Acute Care: Care Implementation and Evaluation.

Acute charge C be Implementation and Evaluation. This appointee will be based almost the dish out that is implemented and evaluated, deep down a National Health supporter (NHS) Foundation Trust (FT). The focus of the assignment will be to talk of devil health problems that a selected patient has and has been admitted to the FT with. The selected patient had been admitted into FT with existent difficulties and as well as wretched from dehydration. The assignment will focus upon the intents that are wad for the patient whilst in FT and the reasons why the finales are caboodle.The patho-physiology of the two problems will in any case be discussed and also the care that had been implemented to fall upon the refinements. Through let on the assignment, the patient will be known as terry cloth with the permission from the patients parents, according to the breast feeding and tocology Council (NMC, 2008) confidentiality guidelines. The assignment will also aim to discuss t he role of the Health Care Professional (HCP) in cookery appropriate care for the patient, in particular, using the assessment proficiency of finale setting by using Specific, Measur fit, Achievable, real and Time readiness (S.M. A. R. T) target planning proficiency (Roper et al, 1996). The reasons for planning care merchantman pick out the HCP assisting in preserveing potential health problems, for example, breathing difficulties for the patient becoming worsened and to also assist in solving problems where possible. Care planning cigaret also assist in alleviating possible health problems that cannot be work by HCP s and so will need the assistance of Multi corrective Team (MDT) , for example, consultant, physiotherapists to further improve an develop the care plan.terry cloth is a 42 year old single man, who lives with his parents, and has suffered from a number of illnesses d wholenessout his life, for example, optical glyoma, Deep Vein Thrombosis (DVT), epilepsy, and also learning difficulties. terry has hassle with breathing, and this appears to comport been piddled by respiratory rhythmicity centre in the medulla and the pons (areas of the brain which can control breathing) and these appeared to not be workings in the correct way (MacKenzie, 1996 Waugh et al 2006). terrys reduced neurological status was collectable to injury that had been suffered in the beat back pathways, and the peripheral organisations, in the brain (Iggulden, 2006). terry cloth was admitted to the Intensive Care Unit (ICU), at heart the NHS FT, suffering from numerous problems that were mainly neurological. Terrys admission to ICU was collectible to the increased breathing difficulties that he was experiencing. callable to the breathing difficulties, the nurse squad, and Terrys consultant, agreed that it would be topper for Terry to have a percutaneous tracheotomy inserted. collectable to Terry suffering from a probable cerebellar lesion, severe learning d ifficulties and scummy communication skills it did appear that Terry could not understand what the nurse squad were informing him of, the medication that he require and the care that was be stageed (NMC, 2008). referable to the accompaniment that Terry appeared not to be able to understand or communicate with the treat squad, and that his parents and family members were with him, the care for squad, and myself, operated that the parents, and family members, were informed of what was happening regarding the care that had assumption to Terry.The detail that Terry could not understand the instructions given to him, payable to learning difficulties, consent to insert a percutaneous tracheostomy had to be given from Terrys parents, to the adviser (NMC, 2008). The tracheostomy that had been inserted into Terry helped the breast feeding group in the ICU and on the ward, to type Oate Terry to the optimum take of 98%. The tracheostomy, also ensured that Terry was able to observe a breathing set out of between 35 and 50 breathes per minute (Bailey, 2008).Although Terry was able to maintain a respiration rate, the normal respiration rate for an big(a) is normally between 14 and 18 breathes per minute (Bailey, 2008). The treat care that had been implemented included ensuring that oxygen was flowing by dint of and finished the tracheostomy and this ensured that Terry had bountiful oxygen in his body for his spirit and lungs to function, and that the heart pumped the oxygenated source more(prenominal) or less the body (Machin et al 1996 Roper et al, 1996 Bailey et al 2008). cod to Terrys respiration centre not working properly, and suffering from breathing problems, this meant that gaseous exchange was impaired, and led to a assay of respiratory acidosis. Gaseous exchange is where the oxygen goes into the alveoli capillaries, and the carbon dioxide is moved out of these capillaries (Bailey, 2008). The respiration centre is made up of a grou p of nerve cells, which are in the reticular endothelial system of the medulla oblongata.These cells orchestrate impulses to the motor neurones, via the spinal cord, and are then sent to the intercostal muscles (Bailey, 2008). The trauma that Terry had suffered with, was a possible cerebella lesion when he was a child. When Terry was admitted, his oxygen level was 82% (Bailey, 2008). The inclination for this problem was to keep Terrys respiration and oxygenation at a level that was suitable. A suitable level of