NUR2300 Evidence Based Nursing Practice

Table of Contents

Question:

Give a brief overview of current medical surgical nursing practice.

To ensure the best possible patient outcomes, discuss and critique your findings.

Answer:

Introduction

The communication skills of nurses in the healthcare industry are often overlooked.

Their knowledge and skills are often the main criteria for their employment. However, communication skills often take a back seat to their ability to communicate.

Research shows that poor communication between nurse and patient can lead to patient’s suffering.

The nurse’s exceptional communication skills help foster a dialogue with the patient and get the message across (McCabe & Timmins 2013, 2013).

This report focuses on the importance of communication within nursing.

Further details are provided in the report on how Mr. Brown should be treated to stay healthy.

He should be instructed on how to monitor his blood sugar and insulin levels at home after he is discharged.

Family members can also be involved in the care of patients, where they can share their opinions.

They receive the appropriate training in handling patients (Arnold & Boggs 2015).

Discussion

According to Mr. Brown’s case, he is 66 years of age with chest pains, breathing problems, Type 2 diabetes and obesity.

He smokes several cigarettes and drinks several beers per day.

For his survival, he needs to receive proper nursing and clinical care.

These are a set of guidelines that ensure all patients with the same medical condition are given appropriate care, regardless of where they live.

The Acute Coronary syndrome (ACS) clinical standard supports healthcare professionals and improves the quality of healthcare.

We will discuss in detail the appropriate nursing care for Mr. Brown.

Symptoms of patients with hyperglycaemia and Coronary Heart Disease

Diabetes is a complicated disease with a significant impact on society.

It affects 90% of diabetic patients.

Multiple organs are affected by type 2 diabetes mellitus, including the liver, pancreas and kidney brain.

The pancreas has decreased beta-cell function and the sensitivity to insulin is low.

This can lead to hyperglycaemia, according to Bell et al. (2014).

Mr. Brown’s ideal weight is between 53 and 65 kg, but his current weight is 143kg. This clearly indicates that he has hyperglycaemia.

He also has a few beers and a pack of cigarettes every day. This makes his diet unhealthy.

Brown had difficulty breathing and acute chest pain when he was admitted to the hospital.

These are signs of Acute Coronary Syndrome (ACS).

Hospitals that provide appropriate nursing care for Mr. Brown

Hyperglycaemia can lead to not only kidney failure, but also cardiovascular disease and blindness.

Mr. Brown must be tested for glycated hemoglobin at least twice per year.

The nurse must perform a proper diagnosis and keep a record of Mr. Brown’s medical history when he is admitted to hospital.

Basic tests for blood and urine should be performed (Martin?Gronert & Ozanne 2012).

There are many tests that can be performed on the patient.

These include a urine test, HbA1c test and an eye dilation test.

To determine if diabetes has affected the eyes blood vessels, a detailed eye dilation test must be done.

A HbA1c test should be performed on the patient.

This test is used to determine the level of glycosylated haemoglobin.

To check for sugar and ketones, a urine test is recommended.

A strip of urine is taken from the patient and then dipped into it.

A change in colour is indicative of the presence ketones.

This test can also detect microalbumin.

This protein is found in the urine of diabetic patients.

Troponin tests can also be used to diagnose heart attacks.

This test is performed when the patient has chest pains, shortness or breath, cold sweat, nausea, and/or chest pain.

Troponin I or T are proteins found in the heart muscle. They are released into blood to treat heart damage.

A high level of Troponin in the blood may indicate that the patient has suffered a heart attack, or another form of heart disease.

Troponin levels can rise within three to four hours after a heart attack and stay there for up to 10-14 days.

To diagnose a heart attack patient, there are both non-invasive and more invasive options.

The non-invasive tests include the use of a needle stick to image, while the invasive tests involve the insertion and removal of a tube.

Mahar (2012). A pain assessment tool must be reliable and precise in order to provide the right amount of information.

Both the staff and patients should have the necessary knowledge to use these tools.

In nursing, PQRST stands for Provoke Quality Radiates Severity Time.

Provokes refers to the question of what caused the pain. Quality is the sensation of the pain and Radiates is the location of the origination.

The severity of the pain is determined by its intensity and the time it lasts.

PQRST allows nurses to assess the entire situation of the patient upon admission (D’Arcy 2013, 2013).

To understand the patient’s medical condition, a complete set of questions are asked.

There are several pain scales available, including the Numerical Rating Scale and Visual Analog Scale (NRS). A pictorial or image scale is also available.

NRS requires that the patient rate his pain from 0 to 10. Zero is the lowest and 10, the highest.

