Question:

Discuss the current state of medical and surgical nursing practice.

Examine and discuss how your research will be applied to Mr Brown’s care in order to achieve the best patient outcomes.

Answer to Question: NUR2300 Evidence Based Nursing Practice

Introduction

The communication skills of nurses are often neglected in the healthcare industry.

The nurses are hired based on their technical and method knowledge, while communication skills often take a back seat.

According to studies, poor communication between nurse/patient can cause a patient’s treatment to suffer.

Exemplary communication skills by nurses help to foster a dialog and get the message to the patient and his families (McCabe & Timmins 2013).

The importance and value of communication in nursing are discussed in this report.

The report also details the care that should be given to Mr. Brown in order to keep him healthy.

He should be taught how to maintain his health at home. This includes blood monitoring and insulin injections.

Family members have been involved in patient care, and they are able to share their views.

They are provided with the necessary training to help them manage patients (Arnold & Boggs 2015.

Discussion

Mr. Brown is 66 and has chest pain, breathing problems, Type II diabetes, hyperlipidaemia, obesity, and other health issues.

He drinks several beers and smokes cigarettes daily.

He must receive the best nursing and clinical care for his survival.

The clinical care standards are guidelines that make sure all patients with the exact same medical conditions are provided with appropriate care.

The Acute Coronary Syndrome (ACS), clinical care standard is designed to assist healthcare professionals and improve the quality of healthcare.

Details will be given on how to provide the right nursing care to Mr. Brown.

Patients with Coronary Heart Disease and Hyperglycaemia: Signs

Diabetes is a complex condition that has significant social consequences.

It is present in 90% of patients suffering from diabetes.

Type 2 diabetes affects multiple organs like the liver, kidney brain, liver, and gastrointestinal tract.

This condition causes a decrease in insulin sensitivity and beta-cell function.

This leads to hyperglycaemia. Bell et. al., 2014.

Mr. Brown’s ideal weight should have been between 53-65kg, but he weighs in at 143kg which clearly shows that he’s overweight.

A couple of beers and one packet of cigarettes a day are part of his unhealthy diet.

Brown was suffering from severe chest pains and difficulty breathing upon his admission to the hospital.

These are the symptoms of Acute Coronary Syndrome (ACS).

Hospitalized Mr. Brown requires appropriate nursing care

Hyperglycaemia results in not only renal failure, but also heart disease and blindness.

Mr. Brown needs to be checked twice annually for glycated hemoglobin.

If Mr. Brown is admitted, the nurse must make a diagnosis and keep a detailed medical record.

Martin?Gronert & Ozanne (2012, 2012): Basic tests of blood or urine should be taken.

The patient may be subject to many other tests.

These tests include HbA1c, urine test, and an eye dilation.

It is important to conduct a thorough eye dilation testing in order to determine whether diabetes has affected eye blood vessels.

The patient should have an HbA1c testing done.

This is a test that measures the amount glycosylated hemoglobin.

It is important to test the urine for levels of sugars and ketones.

The urine of the patient should be collected. A strip will then be dipped into that urine.

The presence of ketones will be indicated by a change in the colour.

This type of test can also be used to detect microalbumin.

This is a protein that can be found in diabetic patients’ urine.

Troponin tests are used to assess the severity of a heart attack.

This test is typically done when the patient presents with chest pain, shortness-of-breath, cold sweat, nausea, or other symptoms.

Troponin I, and T, are proteins of the heart muscle that are released in cases of damage to the heart.

Troponin is a protein that helps in the repair of damaged heart muscle cells.

Troponin levels can increase after a cardiac injury. They may stay elevated for between 3-4 hours.

For diagnosing a person with heart attack, both non-invasive as well as invasive tests can be performed.

Non-invasive includes imaging using a needle stick, while invasive involves inserting a tube.

Mahar (2012). The pain assessment tool should provide accurate and reliable information.

The tools should be accessible to both the patient and staff.

PQRST, in nursing, is an acronym that stands for Provoke. It can also be translated as Quality, Radiates. Severity, Time, and Radiates.

Provokes can be defined as asking the question “What is causing the pain?”. Quality describes how the pain feels, while Radiates refers to where it originated.

Time refers to the length of the pain. Severity is the amount of pain.

PQRST allows nurses and doctors to evaluate the patient’s entire situation upon his admission to the hospital (D’Arcy, 2013,).

For a full understanding of the patient’s medical conditions, a set of questions is asked.

There are many pain scales that can be used, such as the Numerical Rating Scales (NRS), Visual Analog Scales (VAS), and an imaging or pictorial.

