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1 post conference on Tue Nov 29, 2011 5:55 pm

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Delivering difficult news to a patient is something that I have been trying to work on sense I first started nursing school. I have always tried to put myself in my nurse’s shoes to learn from he/she and he/she’s mistake. Through the last year and a half I have picked up a lot of great things that I will carry in my future and a lot of things I hope to never do to any patient of mine.
While reading Marcus Engel’s book, it has helped showed me what a patient feels. It has also really helped me in a cut and dry way of what to say and what not to say. If I had to deliver the difficult news to Marcus and his outcome, I would first make time I had more than enough time to sit down and talk to him that way I don’t leave him in the middle of the conversation. I would then sit him down and explain to him that we are going to talk about his future. I would then explain to him what his diagnoses and outcomes are according to the doctors that gave him these results. I would tell it to him on a level that he can understand seeing that he has no medical background. After all my explanation I would answer all of his questions and his family’s questions in an honest way with the knowledge and explain to him that if I didn’t know the answer then I would have to relay his questions to his doctor. I would then sit with them until I felt like they needed some alone time with just family present.

Ineffective tissue perfusion:
-Measure Capillary refill to determine adequacy of systemic circulation
-Note client’s nutritional and fluid status because protein-energy malnutrition and weight loss make ischemic tissues more prone to breakdown. Dehydration reduces blood volume and compromises peripheral circulation.
-Palpate arterial pulses to determine if and the level of circulatory blockage.
-Administer fluid, electrolytes, nutrients, and oxygen as indicated to promote optimal blood flow, organ perfusion, and function.
Risk for infection:
- Stress proper hand hygiene by all caregivers between therapies and clients because a first-line defense against healthcare-associated infections.
-Encourage early ambulation, deep breathing, coughing, and position changes for mobilization of respiratory secretions and prevention of aspiration/ respiratory infections
Immunity:
-Assess skin for color, moisture, texture, and turgor (elasticity). Keep accurate, ongoing documentation of changes. Preventive skin assessment protocol, including documentation, assists in the prevention of skin breakdown. Intact skin is nature's first line of defense against microorganisms entering the body (Kovach, 1995)
Nurse’s pocket guide A diagnoses, Prioritized Interventions, and Rationales Murr Doenges Moorhouse Pg 468
http://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-risk-for.html

Drugs:
Glucocorticoids- Prednisone
Thyroid hormone- Levothyroxine
B-adrenergic agonists- epinephrine

2 Re: post conference on Tue Nov 29, 2011 8:47 pm

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Thanks Kelli.

Joan

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