NURSING CARE OF PATIENTS.pptx

Patient care is a multifaceted process that can involve a range of tasks such as personal consultations, blood tests, and X-rays [29,51]. As a result, clinical data are collected in many different formats including structured observations, image documents, transcribed notes, or laboratory results

1. DR.ANJLATCHI MUTHUKUMARAN VICE PRINCIPAL ERA COLLEGE OF NURSING SARFRAZGANJ , LUCKNOW 226003 NURSING CARE OF PATIENTS

2. Type of care giving to patients Ambulatory Care Acute And Critical Care Home Health Care Long Term Care Care of newborn Care of infants Care of toddler Care of preschooler Care of adolscent Car of women Care of old ages Care of patients

3. INTRODUCTION The word patient comes from the Latin word patiens , originally meant “one who suffers”. verb, patior , meaning “I am suffering” The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse or other health careprovider.patient is one whom needs care,attention and support from healthcare professionals and family.

4. What is nursing ?

5. CARE IN HOSPITAL Care in hospital is the attention or watchful oversight o supervision and attentive assistance or treatment for the needed by the nurse or other heath care professional and health care setting is a place of organized systems of medical care, including prepaid group medical practices, collective group insurance-covered, fee-per-service medical care, and community clinics organized and run by non-profit or profit-making organizations.

6. HOSPITAL  As an increasing proportion of population and with the shift in disease patterns from acute illnesses to chronic illnesses,the traditional disease management and care focus of the health care professions has expanded . The health care focus must center more on prevention,health promotion and management of chronic conditionsthan in previous times.

7. Hospital and type of services for patients

8. Type of health care organization

9. Nursing care consist of Registration Admission procedure Uniform policy Identificcation Medical /surgical/general ward /icu / hdu etc Progressive care Laboratory services Nutritional services Medical services Surgical service General cleaning of patient/ envt /surrounding /equipment

10. Continued General waste management Biomedical waste Water facilities General facilities daily activities Immunization services Critical care services Rehabilitative services Occuapational services Physiotherapy services Healtheducation Counselling servies Discharges services Follow up Records and report

11. AMBULATION It is the ability to walk from place to place with or without assistance. In ambulation Individual is able to walk at least 10 feet outside the parallel bars with supervision or physical assistance from only one person Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis (i.e. where the patient’s stay at the hospital or clinic, from the time of registration to discharge

12. AMBULATORY CARE Ambulatory health care is provided for the patients in the community or in hospital settings.

13. AMBULATION CLASSIFICATION Non functional -patient cannot ambulate, ambulates in parallel bars only,or requires supervision or physical assistance from more than 1 person to ambulate 1. Ambulator –dependent for physical assistance patient requires manual contacts of no more than one person during ambulation.manual contacts are continuos and necessary to support body weight 2.ambulatory-dependent physical assistance patient requires manual contacts of no more than one person during ambulation.manual condact consists of continuos or intermittent light touch for assistance 3 Ambulator –dependant for supervision patient can physically ambulate on level surfaces without manual condact with another person but for safety requires stand by guarding

14. 4.Ambulatory – independent level patient can ambulate independently on level surfaces but requires supervision 5.Ambulator – independent patient can ambulate independently on non level and level surfaces, stairs and inclines

15. AMBULATORY CARE SETTINGS Ambulatory care nursing includes those clinical , management,educational ,and research activities provided by registered nurse for and with individuals who seeks care and assistance with health maintainence and or health promotion. - AAACN SITES

16. Ambulatory care setting

17. Nursing information system

18. Role of nursing officer in ambulatory care Providing direct patient care Conducting patient intake screenings Treating patients with acute or chronic illnesses or emergency conditions Reffering patients to other agencies for additional services Teaching patients self care activities Offering health education programmes that promote health maintainence Nurses also work as clinical managers,direct the operation of clinics and supervise other health team members Providing advice and emotional support to patients family members. Teach patients and their families how to manage their illness or injury, including post-treatment home care needs, diet and exercise programs, and self-administration of medication and physical therapy counseling to family members of critically ill patients RNs work to promote general health by educating the public on various warning signs and symptoms of disease and where to go for help RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions. Some ambulatory care nurses are involved in telehealth , providing care and advice through electronic communications media such as videoconferencing or the internet

19. Research in ambulatory care It is needed for many reasons; To help to develop new models of nursing care delivery To develop standards of client care To create both performance improvement programmes and nursing intensity systems to determine the number and types of nursing personals needed 

20. AcuteCare Hospital services An acute care hospital is a healthcare facility that offers patient care services of a limited duration to diagnose and/or treat an injury or short-term illness. Services include medical and surgical inpatient services and outpatient diagnostic services.

