Acute Care Nursing

Part 1: Fundamentals of Care

Fundamentals of care: Relational

Establishment of a strong nurse and patient relationship is crucial for effective nursing care and high-quality patient experience in the care setting (Bello, 2017). For healthcare professionals, it becomes important to develop strong relationships with the patients as it helps in the understanding of patient needs with increased transparency and mutual trust for the care and treatment (Sibiya, 2018). This also helps in the improvement of the quality of care received by the patient and overall experience. The Nursing and Midwifery Board of Australia has established a code of conduct that highlights the importance of enhanced communication in nursing and asserts that it can help in improved care, rapport building, a better understanding of patient needs, and delivery of highest quality of care (Cashin, 2017). In the given case scenario, effective communication is needed to help the patient understand the importance of risks assessment and need to undertake essential precautions to prevent the exacerbation of asthma. Patient education is an integral component of nursing and can be delivered through effective communication and strong interpersonal relationship where the necessary care practices and the patient regimens are transferred carefully (Blake & Blake, 2019). 

The communication in nursing can be enhanced by using the following four strategies: 

  1. Maintaining professional boundaries: Respecting and maintaining professional boundaries in nursing is important as it helps in developing mutual respect. The patient possesses the right to privacy in care and it must be respected. This helps build trust and rapport between the carer and the patient and can thus help in establishing strong communication (Dithole et al., 2017). 
  2. Person-centred care: Person-centred care is an effective characteristic of nursing practice and allows the development of interventions and care regimens in consideration of the patient needs. Therefore, it helps in enhancing communication and strengthening the nurse and the patient relationship by directly catering to the patient needs with a focused approach (Blake & Blake, 2019). 
  3. Active listening: Active listening is a core part of communication. As a nurse, it is important to actively listen and understand the patient needs to deliver high-quality care and ensure the beneficence of the patient. Active listening, therefore, helps in communication enhancement by articulating the patient needs and building trust for the carer (Sibiya, 2018). 
  4. Competent nursing practice: The nurse and patient relationship and the effective communication between them can be enhanced by ensuring competence and respect for all the patients (Bello, 2017). 

Fundamentals of care: Physical- Role of nurse in patient safety: Risk assessment, prevention, and minimisation of complications

Patient safety is crucial for good quality care of the patients. In illnesses like asthma, environment safety is essential as it can act as an allergen and trigger an asthmatic attack (Ahluwalia et al., 2018). Asthma is a respiratory health condition that is triggered by an irritant or allergen that is identified by the antigen-presenting cells in the respiratory tract and an immunogenic response is triggered. This triggers the MHCs and the T-cells resulting in an immunogenic reaction. The pathophysiology of asthma is therefore associated with a hyperactive immune response that results in bronchoconstriction, bronchospasms, hyper mucus secretion, tissue remodelling, and eventually causes respiratory distress (Stern et al., 2020). The immune response results in uncontrolled activity of the smooth muscles in the respiratory tract, as a consequence, with excessive mucus secretion and muscle spasms, the respiratory tract is narrowed and the airflow is blocked and the patient undergoes respiratory distress. The respiratory distress due to hindered airflow creates oxygen demand in the body with limited supply.

To compensate the same, the respiratory rate of the patient goes up, the heart rate escalates, and the oxygen saturation levels may drop (Gautier & Charpin, 2017). In severe cases, hypoxia may develop in the patient and if left untreated can result in tissue damage and organ failure. The classical symptoms associated with the condition include breathlessness, wheezing, shallow breaths, with blue lips in severe conditions signalling the onset of hypoxia. Safety for the patients with asthma is crucial as different molecules and particles dispersed in the air can act as an irritant and trigger an asthmatic reaction. These particles can be inhaled by the patient and result in exacerbation of asthma that can serve to be fatal for the health of the patient (Faustino, 2020).

To prevent asthma exacerbation and the current condition of the patient, a risk assessment must be done to ensure the safety of the patient. In the provided case study, Mr. John Brown owns a pet cat. This increases the risk for his condition as pet dander or the dead skin present in skin flakes, saliva, and feather dust can result in exacerbation of asthma (Mendy et al., 2018). Touching or inhaling these compounds by an asthma patient can trigger an immune response and can worsen the symptoms of respiratory distress in the patient (Apfelbacher et al., 2016). Therefore, the primary risk for diagnosed asthma is the pet of the patient. Other risks may include extreme exposure to polluted environments. The patient should, therefore, be asked to undertake medications which can act as preventative measure to avoid triggering of asthma by the irritants in the environment. To ensure the safety of the patient, the environment must be cleaned and kept without potential triggers to prevent exacerbation. The pets must be thus kept outside and limited interaction with the pet should be allowed (Gergen et al., 2018).

