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Ed's Nov.20-Nov.26 While I listen to 94.9 The Surf, baby!!!

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Cool Chapters 3&4:The Other End of the Stethoscope

On the topic of how Marcus explains how to give patients bad news "blunt and focused." I have always supported the idea of being direct and to the point when it comes to delivering bad or good information to a patient. I do feel you have to be caring and personable when delivery news in this manner. I have in the past been a little wordy when talking with patients. Marcus says to shorten everything you say. I can see how this would be helpful. Clear and simple terms is what people remember. A nurse should use short statements and answer questions using a economy of words as Marcus puts it. Giving more information and detail at the patients request. As a student in the past I have always felt like patients want to know all the information we have for them. Ms. Flowers opened my eyes in clinical during the summer. She told us to use basic communication when telling the patient about the meds we were giving. " This is Percocet, it is for your pain." To give more information if the patient requested it. It makes good sense.

"Down at the beach, that's were I want to be!!!!" Sorry got distracted for a moment.

Coming up with a nickname for my patient would be hard for me to do. I haven't always liked the use of nicknames. It does make a person stand out in ones mind. I could see however how this could backfire and hurt an individual. Would nicknames work for older patients? I can understand what Marcus is getting at, but a nurse would have to be really careful in the choice of nicknames. It seems the same as calling someone "sweetie'"or "honey". They say it most of the time as words of comfort and familiarity, but we are told not to use these type of terms. Establishing a repport with your patient for me is learning what you can about their life and feelings. Looking them directly in their eyes or facing them, even when they can't see you, when talking with them. Showing true interest in what they have to say. Really enjoying that personal contact with them. I also feel a nurse has to be comfortable with oneself to be able to develop a good repport with your patient and family members.

Interventions and rationales related to perfusion, infection and immunity with the diabetic patient

I. Help patient turn every 2 hrs. Provide skin care, particularly over boney prominences. R. Helps prevent venous stasis and skin breakdown.

I. Arrange for reverse isolation if patient has compromized immune system. Monitor flow and number of visitors. R. These measures protect patients from pathogens in the environment.

I. Help patient wash hands before and after meals and after using the bathroom, bedpan or urinal. R. Handwashing prevents spread of pathogens to other objects and food.

I. Offer oral hygiene to the patient every 4 hrs. R. To prevent colonization of bacteria and reduce risk of infection.

I. Elevate head of bed 30 degrees or place head of bed on 6"-8" blocks. R. To promote circulation to the lower extremities.

I. Use bed cradle when patient has ulcerations or gangrene. R. This helps prevent heavy sheets and blankets from resting on affected extremeties.

I. Reduce patient's caloric intake to promote weight reduction. R. Extra weight can stress the heart and decrease circulation.

Medications that cause hyperglycemia

1. Corticosteroids- Prednisone(Sterapred)

2. Thiazide Diuretics- Chlorothiazide(Diuril)

3. Atypical Antipsychotics- Olanzapine(Zyprexa)sunny

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Thanks Ed.

Joan

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