunit! to correct errors in techniBue% Education is an ongoing process that reBuires reinforce&ent o er ti&e%
Teach the patient how to use #"ood g"ucose resu"ts in o era"" dia#etes &anage&entI re iew #asic patterns &anage&ent%
E a"uate effecti eness of e er! instruction
Instruct the patient on 0ia#etes &anage&ent during i""ness% o Instruct to ta$e a""

&edications% o Se"fA&onitor #"ood sugar e er! 8 to 7 hours o 0rin$ 4 ounces of f"uids e er! 7 hours% Sugar free drin$s are reco&&ended when the patient is a#"e to &aintain nor&a" car#oh!drate inta$e% Su#stitute drin$s containing sugar when the indi idua" cannot to"erate food as in anorexia% Instruct when to contact pri&ar! pro iderH ."ood g"ucose "e e"s higher than :99&gCd') o&iting for &ore than 8A7 hours) s!&pto&s of deh!dration or s!&pto&s suggesting de e"op&ent of HH/S% Instruct the patient a#out p"anning for dia#etes &anage&ent when tra e""ing such as putting &edications in carr!Aon "uggage% Refer to socia" ser ices to he"p with financia" resources
Ear"! treat&ent of h!perg"!ce&ia pre ents HH/S occurrence%
So&e tra e" &a! in o" e ti&e changes that &a! disrupt the patientJs usua" routines% /onAadherence to a treat&ent p"an &a! occur #ecause of

"i&ited resources in purchasing &edications and #"ood g"ucose &onitoring supp"ies% So&e costs &a! not #e co ered #! hea"th insurance%
Assess&ent NAng dahi"an ng pagpachec$A up $o eh pagsa$it ng puson hanggang sa #a"a$ang)O as c"ai&ed #! the patient Pain sca"e of ;C29 upon assess&ent Positioning to a oid pain Sighing Reduced interaction with the en iron&ent E"e ated te&perature E"e ated @.Fe er <TP :3%4 -= Tur#id urine
/ursing 0iagnosis Acute pain re"ated to infectious process <p!e"onephritis=
Eoa" of -are After 8 da!s of nursing inter ention) the patient wi""I Report pain is re"ie ed <:C29= Fo""ow prescri#ed phar&aco"ogica" regi&en% Ger#a"i*e nonA phar&aco"ogic &ethod that re"ie es pain 0e&onstrates use of re"axation s$i""s and di ersiona" acti ities) as indicated for indi idua" situations
/ursing Inter ention Asses pain characteristics%
Rationa"e The first step of pain &anage&ent strategies So&e peop"e den! the existence of pain when it is present% Attention to associated signs &a! he"p the nurse in e a"uating pain% So&e patients &a! not #e aware of the effecti eness of nonA phar&aco"ogica" &ethods and &a! #e wi""ing to tr! the&) either with or instead f
E a"uation After 8 da!s of nursing inter ention) the c"ientI Reported pain re"ief @as a#"e to fo""ow prescri#ed phar&aco"ogica" regi&en without &iss Ger#a"i*ed nonA phar&aco"ogic &ethod that re"ie es pain 0e&onstrated use of re"axation s$i""s and di ersiona" acti ities) as indicated for indi idua" situations
O#ser e signs and s!&pto&s associated with pain such as .P) heart rate) te&perature) rest"essness and a#i"it! to focus%
Assess patients $now"edge of the arra! of pain re"ief strategies a ai"a#"e%

ana"gesic &edications% One can &ost effecti e"! dea" with pain #! pre enting it% In the &idst of painfu" experience) a patients perception of ti&e &a! #e distorted% Pro&pt response to co&p"ain &a! resu"t decreased anxiet! for patients% Patient experience of pain &a! #eco&e exaggerated with fatigue%
Anticipate need for pain re"ief
Respond i&&ediate"! to co&p"aint of pain
Pro ide rest periods to faci"itate co&fort) s"eep and re"axation%
Pain

&edications are a#sor#ed and &eta#o"i*ed different"! #! patients) so their effecti eness &ust #e e a"uated indi idua""!% Lnow"edge a#out what to expect can he"p the patient de e"op effecti e coping strategies for pain &anage&ent Re"ief &easures &a! #e instructed Re"ief &easures cou"d #e &odified to produce &ore satisfactor! co&fort "e e"s
Ad&inister ana"gesic as ordered e a"uating effecti eness and o#ser ing signs and s!&pto&s of untoward effects
Pro ide anticipator! instruction on pain causes) appropriate pre ention and re"ief &easures Instruct the patient to report pain Instruct the patient to e a"uate and report effecti eness of

