An Electronic Vital Signs Monitor

An electronic vital signs monitor allows you to track a patient's vital signs continually, without having to reapply a blood pressure cuff each time. In addition, the patient won't need an invasive arterial line to gather similar data.
Some automated vital signs monitors are lightweight and battery-operated and can be attached to an I.V. pole for continual monitoring, even during patient transfers. Newer models can also display patient temperature and pulse oximetry as well as blood pressure. A built in printer is also available on certain models. Make sure that you know the capacity of the monitor's battery, and plug the machine in whenever possible to keep it charged.
Before using any monitor, check its accuracy. Determine the patient's pulse rate and blood pressure manually, using the same arm you'll use for the monitor cuff. Compare your results when you get initial readings from the monitor. If the results differ, call your supply department or the manufacturer's representative.
Preparing the device
  • Explain the procedure to the patient. Describe the alarm system so he won't be frightened if it's triggered.
  • Make sure that the power switch is off. Then plug the monitor into a properly grounded wall outlet. Secure the dual air hose to the front of the monitor.
  • Connect the pressure cuff's tubing into the other ends of the dual air hose, and tighten connections to prevent air leaks. Keep the air hose away from the patient to avoid accidental dislodgment.
  • Squeeze all air from the cuff, and wrap the cuff loosely around the patient's arm or leg, allowing 2 fingerbreadths between cuff and arm or leg. Never apply the cuff to a limb that has an I.V. line in place. Position the cuff's “artery” arrow over the palpated brachial artery. Then secure the cuff for a snug fit.
Selecting parameters
  • When you turn on the monitor, it will default to a manual mode. (In this mode, you can obtain vital signs yourself before switching to the automatic mode.) Press the AUTO/MANUAL button to select the automatic mode. The monitor will give you baseline data for the pulse rate, systolic and diastolic pressures, and mean arterial pressure.
  • Compare your previous manual results with these baseline data. If they match, you're ready to set the alarm parameters. Press the SELECT button to blank out all displays except systolic pressure.
  • Use the HIGH and LOW limit buttons to set the specific parameters for systolic pressure. (These limits range from a high of 240 to a low of 0.) You'll also do this three more times for mean arterial pressure, pulse rate, and diastolic pressure. After you've set the parameters for diastolic pressure, press the SELECT button again to display all current data. Even if you forget to do this last step, the monitor will automatically display current data 10 seconds after you set the last parameters.
Collecting data
  • You also need to tell the monitor how often to obtain data. Press the SET button until you reach the desired time interval in minutes. If you've chosen the automatic mode, the monitor will display a default cycle time of 3 minutes. You can override the default cycle time to set the interval you prefer.
  • You can obtain a set of vital signs at any time by pressing the START button. Also, pressing the CANCEL button will stop the interval and deflate the cuff. You can retrieve stored data by pressing the PRIOR DATA button. The monitor will display the last data obtained along with the time elapsed since then. Scrolling backward, you can retrieve data from the previous 99 minutes.

Dementia Nursing Diagnosis, Outcome, Interventions and Evaluation

Dementia Nursing Diagnosis

Impaired Verbal Communication related to cerebral impairment as demonstrated by altered memory, judgment, and word finding


Dementia Nursing Outcome :
  • Demonstrate congruent verbal and nonverbal communication.

Dementia Nursing Interventions
  • Speak slowly and use short, simple words and phrases.
  • Consistently identify yourself, and address the person by name at each meeting.
  • Focus on one piece of information at a time. Review what has been discussed with patient.
  • If patient has vision or hearing disturbances, have him wear prescription eyeglasses and/or a hearing device.
  • Keep environment well lit.
  • Use clocks, calendars, and familiar personal effects in the patient’s view.
  • If patient becomes verbally aggressive, identify and acknowledge feelings.
  • If patient becomes aggressive, shift the topic to a safer, more familiar one.
  • If patient becomes delusional, acknowledge feelings and reinforce reality. Do not attempt to challenge the content of the delusion.
Dementia Nursing Evaluation :
  • Demonstrates decreased anxiety and increased feelings of security in supportive environment