21. Manpower of department PROFESSINAL SERVICES as well as SUPPORT SERVICES MEDICAL STAFF PRIVATE OR GROUP PRACTICE PHYSICIANS ADMINISTRATION NURSING SERVICE BIOMEDICAL ENGINEERING DEPARTMENT PHARMACY PHARMACISTS AND TECHNICIANS BUSSINESS DEPARTMENTS REHABILITATION SERVICES CENTRAL SERVICE/MATERIAL MANGMT DPT PHYSICAL THERAPISTS, DIETARY DEPARTMENT

22. Continued OCCUPATIONAL THERAPISTS, LABORATORY LAUNDRY MEDICAL RECORDS DPT HUMAN RESOURCE DPT VOLUNTEER SERVICES CENTRAL SERVICE/MATERIAL MANGMT DPT DEVOLOPMENT/COMMUNITY RELATIONS DIETARY DEPARTMENT ENVORONMENTAL SERVICES

23. Role of nurse Health care provider Researcher Educator Manager

24. Critical care Critically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. Critical care is a term used to describe “the care of patients who are extremely ill and whose clinical condition is unstable or potentially unstable”. Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients

25. Sub Specialities are ICU ICCU CTVS MICU SICU HDU Casuality and emergency Post-operative area Pre-operative area

26. Child health area PICU NICU SBNC HBNC IMMUNIZATION AREA CTVS- pediatric othersarea

27. Critical care nurse critical care nurses: Respect and support the right of the patient. Help the patient obtain necessary care. Respect the values, beliefs and rights of the patient.

28. Assessment scale in ICU

29. CAUTI assessment

30. VAP checklist

31. CLABSI checklist

32. SSI chceklist ss

33. Legal issue in critical care nursing Malpractice Negligence Duty owed to the patient

34. Damages general(injury),special(all losses and expenses), emotional,punitive Eg : INTENTIONAL TORTS -Civil wrong committed againt a person or persons property Assault - Eg:Threatening a pt with an injection. Battery - Eg:Forcing a patient to ambulate False imprisonment - Eg:Refusing to allow a patient to leave against medical advice

35.  Invasion of privacy Eg:Taking unauthorized pictures of the patient,releasing confidential information to others without consent . Defamation Use of adverse language that affects ones reputation. Eg:falsely accusing staff members in front of others , making false chart entries about patients life style

36. It includes; INFECTIOUS HAZARDS HIV exposure Viral hepatitis exposure MUSCULOSKELETAL INJURIES Occupational back injury(back pain) CHEMICAL HAZARDS Skin irritants,eye irritants,antineoplastic agents et

37. NOISE Sources of noise includes; Ventilators suction machines telephones infusion pumps doors staff conversations monitor alarms.

38. Effects; Prolonged exposure can cause hearing loss and mental irritability CHEMICAL DEPENDANCY Without healthy coping skills; a nurse may secretly turn to drugs or alcohol for emotional and spiritual support. Drugs that are abused commonly include cocaine, alcohol, narcotics and tranquilizers

39. INFORMED CONSENT DURABLE POWER OF ATTORNEY FOR HEALTH CARE DO NOT RESUSCITATE ISSUES LIVING WILLS WITHDRAWAL OF ORDINARY CARE MEASURES DOCUMENTATION

40. critical care nurses Respect and support the right of the patient. Help the patient obtain necessary care. Respect the values, beliefs and rights of the patient.

41. Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse. Intercede for patients who cannot speak for themselves in situations that require immediate action. Monitor and safeguard the quality of care the patient receives. Act as a liaison between the patient, the patient's family and other healthcare professionals

42. Critical care nurses work in a wide variety of settings, filling many roles including bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists and nurse practitioners a particular specialty. The CNS is responsible for the identification, intervention and management of clinical problems to improve care for patients and families. They provide direct patient care, including assessing, diagnosing, planning and prescribing pharmacological and nonpharmacological treatment of health problems. CNS in the critical care setting focus on making clinical decisions related to complex patient care. Their activities include risk appraisal, interpretation of diagnostic tests and providing treatment, which may include prescribing medication.