&easures used
A//e//(ent O#+ecti eI H!perg"!ce&ia Ph!sica" i&&o#i"i*ation
N)r/in' Dia'n /i/ I&paired s$in integrit! re"ated to a"tered &eta#o"ic state <h!perg"!ce&ia= and Ph!sica" i&&o#i"it!
G a" ! Care After 8 hours of nursing inter ention) c"ient wi"" de&onstrate correct foot care practice
N)r/in' Inter+enti n Assess the genera" appearance of the foot% Assess the h!giene%
Rati na"e This pro ides the #asis for future education%
E+a")ati n After 8 hours of nursing inter ention) the c"ient was a#"e to de&onstrate correct foot care practice%
Assess the status of the nai"s% Asses s$in integrit!% /ote the presence or a#sence of ca""us for&ation or corns%
Pressure o er #on! pro&inences "eads to ca""us for&ation% This condition can "ead to the de e"op&ent of s$in #rea$down%
Atherosc"erosis resu"ts in gradua"
FROM THEORY TO PRAXIS decrease of #"ood supp"! in the foot% S!&pto&s &ight #e present due to neuropath! Maceration #etween the toes predisposes the patient to infection A"" surfaces of the foot &ust #e exa&ined inc"uding s$in #etween the toes% Touch wi"" identif! s$in surface a"teration that are not e ident #! sight% This rep"aces &oisturi*ing effects "ost #! autono&ic neuropath!% Se"ect "otion with "ow
Assess the circu"ator! status of the foot #! pa"pation of periphera" pu"ses% Assess for infection
Exa&ine hosier! and shoes
Teach the patient to inspect feet dai"! for cuts) scratches and #"ister% ,se a &irror to exa&ine the #otto& of the foot% Instruct the patient to use #oth isua" and tacti"e inspection%
FROM THEORY TO PRAXIS a"coho" content to pre ent dr!ing of the s$in Ear"! treat&ent is essentia" in pre ention of co&p"ications%
Encourage use of &oisturi*ing "otion at "east once dai"!% A oid areas #etween the toes%
Report signs of infection i&&ediate"! to the pri&ar! pro ider% o Area of s$in #rea$down o Increase in te&perature as co&pared to the sa&e area of the opposite foot% o 0ischarge that de e"ops an odor% Teach patient to
-arefu" dai"! assess&ent reduces ris$ of in+ur! to the foot%
FROM THEORY TO PRAXIS inspect the shoes dai"! #! fee"ing the inside of the shoe for irregu"arities in the "ining) sharp o#+ects in the so"e of the shoe) or foreign #odies in the shoe% Teach the patient to a oid ther&a" in+uries #!I o Testing the te&perature of #ath water with the e"#ow) wrist or ther&o&eter) o A oiding use of heating pad) hot water #ott"es or e"ectric #"an$ets o Maintaining a safe distance fro& heat sources Instruct the patient to a"wa!s wear protecti e
Sensor! neuropath! &a! resu"t in nor&a" pain and te&perature sensation% These changes increases ris$ for #urns%
This pre ents foot in+ur!% Soa$ing can &acerate the s$in and increases the ris$ of infection
FROM THEORY TO PRAXIS footwear% Instruct the patient to a oid soa$ing feet% Instruct the patient to tri& nai"s across and to fi"e sharp corners to &atch contour of the toe% This pre ents foot in+ur!
A//e//(ent
N)r/in' Dia'n /i/
G a" ! Care
N)r/in' Inter+enti n
Rati na"e
E+a")ati n
FROM THEORY TO PRAXIS NMas!ado na ngang &ada&i ang dapat iconsider para &a$ontro" $o tong 0ia#etes $o nga!on e%O O#+ecti eI -o&p"ex &edica" regi&en ReBuire&ent for changes in "ife"ong #asis Increasing se"f care reBuire&ents to &aintain #"ood g"ucose contro" Ris$ for ineffecti e coping re"ated to co&p"ex &edica" regi&en) reBuire&ents of change in "ife"ong #asis and increasing reBuire&ents to &aintain #"ood g"ucose contro" Assist patient to identif! the situations that cause anxiet! or increased stress% A starting point is to as$ the patient what he or she finds &ost difficu"t to do% The patient &a! #e a#"e to cope with on"! one hea"th #eha iour change at a ti&e%
After 8 da!s of nursing inter entions) the patient wi""I .e a#"e to perfor& se"fAcare #eha iors Identifies stressors that interfere with a#i"it! to contro" dia#etes 0e e"ops appropriate action p"an to dea" with stressors
After 8 da!s of nursing inter entions) the c"ient wasI A#"e to perfor& se"fAcare #eha iors A#"e to identif! stressors that interfere with a#i"it! to contro" dia#etes A#"e to de e"op appropriate action p"an to dea" with stressors
He"p patient identif! thoughts and fee"ing associated with stressors%
Fee"ings of anger) denia" and depression are freBuent"! associated with a chronic disease
He"p patient to identif! stressA re"ated
Euiding the patient to iew the situation
FROM THEORY TO PRAXIS dia#etes pro#"e&s and issues o which the patient wants to wor$% He"p the patient identif! adapti e coping strategies into s&a""er parts &a! &a$e the coping &ore &anagea#"e%
Anxiet! can #e reduced when the patient has anticipated a stressor and de e"oped a p"an to reduce or a oid the stressor%
Pro ide education needed to ena#"e the patient to perfor& se"f &anage&ent #eha iors "i$eI
Anxiet! can #e reduced when the patient has technica" $now"edge and a#i"it! to perfor& the se"f care #eha iors reBuired for #"ood g"ucose
FROM THEORY TO PRAXIS o Se"fA."ood E"ucose &onitoring o Medication ad&inistration o Ad+ust&ent of therap! for exercise and i""ness o Mea" p"anning H!poCh!perg" !ce&ia &anage&ent contro"% On adherence to reBuire&ents &a! occur #ecause of patient &isunderstandi ng of infor&ation%
Assist patient in exa&ining a ai"a#"e resources to &eet goa"s% Re iew hea"th care resources that are a ai"a#"e for use
Socia" support increases the a#i"it! of the patient to dea" with stress
FROM THEORY TO PRAXIS Pro ide positi e reinforce&e nt for use of adapti e #eha iors Reinforce&ent increases the patientJs confidence in his or her a#i"it! to perfor& specific #eha iors The patients readiness for change &a! pre ent a"terations in #eha ior
Ac$now"ed ge that change &a! not #e possi#"e
Fro& Theor! to Praxis -ase Ana"!sisI Onco"og! INTRODUCTION
75
-ancer is not a sing"e disease with sing"e causeH rather it is a group of distinct diseases with different causes) &anifestation) treat&ents and prognoses% The scope) responsi#i"ities and goa"s of cancer nursing ae as di erse and co&p"ex as those other nursing specia"t!% -ancer nurses &ust #e prepared to support patients and fa&i"ies through a wide range of ph!sica") e&otiona") socia") cu"tura" and spiritua" crises% 'i$e other chronic diseases) cancer can resu"t to the patientJs depression and he"p"essness as with the fo""owing case to #e discussed% In this report) a case of a 78 !Co housewife who was diagnosed with 'i er -ancer in Septe&#er 8928 wi"" #e discussed% 'oss of appetite and difficu"t! s"eeping &ade her see$ hea"th care attention% She was ad ised to undergo surger! #ut opted to tr! &edications unti" her condition got worse% In /o e&#er 6) 8928) due to diarrhea and #od! wea$ness) she was #rought to /otre da&e 0e -hartres Hospita" .aguio -it! and after assess&ent of the &edica" histor! and diagnostic procedures) she was ad&itted to the Mere Marie Anne @ard for further &anage&ent%
PATIENT PROFILE AgeI 78 SexI Fe&a"e
FROM THEORY TO PRAXIS -i i" StatusI Married Educationa" Attain&entI -o""ege Eraduate <0entistr!= OccupationI Insurance Sa"es Agent AddressI Ma% Aurora) Aurora
PAST MEDICAL HISTORY In 8922) the patient experienced fe er) cough and co"ds occurring a"&ost e er! other &onth which is unusua" for her% She then thought that these s!&pto&s that &ight #e an indication of wea$ening of her i&&une s!ste& is a part of the aging process% Fro& 0ece&#er 8922) she #egan experiencing difficu"t! s"eeping and "oss of appetite% Though ad&itted"! said she ad&it that ti&e that so&ething is wrong) she opted not to see$ &edica" attention !et and o#ser e further her condition% In Septe&#er 8922) she decided to see$ &edica" attention due to consistent s!&pto&s% She undergone series of &edica" exa&inations and diagnostic tests wherein it was found a &ass in her "i er which the! suspect &a"ignant% The ph!sician prescri#ed &u"ti ita&ins and referred her to an onco"ogist for further &anage&ent% She was ad ised to undergo a surger! which ai&s to re&o e tota""! or partia""! the &ass found depending on the resu"ts of e a"uations the &edica" tea& wi"" conduct #ut she refused% Her condition #eco&e worse and other s!&pto&s &anifested #ut she was a#"e to &anage difficu"t! s"eeping then) unti" in /o e&#er 6) 8928) she was #rought to the hospita" due to to diarrhea and #od! wea$ness) she was #rought to /otre da&e 0e
FROM THEORY TO PRAXIS -hartres Hospita" .aguio -it! and after assess&ent of the &edica" histor! and diagnostic procedures) she was ad&itted to the Mere Marie Anne @ard for further &anage&ent%
FAMILY MEDICAL HISTORY The patientJs father died of Pneu&onia in 8996% The patientJs &other is present"! "i ing with the& in hea"th! condition% She <the &other= has contro""ed h!pertension #ut no histor! of chronic i""nesses% Histor! of cancer can on"! #e traced on her grand&other <.reast cancer= on the paterna" side and a far re"ati e a"so on the paterna" side <O arian cancer=%
HEALTH ASSESSMENT A. Hea"t# Per$e%ti n- Hea"t# Mana'e(ent Pattern Though rest"ess and "oses focus) c"ient is a#"e to answer inter iew Buestions with pro ided inter a"s for rest% She is cooperati e and no signs irrita#i"it! during the inter iew% She ad&its ha ing di&inishing s&e"" and taste sensation% She descri#es her hea"th status as poor for her condition &a$es her una#"e to perfor& nor&a" acti ities of dai"! "i ing and sheJs not satisfied with it% She started s&o$ing when she was 82 !ears o"d and stopped when she was 79 !ears o"d) an occasiona" drin$er <7 g"asses of #eer e er! &onth= with no histor! of drug use% The patient has no histor! of other chronic disease) with tetanus i&&uni*ation she co&p"eted after the #irth of her 7th chi"d% She is not sure if he co&p"eted her infant i&&uni*ation%
FROM THEORY TO PRAXIS Aside fro& consu"tations "eading to the diagnosis of 'i er -ancer) she had not a ai"edCsought hea"th care assistance in the past !ear% She is current"! an insurance sa"es agent and during her hea"th! da!s were exposed to noise and extre&es of weather% The wor$ing en iron&ent is different fro& ti&e to ti&e for she has #een assigned in different areas% The patient "i es with her hus#and and four chi"dren in their ho&e at Ma% Aurora which she rates the condition as good% The on"! pro#"e& she identified where the "i&ited techno"og! present in the area "i$e te"eco&&unications and internet% @hi"e waiting for her decision regarding the &anage&ent of her "i er cancer) her ph!sician prescri#ed &u"ti ita&ins which she too$ once dai"! #efore ad&ission% @hen she was ad&itted) the doctor prescri#ed Piperaci""inATa*o#acta&) Furose&ide) Gita&in L and Paraceta&o" &st &edications are gi en intra enous"!% She #e"ie es that this regi&en is the #est for her as it is prescri#ed% The patient does not ha e histor! of accidents and fa""s the past !ear% She has pro#"e&s with hea"ing which she noticed in the &idA8928%
B. N)triti na"-Meta* "i$ Pattern She "ost rough"! 89 $i"ogra&s since the "ast six &onths which she attri#uted to "oss of appetite% ,sua" &ea" that she can to"erate without o&iting is soup) #read and s&a"" a&ount of fruits% She &a$es sure that she drin$s at "east 2 "iter of water per da!%
C. E"i(inati n Pattern
FROM THEORY TO PRAXIS The patient has at "east three #owe" &o e&ents per da! since her diarrhea is contro""ed occurring not on the sa&e ti&e each da!% Most"e she passes soft to "iBuid "ight co"ored stoo"%
D. A$ti+it,-E.er$i/e Pattern The patient does not &anifest c!anosis) with wea$ #ut pa"pa#"e pu"ses% Extre&ities are coo"% -api""ar! refi"" is de"a!ed <5 seconds=% The patient) does reBuire assistance in A0's due to wea$ness and fatigue% She used to s"eep on 2 pi""ow during #ed ti&e% She wa"$s at "east 2 &eter without experiencing difficu"t!% She used to #e an insurance sa"es agent% 0uring free ti&e) she sta!s with her fa&i"! and do so&e househo"d chores at ho&e%
E. S"ee%-Re/t Pattern The patient usua""! s"eeps at "east 29 hours per night and usua""! has a &orning and afternoon naps of 2 hour each% She stated that one of the first s!&pto&s that &anifested in the ear"! stage of her i""ness was difficu"t! fa""ing as"eep #ut "ater on) the s!&pto& di&inished and she is now a#"e to s"eep easi"!) does not usua""! awa$ens at night and wa$es up at 3I99AM% -ogniti eAPerceptua" Pattern 0uring inter iew) she has no reports of pain and #are"! fe"t pain in the course of her i""ness%
FROM THEORY TO PRAXIS Interna" and externa" factors "ingering on the patients &ind &a$es it difficu"t to decide on &a+or decisions to &a$e for her "ife and the situation% The one who &ost"! decides for her is her hus#and who is her pri&ar! caregi er at ho&e%
F. Se"!-Per$e%ti n an& Se"!-C n$e%t Pattern 0uring the assess&ent) the patient is ca"& with &onotonous oice and "oo$s in the e!e of an!one ta"$ing to her% Her &a+or concern is her death% She does not $now when or when the right ti&e wou"d co&e and her readiness for it% She has a neutra" iew for herse"f%
G. R "e-Re"ati n/#i% Pattern /o speech or co&&unication pro#"e&s noted during the assess&ent% In Ma% Aurora) she "i es with her fa&i"!% She finds no difficu"t! in her parenting s$i""s and the fa&i"! did not experience an! "oss the past !ear% She had four pregnancies in which a"" chi"dren are #orn a"i e and ter&% She has stopped &enstruating at the age of 79 #ut prior to that) she uses #irth contro" pi""s for contraception% 0uring her ad&ission) she had a histor! of agina" discharge that "asted for a da! on"!%
H. C %in'-Stre// T "eran$e Pattern -"ient ad&itted that she cries when no#od! is around due to the hope"essness she fe"t% .ut she is now "earning to accept her situation%
FROM THEORY TO PRAXIS At present) she rates her stress hand"ing as a erage and her pri&ar! wa! to do it is to share e&otions and fee"ings to her hus#and She con ersation with her hus#and) she fee"s re"ief% In her case) the inter a" of s!&pto& experience and hea"th care consu"tation is 6 &onths% er#a"i*ed that #! ha ing a
H. Va")e-Be"ie! Pattern The patient is a Ro&an -atho"ic and confessed that in the ear"! stages of her i""ness) her faith was &o ed #ut #egan to regain it again after so&e ti&e% She $eeps on pra!ing to the Supre&e .eing and wishes to attend the &ass as soon as she can%
LABORATORY AND DIAGNOSTIC E1AMINATIONS PARAMETERS @hite ."ood -e""s Red ."ood -e""s He&og"o#in He&atocrit P"ate"et -ount @.- 0ifferentia" /eutrophi"s '!&phoc!tes Monoc!tes Eosinophi"s E"ectro"!tes Potassiu& Sodiu& HEMATOLOGY REPORT RESULTS NORMAL VALUES 25%2 x 29Q: 7%9A29%9 :%5: x 29Q;Cu' :%5A5%9 229 gC' 22%9A25%9 9%::4 9%:39A9%:49 794 x 29Q:Cu' 279A759 9%43 9%28 9%92 9%99 :%95 275%: ASCITIC FLUID -o"orI YE''O@ Transparenc!I S'IEHT'Y T,R.I0 Go"u&eI 44 &' @.-I 2A: ce""sCu' R.-I 7A4 ce""sCu'
i
9%7A9%3 9%89%9%79 9%99A9%9; 9%99A9%97 :%5A5%: 2:5A274 64A293
FROM THEORY TO PRAXIS TUMOR MARKER TEST -EA R899 AFP 2%37 HEPATITIS PROFILE AntiAH.SI S8 H.SAgI /onAreacti e AntiAH-GI /onAreacti e FECAL OCCULT BLOOD TEST Positi e FO.T OTHER LAB E1AM ."eeding Para&eters I/RI 2%:8M PTI 25%; sec E"ucoseI 69%48 &gCd' -ho"estero" Trig"!cerideI 29%37 H0'I 25%83 <'ow= '0'I :98 <High= -reatinineI %;3 &gCd' .i"iru#inI TOTA'I 9%;3 &gCd' 0IRE-TI 9%:6 &gCd' I/0IRE-TI 9%8; &gCd' WHOLE ABDOMINAL ULTRASOUND 3456 Re&ar$sI Hepatic new growthH Ascites WHOLE ABDOMINAL ULTRASOUND 5543 Re&ar$sI Mar$ed hepato&ega"! with &u"tip"e hepatic &assesCnodu"es "i$e"! &etastatic Ascites noted% -ho"e"ithiasis%
PATHOPHYSIOLOGY
i
FROM THEORY TO PRAXIS -ancer is a disease patters that #egins when an a#nor&a" ce"" is transfor&ed #! the genetic &utation of the ce""u"ar 0/A% <S&e"t*er) .are) Hin$"e) ? -hee er) 8929= The ris$ factor that is present and readi"! identifia#"e to the patient is fa&i"! histor!% The other ris$ factors are the fo""owingI -irrhosis /onAa"coho"ic fatt! "i er disease Infection with hepatitis iruses S&o$ing 'ow I&&unit! 0ia#etes Ea"" ."adder Re&o a" Radiation fro& XAra!s or -T scan .od! @eight <o#esit!= .ete" Tuid Af"atoxinH and
FROM THEORY TO PRAXIS -he&ica"s such as in!" ch"oride and arsenic
-arcinogenesis is a &u"tistage process that #egins when a carcinogen causes a genetic change or da&ages the 0/A in a nor&a" ce""% This &a$es the ce"" &ore u"nera#"e to other genetic changes% This stage is ca""ed Uinitiation%U If the process ended here) and the cancerous ce"" did not grow and rep"icate) no cancer wou"d for&% The next stage of carcinogenesis is ca""ed Upro&otion%U This occurs when the initiated ce"" is exposed to an agent that enhances its growth into a "arger &ass% @hen a tu&or actua""! for&s) it has a"" of the sa&e #asic needs as a nor&a" ce""% .ecause the tu&or ce""s are genetica""! da&aged) the! are inefficient and ro# nor&a" ce""s of i&portant ox!gen and nutrients% In addition) a &a"ignant
FROM THEORY TO PRAXIS tu&or grows uncontro""a#"! and can e entua""! interfere with the function of ita" organs) such as the "i er
Metastatic tu&ors for& when "arge progressi e tu&ors shed tu&or ce""s% These tu&or ce""s &ust #e a#"e to grow and function apart fro& the pri&ar! tu&or
Mo e throughout the #od!) usua""! through the circu"ator! s!ste& or the "!&phatic s!ste&%
Often "odge in a #"ood capi""ar!) where the! &a! or &a! not grow% The tu&or ce""s that actua""! grow are so&ehow &ore suited to the new "ocation%
Tend to &utate &ore Buic$"! than nor&a" ce""s) gi ing the& a greater a#i"it! to adapt to their en iron&ent as we"" as a greater a#i"it! to resist therap!%
FROM THEORY TO PRAXIS V More "i$e"! to infect p"aces the! can easi"! reach% .ecause the "i er is c"ose to or actua""! connected to se era" significant organs) and #ecause the "i er p"a!s an i&portant ro"e in #"ood circu"ation #! acting as a fi"ter) &etastatic "i er cancer occurs in o er 35M of a"" ter&ina" cancer patients%
DRUG STUDY Pi%era$i""in4Ta2 *a$ta( -"ass I AntiAinfecti e) .etaA'acta& Anti#iotic) AntiA pseudo&ona" Pennici""in Therapeutic Action 0osage /ursing Responsi#i"ities I I I .actericida" 8%85g Inta enous"! e er! 4 hours O#tain histor! of h!persensiti it! to penici""ins) cepha"osphorins) or other drugs prior to ad&inistration) O#tain speci&en for cu"ture and sensiti it! prior to first dose of the drugH start drug pending resu"ts% Periodic -.seru& with differentia") p"ate"et count) Hg# ? Hgt) and e"ectro"!tes% Monitor for h!persensiti it! responseH discontinue drug and notif! ph!sician if a""ergic response noted% Monitor for he&orrhagic &anifestations #ecause high dose &a! induce coagu"ation a#nor&a"ities%
FROM THEORY TO PRAXIS Instruct fa&i"!Csignificant others to report significant) unexp"ained diarrhea% Monitor ita" signs #ecause of cardiac arrh!th&ias) h!pertension and fe er as ad erse reactions% Instruct the &other not to #reast feed the #a#! whi"e ta$ing the drug without consu"ting ph!sician% F)r /e(i&e -"ass Therapeutic Action I I 0iuretic Inhi#it rea#sorption of sodiu& and water in the ascending "i&# of the "oop of Hen"e #! interfering with the ch"oride #inding site of the 2/aK) 2LK) 8-"A cotransport s!ste&% 'oop diuretics increase the rate of de"i er! of tu#u"ar f"uid and e"ectro"!tes to the dista" sites of h!drogen and potassiu& ion secretion) whi"e p"as&a o"u&e contraction increases a"dosterone production% The increased de"i er! and high a"dosterone "e e"s pro&ote sodiu& rea#sorption of potassiu& 0osage I at the dista"tu#u"es) thus increasing the "oss and h!drogen ions% 89 &g after 7th R.- Transfusion
FROM THEORY TO PRAXIS /ursing Responsi#i"ities I O#ser e patients recei ing parentera" drug carefu""!H c"ose"! &onitor .P and ita" signs% Sudden death fro& cardiac arrest has #een reported% Monitor .P during periods of diuresis and through period of dosage ad+ust&ent% O#ser e o"der adu"ts c"ose"! during period of #ris$ diuresis% Sudden a"teration in f"uid and e"ectro"!te #a"ance &a! precipitate significant ad erse reactions% Report s!&pto&s to ph!sician% 'a# testsI O#tain freBuent #"ood count) seru& and urine e"ectro"!tes) -O8) .,/) #"ood sugar) and uric acid a"ues during first few &onths of therap! and periodica""! thereafter% Monitor for S?S of h!po$a"e&ia% Monitor I?O ratio and pattern% Report decrease or unusua" increase in output% Excessi e diuresis can resu"t co""apse) standard in deh!dration and h!po o"e&ia) circu"ator! and h!potension% @eigh patient dai"! under conditions% Monitor urine and #"ood g"ucose ? H#A2- c"ose"! in dia#etics and patients with deco&pensated hepatic cirrhosis% 0rug &a! cause h!perg"!ce&ia%
FROM THEORY TO PRAXIS Via(in K -"ass Therapeutic Action I I Gita&ins An antihe&orrhagic actor that pro&otes hepatic for&ation of acti e prothro&#in% 0osage doses Indications /ursing Responsi#i"ities I I H!poprothro&#ine&ia IG useI 0i"ute with 9%6M sodiu& ch"oride for in+ection) 05@) or 05@ in 9%6M sodiu& ch"oride for in+ection% Ei e IG #! s"ow infusion o er 8 to : hours% Rate shou"dnJt exceed 2 &gC&inute in adu"ts or : &gC&8C&inute in chi"dren% Effects of IG in+ection are &ore rapid #ut shorterA"i ed than S- or IM in+ections% Protect parentera" products fro& "ight% @rap infusion container with a"u&inu& foi"% For IM ad&inistration in adu"ts and o"der chi"dren) ad&inister in upper outer Buadrant of #uttoc$sH for infants) ad&inister in the antero"atera" aspect of thigh or de"toid region% Anticipate order of wee$"! addition of 5 to 29 &g of ph!tonadione to tota" parentera" nutrition so"utions% I 2 A&pu"e <29 &g= e er! 4 hours intra enous"! for :
FROM THEORY TO PRAXIS Monitor PT to deter&ine dosage effecti eness as ordered% If se ere #"eeding occurs) donJt de"a! other &easures) such as fresh fro*en p"as&a or who"e #"ood% A"ertI watch for signs of f"ushing) wea$ness) tach!cardia and h!potensionH &a! progress to shoc$% .e aware that ph!to&enodione therap! for he&orrhagic disease in infants causes fewer ad erse reactions than do other ita&in L ana"ogues% Fai"ure to respond to ita&in L &a! indicate coagu"ation defects%
Fro& Theor! to Praxis NURSING CARE PLANS A//e//(ent Dia'n /i/ P"annin'
;2
Inter+enti n/
Rati na"e
E+a")ati n
Su#+ecti eI
N/anghihina na a$o) a!o$o na &agAgaga"awO as stated #! the c"ient
Acti it! into"erance rCt genera"i*ed #od! wea$ness
O#+ecti eI