Dementia Treatment

Dementia Treatment

  • Treatment is generally community focused; the goal of treatment is to maintain the quality of life as long as possible despite the progressive nature of the disease. Effective treatment is based on:
    • Diagnosis of primary illness and concurrent psychiatric disorders
    • Assessment of auditory and visual impairment
    • Measurement of the degree, nature, and progression of cognitive deficits
    • Assessment of functional capacity and ability for self-care
    • Family and social system assessment
  • Environmental strategies in order to assist in maintaining the safety and functional abilities of the patient as long as possible.
  • Pharmacologic therapy used for the person with DAT is directed toward the use of anticholinesterase drugs to slow the progression of the disorder by increasing the relative amount of acetylcholine. Available drugs include donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) and tacrine (Cognex). An NMDA-receptor antagonist memantine (Namenda) may be provided in an attempt to improve cognition. Other drugs may be used for behavioral control and symptom reduction.
    • Agitation management: neuroleptic drugs
    • Psychosis: neuroleptic drugs
    • Depression: antidepressants, ECT
  • Hypertension management in vascular dementia is important in reducing the severity of symptoms.
  • Family education is a treatment strategy because statistics indicate that family caregivers provide care for patients with DAT in 7 out of 10 cases. The family and the treatment team collaborate in the delivery of care.

Complications for dementia

  • Without accurate diagnosis and treatment, secondary dementias may become permanent.
  • Falls with serious orthopedic or cerebral injuries.
  • Self-inflicted injuries.
  • Aggression or violence toward self, others, or property.
  • Wandering events, in which the person can get lost and potentially suffer exposure, hypothermia, injury, and even death.
  • Serious depression is demonstrated in caregivers who receive inadequate support.
  • Caregiver stress and burden may result in patient neglect or abuse.

Osteoarthritis - Pain (acute / chronic) Nursing Diagnosis and Intervention

Nursing Diagnosis and Intervention for Osteoarthritis

Definition

Osteoarthritis is known as degenerative joint disease or osteoartrosis (even if there is inflammation) is a joint disorder that most commonly found and often lead to disability.

Osteoarthritis is the arthritis as a cause of disability groups who occupied the first order and will increase with increasing age, the disease is rare below the age of 46 years but more often found at the age of 60 years. Factors age and sex showed a difference frequency.

Classification

Osteoarthritis is classified into:
  • Type of primary (idiopathic) without the occurrence or previous illnesses associated with osteoarthritis
  • Type of secondary as a result of trauma, infection and had a fracture.

Pathophysiology

Degenerative joint disease is a chronic disease, not inflamed, and slowly progressive, as if it is a process of aging, deteriorated joints and cartilage degeneration is accompanied by the growth of new bone at the joint edge.

The process of degeneration is caused by chondrocyte-solving process which is an important element of joint cartilage. Solving allegedly initiated by certain biomechanical stress. Lysosomal enzyme causes dipecahnya expenditure polysaccharide matrix proteins that form around the chondrocytes resulting in cartilage damage. The joints most often affected are the joints that must bear weight, like knee and hip spine. Interfalanga distal joints and proksimasi.
Osteoarthritis in some instances will result in limited motion. This is caused by the pain suffered by or caused by narrowing of joint space or less use of these joints.

Degenerative changes that result because of certain events such as joint injuries and joint infection congenital deformities other arthritic diseases will cause trauma to the cartilage that are intrinsic and extrinsic ligaments causing existing fractures or joints metabolic changes that ultimately result in cartilage have erosion and destruction, the bones become thicker and there was narrowing of the joint cavity that causes pain, leg kripitasi, deformity, presence of hypertrophy or nodules.


Osteoarthritis Nursing Diagnosis

Pain (acute / chronic) related to tissue distension by fluid accumulation / inflammation process, distruksi joints.

Osteoarthritis Nursing Interventions:

Assess complaints of pain; note the location and intensity of pain (scale 0-10). Write down the factors that accelerate and signs of non-verbal pain

Give mat / hard mattress, small pillow. Elevate the bed according to current needs of the client to rest / sleep.

