NUR251 Essentials Of Teaching And Learning

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NUR251 Essentials Of Teaching And Learning

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NUR251 Essentials Of Teaching And Learning

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Course Code: NUR251
University: Charles Darwin University

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Country: Australia

Question:
Assessment 1 Tasks:
Using the template provided in the Assessment 1 folder and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following tasks. Do not make up or assume information in relation to or about Ruby. Only use what you know from the information you received today.
Based on the case scenario and in grammatically correct sentences identify:

Four (4) priority nursing assessments you would conduct prior to transferring Ruby to the ward?

For each assessment you have identified explain:

Why it is necessary for Ruby’s condition and nursing care?
What consequences can occur if this assessment is not completed accurately?
What chart or document you would use to assist with your assessments?

Task 3: Patient education
Discharge planning
An important aspect of nursing practice is to effectively and succinctly communicate relevant information related to ongoing disease management or prevention of reinfection or deterioration on discharge. Patient education and discharge planning starts on admission and you need to provide Ruby with education during your shift in preparation for discharge home.

Explain three (3) important points/topics you will need to include in Ruby’s preparation for discharge to aid healing and prevent further illness. For each education point identified provide:
One (1) strategy to assist Ruby to implement the education into her daily routine.

Task 4: Documentation
An important legal requirement of nursing practice is to effectively and succinctly document relevant information, actions and outcomes related to patient care and provide an accurate reflection of the health status of the patient, their responses to care and the patient’s perspective.

Make an entry into Ruby’s patient progress notes documenting the successful implementation of your nursing care plan. You can choose any progress note format but your documentation must:

Ø Demonstrate person-centred care
Ø Adhere to the legal and professional standards for documentation
Ø Appropriate professional language must be used – legally recognised abbreviations may be used in this task (handover) but a KEY with full terminology must be provided after the assignment references – key will be excluded from word count tally.
 
Answer:

Introduction
The four most priority assessments that are essential for being conducted for Ruby Smith by the doctors before transferring her to the ward are provided in the following points:-

Postoperative assessments:

The postoperative assessment is essential for the purpose of determining Ruby’s condition after the operations are executed. Some of the tests are carried out such as chest X- rays, ECGs, FBC test and biochemistry for the purpose of determining the complications that can be raised after the execution of the operation. It is enabling the doctors to determine the WBC count and the abnormal uterine bleeding after the operation of the Ruby Smith is undertaken. The assessments made also are depicted to be showing the development of the complications in the Ruby Smith instead of having normal blood pressure (Davis, Tschudin & De Raeve, 2006).  
 

Strict monitoring of the fluid monitoring assessments:

The strict monitoring of the fluid will enable the perioperative nurse to determine appropriate blood circulations and the other fluids present in the body of Ruby Smith. After carrying out this assessment, the abnormal vaginal blood loss is seen which is creating complexity after the operation is carried out. The blood flow is found to be normal and also the area is also found to be in the normal state. The pathology chart is being used for determining the fluid monitoring assessments.

Pain management assessments

The pain management assessment is depicted to be indicating the perioperative nurse to monitor the pains present in the patient. It will enable the patient to pains of the patient with the implementation of the anesthesia for the purpose of reducing the pains (Tourigny, 2016).

Monitoring the PV loss assessments

The monitoring of the PV loss assessment is essential for Ruby as it is identified in this case. It is enabling the perioperative nurse to determine the PV loss which is found to be positive as per the test is being made according to the pathology chart.
 
Nursing Care Plan:   RUBY SMITH

Nursing problem: Acute Pain

Related to:  The patient has gone through a vaginal hysterectomy for the treatment of abnormal uterine bleeding. Because the patient has gone through a critical surgery, she has been suffering from severe pain.  Moreover, the preoperative nurse has to take care of the pain of the patient and with the help of effective pain management plan, patient’s pain should be reduced (Thompson, Melia, Boyd & Horsburgh, 2006). 

Goal of care

Nursing interventions

Rationale

Evaluation

 
 
The goal of nursing care is to reduce the pain of Ruby Smith, the vaginal hysterectomy patient.  The goal is to reduce the pain scale from 10 to 2 as the sign of a stable position (Streicher, 2013).
 
 
 
 

Independent
· Evaluation of pain on a regular basis to understand the intensity
· Apart from medication other non-drug pain treatments like deep breathing exercise can be included to improve efficiency.
· Reposition of the patient as indicated
· Identification of limitation of particular activity
· Monitor critical signs  
Dependent
· Administration of IMI Ketorolac 30mg TDS as per the prescription of the surgeon to reduce pain.

· It is very important to decrease the pain of the patient and hence it is essential to administrate Opioids is a useful drug to reduce pain.
· Other non-drug treatments can reduce the pain of the patient.
· Helps in avoiding the undue strain of the patient
· It supports in managing pain as well as improving circulation
· It helps in relieving muscle as well as the emotional tension of the patients
Dependent
To provide relief from moderate pain

· Time to time monitoring and evaluation is necessary to manage the pain of the patient and it helps in reducing the pain.
· The pain level has been decreased significantly and attains the goal.