.od! &a"aise noted 0iaphoresis Ina#i"it! to concentrate Ina#i"it! to perfor& usua" A0's @ea$ in appearance 'i&ited ROM
After 4 hours of nursing inter entions ) patient wi"" participate wi""ing"! in necessar! acti it!) wi"" "earn how to conser e energ! and er#a"i*e re"ief fro& fatigue%
E a"uate ptJs current acti it! to"erance Ad+ust acti it! and reduce intensit! of tas$ that &a! cause undesired ph!sio"ogica" changes Increase exercise and acti it! "e e"s gradua""!
Pro ide cooperati e #ase"ine To pre ent o er exertion
Enhances acti it! to"erance He"ps &ini&i*e waste of energ!
Teach &ethods to conser e energ! such as sitting than standing whi"e dressing 0e&onstrateCAssist the patient whi"e doing A0'
After 4 hours of nursing inter entions ) patient participated wi""ing"! in necessar! acti ities) "earned how to conser e energ! and er#a"i*ed re"ief fro& fatigue Eoa" &et
0ifficu"t! initiating &o e&ents
Ei e the patient infor&ation that pro ides e idence progress
Protect patient fro& in+ur! To sustain patientJs &oti ation
Encourage c"ient to do whate er possi#"e e%g% se"fA care
Pro ides for sense of contro" and fee"ing of acco&p"ish&e nt
A//e//(ent
Dia'n /i/
P"annin'
Inter+enti n/
Rati na"e
E+a")ati n
Su#+ecti eI N/apansin $o na "u&a"a$i ang ti!an $oO as er#a"i*ed #! the patient O#+ecti eI @ea$ in appearance (aundice A#do&ina" distention noted A#do&ina" girth of :8O
F"uid o"u&e excess rCt co&pro&ised regu"ator! &echanis& secondar! to cirrhosis of the "i er as &anifested #!) wea$ in appearance) +aundice) a#do&ina" distention) a#do&ina" girth of :8O
After 8 da!s of nursing inter entions) patient wi"" de&onstrate sta#i"i*ed f"uid o"u&e and decreased a#do&ina" girth%
Monitor ita" sign Measure inta$e and output
Esta#"ished #ase"ine data Ref"ects circu"ating o"u&e status) de e"oping f"uid shifts) and in response to therap! .P e"e ations are usua""! associated with f"uid o"u&e excess Indicati e of pu"&onar! congestionCede& a
After 8 da!s of nursing inter entions) the patient de&onstrated sta#i"i*ed f"uid o"u&e and decreased a#do&ina" girth% Eoa" &et%
Monitor .P
Assess respirator! status
Monitor a#do&ina" girth
Ref"ects accu&u"ation of f"uid <ascites=
Restrict sodiu& and f"uids as ordered
Sodiu& &a! #e restricted to &ini&i*e f"uid retention in extra ascu"ar spaces% F"uid restriction &a! #e necessar! to pre ent di"utiona" h!ponatre&ia ,sed with caution to contro" ede&a and ascites) #"oc$ effect of a"dosterone) and increase water excretion whi"e sparing potassiu&
Ad&inister diuretics as ordered
FROM THEORY TO PRAXIS A//e//(ent Dia'n /i/ P"annin' Inter+enti n/ Rati na"e E+a")ati n
Su#+ecti eI N@a"a I&#a"ance nutritionI "ess a$ong ganang than #od! $u&ainO as er#a"i*ed reBuire&ents rCt "oss of appetite Report of weight "oss O#+ecti eI