respiration for an adult is between 14 and 18 breaths per minute, and an oxygen level of around 97 to 98% (Bailey, 2008).The patho-physiology of breathing difficulties includes a lack of oxygen to the tissues of the body, including the brain, and even demise (MacKenzie, 1996 Waugh et al 2006). Due to Terry haiving an oxygen strength level of 82%, we set the goal that we would aim for and set this goal with his parents. The goal that the nurses had set with Terrys parents, cod to the fact that Terry had learning difficulties and could not set the goal with the nurses. The goal was set as the nurses aimed to have his oxygen saturation level between 95% and 98% within two hours.The goal had to jeer in with the Specific, Measurable, Achievable, realistic and Time flummox (S. M. A. R. T) target planning technique (Roper et al, 1996 Faulkner, 2000). Terrys sitting and lying position had to be carefully planned around him, this ensured that we as a nursing aggroup where able to ensure that his lungs would fatten to their optimum and to maintain a satisfactory oxygen saturation levels within his body (Roper et al 1996 Machin et al 1996 Hackman, 2008). The normal oxygen saturation level is between 95% and 98% (Woodrow, 1999).The fact that Terry had an oxygen saturation level of just 82%, the Consultant had to prescribe oxygen for Terry. The oxygen that had been appointed for Terry, had been increased from 24% to 40% (NMC, 2002). The consultant advised us to ensure that the oxygen was to be humidified. Due to Terry having the tracheostomy, we were able to incline the oxygen with the use of a tracheostomy mask and what is called a T-piece set (Machin et al 1996 Dolan, 2008 Soady, 2008).The consultant also advised the nursing police squad to ensure that neurological observations were undertaken, especially the oxygen saturation levels, every 15 minutes until Terrys oxygen saturation levels had risen to 96% (Machin et al 1996 Dolan, 2008 Soady, 2008) The neurological observations with regards to the goal, meant that the nurses were able to discontinue oxygen, which would enable the oxygen saturation level to be retained (Machin et al 1996 Dolan, 2008 Soady, 2008).Once the nursing group up had ensured that the oxygen had been standed to Terry at 40% and was humidified, they then ensured that 15 minute observations were maintained. The Consultant had to ensure that the 40% oxygen that he had verbally impose, was accounted a nd written clearly in Terrys checkup notes and on his prescription sheet (NMC, 2002 NMC, 2004). The fact that Terry had been official the higher rate of oxygen, this needed to be clearly scheduleed within Terrys nursing notes (NMC, 2004).The rollation was needed, so that the other nurses were informed of the change. Although the observations had been maintained every 15 minutes, with regards to Terrys oxygen saturation levels, this ensured that the nursing team maintained Terrys neurological observations (Machin et al 1996 Dolan, 2008 Soady, 2008). The goal that had been set by the nursing team and Terrys parents, for his oxygenation levels did fit into the Specific, Measurable, Achievable, Realistic and Time desexualise (S. M. A.R. T) target planning technique. The goal was specific, measurable and realistic for Terry and the nursing team warmth for him, as well as existence achievable in the term mold that had been set by Terrys Consultant (Faulkner, 2000). Due to the fac t that the nursing team had achieved this goal for Terry, proved that the nursing care and interventions made by the nursing team, were effective. The nursing care and interventions were effective decorous, for this goal to have been met (Roper et al 1996).The goal that had been set for Terry with regards to his oxygen saturation level, had to be documented. The goal had to be documented within the nursing notes, which the nursing team had to document clearly. The nursing team were able to hand everyplace the information approximately Terry, to the nursing staff that would have been caring for him on the next shift. (NMC, 2004) The turn of Terrys problems is that he was at risk of dehydration, this was referable to the fact that Terry could not swallow as he had a reduced neurological status.The fact that Terry could not swallow was referable to the motor area of noetic cortex of his brain, did not work in the way that it should (Waugh et al 2006). The motor area of the cereb ral cortex of Terrys brain, was damaged due to the increase in epileptic seizures. Dehydration can cause the cells to deplete, due to not having enough blands for them to replenish. The cells replenish in the sense that the smooth-spokens help the cells to regenerate, regulate the body temperature, to burn the waste products within the body, and to maintain the level of fluids within the tissue fluid and blood (Waugh et al 2006).The patho-physiology of dehydration includes thirst, the mouth being dry, the tongue would seek leathery, and fluid from within the tissues and skin would be withdrawn (Roper et al 1996 Brown, 1997 Day, 1997). Due to Terry not being able to drink fluids, he was not able to regulate his own body temperature, nor was his body able to elongate the poisonous substances in his body (Waugh et al 2006). Due to fluid being withdrawn from the body, this would mean that the body would not be able to maintain its own volume in blood (Roper et al 1996).The patho-ph ysiology of not having enough fluids also includes the