VAS requires that the patient depicts his pain without using numbers. An image scale allows for a range of faces, from a smiling to a crying one.

A time limit of 10 minutes is allowed for heart attacks to be treated. An experienced paramedic can also perform an ECG (Macintyre & Schug 2014).

As the first treatment, you should give soluble aspirin, intravenous (IV), nitro-glycerine and Morphine.

It is important to carefully examine Mr. Brown’s symptoms and determine what type of medicine should be given.

Patients with low-risk symptoms need to be evaluated with biomarkers. Patients with high-risk conditions should be administered aspirin, beta-blockers and clopidogrel.

One option is angiography (Abbate and co-authors, 2012).

A change in lifestyle and weight must be made.

Self-monitoring glucose should be done, along with a thorough check-up.

The nurse should teach Mr. Brown the steps to self-monitoring blood sugar.

First, use a meter.

First, the patient must pierce his finger with a needle. Next, he needs to place the drop of blood on a strip.

The blood sugar count is displayed on the strip.

These meters can be found in local pharmacies. They come in a variety of sizes, speeds, portability, and costs.

The meters display the results in about 15 seconds, can store them for future use, and often have a software kit that displays and inputs relevant charts and graphs.

This is the traditional method of testing glucose.

New devices allow the patient to test his blood sugar using the forearm, upper arm, or thigh.

There are significant differences in the results between blood taken from the thumb or the arm.

Insulin pumps can be used to monitor blood sugar levels and to identify changes in sugar levels.

A nurse should demonstrate to Mr. Brown how to monitor his sugar levels.

The nurse should demonstrate to Mr. Brown how to monitor his blood sugar levels.

This monitoring should be done in the morning before eating or drinking.

The patient should check the sugar level at 3 AM in the morning if it is high.

It is important to test the sugar levels before eating.

Diabetes is a complicated disease that can vary from one person to the next. Therefore, it is important to observe the relationship between food intake and blood sugar.

Post-meal blood testing is encouraged.

Proper management and care are key to managing hyperglycaemia.

If necessary, the nurse should instruct Mr. Brown how to inject insulin at his home.

B-hydroxybutyrate normalization should be used to determine insulin therapy (Inzucchi 2015).

Fixed rate insulin combination is the best choice to reduce hepatic glucose production and ketogenesis.

Insulin injections are not recommended for type 2 patients.

The blood sugar level can be decreased by lifestyle changes and taking medications.

It is possible that a patient may want insulin because it lowers blood sugar levels and is less expensive than other diabetic medications.

The ideal insulin level should be between 100 and 250 mg/dL glucose in the blood.

A recommended insulin level should not exceed 0.3 units per kilogram if the patient has uncontrolled diabetes or an A1C level greater than 9.9.

A nurse or doctor will determine the exact insulin dose Mr. Brown will need based on his weight, age, and diet.

Insulin can be injected at the hips, hips, abdomen, hips, thighs and arms (Pledger et. al. 2012).

For his injection, the patient must avoid any scarring, moles, or broken blood vessels.

Repeat injections should be avoided at the same site.

Insulin is rapidly absorbed by the stomach and works quickly.

To inject insulin, you can use syringes or needles as well as pens.

The needle should measure 12mm in length.

Another invention in this field is the insulin pump, which helps to inject the insulin into your body (Savage and al. 2012).

This is an external device.

It contains a tube and needle that inject insulin into the bloodstream.

This process requires a lot training.

This article explains the procedure for injecting insulin.

First, wash your hands with soap water. Next, pull the plunger until it reaches the correct dosage level.

The patient should then take out the caps from the insulin vials and needle. Push the needle down into the stopper to inhale the air.

Turn the needle upside-down and push the plunger until the top of its back plunger reaches the dosage level.

To send any bubbles into the vial, the patient must tap the needle lightly.

With the index finger pointing off the plunger, the insulin vial must be held down.

After the injection site is secured with an alcohol pad, one- to two inches of skin must be pinched. The needle should then be inserted at a 90-degree angle.

You must push the plunger down completely and wait for 10 seconds.

The needle can be removed and the pinched skin will be released immediately.

If bleeding is occurring, a bandage can be applied.

A nurse can offer tips for the patient to make the procedure more comfortable. For example, he can use ice to numb his skin before alcohol is applied. He should also avoid injecting at the roots of the body hair.

The patient can choose from a variety of insulin depending on their speed and purpose.

You can choose from short acting, intermediate, long acting, or pre-mixed insulin.

To cure the patient, there must be some diet changes (Hayashino 2012).

