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Week 2 ATI: Client Comfort and End of Life Care

Sofia Herrera

Chamberlain University

NR341 Adult Health

November 2, 2022

Reflective Paragraph

The way I communicate with my patients and their families is one adjustment I’d like to make in my clinical practice as a result of what I’ve learned from this tutorial. The patient’s family members were debating several of the patient’s alternatives and what they believed to be best for them in the scenario. In my clinical work, I want to make sure that my patients are making their own choices based on their own needs and what they believe to be right. When a patient has many people telling them what they want, it becomes difficult for them to even discuss possibilities. For the patient, this is improper and unhealthy because they require space to recuperate and alone time to consider their options. In order to get the proper care that my patients want and deserve, I would make sure that we were speaking one-on-one while I was in my clinical practice, and we were discussing possibilities. Additionally, I would make sure that my patient was informed of all their options so they could choose what was best for them and consult someone if they so desired.

Registered Nurses responsibilities in treating patient’s pain according to the Texas Board

Pain management aims to therapeutically address the patient’s pain in connection to their general health, including aspects of physical function, psychological well-being, social functioning, and occupational considerations. A registered nurse’s obligation to treat a patient’s pain involves an ethical obligation to end the suffering that the patient’s discomfort creates. A customized nursing intervention plan is used by nurses to treat each patient according to their unique needs and the level of pain they are treating. Interprofessional approaches are used in pain relief for all clients, and the nursing process directs the nurse’s actions to improve pain management. (Texas Board, 2020)

In accordance with the rules of your state, if a patient lacks a medical power of attorney, who are the patient’s next three decision-makers

According to Texas law, an adult may serve as a surrogate for an adult hospital patient who lacks the mental capacity to make decisions for themselves. The following parties, in this sequence, may agree to a patient’s treatment: Most of your children, your spouse, your parents, an adult child who was legally authorized to act on your behalf prior to your becoming incapacitated (with the waiver and approval of all other legally authorized adult children), and that child’s adult children (Texas Law, 2020) However, there are some scenarios in which the health care surrogate is unable to make choices, including ones that involve being taken off a ventilator or other life-sustaining measures. If no one is available to act as a surrogate decision maker, the court-appointed guardian will be the only one who has the authority to decide whether to terminate treatment or remove life support, with the help of the physician.

Ways is a patient considered incapable under state law

According to Texas public law, a minor qualifies as an incapacitated person.

an adult who, due to a physical or mental condition, is significantly unable to look after their own physical needs, manage their own finances, or provide for their own food, clothing, and shelter; or who needs to have a guardian appointed in order to receive money owed to them from a government source (Texas Law, 2019)

References

Texas board of Nursing. (2014). Texas Administrative. Retrieved January 06, 2020, from https://www.ban.texas.gov/rr_current/229-1.asp

Texas Public Law. (2019, February 2). Texas state sec. 103.016 Incapacitated Person. Retrieved March06,2022, from https://texasestates.public.laws//tex_code_section_103.0169765433

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Pre-Sim: Susan Weil

Kamila Mohamad

NR 341-Complex Adult Health

Dr. Pettifor

November 6th, 2022

Pre-Sim: Susan Weil

Clinical Manifestations Representative of ST Segment and Non-ST Segment

Patients who experience Non-Stemi symptoms should seek emergency medical attention right away because they can be lethal. Understanding and being alert to the symptoms of this condition immediately can help to prevent future cardiac damage (Huecker., 2022). Clinical Manifestations that are indicative of a non-ST segment include breathing difficulties, chest discomfort, a feeling of weight or pressure, dizziness, excessive perspiration, and back pain or irritation. The client may first show hardly any symptoms or more progressive ones with ST segment presentations. Regular checkups for the client are crucial in this situation. Usually, the heaviness in the chest, aching throughout, shortness of breath, or nausea and vomiting are the first noticeable symptoms (Huecker., 2022).