@ea$ in appearance Poor &usc"e tone (aundice noted E&aciated E"ectro"!te i&#a"ance
After : da!s of nursing inter entions) patientJs appetite wi"" i&pro e fro& 8 t#sp to at "east 5 t#sp per &ea"% And wi"" de&onstrate c"ose to nor&a" "a#orator! a"ues
Monitor ita" signs Assist in ora" h!giene #efore &ea"s%
0iscuss eating ha#its inc"uding food preferences% Ser e fa orite foods that are not contraindicated% Ma! ha e Pre ent or negati e effect % &ini&i*e on appetite unp"easant odors during &ea" ti&e% To sti&u"ate the Ser e foods that appetite are attracti e and pa"ata#"e%

For #ase"ine data After 4 hours of nursing inter entions) patientJs appetite A c"ean &outh i&pro ed fro& enhances 8 t#sp to 5 t#sp appetite per &ea" and de&onstrated c"oser to To appea" to nor&a" c"ient "i$es and "a#orator! dis"i$es a"ues
Reco&&end s&a"") freBuent &ea"s
Poor to"erance to "arger &ea"s &a!
FROM THEORY TO PRAXIS #e due to increased intraA a#do&ina" pressureCascites
Restrict inta$e of caffeine) gasA Aids in reducing producing or gastric irritation spic! and ? a#do&ina" excessi e"! hot or disco&fort that co"d foods &a! i&pair ora" inta$eCdigestion
Pro ide assistance with acti ities as needed% Pro&ote undistur#ed rest periods) especia""! #efore &ea"s Ad ise to consu&e nutritious foods
-onser ing energ! reduces &eta#o"ic de&ands on the "i er and pro&otes ce""u"ar regeneration%
A//e//(ent
Dia'n /i/
P"annin'
Inter+enti n/
Rati na"e
E+a")ati n
Su#+ecti eI
NPa&insan &insan) hirap padin a$o &a$atu"ogO as c"ai&ed
0istur#ed s"eep pattern
After 7 hours of nursing inter entions) patient wi"" esta#"ish adeBuate s"eep pattern and report rested%
E a"uate "e e" of stress
O#+ecti eI Sun$en e!e#a""s Fatigue Mood a"terations .od! wea$ness noted
Increasing confusion) disorientation) and uncooperati e #eha ior &a! interfere with attaining restfu" s"eep 0ecreases need to get up to go to #athroo& during s"eep Reduces sensor! sti&u"ation #! #"oc$ing out other en iron&enta" sounds that cou"d interfere with restfu" s"eep
After 7 hours of nursing inter entions) patient esta#"ished adeBuate s"eep pattern and reported rested% Eoa" &et
Ad ise to reduce f"uid inta$e at night Pro ide soft &usic or Nwhite noiseO if a ai"a#"e
A//e//(ent
Dia'n /i/
P"annin'
Inter+enti n/
Rati na"e
E+a")ati n
Su#+ecti eI
NLada"asan nangangati a$oO as c"ai&ed #! the patient
Ris$ for i&paire d s$in integrit !
O#+ecti eI Pruritus noted 0r! s$in Er!the&a noted Sca"! s$in

After 4 hours of nursing inter entions) patient wi"" &aintain s$in integrit! and identif! indi idua" ris$ factors and de&onstrate #eha iorsCtechni Bue to pre ent s$in #rea$down%
Inspect s$in surfaceCpressure points routine"!% Eent"! &assage #on! pro&inences or areas of continued stress
EncourageCassist with repositioning on a regu"ar schedu"e whi"e in #ed) chair and acti e passi e ROM exercises as appropriate
Ede&atous tissues are &ore prone to #rea$down and to the for&ation of decu#itus u"cers% Ascites &a! stretch the s$in to the point of tearing in se ere cirrhosis Repositioning reduces pressure on ede&atous tissues to i&pro e circu"ation% Exercises enhance circu"ation and i&pro e) &aintain) +oint &o#i"it! Moisture
After 4 hours of nursing inter entions) patient &aintained s$in integrit! and identified indi idua" ris$ factors and de&onstrated #eha iorsCtechniB ues to pre ent s$in #rea$down%
Leep "inen dr! and free of wrin$"es
Suggest c"ipping finger nai"s short
aggra ates pruritus and increases ris$ of s$in #rea$down Pre ents c"ient fro& inad ertent"! in+uring the s$in especia""! whi"e s"eeping
Fro& Theor! to Praxis -ase Stud!I -ardio"og! INTRODUCTION
32
M!ocardia" infarction is the "eading cause of death in the ,nited States and in &ost industria"i*ed nations throughout the wor"d%
The fo""owing case is a case of a 7: !ear o"d &a"e who was rushed to the hospita" due to co&p"ains of consistent chest pain and shortness of #reath% Thorough c"inica" assess&ent re ea"ed occurrence of M!ocardia" Infarction and i&&ediate treat&ent &easures are rendered%
PATIENT PROFILE AgeI 7: SexI Ma"e AddressI Taca! Rd%) Pinsao Proper) .aguio -it!) .enguet OccupationI House -areta$er Ad&itting 0iagnosisI Acute -orona! S!ndro&e) ST E"e ation M!ocardia" Infarction) Midd"e Inferior @a"" -o&p"ete Heart ."oc$ 8O
HISTORY OF PRESENT ILLNESS
FROM THEORY TO PRAXIS In Octo#er 8928) patient had se era" episodes of chest pains which "ast for :9 &inutes &ost"! re"ie ed with rest% Few hours #efore his ad&ission) patient sudden"! co&p"ains of continued episode of chest pain with hea iness) characteri*ed as chest tightness) shortness of #eath and pa"pitations%
FAMILY MEDICAL HISTORY PatientJs father has a contro""ed dia#etes &e""itus% His &other has no fa&i"! histor! of chronic i""ness%
LABORATORY AND DIAGNOSTIC E1AMINATION COMPLETE BLOOD COUNT 75545846956: PARAMETERS RESULTS NORMAL VALUES @hite ."ood -e""s 6%3 x 296C ' 7%9A29%9 R.- Morpho"og! /or&oc!ticCnor&ochro&ic He&og"o#in 253 gC' 22%9A25%9 He&atocrit 9%73 9%:39A9%749 P"ate"et -ount 724 x 296 C ' 279A759 @.- 0ifferentia" /eutrophi"s 9%;3 9%7A9%3 '!&phoc!tes 9%83 9%89%9%79 Monoc!tes 9%9; 9%99A9%9; Eosinophi"s 9%99A9%97 COMPLETE BLOOD COUNT 75545;46956: PARAMETERS RESULTS NORMAL VALUES @hite ."ood -e""s 29%6 x 29:Cu' 7%9A29%9 ; Red ."ood -e""s :%6; x 29 Cu' 7%9A5%59 He&og"o#in 28: gC' 289A2;9 He&atocrit 9%:39 'C' 9%799A9%599 P"ate"et -ount 898 x 29:Cu' 259%9A759%9 @.- 0ifferentia" /eutrophi"s 9%38 9%79A9%39 '!&phoc!tes 9%84 9%89A9%79 Monoc!tes 9%99 9%9A9%9; Eosinophi"s 9%99 9%9A9%97
i
FROM THEORY TO PRAXIS Ot#er La* rat r, E.a(inati n/ 75545<46956: RESULTS NORMAL VALUES
TEST Fasting ."ood
257%27 &gCd' <H= 39%99A295%99 E"ucose ,ric Acid 3%38 &gCd' :%59A3%89 -ho"estero" 242%57 &gCd' 9%99A899%99 Trig"!cerides 296%6: &gCd' 9%99A259%99 '0' 286%;: &gCd' <H= 9%99A299%99 H0' 86%68 &gCd' <'= :5%99A;9%99 SEOT 829%25 ,C' <H= 9%99A79%99 SEPT 49%75 ,C' 9%99A72%99 OTHER LABORATORY E1AMINATIONS 75545;46956: SEOT 37%8:9,C' <H= 9%99A9%79 SEPT 4:%39 ,C' <H= 9%99A9%72 Hg#A2;%79 M 7%:A;%7 PROTHROMBIN TIME 7 5545846958: APTT 29%2 sec <RefI 29%4A2:%4s= M Acti it!I 29:%9M I/RI 9%68 APTTI :8%; <RefI :2%;A79%8s= TROPONIN I 9%99:ngC&' <RefI S9%98ngC&'= ECHOCARDIOGRAPHY WITH COLOR FLOW DOPPLER CONCLUSON= -oncentric "eft entricu"ar h!pertroph! with seg&ent wa"" &otion a#nor&a"it! with adeBuate s!sto"ic function%
E+ection fraction is isua""! esti&ated at 35M tissue 0opp"erC&itra" 0opp"er indices are nor&a"
/or&a" 'eft atriu& with e"e ated o"u&e index