kidneys would excrete less than they normally would a person would be lethargic the skin would lose its elasticity and would appear to be more wrinkled (Roper et al 1996 Brown, 1997 Day, 1997). If Terry had been suffering from dehydration, his would have seeed sunken and his peeing output would be reduced as well as being more concentrated. If Terry had been suffering from a severe case of dehydration, his blood volume would be reduced.If the blood volume was to cause a circulation deficiency, this would cause his kidneys to fail to excrete the waste products that they normally excrete (Roper et al 1996 Brown, 1997 Day, 1997). Due to Terry not drinking the recommended two litres of fluids per day, we had to set a goal. The goal that had to be set, had to be set with Terrys parents (Roper et al 1996). The goal for the second problem, was to prevent dehydration during Terrys stay in hospital, with ensuring that Intravenous sali ne solution was supplyed through venous approach shot (Dougherty et al 2008).The Intravenous saline solution had to be delivered through venous access, due to the fact that this was the most effective way in which to infuse fluids. The fluids had to be infuse all over a stopover of 24 hours, due to the volume of the fluids. The Consultant prescribed two litres of Intravenous saline, and the nursing team ensured that it was delivered (NMC, 2002 NMC, 2004 Dougherty et al 2008). Due to the fact that the fluids needed to be infused, the nursing team ensured that the fluids were delivered through the venous access, by using an infusion pump.The pump that was used by the nursing team, was the volumetric pump. The volumetric pumps allow health care professionals to administer large amounts of infusions, and this is why were used this type of pump to deliver the fluids that Terry needed over a 24 hour period (Sarpal, 2008). Due to the fact that the nursing team were delivering Intraven ous salty to Terry, it was all-important(a) that this was documented by the nursing team within his nursing notes. The fact that this was documented in Terrys notes, ensured that the information was handed over to the nursing team on the next shift (NMC, 2004). It was important hat a fluid balance chart was also documented, as this would help the nursing team to ensure that the amount of input from fluids, was similar to Terrys urine output. The fact that the nursing team were able to monitor Terrys fluid input and output, ensured that his body was not retaining any of those fluids within a 24 hour period (Hunt et al 2008). The goal for dehydration by providing two litres of Intravenous Saline over a 24 hour period, did fit into the Specific, Measurable, Achievable, Realistic and Time dress circle (S. M. A. R. T) target planning technique. This was due to the fact that the goal was specific, measurable and cadence set.The goal was achievable and realistic, moreover only while T errys venous access was as good as it was. When Terrys venous access for the Intravenous Saline to be delivered was unretentive, this meant that the nursing team had to find another route to deliver these fluids. The nursing team had to re-set the goal for delivering the Intravenous Saline. (Faulkner, 2000) Due to the fact that the nursing team could not deliver the Intravenous Saline through the venous route, had to be documented. The nursing team had to document the fact that Terry had poor venous access, and that they had asked his Consultant to review Terry (NMC, 2004).When Terrys Consultant had been to review him, the Consultant advised the nursing team to deliver the Saline through Terrys oarlock tube. Terrys Consultant had to document the fact, that he had advised the nursing team to deliver the Saline through Terrys control stick tube. The Consultant also had to document that his advice was due to Terrys poor venous access in Terrys medical notes, and he had to document t his on the prescription chart (NMC, 2004). Due to Terry having a transcutaneous endoscopic Gastrostomy ( arrest), the nursing team and Terrys parents re-set the goal to deliver the fluids that Terry needed (Faulkner, 2000).The new goal that had been set, was to deliver one litre of Intravenous Saline through Terrys PEG tube. The litre of Saline was delivered to Terry through his PEG tube, over an 8 hour period rather than a 24 hour period. Even though the nursing team had to deliver the fluids through the PEG tube, they had to ensure that the goal did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. This goal was specific, measurable, achievable, realistic and quantify set for Terry and the nursing team (Faulkner, 2000).Before the nursing team could deliver the Saline through Terrys Percutaneous Endoscopic Gastrostomy, the Saline had to be prescribed by his Consultant. The Consultant had to document the Saline on Ter rys prescription chart, and also had to document the route that the nursing team were to deliver the Saline (NMC, 2004). The Saline that had been prescribed by Terrys Consultant, also had to document in Terrys medical notes, that he had prescribed this and also document the route that he had advised to the nursing team (NMC, 2002 NMC, 2004).When the nursing staff had commenced the delivery of the Saline through the Percutaneous Endoscopic Gastrostomy (PEG) tube, they themselves had to document this. The nursing team had to document the Saline running game through the PEG tube, to enable the nursing notes for Terry