U2 O2 - Nursing the critical patient Flashcards
What is a Hospital Acquired
Infection (HAI) /
Nosocomial infection?
Infection acquired whilst the patient is in hospital.
Hospital acquired infection (HAI) rather than
community acquired (CAI). Some now use the
term hospital acquired in place of nosocomial
What is RER?
Resting energy requirement. Calories required
by an animal when at rest.
What is enteral nutrition?
Providing nutrients directly into the gastrointestinal (GIT) tract
What is parenteral nutrition?
Providing nutrients directly into the blood stream,
bypassing the gastro-intestinal tract
What is an enterocyte?
The cells that line the gastro-intestinal tract.
What are the 4 steps in a nursing care plan?
The nursing process is cyclical, consisting of four stages – assessment, planning,implementation (or intervention) and evaluation. Each of these stages will be considered in turn
What type of information is needed to gather a history for a patient to help create a nursing care plan?
• Age, sex and neutering status of the patient
• The nature of the problem
• When the problem started
• The reason for hospitalisation
• The type of assistance the patient might require
• The patient’s normal lifestyle- working dog, housecat etc.
• Normal diet and fluid intake- food type and preparation, frequency and types
of dishes used.
• Current nutritional status and current food/ fluid intake
• Normal exercise schedule
• Ability to exercise currently
• Usual location and substrate for urination and defaecation or commands used
etc.
• Other medical conditions and treatments
• Current medication and how administered
• Temperament and how it gets on with other animals/people
• Pain score and last analgesia administration
• TPR
• Any other relevant information e.g. afraid of men, white coats etc
What type of things should be considered during the planning stage of a patient care plan?
The following includes examples of things to consider during the planning stage N.B.
they may not ALL be relevant, at this stage, for each patient:
• What is the patient’s RER?
• What will the patient be fed?
• How often will they be fed?
• How much food will be given?
• How often will the amount of food eaten be monitored?
• How will the patient be fed?
• What type of accommodation will the patient be given?
• What bedding/ hides should be provided?
• What medication is required?
• How often will this be given?
• How will this patient manage to urinate and defaecate?
• What are the actual problems for this patient e.g. recumbency?
• What are the potential problems for this patient e.g. depression, decubitus
ulcers, aspiration pneumonia?
• How much pain is the patient feeling and what are its analgesic needs? N.B.
This should be assessed by using a validated pain scoring system. Whether
any medication is required, which medication to use, what dose and what
route should all be decided by the veterinary surgeon, but their decision is
likely to be affected by the results of nursing observations, interventions and
monitoring. There are many non-medical nursing interventions that could be
considered in the planning stage that would be important in pain management
e.g. deep bedding/ memory foam bedding and ensuring the patient is in a
quiet area. Other considerations may be added or removed as appropriate.
For example, although a patient with osteo- arthritis may have limited mobility,
it is likely to benefit from short gentle exercise on a very regular basis to
maintain blood flow and reduce stiffness.
Why do call orders need to be agreed with the veterinarian when planning a care plan for patient?
Call orders need to be agreed with the veterinary surgeon, especially in the ECC setting. For example, what heart rate will prompt the nurse to immediately inform the veterinary surgeon of a change in patient status? The nursing plan also needs to include contingency planning for if things going wrong- such as the animal developing other problems, not responding to treatment or developing side effects from the current treatment. Thus, the nursing plan is not fixed but is dynamic – it will change from day to day or even hour to hour, especially in the ECC setting. It is also important that the nursing plan fits in with the veterinary surgeon’s treatment plan.
Effective communication between the veterinary nurse and veterinary surgeon is vital.
What does the implementation of a care plan involve?
As the name suggests this is the nursing care that is delivered to the patient- giving medication, offering fluid, hand-feeding the inappetent patient, wound management, grooming, exercise, tender loving care (TLC) etc. All the medications administered, nursing care and the timing should be documented along with the patient response.
During the implementation phase it may be that further findings are reported to veterinary surgeon, that may then influence the ongoing treatment plan for the patient.
Examples of this type of situation include-
➢ noting signs suggestive of nausea when offering food to the patient
➢ repeating a pain score following administration of an analgesic and finding
that the patient’s level of pain relief is inadequate.
What does the evaluation stage of a nursing care plan involve?
This is the stage when the effectiveness/outcome of the nursing care is examined.