i
Moderate tricuspid regurgitation
Mini&a" epicardia" effusion%
/or&a" Pu"&onar! arter! pressure%
CORONARY ANGIOGRAPHY 75545846956: -O/-',SIO/I -oronar! Arter! 0isease) 8A esse" in o" e&ent <R-A and '-x= Acute -oronar! S!ndro&e) Inferior @a"" STEMI) :rd degree AG ."oc$
RE-OMME/0ATIO/I P-I of the R-A <-u"prit Gesse"=
HEALTH ASSESSMENT Hea"t# Per$e%ti n- Hea"t# Mana'e(ent Pattern
FROM THEORY TO PRAXIS Patient is oriented with date) ti&e and p"ace% He descri#es his hea"th status as poor% He is a cigarette s&o$er <25 stic$s per da!= and drin$s a"coho"ic #e erage at "east once a wee$% He has no histor! of i""ega" drug use and no histor! of chronic i""ness% -"ient has no histor! of hea"th consu"tation in the pre ious !ear% He is a house careta$er% He rates his "i ing condition at ho&e as good with no difficu"t! securing ser ices of groceries) phar&ac!) hea"th care faci"it!) transportation and te"ephone% He ta$es his &edication as prescri#ed and ne er &isses% He does not exercise on a regu"ar #asis%
N)triti na"-Meta* "i$ Pattern The patient does not notice weight gain or "oss in the "ast ; &onths% He has a good appetite with no food into"erance without dietar! restriction #efore he was ad&itted% His &ea"s usua""! consists of rice and por$ and se"do& egeta#"e with a cup of coffee in e er! &ea"% He drin$ at "east 2 "iter of water per da!%
E"i(inati n Pattern The patient usua""! has 8 #owe" &o e&ents e er! da! and experienced no change e en after his ad&ission% He has no difficu"t! defecating% ,sua""!) his stoo" is soft) #rown co"ored with no signs of #"eeding% He urinates at "east ; ti&es a da! with no difficu"t!%
FROM THEORY TO PRAXIS A$ti+it,-E.er$i/e Pattern The patient #efore his ad&ission is not engaged in exercise regi&en% He is a house careta$er and the usua" acti it! inc"udes c"eaning of the house and gardening% 0uring his free ti&e) he usua""! s"eeps or watch te"e ision or so&eti&es find so&eone to drin$ an! a"coho"ic #e erage% On the ti&e of assess&ent) .P is 289C49 and a"" pu"ses are pa"pa#"e% Shortness of #reath occurs during acti ities and .P increases up to 89&&Hg s!sto"ic) pu"se rate increases to 225 .PM% Patient co&p"ains of wea$ness and needs assistance when doing A0's #ut er#a"i*es that he hi&se"f o#ser es i&pro e&ent as the da!s pass #!%
S"ee% Re/t Pattern The patient usua""! s"eeps fro& 6PM to 5AM% 0uring his first da!s in the hospita") he finds it difficu"t to s"eep whi"e in pain #ut &anages to s"eep we"" when &edicated%
C 'niti+e-Per$e%t)a" Pattern Patient is oriented with date) ti&e and p"ace% He exhi#its no signs of pain as co&pared to the ti&e he is ad&itted% 0ecision &a$ing is eas! and can restate current therapeutic regi&en%
Se"!-Per$e%ti n an& Se"!-C n$e%t Pattern The patient appears ca"&%
FROM THEORY TO PRAXIS His &a+or concern at the current ti&e is the fear of the experience to recur% He is read! to change his "ifest!"e for pre ention of possi#"e recurrence% He is wi""ing to attend fo""ow up consu"tations with his cardio"ogist% Though thin$ing that he is wea$er as co&pared #efore) he has sti"" positi e iew of hi&se"f% He #e"ie es that he can pass this e ent in his "ife and "i e hea"thi"! starting the present da!%
R "e Re"ati n/#i% Pattern He is a father of four chi"dren and "i es happi"! with the& together with his wife% His wife owns a sari sari store which ser es as their pri&ar! source of inco&e% His socia" interaction is sti"" &aintained and expects it to #e the sa&e on the ti&e of his discharge fro& the hospita"% In ter&s of the usua" fa&i"! ro"e) he sa!s there wou"d #e no change in his parenta" ro"e and his occupation as a house careta$er except for so&e restrictions i&posed #! his present i""ness which he #e"ie es &anagea#"e with the right "ifest!"e &odification and consu"tation%
Se.)a"it,-Re%r &)$ti+e Pattern He ad&its that there wou"d #e so&e changes with regards to sexua" functioning as expected with other patients with histor! of M!ocardia" Infarction%
C %in'-Stre// T "eran$e Pattern
FROM THEORY TO PRAXIS At this point of his "ife) according to the patient) his present condition and the s!&pto&s he fe"t was the &ost stressfu" e ent in his "ife fee"ing that he is near death% In a"" the stressfu" e ents of his "ife) his fa&i"! is his co&panion and ta"$ing his pro#"e& with his wife is his out"et of re"ief% He rates his stress hand"ing as good%
Va")e-Be"ie! Pattern He is not er! satisfied with the de e"op&ent of his "ife dea"ing with his present i""ness at the age of 78 for he said his ad&ission is a financia" #urden for his fa&i"!% His ad&ission wi"" change his future p"ans in a positi e wa!% He is a -atho"ic #ut does not attend the &ass regu"ar"! and does not pra! freBuent"!% .ut after his "ifeAthreatening experience) he ad&its that he p"ans to change his practice for the #etter for he #e"ie es his second "ife was a gift fro& Eod and he wi"" #e fore er than$fu" for it%
PATHOPHYSIOLOGY Six pri&ar! ris$ factors ha e #een identified with the de e"op&ent of atherosc"erotic coronar! arter! disease and MII h!per"ipide&ia) dia#etes &e""itus) h!pertension) to#acco use) &a"e gender) and fa&i"! histor! of atherosc"erotic arteria" disease% The presence of an! ris$ factor is associated with dou#"ing the re"ati e ris$ of de e"oping atherosc"erotic coronar! arter! disease% A&ong the &entioned ris$ factors) the ris$s that is assessed present to the c"ient are gender) h!per"ipide&ia) cigarette s&o$ing and ph!sica" inacti it!%
FROM THEORY TO PRAXIS In &!ocardia" infarction) an area of the &!ocardiu& is per&anent"! destro!ed) t!pica""! #ecause p"aBue rupture and su#seBuent thro&#us for&ation resu"t in co&p"ete occ"usion of the arter!% The &ost co&&on triggering e ent is the disruption of an atherosc"erotic p"aBue in an epicardia" coronar! arter!) which "eads to a c"otting cascade) so&eti&es resu"ting in tota" occ"usion of the arter!% Atherosc"erosis is the gradua" #ui"dAup of cho"estero" and fi#rous tissue in p"aBues in the wa"" of arteries <in this case) the coronar! arteries=)t!pica""! o er decades% P"aBues can #eco&e unsta#"e) rupture) and additiona""! pro&ote a thro&#us <#"ood c"ot= that occ"udes the arter!H this can occur in &inutes% @hen a se ere enough p"aBue rupture occurs in the coronar! ascu"ature) it "eads to &!ocardia" infarction <necrosis of downstrea& &!ocardiu&=%In a STEMI <ST seg&ent e"e ation MI=) the coronar! arter! is co&p"ete"! #"oc$ed off #! the #"ood c"ot) and as a resu"t irtua""! a"" the heart &usc"e #eing supp"ied #! the affected arter! starts to die% A"so) an inferior wa"" MI &a! a"so occur #ecause of the occ"usion of the right coronar! arter! and it usua""! occurs a"one or with a "atera" wa"" or right entricu"ar infarction% If i&paired #"ood f"ow to the heart "asts "ong enough and there is an i&#a"ance in the &!ocardia" ox!gen supp"! and de&and) it triggers a process ca""ed the ische&ic cascadeH causing ce""u"ar in+ur! and e entua""!) the heart ce""s in the territor! of the occ"uded coronar! arter! die <chief"! through necrosis= and do not grow #ac$%
DRUG STUDY A/%irin -"ass I Antip"ate"et Aggregation) antip!retic) ana"gesic)
FROM THEORY TO PRAXIS antiAinf"a&&ator!) antirheu&atic Therapeutic Action I Inhi#ition of p"ate"et aggregation is attri#uta#"e to the inhi#ition of p"ate"et s!nthesis of thro&#oxane inducer of p"ate"et 0osage Indications A8) a potent aggregation% I :99&g once a da! I Reduction of ris$ for death of nonfata" MI in patients with histor! of infarction or unsta#"e angina pectoris MI proh!"axis Mi"d to &oderate pai) fe er) inf"a&&ator! conditions /ursing Responsi#i"ities I ."ac$ .ox @arningI 0o not use in chi"dren and teenagers to treat chic$enpox or f"u s!&pto&s without re iew for Re!eJs S!ndro&e) a rare #ut fata" disorder% Ei e drug with food or after &ea"s if EI upset occurs% Ei e drug with fu"" g"ass of water to reduce ris$ of ta#"et or capsu"e "odging into the esophagus% 0o not use aspirin that has strong inegarA"i$e odor Ta$e extra precaution to $eep this drug out of reach of chi"drenH this drug can #e er! dangerous for chi"dren asoconstrictor and
FROM THEORY TO PRAXIS Report di**iness) ringing in the ear) di**iness) confusion) a#do&ina" pain) rapid or difficu"t #reathing) nauseas) o&iting and #"ood! stoo"% C" %i& 're" -"ass Therapeutic Action I Antip"ate"et) Adenosine diphosphate antagonist I Inhi#its p"ate"et aggregation #! #"oc$ing A0P receptors on p"ate"ets% 0osage Indications I 35&g .I0 I Treat&ent of patients at ris$ for ische&ic e entsA recent MI) recent ische&ic -GA) periphera" arter! disease Treat&ent of patients with A-S /ursing Responsi#i"ities I Pro ide freBuent s&a"" &ea"s if EI upset occurs Pro ide co&fort &easures and arrange for ana"gesic if headache occurs Instruct patient to ta$e dai"! as prescri#ed Report s!&pto&s of a""ergic reaction
Ir*e/artan -"ass Therapeutic Action I Antih!pertensi e I Se"ecti e"! #"oc$s the #inding of angiotensin IIto specific receptors 0osage I 259&g O0
FROM THEORY TO PRAXIS Indications /ursing Responsi#i"ities I H!pertension I Ad&inister without regards to &ea"s ."ac$ .ox @arningI Ensure that if patient is fe&a"e) she is not pregnant #efore #eginning the therap!H suggest using #arrier #irth contro" whi"e using Ir#esartanH feta" in+ur! and death ha e #een reported% Monitor patient c"ose"! in an! situation that &a! "ead to decreased .P secondar! to reduction of f"uid o"u&e <excessi e perspiration) deh!dration and o&iting episodes=% H!potension can occur% M r%#ine S)"!ate -"ass Therapeutic Action I Opioid Agonist ana"gesic I Acts as agonit of at specific opioid receptors in the -/S to produce a"gesia) euphoria and sedation 0osage Indications I 8%5&g IG Stat I Re"ief of &oderate to se ere acute and chronic pain Preoperati e &edication to sedateand a""a! apprehension) faci"itate induction of anaesthesia and to reduce anaesthetic dosage%
FROM THEORY TO PRAXIS /ursing Responsi#i"ities I 0i"ute and ad&inister s"ow"! IG to &ini&i*e "i$e"ihood of ad erse effects Te"" patient to "ie down duing IG ad&inistration Leep opioid antagonist and faci"ities for assisted or contro""ed respiration readi"! a ai"a#"e
Car+e&i" " -"ass I A"pha and #eta adrenergic #"oc$er) Antih!pertensi e Therapeutic Action 0osage Indications I -o&petiti e"! #"oc$s a"phaA) #etaA) and #eta8) I 28%5&g .I0 I H!pertension ,n"a#e"ed ,seI Angina /ursing Responsi#i"ities I @arningI 0o not discontinue a#rupt"! after chronic therap! <h!persensiti it! to catecho"a&ines &a! exacer#ation of angina) MI gradua""! ha e de e"oped) causing and entricu"ar arrh!th&iasH taper drug o er 8 wee$s with &onitoring Ei e drug with food Monitor dia#etic patient c"ose"!H drug &a! &as$ or worsen h!pog"!cae&ia
FROM THEORY TO PRAXIS Monitor patient for an! sign of hepatic i&pair&ent <pruritus) dar$ urine or stoo") anorexia) +aundice or pain= Arrange for 'FTs and discontinue drug if tests indicate "i er fai"ure