The residence should be kept devoid materials like carpets that can potentially hold pet dander. This can help in limiting the amount of irritant exposed. A cleaner with HEPA filter should be used by the individuals to limit the exposure (Ahluwalia et al., 2018). The rooms should be well ventilated, and dusting with a damp cloth should be done for cleaning of the environment to limit the spread and suspension of the dander in the environment. Anti-histamine sprays are also recommended for patients with close surroundings with pets or other risks that have high chances of irritant exposure. This helps in managing the immune reaction and helps in prevention of exacerbation. In some cases, hypoallergic pets are also recommended. Certain breeds of acts and animals are known to cause a less severe reaction is relatively low risk for asthmatic patients.

To ensure the safety of the patient, the respiratory state of the patient must be monitored regularly for oxygen saturation levels and respiratory rates (Ahluwalia et al., 2018). Use of spirometer and handling should be taught to the patient and his family so that assessments can be done regularly for the same. The breath sounds of the patient must be noted regularly and safety must be ensuring with inhalers. The inhalers for asthmatic patients contain bronchodilators and help in easing the respiration in the patient by easing the airways and enhancing respiration (Mendy et al., 2018). The patient must also be ensured to be seated in the High Fowler’s position to minimise respiratory distress (Apfelbacher et al., 2016). Seating the patient in the High Fowler’s helps in minimisation of distress by easing the pressure on the chest and allowing the expansion of the lungs and thereby promoting the ease of breathing. Ensuring risk assessment and inclusion of these safety measures is crucial for the case of Mr. Brown as it helps in prevention of exacerbation and management of condition effectively (Faustino, 2020).

Fundamentals of care: Psychosocial

Mr. Brown requires essential care and psychosocial support as he is retired personnel who has been diagnosed with asthma and will require distancing from his six-year-old cat. A pet can be an essential psychological support for the elderly as it helps them stay engaged and prevents loneliness and withdrawal (Liu et al., 2016). Cats are considered great for companionship for the elderly as its care requires minimal mobility. Therefore, asking for distance from the pet can trigger loneliness and isolation in the patient. Separation from a pet can also result in triggering of depression and anxiety in elderly patients (Sussman, 2016). Therefore, for Mr. Brown additional psychosocial care is required to prevent such an incidence. The patient needs to be educated about the importance of maintaining and adopting the required interventions to ensure his beneficence and to prevent exacerbation of asthma from excessive proximity to the pet. The support should be empathetic and considerate as separation from pets can be difficult (Patto, 2020). Therefore, suitable interventions and exposure minimisation strategies and risks should be evaluated and communicated with extensive care for adherence by the patient to ensure his wellbeing (Liu et al., 2016).

Mr. Brown lives with his family with his wife and children therefore family and friendly support can be provided and ensured to the patient. Psychological support to the patient is important as it helps in the management of the condition by providing support. Psychological and social assistance helps in instilling optimism in the patient and thereby motivate them towards recovery and management of the condition (Sussman, 2016). For elderly patients like Mr. Brown, it is extremely crucial as it helps them feel involved and in control of their medical condition and undertake the suitable medical interventions for enhancing longevity and overall health care. The psychological support for the patient must be ensured, psychosocial support in nursing can help in the establishment of therapeutic relationships with the patient (Maia et al., 2017). It helps in the healing and reestablishment of social structure required for the maintenance of the illness. Provision of psychosocial care ensures holistic care for the patient with spiritual and cultural considerations through empathetic care. Therefore, psychosocial support in nursing helps the provision of person-centred care to ensure the beneficence of the patient.

Psychological support and competent care for Mr. brown will help in the management and recovery of the patient’s health through the development of a strong interpersonal relationship between the nurse and the patient, development of psychological support from the family, and, competent care for the patient (Maia et al., 2017). This will help in the management of the condition, prevent the exposure to the health risks, and minimise incidences of exacerbation (Patto, 2020). Further, ensuring psychological support will also help in keeping patient engaged in care, prevent feelings of loneliness and withdrawal from the pet, Bruce.

Part 2: ISBAR Handover

Identification: Hello, this is care nurse reporting regarding patient Mr. John Brown (68 years), record number 012345

Situation: The patient has been admitted regarding intolerance to activity and decreased oxygenation levels and moist productive cough and has been diagnosed with bronchial asthma.

Background: The patient possesses medical history of asthma, hypertension, type two diabetes mellitus. Further, the patient had also undergone a hip replacement surgery three years ago and has been undergoing medication Metformin (500 mg) BD. For the diagnosed bronchial asthma patient has been supplemented with 4L oxygen and 2.5mg Salbutamol 2-4 hours PRN. The patient lives with his family, wife and two children and possesses a six year old pet cat and has retired recently from police force.

Assessment: The temperature of the patient is at 37.5 degrees (normal) with pulse rate at 96 beats per minute (normal), respiratory rate of 22 breaths per minute (high), blood pressure recording at 145/90 mmHg (high) and has oxygen saturation levels at 96% (normal) with 4L oxygen supplementation through the nasal specs. The bowels of the patient have not opened in the last three days.