Brown should eat small amounts, swap high-calorie foods with fruits and vegetables, eat whole grains, legumes, and cut down on salt and sugar.

The patient’s treatment should include exercise.

Patients should engage in strength training and aerobic exercise.

Aerobic exercise can be done by walking, running, swimming, jogging, and dancing.

Strength training includes lifting weights without restrictions and using weight- and resistance machine machines.

Before you begin exercising, make sure to check your glucose levels.

Family and Patient-Centered Care

Patients and their families are becoming more popular, and communication is a key component.

It’s a two-way process.

On the one hand, the patient’s decision is respected and the relatives are considered advisors to health care practices (Flynn & Preuster 2014).

Family members and relatives of the patient are encouraged to voice their opinions regarding the care of their loved one.

Family members are invited to participate in emergency situations and help nurses.

They are called caregivers and they interact with doctors and nurses to ensure the proper treatment. (Reinhard & Samis 2012).

The caregivers spend time with the patient and learn about appropriate techniques for aftercare.

The caregivers are provided with a pain education program that teaches them about pain assessment, pharmacologic, and non-pharmacologic interventions (Kim & Rich 2016, 2016).

The caregivers are also taught by nurses how to solve problems and manage medication safely.

Caregivers are also taught how to manage the patients’ behavioural changes.

This method was first developed by Anthony M.DiGioia, and his team at University of Pittsburgh Medical Centre (Verbeek 2012).

The six-step process is composed of two steps. The first involves describing the whole program, including the start and ending. The second involves creating a council to guide the process.

The third step involves defining the current process. The fourth step is to expand the council to include a group.

The fifth step involves creating a story from the perspective of the patient and their family. The sixth step involves creating teams to help bridge the gap between the ideal and current situation.

This helps maintain accountability and ethics as family members are considered partners in the patient’s care system (Gillick 2013, Gillick).

Conclusion

The above discussion suggests that nurses should adhere to a number of protocols in order to treat their patients.

Because of his unhealthy diet and obesity, Mr. Brown was diagnosed with type 2 diabetes as well as heart disease.

His treatment requires holistic care from a nurse.

Nurses will help patients establish healthy relationships with their family members and create a diet and exercise program.

Nursing staff take many measures to ensure patient-oriented care. They also use new methods of injecting insulin, maintain a constant glucose level, and minimize pain during angiography.

Nursing is both science-art.

Nurses should teach patients how to use insulin correctly and monitor blood sugar levels.

Family members that are considered caregivers should also be involved in patient care. Their opinions are valued.

They are crucial to the healthcare system. They must interact with nurses to get information, equipments, and services.

This will create a positive relationship between the patient, his family, and the nurses.

Refer to

Acute coronary syndrome and thrombosis.

A systematic review and meta-analysis of the effectiveness of carbohydrate counting in type-1 diabetes.

The Lancet Diabetes & Endocrinology 2(2): 133-140.

A Compact Clinical Guide to Trauma, Critical Care, and Emergency Pain Management: An Evidence Based Approach for Nurses.

Springer Publishing Company.

Caregivers play a crucial role in patient-centered care.

A meta-analysis of randomised controlled trials examining the effects of supervised exercise on blood pressure control and lipid profiles in type 2 diabetics:

Diabetes research and clinical practice. 98(3): 349-360.

Hyperglycaemia in type-2 diabetes management, 2015. A patient-centred approach.

Update to the position statement of the American Diabetes Association (EADA) and the European Association for the Study of Diabetes.

Care of older adults with multiple chronic conditions and cardiovascular disease that is patient-centered

Canadian Journal of Cardiology 32(9), 1097-1107.

A practical guide to acute pain management.

CRC Press.

A systematic review of the frequency and use pain assessment tools in adult burns patients: Randomized controlled trials.

Metabolic programming for insulin action and secretion.

Metabolism, Diabetes, Obesity, and Metabolism 14(s3), 29–39.

Palgrave Macmillan.

Functional foods against metabolic syndrome (obesity and diabetes, hypertension, dyslipidemia, and hypertension) and cardiovasular diseases.

Trends in Food Science & Technology 35(2): 114-128.

Diabetes injection technique is important.

Journal of Diabetes Nursing, 16(4).

Home alone: Family caregivers who provide complex chronic care.

Washington, DC: AARP Public Policy Institute.

Joint British Diabetes Societies guideline on the management of diabetic ketoacidosis.

Diabetic Medicine 28(5), 508-515.

A process evaluation of the experiences of family caregivers as well as nursing staff in small-scale dementia care facilities.

International journal of nursing studies 49(1): 21-29.

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