S &i)( Pi$ /)"!ate -"ass Therapeutic Action I 'axati e I Sodiu& picosu"fate wor$s #! sti&u"ating the ner e endings in the wa""s of the "arge intestine <co"on= in the intestina" increased <a process contents of the that the 0osage Indications and rectu&% This causes the &usc"es wa"" to contract &ore often and with force% @hen these &usc"es contract $nown as perista"sis=) this &o es the intestine through the co"on to the rectu& so #owe" can #e e&ptied% I :9cc for co&pact stoo" I -onstipation
Met! r(in -"ass I Antidia#etic
FROM THEORY TO PRAXIS Therapeutic Action I Exact &echanis& is not understoodH possi#"! increases periphera" uti"i*ation of g"ucose) decreases hepatic g"ucose production) and a"ters intestina" a#sorption of g"ucose% 0osage Indications I I 459 &g ta#"et twice a da! Ad+unct to diet to "ower #"ood g"ucose with t!pe 8 dia#etes &e""itus in patients who are 29 !ears o"d or o"der and extended re"ease in patients 23 !ears o"d and o"der As part of co&#ination therap! with su"fon!"ureas or insu"in when either drug a"one cannot contro" g"ucose &e""itus /ursing Responsi#i"ities I Monitor urine and seru& g"ucose "e e" to deter&ine effecti eness of drug and dosage Arrange for transfer to insu"in therap! during periods of high stress Patient Teaching I 0o not discontinue this &edication without consu"ting hea"th care pro ider Swa""ow extended re"ease ta#"et as who"e) do not crush ) #rea$ or chew% "e e"s in patient with t!pe 8 dia#etes
Fro& Theor! to Praxis NURSING CARE PLANS
43
Assess&ent N Sa nga!on pa$ira&da& $o &ada"i a$ong &apagod $a!a hindi a$o gaanong $u&i$i"os) as er#a"i*ed O#+ecti eI @ea$ in appearanceW
/ursing 0iagnosis Acti it! Into"erance re"ated to genera"i*ed wea$ness and i&#a"ance #etween ox!gen supp"! and de&and
/ursing Eoa"s After 8 da!s of nursing inter entions) the c"ient wi"" #e a#"e to to"erate progressi e acti it!) as e idenced #! HR and .P within expected range and no co&p"aints of d!spnea or fatigue%
Inter entions
Rationa"e
E a"uation
After 8 da!s of RAssess the patients RPro"onged #edrest nursing respirator! and are indicated on"! inter entions) the cardiac status #efore for he&od!na&ic c"ient was a#"e to initiating acti it! unsta#"e patients% If to"erate progressi e the patient is sta#"e) acti it!) as acti ities can #e e idenced #! HR gradua""! and .P within progressed% Assisted expected range and h!giene and no co&p"aints of a&#u"ation are d!spnea or fatigue% appropriate to reduce ph!sica" deconditioning associated with #ed rest% RO#ser e response to acti it!% Signs of a#nor&a" response inc"udes the fo""owingI R-"ose &onitoring ser es as a guide for opti&a" acti it! progression
Increased HR of 89 #eatsC&in o er resting rate during acti it!) or 289 #eats per &inute Increased .P of 89 && Hg s!sto"ic during acti it! -hest disco&fort diaphoresis Pa""or d!spnea "a#ored #reathing excessi e fatigueCwea$ness REncourage adeBuate rest periods) especia""! #efore acti ities <A0's) isiting hours)&ea"s= RPro ide "ight RRest #efore acti ities pro ides ti&e for energ! conser ation
RThis faci"itates
FROM THEORY TO PRAXIS &ea"s digestion and reduces energ! needs RThese acti ities sti&u"ate Ga"sa" a Maneu er) which affects endocardia" repo"ari*ation and predisposes the patient to entricu"ar d!srh!th&ias% RThis reduces reduces possi#"e anxiet! a#out o erexertion of the heart
RInstruct patient not to ho"d #reath whi"e exercising or &o ing a#out in #ed and not to strain during #owe" &o e&ent RPro ide e&otiona" support when increasing acti it!
Assess&ent NSan pa #a ito na$u$uha &a"i#an sa pag$ain $o ng &atata#a) #a#a"i$ pa #a a$o sa nor&a"XO as er#a"i*ed
/ursing 0iagnosis Lnow"edge 0eficit re"ated to unfa&i"iarit! to disease process) treat&ent and reco er! as e idenced #! &u"tip"e Buestions
/ursing Eoa"s After 4 hours of nursing inter entions) the patient wi"" er#a"i*e understanding of condition) need for o#ser ation in critica" care unit) diagnosis of treat&ent of MI and hea"ing process of MI
Inter entions REncourage patient to er#a"i*e concerns% RPro ide infor&ation on the fo""owingI 0iagnosing MI Hea"ing Process
Rationa"e RThe patient &ust #e an acti e partner in fo""ow up care
E a"uation After 4 hours of nursing inter entions) the patient er#a"i*ed understanding of condition) need for o#ser ation in critica" care unit) diagnosis of treat&ent of MI and hea"ing process of MI
RExp"aining procedures &a! reduce anxiet!% RIt ta$es ; wee$s for necrotic tissue to #e rep"aced #! scar tissue RPatients &a! not rea"i*e that a c"ot has caused MI thin$ing instead that cho"estero" p"aBue is the cu"prit RMore than 45M of patients return to fu"" acti it! "e e"
Medications
Expected return to prior "ifest!"e <8
FROM THEORY TO PRAXIS or : &onths=
Assess&ent NAng i$inatata$ot $o "ang) #a$a &au"it ito% Munti$ na a$o &a&ata!%O As stated% /arrowed focus on the source of the fear
/ursing 0iagnosis Fear re"ated to threat to hea"th status as e idenced #! narrowed focus on the source of the fear
/ursing Eoa"s After 4 hours of nursing inter ention) the patient wi"" er#a"i*e reduce fear) and de&onstrate positi e coping &echanis&
Inter entions RAc$now"edge awareness of patientJs fear
Rationa"e RAc$now"edge&en t of patientJs fee"ing a"idates the fee"ing and co&&unicates acceptance of those fee"ings RAnxiet! can #e reduced when patient has accurate $now"edge of rea"istic prognosisH hospita" &orta"it! rate is on"! 5M RThese &easures enhance the patients opti&is& a#out reco er! RThe staffJs anxiet! &a! #e easi"! percei ed #! the
E a"uation After 4 hours of nursing inter ention) the patient was a#"e to er#a"i*e reduce fear) and de&onstrate positi e coping &echanis&
RA""ow patient to er#a"i*e fears of d!ing% Reassure patient that &ost deaths occur #efore reaching the hospita"% ROffer rea"istic assurances that reco er! is fu""! anticipated RMaintain confident assured &anner
FROM THEORY TO PRAXIS patient% The patientJs fee"ing of sta#i"it! increases in a ca"& en iron&ent R This reduces anxiet! RThis pro ides a &easure of safet! RAnxiet! &a! esca"ate with excessi e con ersation) noise and eBuip&ent around patient%
RExp"ain in si&p"e ter&s arious aspect of MI and c"arif! &isconceptions RAssure patient and significant others a continuous &onitoring that wi"" ensure pro&pt inter ention
RReduce unnecessar! sti&u"i % RExp"ain a"" procedures as appropriate) RInfor&ation a""a!s $eeping exp"anation anxiet!% #asic% R0i ersion can #e RPro ide re"axing) pre ent di ersiona" &ateria" anxiet! and pre ent fee"ings of iso"ation REsta#"ish rest periods during care RPacing acti ities and procedure% he"ps the patient re"ax and gain
FROM THEORY TO PRAXIS e&otiona" #a"ance
Assess&ent N Pa"aga! $o sir &ag#a#ago ang #uha! $o pag"a#as $o pagdating sa &ga na$agawian $o) sa pag$ain at sa &g adapt $o ingatanO) as er#a"i*ed O#+ecti eI Recent change in hea"th status Percei ed change in hea"th status
/ursing 0iagnosis Ris$ for ineffecti e coping
/ursing Eoa"s After 4 hours of nursing inter entions) the patient wi"" #e a#"e to identif! his own coping #eha ior) identifies his ps!cho"ogica" and socia" support s!ste& and i&p"e&ent positi e coping &echanis&
Inter entions RAssess specific stressors
Rationa"e RAccurate appraisa" faci"itates de e"op&ent of appropriate coping strategies R Successfu" ad+ust&ent is inf"uenced #! pre ious coping success R O"der persons with "ife"ong cardiac disease &a! ha e reduced contact with significant others RThis pro ides an i&portant starting point when inter ening with
E a"uation After 4 hours of nursing inter entions) the patient was a#"e to identif! his own coping #eha ior) identifies his ps!cho"ogica" and socia" support s!ste& and i&p"e&ent positi e coping &echanis&
RAssess a ai"a#"e or usefu" past and present coping &echanis& RE a"uate resources of support s!ste&s a ai"a#"e to patient at ho&e
RAssess the "e e" of understanding and readiness to "earn needed
FROM THEORY TO PRAXIS "ifest!"e changes REncourage er#a"i*ation of concerns patients RAc$now"edging awareness of the cha""enges re"ated to reco er! can open doors for ongoing co&&unication RPatients who are not coping we"" &a! need &ore guidance initia""! R@ith shortened exposure to cardiac reha#i"itation ser ices) patients can easi"! #eco&e o erwhe"&ed #! the "arge nu&#er of changes that are expected of the& in a short ti&e% 'ifeti&e changes shou"d #e considered o er a "ife"ong period% RTo pro ide
REncourage patient to see$ infor&ation that wi"" enhance coping s$i""s RPro ide infor&ation that patient wants or needs%
RPro ide re"ia#"e
FROM THEORY TO PRAXIS infor&ation a#out the hea"ing process so that &isconceptions can #e c"arified% RPoint out signs of positi e progress or change reassurance and confidence a#out resu&ing acti it!
RPatients who are coping ineffecti e"! &a! not #e a#"e to assess progress
Assess&ent NPwede na daw a$ong "u&a#as pero anda&i na&ing iniresetang ga&ut &a$$a"i&utan $ pa $ung $e"an iinu&in !an e%O as er#a"i*ed -o&p"exit! of therapeutic regi&en
/ursing 0iagnosis Ris$ for ineffecti e therapeutic Regi&en Manage&ent
/ursing Eoa"s After 4 hours of nursing inter entions) the patient wi""I Rdescri#e s!ste& of ta$ing &edication R er#a"i*e intention to fo""ow prescri#ed regi&en
Inter entions RAssess patientJs hea"th a"ues and #e"ief
Rationa"e RHea"th #eha ior &ode"s propose that patients co&pare factors such as percei ed suscepti#i"it! to and se erit! of i""ness or co&p"ications with percei ed #enefits of treat&ent in &a$ing decisions regarding adherence to therap! R'ong ter& therap! pro ides &ore opportunit! for nonAadherence RLnow"edge of causati e factors pro ides direction for su#seBuent inter entions
E a"uation After 4 hours of nursing inter entions) the patient was a#"e toI Rdescri#e s!ste& of ta$ing &edication R er#a"i*e intention to fo""ow prescri#ed regi&en
RAssess pre ious pattern of adherence
RAsses for ris$ factors that &a! negati e"! affect adherence with regi&en
FROM THEORY TO PRAXIS RThe &ore often patients ha e to ta$e &edicines during the da!) the greater the ris$ of non co&p"iance RPatients who #eco&e co&anagers of their care ha e a greater sta$e in achie ing positi e outco&e% RTo pre ent or contro" occurrence
RSi&p"if! drug regi&en
RInc"ude patient in p"anning treat&ent regi&en
RIf negati e side effect of prescri#ed treat&ent are a pro#"e&) exp"ain that &an! side effects can #e contro""ed or e"i&inated
RThis encourages RInc"ude significant support and others in assistance in app"ications and reinforcing teachings appropriate #eha ior and
FROM THEORY TO PRAXIS faci"itating "ifest!"e &odification
Fro& Theor! to Praxis LEARNING FEEDBACK DIARY
66
@EEL 2 I EMEREE/-Y 0EPARTME/TC O,TAPATIET 0EPARTME/T 0AY 2 Ti(e 6I:9AM Y 29I99 AM A$ti+itie/ -ourtes! ca"" and &eeting with Sr% -ora*on .unagan) the /0-H /ursing Ser ice 0irectress and orientation profi"e of the hospita"% 29I99AM Y 29I229AM 29I:9AM Y 28I99// Hospita" Tour Orientation to the area done #! the ER head nurse Patient assess&ent and o#ser ation 28I99// Y 2I99PM 2I99PM Y :I99PM :I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM 'unch .rea$ Assist in the pro ision of Bua"it! care to patients% Participate in patient endorse&ent and aftercare% Post conference 0ocu&entation regarding the po"icies and