This is a particularly important stage - ideally the nursing goals have been achieved and the patient is responding well. If not, then the plan will need to be reviewed - the original plan may have been effective, but the patient may have developed new problems in the meantime. Or the original plan, or more likely aspects of it, were not suitable and need to be reviewed to meet the patient’s ongoing needs.
How often should evaluation of a nursing care plan take place?
Evaluation will often take place at the same time
as implementation- something has worked well or not; evaluation will also take place at least once daily when ‘ward rounds’ are being carried out; or when there is staff handover.
What different nursing care plan models are most commonly used in the veterinary setting?
Various versions of theoretical nursing models have been used in human nursing to develop nursing plans. The two versions which were initially applied to veterinary nursing are the Roper, Logan and Tierney model and the Orem model. Since 2007, the Orpet and Jeffery Ability Model has been increasingly used in the nursing of
veterinary patients
What is the basis of the roper, logan and tierney nursing model?
The basis of this model is to relate the nursing care of the patient to the normal activities of daily living
What do the authors of the roper, logan and tierney nursing model considered the twelve activities of human daily living?
The authors described twelve activities of human daily living that they considered normal- • A safe environment • Communication • Breathing • Eating / drinking • Eliminating waste Grooming • Controlling body temperature • Movement • Work / play • Expressing sexuality • Sleeping • Dying
An assessment of how well the patient can carry out each of these is made and how they affect the nursing care that will be required.
What is the Orem nursing care model focussed on?
Orem’s model also follows the basic concepts of assessment, planning, implementation and evaluation, but the nursing care is focussed on the ability of the
patient to care for themselves (Orem, 2001). The role of the veterinary nurse therefore is to make up any deficit between what the animal should do to care for
themselves and what they are able to do. For example, if the patient is not able to groom themselves, then the veterinary nurse will need to carry this out.
What are the 8 self care requisites that are considered in the Orem nursing care plan model?
Orem listed eight self-care requisites for humans which can also be applied to animals
• Provision of air
• Provision of water
• Provision of food
• Elimination of waste
• A balance between activity and rest
• A balance between solitude and social interaction
• Prevention of hazards
• To feel normal in relation to other- N.B. this can be particularly challenging to
assess in veterinary patients. There are many questions over how developed
their emotions are and how to assess what is “normal” for the species.
What is the basis of the orpet and Jeffrey ability nursing care plan model?
This is the first veterinary care model based on • Assessment • Care Plan • Evaluation • Influencing factors
The rationale behind this model is eliciting information from the owner on the patient’s usual routine against the ten ‘abilities’ from the model. The patient’s ability
to perform these, along with potential and actual problems are considered. All the information is then used to create a care plan for the period of hospitalisation
What are the 10 abilities that should be considered in the Orpet and Jeffrey ability nursing care plan model?
Is the animal able to - • eat adequate amounts? • drink adequate amounts? • urinate normally? • defaecate normally? • breath normally? • maintain body temperature? • groom and clean itself? • mobilise adequately? • sleep & rest adequately? • express normal behaviour?
What would be considered to be a nursing process?
➢ assess ALL the patient’s needs
➢ plan the nursing care
➢ fully implement nursing to meet the patient’s needs and support its recovery
➢ evaluate the nursing care.
What will the frequency of how often a patients nursing care plan is evaluated depend on ?
The frequency with which all of this is done will depend entirely on the patient’s underlying problem. With critical patients there will be very frequent assessments and the plan may be altered often. It is crucial with ECC patients not to overlook or
be distracted from the nursing process during the case management. With ECC patients, it is essential to consider all the patient’s current needs and the nursing
care appropriate to its current condition. However, as this is a dynamic situation, the patient’s needs and nursing care requirements may change rapidly and frequently. It is also important to consider the whole patient and not just focus on the disease/
injury in relation to the patient’s needs and care. For example, detailed wound care may be planned and implemented in a trauma patient, but if appropriate nutrition is not provided, the patient’s wound is not likely to heal well.
What is a catabolic process?
Without adequate nutrition, the patient must
rely on its own body stores for production of glucose for energy - this results in a catabolic process leading to break down of fats, carbohydrates and, most significantly, because of sympathetic nervous system stimulation, proteins.
Why does the breakdown of proteins occur particularly in critical care patients?
occurs, particularly in critical care patients, to provide amino acids for immunoglobulin and acute phase protein production - the two mainstays of the
body’s defence system.
What happens to the metabolic rate in ill patients?
The metabolic rate of animals in starvation normally
decreases but in ill patients, it increases meaning the patient’s energy requirements
increase.