Nursing problem: Risk of fluid imbalance

Related to:  After the vaginal hysterectomy, the volume of fluid used to be reduced due to excessive blood loss as observed by the pallor of vaginal bleeding.  The specific patient Ruby Smith has gone through a vaginal hysterectomy for the treatment of abnormal uterine bleeding. The hysterectomy is the removal of the part of her uterus that causes excessive blood loss and grows the risk of fluid imbalance (Polit & Beck, 2010).

Goal of care

Nursing interventions

Rationale

Evaluation

 
 
 
The goal of the nursing care is to improve the fluid balance of the patient of vaginal hysterectomy. The improved conditions can be understood by the vital sign of stability and improved skin turgor (Haussler, 2008).   
 
 
 
 
 
 

Independent
· Observe the major signs and compare with the past readings or normal reading of the patient.
· Record the patient’s individual physiological response to the bleeding like weakness, pallor, and restlessness.
· Monitoring the intake as well as outputs of the patient
· Maintain the patient’s bed rest and schedule her actions to plan undisturbed resting period (Mabbott, 2013).
Dependent
· Blood transfusion
· Observation of Hb, RB count, and Hct.

Independent
· Alteration of the major signs can be utilized for a rough estimation of blood loss.
· Symptomatology might be ineffective in measuring the seriousness of the length of the bleeding period.
· Provide direction for the replacement of fluid
· Activity may enhance intra-abdominal pressure as well as can be predisposed for further bleeding.
Dependent
· Fluid alternation is reliant on the bleeding duration. Volume expanders might be infused until the types as well as cross-matching will be finished and start blood transfusion (Philbrick, 2013).   
· Helps in accomplishing the blood alternation needs as well as observing the effectiveness.

After a few hours of nursing care and intervention Mrs. Ruby Smith was able to:
· Show improved fluid balance as observed by stable key signs and fine skin turgor.  

Nursing problem: Reduced mobility

Related to:  After the vaginal hysterectomy the mobility of the patient has been reduced and the lower portion of the body of the patient cannot mobilize because of severe pain and the wound.

Goal of care

Nursing interventions

Rationale

Evaluation

 
 
The goal of care is to improve the mobility of the patient after her vaginal hysterectomy.  The goal is to improve her mobility within the next 16 hours.
 
 
 
 
 
 

Independent
· Assist the patient in moving
· Help her in uplifting her upper body part
· Help her in sitting in the bed.
· Encourage the patient to do deep breathing exercise
· Encourage to stress her body
· Monitoring the movement of the patient
 
Dependent
· Administer the pain relief medicines in order to decrease her pain.
· Perform some massage to improve the mobility of the patient (Cutcliffe & Ward, 2014).
 

Independent
· Patient movement is most essential as it helps in avoiding the cramps in the muscles of the patient (Goldman & Vasavada, 2008).
 
 
 
 
 
 
Dependent
· The analgesic or painkiller medication helps in decreasing the pain of the patient
· Massage helps in giving some relief to the patient. 

After 16 hours of the nursing care and intervention activities, it is observed that the patient has been improving. The patient can be able to move her limbs, can be able to sit on her own and can be able to lift her upper body parts.   

Nursing problem: Risk of anxiety

Related to:  After the vaginal hysterectomy for the treatment of abnormal uterine bleeding, the probability of increasing the anxiety of the patient is very high. The concerned patient Ruby Smith has undergone a vaginal hysterectomy for the treatment of abnormal uterine bleeding. The part of the Uterus has been parted from her body. It may raise anxiety in her and hence, there is a significant risk of anxiety in the case of Ruby Smith.

Goal of care

Nursing interventions

Rationale

Evaluation

 
The goal of the nursing care is to reduce the anxiety level of the patient by appropriate intervention plan. Within 16 hours the level of anxiety will be reduced (Crawford, 2009).
 

· Independent
· Establishing rapport with the patient
· Focus on ordered diet
· Observation of major signs
· Providing comfort measures
· Encouraging to perform the deep breathing exercise
· Providing safety measures
· Developing communication review process and convey the patient at the time treatment will pain
· Administration of analgesic according to the indication to the maximum doses   

· For gaining trust
· For encouraging the patient to not eat any undulated foods
· For collecting baseline data
· For satisfying the confinement of  Ruby Smith the patient
· For inhibiting the pain
· To precaution from any type of injury
· To change pain as well as eliminate emotional stress
· To reduce concern about the unknown facts  and related muscle tension
· To maintain a level of acceptable pain
 

After 16 hours of the nursing care and intervention activities, it is observed that the patient’s condition has been improving.
The patient has been observed more tension free.