Electrocardiogram and Cardiac Biomarkers with STEMI Event

Cardiac biomarkers help medical practitioners identify the underlying cause of a patient’s symptoms, including a heart attack (myocardial infarction), angina, heart failure, or another condition (W;, 2010). Acute coronary syndrome or myocardial ischemia could both be indicated by increases in cardiac enzymes (ACS). It is impossible to tell whether a STEMI has occurred without doing an electrocardiogram (ECG), a test that shows the electrical activity of the heart as a wave pattern. When someone displays the warning signs and symptoms of a probable heart attack, the 12-lead electrocardiogram, also referred to as a “ECG,” is an essential diagnostic technique. Paramedics and EMTs may do this test in the patient’s home. They are searching for an elevated ST-segment on the 12-lead ECG. There are numerous ways to transmit the ECG to the hospital, allowing doctors to read it while the patient is still in the field. It might be difficult to interpret an ECG since ST-segment elevation can be caused by diseases other than heart attacks. For that reason, ECG Medical Training was developed. In essence, it says, “We have identified a patient who is experiencing an ST-elevation myocardial infarction (STEMI) and we are officially demanding that a life-saving team and equipment be established immediately.” Different EMS organizations and emergency hospitals use the term “Code STEMI” (W;, 2010).

Actions, Side Effects, and Nursing Interventions Required for Administering Medications

Aspirin

Nonsteroidal anti-inflammatory drugs like aspirin are used to relieve edema, fever, and mild pain. Hemorrhaging, liver or renal damage, and other negative effects of this medication are possible. (Vallerand & Sanoski, 2023). A nursing intervention for this drug would be to evaluate the client’s pain and determine whether she is pregnant, as it shouldn’t be administered to patients who are pregnant or who have gotten the varicella vaccine due to the danger of Reye’s Syndrome. (Vallerand & Sanoski, 2023).

Nitroglycerin

A medication called nitroglycerin is used to lower arterial blood pressure and, by relaxing heart muscle, lower myocardial oxygen demand. Headaches, dizziness, hypotension, syncope, cold sweats, and N/V are only a few of this medication’s negative effects. Giving sublingual preparations under the tongue with water as a delivery method is one possible intervention for this (Vallerand & Sanoski, 2023).

Morphine

Morphine is prescribed for painful conditions. However, this medication has the potential to produce symptoms such as respiratory depression, hypotension, itching, and blurred vision. Nurses can help with this by checking the client’s vitals every 15 to 30 minutes and asking the client to report any worsening signs of tiredness or signs of respiratory depression. (Vallerand & Sanoski, 2023). As a backup plan in case of overdose, the nurse should also carry naloxone on standby (Brown & Capili, 2020).

Heparin

A medicine called heparin is used to treat atrial fibrillation and stop blood clots from forming. Headaches, chills, nausea, epistaxis, bruises, and constipation are among the side effects that this medication may produce (Vallerand & Sanoski, 2023). A nurse should review the patient’s past medical history to look for any recent surgeries or injuries. The findings of the client’s coagulation test should also be taken into consideration when the nurse modifies dosages. As a final precaution against repeated injections, the nurse should additionally use a heparin lock needle (Vallerand & Sanoski, 2023).

Oxygen

Finally, clients who require oxygen supplementation are treated with oxygen therapy to maintain targeted SPO2 levels. It’s important to conduct a comprehensive assessment of the client when they’re undergoing oxygen treatment to figure out what level of saturation is appropriate. An hourly check of the oxygen flow rate, the integrity of the tubing, and the humidifier settings is required of the nurse in addition to the assessment of the client’s airway and the best position for it. Substernal heaviness, chest pain, coughing, and dyspnea are some potential side effects (Vallerand & Sanoski, 2023).

References

Brown, K. G., & Capili, B. (2020, June). 
CE: Opioid use disorder: Pathophysiology, assessment, and effective interventions. The American journal of nursing. Retrieved November 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446957/ 

Vallerand, A. H., & Sanoski, C. A. (2023). 
Davis’s drug guide for Nurses. F.A. Davis. 

. Huecker., M. (2022, September 9). 
Non ST segment elevation myocardial infarction – statpearls – NCBI … Retrieved November 3, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK513228/ 

W;, N. J. V. B. (2010, February 21). 
The evolution of electrocardiographic changes in st-segment elevation myocardial infarction. The American journal of emergency medicine. Retrieved November 2, 2022, from https://pubmed.ncbi.nlm.nih.gov/19751632/