43. Principles of critical care nursing

44. Legal issue and neligence in nursing

45. Home care Home Care (also referred to as domiciliary care or social care)is health care or supportive care provided in the patient's home by health care professionals (often referred to as home health care or formal care) Home Health Nursing is about patients receiving nursing care in their home. Home health nurses have a new environment every day and face many challenges. Patients are going home from the hospital with more acute problems and the home health nurse must rise to the occasion.

46. A Home Health Care Nurse works with patients in their homes. These nurses mainly work with the elderly, but sometimes work with younger children who have developmental or mobility issues . A Home Health Care Nurse is great for people that would rather work outside of a hospital.

47. HHNA The Home Healthcare Nurses Association (HHNA) is a national professional nursing organization of members involved in home health care and hospice nursing practice, education, administration and research. HHNA provides leadership and a unified voice so that home care and hospice nurses may improve their specialty and influence public policy as it relates to home care and hospice

48. The HHNA’s predecessor organization was founded in 1993 by the JB Lippincott Company with the vision of providing a forum for members to discuss and refine professional, educational and conceptual aspects of the home healthcare nursing practice as a specialty.

49. 33.  The HHNA is committed to improving the specialty of home care and hospice nursing and influencing public policy as it relates to home care and hospice. HHNA is a forum that recruits and brings together energized home care and hospice nurses who want to become leaders in their field and enable them to speak out in a unified voice.

50.  Develop the specialty of home care and hospice nursing Foster excellence in the practice of home care and hospice nursing Promote high standards of patient care in home care and hospice Provide an organized and unified voice among the home care and hospice nursing profession Disseminate and exchange information with those involved in the home care and hospice nursing specialties

51. Honor and select the top home care and hospices nurses across the country. Learn about changes in laws or regulations which impact your work. Establish home health and hospice care best practices. A subscription to Caring Magazine, the only publication received by the entire home care and hospice community as well as all U.S. hospitals and physicians who serve the home care community. Receive the Home Healthcare Nurse Journal and keep up to date on new protocols, best practices, and clinical and therapeutic advances.

52. 36.  The National Association for Home Care & Hospice is the nation's largest trade association representing the interests and concerns of home care agencies, hospices, and home care aide organizations.

53.  Professionals providing home care include:  licenced practical nurses ,  Registered nurses , Home Care Aids, and Social workers . Rehabilitation services are provided by: Physical therapists , Occupational therapists , Speech therapist pathologists and Dietitians. Home care aides are trained to provide non-custodial care, such as helping with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals.

54. Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home . These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychologicalassessment , management, wound care, medication teaching, pain management,disease education and physical therapy, speech therapy, or occupational therapy . Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance . To prepare for early hospital discharge and possible need for follow up care in home,discharge planning begins with patients admission

55. COMMUNITY RESOURCES AND REFERRALS Home health nurses and public health nurses act as case managers . after assessing patients needs they may refer to the other team members. Home health care nurse is responsible for providing information about various resources . resource booklet should be provided for the patient which includes the resources available in the community.

56. Nurse should review the patients referral form to contact the reffering agency if the purpose for the referral is unclear Call the patient and obtain permission and schedule the time for visit. Ask permission before entering the house and explain the purpose of referral.

57. CONDUCTING A HOME VISIT Whenever the nurse makes a visit,the agency should know the nurses schedule and locations of the visits. Initiate the visit in which the patient is evaluated and a plan of carevis established Determine the needs for future visits such as current health status,home environment,level of self care abilities ,mental status etc

58. Learn a cellular phone with the telephone numbers of the agency ,police and emergency services Let the agency know your daily schedule and telephone numbers of your patients Know where the patient lives Schedule visit only in day hours When making visits in crime areas visit with another person

59. AMBULATORY SETTINGS Ambulatory health care is provided for the patients both in community and hospital settings . types of agencies includes medical clinics,ambulatory care units,mental health centres,student health centres etc 

60. OCCUPATIONAL HEALTH PROGRAMMES Occupational nurses work in industrial setting or they may serve as consultants on a limited or part time basis The occupational health nurses works in several ways and provide direct care to the employers who becomes ill or injured and conduct health education programmes . Some school nurse programmes provide community care . physical examinations are performed by advanced practice nurses who then diagnose and treat students and families for acute and chronic illnesses . nurse act as care provider.consultant.educator and counselor.