Nursing problem: Self-care deficit  

Related to:  The treatment and procedure of vaginal hysterectomy may reduce the self-care of the patient who has gone through the vaginal hysterectomy. The patient named Ruby Smith has undergone the vaginal hysterectomy of abnormal uterine bleeding. 

Goal of care

Nursing interventions

Rationale

Evaluation

 
 
The main goal of the nursing care service is to improve the self-care deficit of the patient (Burns, 2005).

Independent
· Encourage the patient to take care of her
· Make the patient understand the significance of self-care in order to improve her condition
 

Independent
The self-care should be improved
It helps in improving the condition of the patient   

After the nursing care and intervention, the condition of the patient has been improved.

 
 
Patient Education
 The three important points which can be referred to Ruby for the purpose of including in the preparation of the discharge to aid healing and preventing further illness are provided in the following points:-

The infection control programs must be provided which is including the responsibilities that must be carried out by Ruby.

The infection control programs are essential for Ruby so that the decrease in the infection rates for the purpose of validating the controlled activities for Ruby. It will enable Ruby to take care of the infection control processes as the nurses carried out the process for controlling the infections (Buccheri & Sharifi, 2017). The knowledge must be provided to Ruby before the discharge planning processes for the purpose of creating a preventive environment for Ruby.

Anti-biotic usage and the invasive medical device usages must be suggested to Ruby.

The anti-biotic usage medications will enable Ruby to heal up quickly as well as the appropriate treatment processes can be carried out by Ruby for the purpose of healing. The process will enable Ruby to cope up with the processes as it will enable Ruby to cope up with the diseases (Branscombe, 2008).  

Hygienic environment maintenance for Ruby

The hygiene environment maintenance will enable Ruby to create a hygienic environment for the purpose of removing the spreading to infection. The hygienic environment process is indicating the appropriate fluid monitoring processes as well as it will enable Ruby to establish an appropriate environment for carrying out the monitoring processes (Bates, O’Connor, Dunn & Hasenau, 2014).
 
Documentation  

Demonstration of Person-Centered Care

Legal and Professional Standards

Professional Languages

Actions and Outcomes of the Patient

Maintenance of Privacy and  the dignity of the patients

Professional RCT nursing standards must be followed.

English

Appropriate maintenance of the privacy and the dignity is maintained.

Responsibilities must be properly carried out by the Nursing staffs present in the treatment processes carried out for Ruby

Professional RCT nursing standards must be followed.

English

Appropriate responsibilities are carried out for Ruby while carrying out the treatment processes.

 Professional standard of nursing care and the treatment processes must be carried out for the patient Ruby.

Professional RCT nursing standards must be followed.

English

Appropriate professional standards are maintained for the welfare of the treatment of Ruby.

The documentation processes carried out for Ruby is illustrating the achievement of the goals in an appropriate way as well as it is depicted to be aiming at providing the fruitful outcomes of the study (Avery, 2017). The changes in the processes, as well as the needs, can be fulfilled by maintaining the appropriate environment for the treatment of Ruby.
 
References
Avery, G. (2017). Law and ethics in nursing and healthcare. Sage Publications Ltd.
Bates, O., O’Connor, N., Dunn, D., & Hasenau, S. (2014). Applying STAAR Interventions in Incremental Bundles: Improving Post-CABG Surgical Patient Care. Worldviews On Evidence-Based Nursing, 11(2), 89-97.
Branscombe, L. (2008). Post-operative care: nursing the postoperative spinal patient. Veterinary Nursing Journal, 23(12), 19-21.
Buccheri, R., & Sharifi, C. (2017). Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice. Worldviews On Evidence-Based Nursing, 14(6), 463-472.
Burns, E. (2005). Evidence-based searching. The Lancet, 366(9490), 979-980.
Crawford, C. (2009). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. AORN Journal, 89(2), 426.
Cutcliffe, J., & Ward, M. (2014). Critiquing nursing research. Luton: Andrews UK.
Davis, A., Tschudin, V., & De Raeve, L. (2006). Essentials of teaching and learning in nursing ethics. Edinburgh: Churchill Livingstone.
Goldman, H., & Vasavada, S. (2008). Female Urology. Totowa, NJ: Humana Press Inc.
Haussler, S. (2008). The Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. The Journal Of Continuing Education In Nursing, 39(9), 432-432.
Mabbott, I. (2013). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence – Seventh editionThe Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence – Seventh edition. Nursing Standard, 27(31), 30-30.
Philbrick, V. (2013). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, 2nd Edition. AORN Journal, 97(1), 157-158.
Polit, D., & Beck, C. (2010). Essentials of nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Streicher, L. (2013). The essential guide to hysterectomy. Lanham: M. Evans.
Thompson, I., Melia, K., Boyd, K., & Horsburgh, D. (2006). Nursing Ethics – Elsevieron VitalSource. Saintt Louis: Elsevier Health Sciences UK.
Tourigny, L. (2016). Nursing and Patient Care. Journal Of Nursing & Patient Care, 01(01).

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