Recommendations: The patient should be administered liquid diet and should be checked for irritable bowel syndrome common in patients with asthma and other comorbidities like diabetes and hypertension that qualifies Mr. Brown. The asthma of the patient seems to be in control with supplemented oxygen. However, it is recommended that the exacerbation is controlled to ensure healthy vitals without supplementation. It is recommended that the patient is administered systematic care for asthma and tested for health conditions like IBD that are restricting bowel to prevent secondary complexities. The vitals must be kept in check and recorded frequently.

References for Acute Care Nursing

Ahluwalia, S. K., & Matsui, E. C. (2018). Indoor environmental interventions for furry pet allergens, pest allergens, and mold: Looking to the future. The Journal of Allergy and Clinical Immunology: In Practice, 6(1), 9-19. https://www.sciencedirect.com/science/article/pii/S2213219817307924

Apfelbacher, C., Frew, E., Xiang, A., Apfel, A., & Smith, H. (2016). Assessment of pet exposure by self-report in epidemiological studies of allergy and asthma: A systematic review. Journal of Asthma, 53(4), 363-373. https://www.tandfonline.com/doi/abs/10.3109/02770903.2015.1099161

Bello, O. (2017). Effective communication in nursing practice: A literature review. Nursing, 18, 75. https://www.theseus.fi/handle/10024/130552  

Blake, T., & Blake, T. (2019). Improving therapeutic communication in nursing through simulation exercise. Teaching and Learning in Nursing, 14(4), 260-264. https://www.sciencedirect.com/science/article/pii/S1557308719300551

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., ... & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266. https://www.sciencedirect.com/science/article/pii/S1322769616300038

Dithole, K. S., Thupayagale-Tshweneagae, G., Akpor, O. A., & Moleki, M. M. (2017). Communication skills intervention: Promoting effective communication between nurses and mechanically ventilated patients. BMC Nursing, 16(1), 1-6. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0268-5

Faustino, E. V. S. (2020). Intravenous magnesium for asthma exacerbation. The Journal of Pediatrics, 220, 1-3. https://www.jpeds.com/article/S0022-3476(20)30399-1/abstract

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management of asthma. Journal of Asthma and Allergy, 10, 47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349698/

Gergen, P. J., Mitchell, H. E., Calatroni, A., Sever, M. L., Cohn, R. D., Salo, P. M., ... & Zeldin, D. C. (2018). Sensitization and exposure to pets: the effect on asthma morbidity in the US population. The Journal of Allergy and Clinical Immunology: In Practice, 6(1), 101-107. https://www.sciencedirect.com/science/article/pii/S2213219817303811

Liu, L., Gou, Z., & Zuo, J. (2016). Social support mediates loneliness and depression in elderly people. Journal of Health Psychology, 21(5), 750-758. https://journals.sagepub.com/doi/abs/10.1177/1359105314536941

Maia, V. L. L. B., Lago, E. C., Ramos, C. V., Fernandes, M. A., & Alves, E. L. M. (2017). Training of Professionals from the Family Health Strategy for Psychosocial Care for the Elderly. International Archives of Medicine, 10. http://imedicalpublisher.com/ojs/index.php/iam/article/view/2265

Mendy, A., Wilkerson, J., Salo, P. M., Cohn, R. D., Zeldin, D. C., & Thorne, P. S. (2018). Exposure and sensitization to pets modify endotoxin association with asthma and wheeze. The Journal of Allergy and Clinical Immunology: In Practice, 6(6), 2006-2013. https://www.sciencedirect.com/science/article/pii/S2213219818302800

Patto, M. V. (2020). Neurological perspectives on pets and the elderly: The truth about cats, dogs and grandparents. In Pets as Sentinels, Forecasters and Promoters of Human Health (pp. 269-293). USA: Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-30734-9_12

Sibiya, M. N. (2018). Effective communication in nursing. Nursing, 19, 15 https://books.google.com/books?hl=en&lr=&id=Ib-QDwAAQBAJ&oi=fnd&pg=PA19&dq=effective+communication+in+nursing&ots=7ftAG1w1tK&sig=0LSCsv3P3q8S34qGcqo2UckYzbc

Stern, J., Pier, J., & Litonjua, A. A. (2020). Asthma epidemiology and risk factors. In Seminars in Immunopathology (pp. 1-11). Berlin Heidelberg: Springer. https://link.springer.com/article/10.1007/s00281-020-00785-1

Sussman, M. B. (2016). Pets and the family. United Kingdom: Routledge. https://books.google.com/books?hl=en&lr=&id=zMveCwAAQBAJ&oi=fnd&pg=PP1&dq=loss+of+pets+for+elderly&ots=PD5FXDMTHU&sig=rirSRn5PDsOf-5mqoMgixtzWZHU

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