0AY 8 Ti(e 3I99 AMA 3I:9AM 3I:9AMA 7I99PM A$ti+itie/ Endorse&ent Staff shadowing -ases encounteredI
FROM THEORY TO PRAXIS ST E"e ation M!ocardia" Infarction 'ung -ancer .reast -ancer H!pertension Assisted for a fo""ow up chec$Aup of c"ient with pace&a$er with a possi#"e co&p"ication
:I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM
Participate in patient endorse&ent and aftercare% Post conference 0ocu&entation
0AY : Ti(e 3I99 AMA 3I:9AM 3I:9AMA 7I99PM Endorse&ent /ursing -are of Patient with E&ergenc! -onditionsI Spontaneous A#ortion Ethical considerations were applied in care of a patient with suspected spontaneous abortion Asth&a Mu"tip"e Sc"erosis A$ti+itie/
FROM THEORY TO PRAXIS :I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Endorse&ent Post -onference 0ocu&entation
0AY 7 Ti(e 3I99 AMA 3I:9AM 3I:9AMA 7I99PM -onditions Ra#ies .ite Gehicu"ar Accident @o&an in 'a#or H!pog"!ce&ia .od! wea$ness :I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Participate in patient endorse&ent and aftercare% Post conference 0ocu&entation Endorse&ent /ursing -are of Patient with E&ergenc! A$ti+itie/
0AY 5 3I99 AMA 3I:9AM 3I:9AMA 7I99PM Endorse&ent /ursing -are of Patient with E&ergenc! -onditions 0ia#etes Letoacidosis
FROM THEORY TO PRAXIS Genous Stripping M!ocardia" Infarction :I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Participate in patient endorse&ent and aftercare% Post conference 0ocu&entation
0AY ; 3I99 AMA 3I:9AM 3I:9AMA 7I99PM Endorse&ent /ursing -are of Patient with E&ergenc! -onditions M!ocardia" Infarction E"auco&a Rena" fai"ure End Stage Rena" 0isease Eonorrhoea :I99PM Y 7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Participate in patient endorse&ent and aftercare% Post conference 0ocu&entation
@EEL 8I FATHER 'O,IS -HA,GET @AR0 0AY 2 Ti(e A$ti+itie/
FROM THEORY TO PRAXIS 3I99AMA3I:9AM 3I:9AMA4I:9AM 4I:9AMA7I99PM Endorse&ent .edside Endorse&ent Orientation Staff Shadowing 7I99PM Y ;I99PM ;I99PMA 3I99PM Post conference 0ocu&entation
0AY 8 Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations Asth&a -ho"e"ithiasis -ase Ana"!sisI 0ia#etes Re iew of fi"es Assess&ent :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
FROM THEORY TO PRAXIS 0AY : Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
0AY 7 Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
0AY 5 Ti(e 3I99AMAI3I:9AM A$ti+itie/ Endorse&ent
FROM THEORY TO PRAXIS 3I:9AMA 4I99AM 4I99AMA:I99PM :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
0AY ; Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
@EEL :I MERE MARIE A//E @AR0 0AY 2 Ti(e 3I99AMA3I:9AM 3I:9AMA4I:9AM 4I:9AMA7I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent Orientation
FROM THEORY TO PRAXIS Staff Shadowing 7I99PM Y ;I99PM ;I99PMA 3I99PM Post conference 0ocu&entation
0AY 8 Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations A patient with myocardial infarction was brought in the ward while waiting for an ICU bed. Proper care was rendered and assistance to diagnostic examinations were done. :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
0AY : Ti(e 3I99AMAI3I:9AM 3I:9AMA 4I99AM 4I99AMA:I99PM A$ti+itie/ Endorse&ent .edside Endorse&ent /ursing -are of Patient with Hea"th A"terations
FROM THEORY TO PRAXIS :I99PMA:I:9PM :I:9PMA7I99PM 7I99PM Y ;I99PM ;I99PMA 3I99PM Endorse&ent .edside Endorse&ent Post conference 0ocu&entation
0AY 7 Exit inter iew with Sr% -ora*on .unagan SP-
Ref"ection .ased on (ean @atsonJs 29 Pri&ar! -arati e Factors
F r(ati n ! H)(ani/ti$-A"tr)i/ti$ S,/te( ! Va")e /ursing with "o ing $indness cou"d #e o#ser ed to &ost of the e&p"o!ees of the hospita"% The pre ai"ing cu"ture of a"truistic a"ues upho"ds the dignit! of patients confined in the hospita"% This practice is ref"ected in their ision and &ission state&ents which ser es as their guide in e er!da! interactions with cowor$ers and patients%
T#e in/ta""ati n ! !ait# # %e /otre 0a&e de -hartres practice not +ust within the standards of Bua"it! hea"thcare #ut a"so the standards of #eing hospita" of -hristians% The hospita" accepts patients of an! re"igion and encourages e er!one to co&e c"oser to the Supre&e .eing especia""! in &o&ents of sic$ness%
C)"ti+ati n ! /en/iti+it, t
ne>/ /e"! an& t
t#er/
The interpersona" interaction is a"so i&portant for the nurses of /0-H% Their practice &eets the idea" practice of esta#"ishing patient rapport and #eing sensiti e to their e&otions%
T#e &e+e" %(ent ! a #e"%in'-tr)/t re"ati n/#i%
FROM THEORY TO PRAXIS The &ode of co&&unication #etween nurse to cowor$ers and nurse to patients are continuous #e it #! &eans of con ersation or through other channe"% This open co&&unication pro ides opportunit! to connect to the patients and effecti e"! assessed their needs% On the other hand) this open co&&unication channe" #etween nurses and cowor$ers &a$es the& wor$ har&onious"! resu"ting to a &ore effecti e pro ision of hea"thcare%
Pr ( ti n an& a$$e%tan$e ! t#e e.%re//i n ! % /iti+e an& ne'ati+e !ee"in'/ The #a"anced wor$"oad of the nurses pro ides the& a&p"e ti&e to ta"$ to the patients% .! doing this) nurses are &ade aware of the patientsJ a#"e to pro ide their nursing needs% A"though this was supposed to #e an ordinar! scenario in hospita"s) the current situations does not pro e so in &ost hospita"s in the region% It is +ust an e idence of the Bua"it! of hea"thcare one can a ai" in /0-H%
S,/te(ati$ )/e ! t#e /$ienti!i$ %r *"e(-/ "+in' (et# & ! r &e$i/i n (a?in' Effort to understand patient condition and he"ping the& exp"ore a"ternati es are co&&on practice of nurses and e&p"o!ees% So"utions are easi"! identified #! the patients through the he"p of resource persons of the hospita" and proper education and couse""ing done #! the nurses%
Pr ( ti n ! inter%er/ na" tea$#in'-"earnin'. E er! ti&e a nurse spea$s with the patient) there are a"wa!s hea"th teaching
FROM THEORY TO PRAXIS #eing shared and feed#ac$ are encouraged% This practice is e ident in nurses especia""! in the wards where &ost hea"th education occurs i&&ediate"! #efore the ti&e of discharge%
Pr +i/i n ! r a /)%% rti+e@ %r te$ti+e an& 4 r $ rre$ti+e (enta"@ %#,/i$a"@ / $i $)"t)ra" an& /%irit)a" en+ir n(ent. These are one of the things that &a$e the hospita" different fro& the others% Ser ices of fo""ow up care) counse""ing #! socia" wor$ers and the sisters of St% Pau" he"ps c"ients exp"ore so"utions and de e"op goa"s in "ife%
A//i/tan$e Ait# t#e 'rati!i$ati n ! #)(an nee&/ Assisting to &eet patient needs) upho"ding dignit! and pro&oting pri ac! are satisfactori"! &et in the hospita"% Patients rare"! co&p"ains a#out the nursing ser ice the hospita" pro ides #ut are er! than$fu" for assisting the& to reco er!%
A"" Aan$e ! r e.i/tentia"-%#en (en " 'i$a" ! r$e/ The acceptance on how the patient iew hisCher own situation is i&portant to attain indi idua" patient goa"s% 0uring the praxis) no conf"ict of #e"ief #etween the nurses and patients was o#ser ed% This i&p"ies that the nurses are aware that the acceptance of patient iews are re"e ant in esta#"ishing goa" towards reco er!%
.est Practices O#ser ed E&)$atin' %atient/ re'ar&in' t#eir ri'#t/ an& re/% n/i*i"itie/ ,pon ad&ission) c"ients are gi en copies of the patientsJ rights and responsi#i"ities which ser es as their guides to &easure standards of care the! recei e and assess which a&ong the nurseJs does to the& are within proper conduct% This protoco" sa es patients fro& ignorance of their rights%
En& r/e(ent L '* ? The ris$ for discontinuit! of patient care is "essen through a "og#oo$ #eing used #! charge nurses in which docu&entation of the treat&ent and specia"
ordersCendorse&ent are written and cou"d #e re iewed whene er necessar!% Specia" announce&ents are a"so written so that it wi"" reach a"" the nurses wor$ing on different shifts during the da!%
T#e ;/ P#i" / %#, The 3s Phi"osoph! does not on"! exist on hard #oards posted on hospita" wa""s% It is #eing practice e er! ti&e a nurse is on dut!%
Sati/!,in' N)r/e-P#,/i$ian Re"ati n/#i%
FROM THEORY TO PRAXIS This was the first thing I o#ser ed when I was exposed in the E&ergenc! Roo&% Ph!sicians on dut! wor$s s&ooth"! with the nurses and other &e&#ers of the hea"thcare tea&% C -/i'nat)re n Me&i$ati n A&(ini/trati n Re$ r& Two nurses are reBuired to chec$ the &edication to #e ad&inistered to patient% This practice reduces the ris$ of erroneous &edication ad&inistration% Ei en the co&&on situation in &ost hospita"s that doctors i&p"! to nurses that the! are the $e! peop"e in the hea"thcare tea& therefore the! are of higher i&portance and &ust #e treated a#o e of what is usua") /0-H ph!sicians see&s to #e different%
B)a"it, A//)ran$e Pra$ti$e/ Tua"it! assurance are done on different "e e"s% There is a Bua"it! assurance done on specific units on an unannounced date and the /ursing Audit of a"" the units conducted once a &onth%
C (%)teri2e& S,/te( ! Patient Re$ r&/ Records are accessi#"e and &edication in entor! inc"uding anticipation of c"ient needs are &ade eas! through their s!ste&%
Suggestions and Reco&&endation I ac$now"edge the exce""ence of /otre 0a&e 0e -hartres Hospita" in pro iding Bua"it! hea"thcare% As a contri#ution to its continuous effort to up"ift the Bua"it! of care the! pro ide) here are so&e reco&&endation for &inor pro#"e&s encounteredI More gar#age #ins on accessi#"e areas Patient) re"ati es and significant others education on waste segregation I&&ediate disposa" of sharps) ia"s) a&pu"es and used s!ringes More inAser ice training for staff Persona" protecti e eBuip&ent readi"! a ai"a#"e for use Effort to train staff <especia""! the +uniors= to hand"e une entfu" situations
Further&ore) I reco&&end that the good practices of the hospita" #e i&p"e&ented continuous"! to achie e satisfactor! resu"ts
Fro& Theor! to Praxis
227
References 0ia#etes /ew Zea"and% <n%d%=% Diabetes and Infection% Retrie ed /o e&#er :9) 8928) fro& 0ia#etes /ew Zea"andI httpICCwww%dia#etes%org%n*Ca#out[dia#etesCco&p"ications[of[dia#etesCinfections A&erican 0ia#etes Association% <n%d%=% Nutrition ecommendations and Inter!entions for Diabetes. Retrie ed August 26) 8928) fro& httpICCcare%dia#etes+ourna"s%org% .autista) (% /% <8993=% Understanding "uman Diseases. 0oenges) M% E%) Moorhouse) M%) ? Murr) A% -% <8994=% Nurse#s Poc$et %uide. Larch) A% <8994=% &ocus on Nursing Pharmacology. Larch) A% M% <8994=% '(() *ippincott#s Nursing Drug %uide. S&e"t*er) S% -%) .are) .% E%) Hin$"e) (% '%) ? -hee er) L% H% <8929=% +runner and ,uddharths#s -extboo$ of .edical ,urgical Nursing <Go"% Go"u&e 2=% <H% Surrena) Ed%= Phi"ade"phia PAI 'ippincot @i""ia& and @i"$ins% @or"d Hea"th Organi*ation% <8928) Fe#ruar!=% Cancer% Retrie ed (une 24) 8928) fro& @or"d Hea"th Organi*ationI httpICCwww%who%intC&ediacentreCfactsheetsCfs863CenC
Appendices