61. CARE FOR HOMELESS Homeless have difficulty in affording or gaining acess to health care . they will experience high rates of trauma,tuberculosis and other communicable diseases.community health nurses who works with homeless shoulb be patient,non judgemental and understanding.nursing interventions are aimed at obtaining health care services for homeless. A home health care nurse helps to care for the elderly, disabled, chronically ill or mentally impaired. Daily tasks for a home health care nurse can include administering medication, checking on patients' status, performing routine procedures and helping administer treatments that patients need. Some home health care nurses will also provide for the basic needs of patients, helping them to bathe or providing nutritious meals . At times, they must also provide support to patient's family members and other caretakers, instructing them on how best to care for the patient and providing emotional support.

62. The roles of the home care rehabilitation nurse include, but are not limited to, those outlined below. Practitioner Serves as a clinical resource for those involved in rehabilitation nursing practice and in the care of clients with a complex chronic illness, a disabling condition, or both Acts as a resource during a crisis that is aggravated by a chronic illness or a disabling condition Assesses the appropriateness of a client's admission to, and the delivery of rehabilitation services in, the home environment Provides assistance with discharge planning to ensure a smooth transition into the community or, when appropriate,

63. Collaborates with the interdisciplinary team in the management of the team function in the home environment Helps the client and the client's family adapt to changes in lifestyle necessitated by the disabling condition Implements rehabilitation nursing care based on scientific knowledge, home care standards, and rehabilitation principles that are appropriate environment to the home care

64. Consultant Identifies clients and families who could benefit from rehabilitation home care services Serves as a liaison with third-party payers and justifies the use of funds for rehabilitation home care Serves as a resource for rehabilitation nurses and as a process consultant to staff in the home care setting Promotes rehabilitation nursing services to community health professionals and to the community at large areas Researcher Participates in research involving home care clients and their families Participates in the analysis and dissemination of evaluative data that may have an impact on clients and their families Incorporates evaluative data into nursing practice

65. Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes.

66.  Long-Term Care Nurse A Long-Term Care Nurse cares for patients who have a disability or illness in need of extended care. Many of their patients live in long-term care facilities, rehabilitation centers, or nursing homes What Is Long Term Care? When a person requires someone else to help him with his physical or emotional needs over an extended period of time, this is long-term care EG:WALKING,BATHING,DRESSING etc 54.  Temporary long term care (need for care for only weeks or months) Rehabilitation from a hospital stay Recovery from illness Recovery from injury Recovery from surgery Terminal medical condition 55.  Ongoing long term care (need for care for many months or years) Chronic medical conditions Chronic severe pain Permanent disabilities Dementia Ongoing need for help with activities of daily living Need for supervision

67. SUBACUTE OR TRANSITIONAL CARE For people who require ongoing care or recovery for an acute conditionbut donot need to receive the services on an acute hospital unit. ASSISTED LIVING FACILITY A form of housing that provide 24 hr staffing,meals,supervision of medications,personal assistance care.

68. ADULT DAY CARE A day time programme for people who typically have the same level of impairments as nursing home residants but who receive care in the community usually family members.the client is transported to the center and receives structured activities,meals,personal health care supervision. care assistance, and 

69. HOME CARE For community based people who are home bound and who need caregiving assistance or specialtreatments . For people who r terminally ill and in need of care.this care can b provided in the home or in a day hospital setting care of dying is common experience in long term care caring behaviours of staff at the time of death,allowing family to be involved with the resident and providing spiritual support are important and valued nursing functions.

70. Long-term care services may be provided in any of the following settings: In the home of the recipient In the home of a family member or friend of the recipient At an adult day services location In an assisted living facility or board-and- care home In a hospice facility In a nursing home

71. Residants of LTCFs can be of any age,although most of them are older adults.The risk of being in an LTCFs increases with each decade of life:average age of resiants is 82yrs.Women outnumber men ratio is 3:1. Most residents have conditions that impair their selfcae capacity or require interventions that they cannot perform independently.About one half have progressive cognitive impairment,such as alzheimers disease,arthritis,cardiovascular disease,impaired vision,impaired hearing or combination of illnesses.Most residents need assistance with atleast several ADL . Although most residents spend remainder of their lives in the facility,an increasing number do recover ,have return to the community. restored function and According to federal regulations a reggisterd nurse must be on dutyatleast 8 consecutive hours per day,7 days a week and a full time director of nursing must be on staff if the facility has more than60 beds . The propotion ofnursing staff is not stated,although it is required that “the facility to provide 24 hour nursing services which are sufficient to meet otal nursing care needs”.