to be up-to-date. The nursing team to document the amount of Saline that was to run through Terrys PEG tube, and what time the Saline infusion began. The nursing team also had to document how a lot of the Saline was to be infused in any one hour, when the Saline was due to finish, as well as document the lot number and demise date that were on the bag of Saline. NMC, 200 2 NMC, 2004) The documentation of the infusion of the Saline running through Terrys Percutaneous Endoscopic Gastrostomy (PEG) tube, ensured that the nursing team could hand over the information to the nursing team that were due to care for Terry on the next shift (NMC, 2004). The goal that had been re-set by the nursing team, and Terrys parents, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique (Faulkner, 2000).The fact that the goal had to be re-set, ensured that the nursing team had been able to deliver the Saline through the Percutaneous Endoscopic Grastrostomy (PEG) tube. The goal to deliver the Saline through the PEG tube, had been specific, measurable, realistic and time set for Terry and the nursing team. This goal had been achieved, due to the fact that the care that the nursing team had been able to deliver the Saline in the time that they had set with Terrys parents (Faulkner, 2000).Due to the goal being achieved in the time frame that had been set by the nursing team, and Terrys parents, meant that the nursing team had been able to deliver the care that had been needed to achieve this goal (Faulkner, 2000). I am now at the point in this assignment when I can reflect. For my reflection, I will be using the Gibbs ruminative rhythm to reflect upon this assignment, which is documented within his book that was published in 1988 and authorise Learning by Doing A Guide To Teaching and Learning Methods (Gibbs, 1998). Due to the fact that Terry ad a number of health problems, I had a hard task of choosing which two that I would use. I did have to think long and hard about which two health problems that I would use, but I was given permission from his parents to enable me to write this assignment (NMC, 2008). The two health problems that I had chosen, were breathing difficulties and dehydration. Due to the breathing difficulties that Terry suffered with, meant that his oxygen saturation levels were low. Due to Terrys breathing difficulties, this is why the nursing team, and his Consultant, had to move on consent from Terrys parents, to insert a percutaneous tracheostomy.The fact that the tracheostomy was inserted in brief after Terrys admission, enabled the nursing staff within the ITU and the ward of the NHS FT, to ensure that Terrys oxygen saturation levels were maintained. Therefore, this is the reason why a goal was set. Due to a goal being set for Terrys oxygen saturation levels to be maintained, provides proof to show that the nursing interventions were effective. The effectiveness of these nursing interventions, proves that goals that are set for an several(prenominal) patient can also be met.The second goal that had been set for Terry by the nursing team, and his parents, had fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. Due to the fact that this goal was only partially met, did not necessarily mean that the care that had been delivered to Terry, had been ineffective. The care that had been delivered to Terry had been effective, but the goal could no longer be achieved through the venous route, due to the fact that Terrys venous access was poor. Due to Terrys poor venous access, this is why the nursing team had to re-set the goal with his parents.The goal that had to be re-set, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. The goal had been re-set, and had also been achieved in the time frame that had been set with Terrys parents. The goal that had been re-set, had been achieved in the time frame that had been set. The goal had been achieved due to the fact that, the nursing team were able to deliver the Intravenous Saline through the Percutaneous Endoscopic Gastrostomy (PEG) that Terry had in place.The fact that the nursing team could not achieve this goal when it had first gear be en set, was not an issue that could have been anticipated. Even though nursing teams can not anticipate why the goals are not met, they can re-set the goal and in time, meet the new goal. Therefore, the nursing care and interventions that are delivered, do make nursing care effective. Documentation of all care from the nursing team was important, due to the fact that the nursing team on one shift, were able to inform the nursing team of the next shift.Documentation also ensures that if the nursing team were unsure of any test results, that they were able to look over the nursing notes to ensure they knew where we were up to with the patient. The Consultants documentation in the patients medical notes, ensured that other doctors or Consultants were also aware of the patients condition and any tests that whitethorn have been ordered. Bibliography. Bailey, M. , Crossen, S. , Holland, J. , & Hollis, V. (2008) Observations in Dougherty, L & Lister, S. (eds) The kingly Marsden hospital Manual of clinical care for Procedures. 7th ed. Chapter 25, Pages 496-544.Oxford Wiley-Blackwell issue. Brown, A. (1997) Caring for the Patient Undergoing Surgery in Walsh, M. (ed) (1997) Watsons clinical Nursing and Related Sciences. 5th ed. Chapter 10, Pages 232-259. 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