FINAL ADVANCE PRACTICE NURSING (Contents)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

FINAL ADVANCE PRACTICE NURSING (Contents)

Uploaded by

Copyright:

Available Formats

FROM THEORY TO PRAXIS ACKNOWLEDGMENT The researcher wish to express their profound gratitude and sincere appreciation to e er!

FROM THEORY TO PRAXIS Ta#"e of -ontents

Hu&an Resource Anci""ar! S cs /ursing Ser ice Support S cs

F /urse Super isors F Head /urses F Staff /urses

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

She has no $nown food and drug a""ergies%

difficu"t!) retention) pain or #"adder spas&%

FROM THEORY TO PRAXIS

Ket r "a$ -"ass I /SAI0) /onopioid Ana"gesic) Antip!retic

Assess for signs of h!perg"!ce&ia

Re iew #"ood g"ucose histor! Assess current eating ha#its

Instruct patient to ta$e

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

E a"uate effecti eness of e er! instruction

FROM THEORY TO PRAXIS

Ear"! treat&ent of h!perg"!ce&ia pre ents HH/S occurrence%

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

/ursing 0iagnosis Acute pain re"ated to infectious process <p!e"onephritis=

/ursing Inter ention Asses pain characteristics%

Assess patients $now"edge of the arra! of pain re"ief strategies a ai"a#"e%

FROM THEORY TO PRAXIS

Anticipate need for pain re"ief

Respond i&&ediate"! to co&p"aint of pain

Pro ide rest periods to faci"itate co&fort) s"eep and re"axation%

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

A//e//(ent O#+ecti eI H!perg"!ce&ia Ph!sica" i&&o#i"i*ation

Atherosc"erosis resu"ts in gradua"

Exa&ine hosier! and shoes

-arefu" dai"! assess&ent reduces ris$ of in+ur! to the foot%

N)r/in' Dia'n /i/

He"p patient identif! thoughts and fee"ing associated with stressors%

He"p patient to identif! stressA re"ated

Euiding the patient to iew the situation

Ac$now"ed ge that change &a! not #e possi#"e

Fro& Theor! to Praxis -ase Ana"!sisI Onco"og! INTRODUCTION

PATIENT PROFILE AgeI 78 SexI Fe&a"e

9%7A9%3 9%89%9%79 9%99A9%9; 9%99A9%97 :%5A5%: 2:5A274 64A293

FROM THEORY TO PRAXIS -he&ica"s such as in!" ch"oride and arsenic

N/anghihina na a$o) a!o$o na &agAgaga"awO as stated #! the c"ient

Acti it! into"erance rCt genera"i*ed #od! wea$ness

Pro ide cooperati e #ase"ine To pre ent o er exertion

Enhances acti it! to"erance He"ps &ini&i*e waste of energ!

FROM THEORY TO PRAXIS

0ifficu"t! initiating &o e&ents

Ei e the patient infor&ation that pro ides e idence progress

Protect patient fro& in+ur! To sustain patientJs &oti ation

Encourage c"ient to do whate er possi#"e e%g% se"fA care

Pro ides for sense of contro" and fee"ing of acco&p"ish&e nt

FROM THEORY TO PRAXIS

FROM THEORY TO PRAXIS

Monitor ita" sign Measure inta$e and output

Assess respirator! status

Monitor a#do&ina" girth

Ref"ects accu&u"ation of f"uid <ascites=

FROM THEORY TO PRAXIS

Restrict sodiu& and f"uids as ordered