72. Health care plans such as health insurance plans, Medicare, Medicaid and the Veterans Administration. They are used primarily to differentiate care provided by medical specialists as opposed to care provided volunteers, family or friends. by aides, A patient receiving skilled care in a nursing home from Medicare not only receives care from skilled providers such as nurses, therapists or doctors but also receives care from custodial providers consists such as help aides. with This care usually dressing,of ambulating , toileting, bathing,

73. ASSESMENT Nurse hav to assess residents within the first 14 days of admission and atleast annually there after;residants are to be reassed whenever thereis change in their status. CARE PLANNNG Regulations require that a careplan be written for each resident within 7 days after completion of assessment.care plan is a interdisciplinary one and is the blue blue print for nursing actions. CAREGIVING Nurses performs selected roles,such as administering medications and treatments and they may be involved in total care activities. NURSE have to make the residants to face many adjustments; ROUTINES AND SCHEDULES ENVIRONMENT PEOPLE INDEPENDENCE COMMUNICATION

74. COMMUNICATION Proper communication helps the nurse for identifying and obtaining timely treatment of complications and new health problems and also nurse must make sure that physicians learn of condition in a timely manner. changes in residants Provide the physician with complete information that can aid in medical decision making.  Eg : current and manifestations etc usual vital signs,clinical Avoid making diagniosis.report th clinical manifestations and allow physicaian to make medical judgement . Take order directly from the physician If there is anything wrong in the order question the physician

75. MANAGEMENT Nurse performs some management functions such as: Delegating assignments Supervising other staffs Evaluating performance Implementing disciplinary actions Completing reports Reviewing and auditing records Communicating needs to other departments Handling complaints Ordering supplies Communicating with regulatory agencies.

76. Nursing management system

77. Essential care for patient

78. Nursing care plan assessment

79. Care of newborn baby

80. Care of infants Maintain body temperature Immunization Breast feeding Position of the baby Growth an development Umblical cord care Eye care ,ear care , spongy bath, Bowel andd bladder movement Sleeping pattern Prevention of infection

81. Care of toddler Growth and development Immunization Weaning /balancing diet Dental care Prevention of warm infestation Vitamin A prophylaxis Play needs Prevention of accidents Prevention respiratory infection

82. Care of preschooler Growth and development Immunization Balancing diet Prevention of dental caries Prevention of warm infestation Prevention of malnutrition Prevention of accidents Play and basic needs Vitamin A prophylais Prevention of respiratory infection

83. Care of school going childrens Growth and development Immunization Balancing diet Personal hygiene Prevention of skin diseases prevention of communicable disease s Prevention of non communicable disease Prevention of respiratory infection Prevention of accident Prevention of dental caries Vision screening Prevention of warm infestation

84. Care of adolescent Growth and development Secondary sexual characteristic Immunization Personal hygiene Menstrual hygiene Sexual hygiene Health education Prevention of anemia Maintain the balance nutrition Prevention of warm infestation Prevention of infection

85. Care of adults General check up of height, weight, ABG, BMI etc General condition like vital sign, rbs , saturation etc. Immunization Maintain dental hygiene Maintain balancing diet Prevention of anemia Yoga Meditation Exercises Psychological support Physical balancing of daily activities Sleeping pattern Bowel and bladder movement

86. Care of antenatal mother

87. Care of post natal mother

88. Care of unconscious patient

89. Care of the patient with tracheostomy

90. Care of vulnerable patients

91. Continued

92. Monitoring and evaluation of care

93. Care of geriatric patients

94. Care of dying patients

95. End of life care and health insurance

96. References TEXT BOOK OF MEDICAL SURGICAL NURSING-JOYCE M BLACK-7 EDITION-ELSEVIER PUBLICATION-2005-PAGE NO:121 – 189 TH CRITICAL CARE NURSING-2 ND EDITION-JOHN M CLOCHESY-W.B SAUNDERS COMPANY PUBLISHERS,PAGE NO: 28 – 35,1996 CRITICAL CARE NSG-PATRICIA GONCE MORTON,DORRIE.K.FONTAINE SUZANNE .C .SMELTER,MSN-LIPPINCOTT WILLIAMS AND WILKINS PUBLISHERS PAGE:6-25- 10 TH EDITION-2004 WWW.MEDICARE.GOV.IN WWW.DISCOVERNSG.IN WWW.LONGTERMCARE.LINKNET CANADIAN JOURNAL OF RESEARCH NURSING TIMES –MARCH 30-2012 WWW.PUBMED.COM JOURNAL OF NURSE OLDER PEOPLE 2012 

97. Thank you