Gella Rivka Paolucci D41138669 NR341-Complex Adult Health Clinical Professor Kelly October 7, 2022 1. What is the nurse’s role in providing family-centered care during and after a crisis? During a crisis the nurse should keep the family informed about what is happening. After the crisis the nurse should make sure the family is informed about what happened and what is going to happen. The nurse should also address any questions or concerns the family has. 2. Differentiate the pathophysiological processes and treatment options used in the two major types of stroke. -Ischemic stroke is the result of an obstruction in a blood vessel that supplies blood directly to the brain -Hemorrhagic stroke is when a weakened blood vessel ruptures Treatment options for an Ischemic stroke is primarily clot removal. The patient should also be administered tPA which is a clot buster to preserve the brain and reduce any potential damage. Thrombectomy is another option for treatment if tPA does not work or is not a potential option. Treatment options for a Hemorrhagic stroke is primarily emergency treatment. The patient is monitored for any signs of additional strokes, medication is administered such as anti-seizure meds, or medication to stop the bleeding. 3. Provide three nursing considerations for administration of rt-PA. List and describe potential contraindications for rt-PA administration. What may result if administration of rt-PA is too fast or too slow? 1. Monitor the patients vital signs for any signs of instability 2. Monitor the patients neurological status 3. Monitor the patient for any signs of a stroke Contraindications for rt-PA is a patient on blood thinners, patient who has an increased of bleeding, patient who had a recent MI, patient whose onset of symptoms was longer than 3 hours ago, any signs of TIA and inter-cerebral hemorrhage. Administration of rt-PA too rapidly can result in the patient having a hemorrhage or can cause a clot to break free leading to an Ischemic stroke. It can ultimately lead to death by increasing the symptoms of a stroke. Administration of rt-PA too slowly can cause increased damage the brain and ultimately death as well. 4. Name two priority safety items to consider in administering transdermal fentanyl. The first priority is to assess the patient for “opioid tolerance”. A patient needs to be ingesting at minimum 60mg of morphine, 30mg of oral oxycodone, 8mg or oral hydromorphone daily for at least a week in order to receive transdermal fentanyl. The second priority is to double and triple check the patients weight. Do not assume that the weight the patient gave you is accurate. 5. What three therapeutic communications techniques can be used to communicate positively with the patient and her partner? 1. Silence- deliberate silence allows time for the patient to think through and process what comes next. It gives the patient and their partner time. 2. Active listening- verbal and nonverbal cues encourage patients and their partners to continue talking 3. Voicing doubt-this technique calls attention to incorrect or delusional ideas and can force the patient and their partner to examine their assumptions 6. Name four of the seven warning signs of cancer? 1. Unexplained weight loss 2. Change in bowel or bladder habits 3. Sore that doesn’t heal 4. Fatigue that is unusual and does not resolve after rest 7. Discuss adenocarcinoma of the lung, including symptoms, and treatments? Adenocarcinoma is a cancer of the lungs that start in the cells that secrete mucus. Typically seen in smokers and former smokers but is the most common lung cancer in non-smokers. It is more common in women than men. It is considered a non-small cell lung cancer (NSCLC). Risk factors include smoking, secondhand smoke exposure, radon, diesel exhaust, chromium compounds, beryllium, nickel, soot, tar or asbestos exposure. High levels of arsenic in the drinking water can be a risk factor as well as HIV or taking beta carotene supplements. Symptoms include a persistent cough, shortness of breath, chest pain, raspy voice, fatigue, difficulty breathing or swallowing, wheezing, a cough with bloody mucus, loss of appetite, facial swelling, swelling of the veins in the neck and unexplained weight loss. Treatment options include pneumonectomy, lobectomy, segmentectomy or sleeve/wedge resection, radiation therapy, immunotherapy, chemotherapy and targeted therapy 8. Describe the five stages of grieving according to Elizabeth Kubler-Ross. The five stages are denial, anger, bargaining, depression, and acceptance. Denial includes avoidance, confusion, elation, shock and fear. Anger includes frustration, irritation and anxiety. Bargaining includes struggling to find meaning, reaching out to others and telling one’s story. Depreion includes feeling overwhelmed, helpless, hostility and flight. Acceptance includes exploring options, having a new plan in place, and moving on. 9. Discuss two interventions to combat loneliness in a patient or family member? Support groups, a pet, meditation and exercise are all good interventions to combat loneliness. In in-patient facilities introduction to other patients and recreational activities are good ways to combat loneliness. 10. Describe one tool that can be used to measure depression in the elderly? The GDS scale is used to measure depression in the elderly. It is known as the Geriatric Depression Scale. It is a self-reporting yes or no, 30 question questionnaire. 11. Describe what post-mortem care includes. Post-mortem care includes contacting the medical examiner, physicians, and clinicians involved in the patients care. Then proceed to wash the patient, position and dress the body, remove any medical equipment, replace dentures and close the patients eyes, remove any tubing and place pads underneath the body, bag and tag the body and the body bag to move to the morgue.
