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Vital sign exam
The importance of vital signs
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Vital sign exam
The importance of vital signs
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Recommended: Vital sign exam
Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
The CIWA evaluation tool is sometimes replaced with the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method (CAM) assessment tools when patients reside in the ICU.24 These are well validated tools that evaluate the level of a patient’s agitation versus sedation and presence or absence of
“Fatigued: A Case on Blood” 1. The values collected from a CBC can reveal a great deal of information about a patient’s health. This information can be broken down into three broad categories, which are listed below. For each of these categories, list all of the CBC values that would provide information on that aspect of the patient’s health. OXYGENATION STATUS (oxygen-carrying capacity): Hemoglobin, Hematocrit, RBC count, Mean RBC volume IMMUNE STATUS (signs of infection, allergy, immune suppression): Neutrophils, Basophils, WBC count HEMOSTASIS (blood clotting): Platelets 2. Review the measurements in the CBC.
(College of Nursing, 2015:24). Nursing Consideration: Monitor vital signs frequently to find the possible side effect of hypotension. Please give a comfortable lying or sitting position for the patient when taking GTN to avoid hypotension and syncope (Brunner and Suddarth’s, et al, 2010: 765
Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
The patient follows the doctor’s recommendation for completing blood work to ensure the medication is consistently within the therapeutic level. Therefore, the International Normalized Ratio (INR), prothrombin time
Temperature: 97.20F, Heart rate: 70 beats per minute, BP: 130/76 mmHg, respiration: 18breaths per minute, and Pulse oximetry: 98% on room air. Rudd reports no pain on pain assessment using PQRST pain assessment method. Rudd is looking very happy to go back home. The nurse brings the discharge paperwork, educational booklet and discharge medication reconciliation form.
Risk for Infection Next, by implementing the VAP bundle, it did help to prevent further decline. All aspects of the bundle should be continued; the Heparin, sequential compression devices, oral care, Pepcid, and all other bundle activities. Having the head of the bed up was essential to prevent VAP, but it did end up making her body move to the foot of the bed. Pillows were used to help keep her further up and off the side of the bed.
melcoml turnball wants to send baby asha and her mother back to nauru whereas daniel andrews wrote a letter to mr turnball called " the hon of daniel andrews" adressing the issue. daneil andrews says "victiorians stands ready to assist and care for the children of nauru and their families who were brought to autralia from nauru. mr andrews wants to convice mr turnball that letting baby asha stay will not cause problems because the people are supporting the family. mr andrew write this letter with facts and logic to the autralian government and the people in australia supporting baby asha. in the newpaper sharon murdoch placed a picture of turnbull holding baby asha in his arms and singing a lullaby.
Thank you for your sharing. It is a very nice post. I understand more on how the nursing-sensitive indicators work with your appropriate example. For my understanding, “nursing-sensitive indicators” work like as a meter. The low meter reading represents something such as inefficiency or low score.
The desired outcome will be having the patient with clear lung sounds, edema free and denies dyspnea on exertion. To achieve these outcomes we need to monitor body weight daily, ? changes in bodyweight reflect changes in body fluid volume? (Methney, 2010). Mean time we need to monitor extension and location of edema?
Medication Nursing Assistants Nursing assistants have long been the heartbeat of assisted living, long-term care and rehabilitation facilities alike. Over time, their roles in these settings have evolved to accommodate the needs of the RNs/ LPNs they work alongside and the cliental they care for. In 2001, the National Council of State Boards of Nursing (NCSBN) expanded the capacity of NAs in an effort to facilitate safer staffing ratios.
In the case study, it shows that the nurses did not treat the patient according to his/her needs. The nurses have failed to deliver an ongoing assessment of the pressure area, and this has resulted in harm to the patient. 2.1 Risk assessment form One of the tools not used to safeguard patient safety was the risk assessment form. When a patient is admitted to a hospital, risk assessment should be done at-least within 8 hours of admission and frequently continue throughout patients stay (ACSQHC, 2012). Risk assessments consist of Braden scale, which is used to provide a prediction of the patient’s risk of pressure areas outcome, based on causes for example mobility.
RN can ask the CNA to take the patient’s vital signs and document, but cannot ask to assess the patient for her high blood pressure. Communication is another important point of delegation. If the CNA notice that patient’s blood pressure is high and fail to communicate to the RN, the result could be detrimental for the patient. Another example is that RN told the CNA to check a patient’s blood pressure but did not explain why or when she should check the blood pressure. The RN need to give 9 AM blood pressure medicine and waiting for the CNA to let her know the blood pressure.
(Marieb and Hoehn, 2016) In my clinical setting, it was expected that a level of proffesional protocol is carried out for a correct, and safe arterial reading while maintaining a hygienic and aseptic approach that is safe, and reduces the risk of detrimental harm to myself as a healthcare professional and to the patient in my care. Bp is read from patients as a matter of determining illness by monitoring what is known as a NEWS score, presenting a validating number to recognise the level of health of an individual. (Royal College of Nursing, 2015) Hypertension, high blood pressure, or hypotension, low blood pressure, can be a sign of a decreased state of health for my patients, therefore it was imperative that a bp exam is carried out in the correct way for the