Help clients take a comfortable position when sleeping or sitting in a chair. Depth of bed rest as indicated.

Monitor the use of pillows.

Encourage clients to frequently change positions.

Help clients to a warm bath at the time of waking.

Help clients to warm compresses on the sore joints several times a day.

Monitor temperature compress.

Give a gentle massage.

Encourage the use of stress management techniques such as progressive relaxation bio-feedback therapeutic touch, visualization, self hypnosis imagination guidance and control of breath.

Engage in activities of entertainment that is appropriate for individual situations.

Give the drug prior to activity / exercise that is planned as directed.

Help clients with a physical therapist.

The expected outcome / evaluation criteria

Pain showed reduced or controlled

Looks relaxed, can rest, sleep and participate in activities according to ability.

Following the therapy program.

Using the skills of relaxation and entertainment activities into a program of pain control.

Nursing Diagnosis - Interventions for Excess Fluid Volume

Nursing Diagnosis - Interventions for Excess Fluid Volume

Nursing Diagnosis Excess Fluid Volume

related to decreased glomerular filtration rate (decrease in cardiac output) and the retention of sodium / water.

Characterized by:
Orthopnea, S3 heart sound, oliguria, edema, weight gain, hypertension, respiratory distress, abnormal heart sounds.

Objectives / evaluation criteria:
Clients will be demonstrating the stable fluid volume with the balance of inputs and expenditures, breath sounds clean / clear, vital signs within an acceptable range, stable weight and no edema, fluid restriction expressed understanding of the individual.

Nursing Interventions Excess Fluid Volume :
Monitor urine output, record the number and color of the time in which diuresis occurs.
Rational: Spending a little and concentrated urine may be due to decreased renal perfusion. Supine position so that helps diuresis of urine may be increased during bed rest.

Monitor / calculate the balance of income and expenditure for 24 hours.
Rational: diuretic therapy may be caused by a sudden loss of fluid / redundant (hypovolaemia), although edema / ascites is still there.

Keep sitting or bed rest with semifowler position during the acute phase.
Rationale: The position is increasing kidney filtration thus improving diuresis.

Monitor blood pressure and CVP (if any).
Rational: Hypertension and increased CVP indicates fluid overload and may indicate an increase in pulmonary congestion, heart failure.

Assess bowel sounds. Record complaints of anorexia, nausea, abdominal distension and constipation.
Rational: visceral congestion can interfere with the function of gastric / intestinal tract.

Administration of drugs as indicated (collaboration)
Consult with the dietitian.
Rational: to provide an acceptable diet that meets client needs calories in sodium restriction.

Nursing Diagnosis Activity Intolerance related to imbalance between oxygen supply - Congestive Heart Failure

Activity intolerance related to imbalance between oxygen supply, general weakness, long bed rest / immobilization.

Characterized by:
Weakness, fatigue, changes in vital signs, presence of dysrhythmias, dyspnea, pallor, sweating.

Objectives / evaluation criteria:
Clients will participate in desired activities, meet self-care, achieving increased tolerance activity can be measured, evidenced by decreased weakness and fatigue.

Nursing Diagnosis - Intervention - Activity Intolerance:
Check vital signs before and immediately after activity, especially when the client is using vasodilators, diuretics and beta blockers.
Rational: orthostatic hypotension may occur with activity because the effects of the drug (vasodilation), the displacement of fluid (diuretics) or influence cardiac function.

Record the cardiopulmonary response to activity, noted tachycardia, dysrhythmias, dyspnea sweaty and pale.
Rational: Decrease / inability of the myocardium to increase the volume of activity during dpat sekuncup cause an immediate increase heart rate and oxygen demand is also increasing fatigue and weakness.

Evaluation of an increase in activity intolerance.
Rational: to show an increase in cardiac decompensation rather than excess activity.

Implementation of cardiac rehabilitation programs / activities (collaboration) Rational: a gradual increase in activity to avoid cardiac work / oxygen consumption is excessive. Strengthening and improvement of cardiac function under stress, if cardiac function can not be improved again.

Nursing Diagnosis Activity Intolerance related to imbalance between oxygen supply - Congestive Heart Failure

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