NRS is a pain scale where the patient must rate his pain. Zero being the least severe and 10 being the greatest.

VAS is where the patient must describe his pain without the use numbers. However, an image scale can have a range from smiling faces to crying faces.

If the patient has suffered a heart attack, a maximum of 10 minutes can be allowed to treat the patient. An experienced paramedic will perform an ECG.

Primarily, patients should receive intravenous (IV), Nitro-glycerine, soluble Aspirin, and Morphine.

After carefully observing Mr. Brown’s symptoms, it is possible to decide what medicine should be administered to him.

Patients with low risk symptoms should be assessed using biomarkers. They should then be administered beta-blockers or aspirin. Patients with high-risk syndromes should be given clopidogrel, aspirin and betablockers.

Abbate, et al. 2012 consider angiograms as one option.Steps To Be Taken By Mr. Brown Post Discharge

You must make a change in your lifestyle.

Also, self-monitoring and self management of glucose must be included.

Self-monitoring blood sugar is as easy as it gets. The nurse must show Mr. Brown these steps.

The first step is to use a glucose meter.

The patient needs to first pierce his finger using a needle. After that, place the droplet of blood on a piece of paper.

The blood sugar count can be displayed by placing the strip on a meter.

These meters can be purchased at your local pharmacies.

These meters are quick to display the results, keep them stored for future use, and can sometimes be equipped with a software tool that inputs the results and displays relevant graphs and charts.

This method is the oldest way to test for glucose.

There are now new devices that allow the patient check the glucose levels from his forearm, upper arm and thighs.

The results of blood drawn from the thumb and arm will differ.

Insulin pumps help you monitor your blood sugar levels and track changes.

The nurse should clearly demonstrate to Mr. Brown the proper way to monitor his blood sugar levels.

The patient with type-2 diabetes should be able to check his blood sugar levels at minimum twice per day.

This type of monitoring should be performed in the morning, before any food or drink.

To check if the sugar level is high in the early morning, the patient should get up around 3 AM at night.

The pre meal testing is vital as it provides a baseline reading on the sugar level prior to meals.

Diabetes is complex and can be influenced by many factors. Patients must also pay attention to the relationship between blood sugar levels and food.

Also, it is important to check blood sugar levels after meals.

Proper management and proper care is essential for managing hyperglycaemic crises.

The nurse should inform Mr. Brown about how to inject insulin at home if needed.

Inzucchi (2015) recommends that insulin therapy be determined using b-hydroxybutyrate standardization.

An insulin injection is not necessary. A fixed rate insulin combination is best to suppress liver glucose production, lipolysis, ketogenesis, or insulin resistance.

Insulin injections are not recommended to type 2 patients.

It is possible to lower your blood sugar by changing your lifestyle and taking certain medications.

Sometimes, however, a patient might want to take insulin. It lowers blood sugar and is cheaper than other diabetic drugs.

The optimal insulin range should be between 100 to 250 mg/dL blood glucose.

A recommendation of 0.3 units should be used if the patient has a level of insulin more than 9%, or has uncontrolled diabetic symptoms.

The exact insulin dosage that Mr. Brown will require will be determined by the doctor, nurse, or both depending on his weight and age.

The insulin can be injected at the hips and hips (Pledger, et al. (2012)).

He should avoid moles, scars, and broken blood vessels.

You should never use the same injection site again and again.

Insulin, when injected in the abdomen, is quickly absorbed.

You can inject the insulin using a variety of tools, including syringes and needles.

The needle should be 12 mm long.

An insulin pump is another invention that aids in administering insulin to the body (Savage. et. al., 2012).

It is an externally worn device.

It is made up of a tube that contains insulin and a needle.

To perform this procedure, it takes a lot to train.

We will detail the process of injecting insulin.

To begin, wash the hands with soapy water. Then, slide the plunger down to the desired dosage level.

Next, he must remove the caps of the insulin vials from his needle and put the needle in the stopper. Finally, he should push the plunger down so that the air inside is taken in.

He must turn the needle upsidedown and push down the plunger until it reaches the dosage level.

If the needle is full of bubbles, the patient will need to gently tap the plunger to push them into the vial.

The insulin vial and the syringe must be held together with the finger off the plunger.

The alcohol pad must be used to cover the injection site. After that, a pinching of one to two inches of skin should be done. Finally, the needle can then be inserted at a 90° angle.

The plunger must be pushed all the way to the bottom and held there for 10 seconds.

The needle must be removed immediately after the pinched skin has been released.

You can use bandage if there is bleeding.

The nurse may offer some suggestions to help the patient feel comfortable.

The patient can choose from a variety of insulin depending on his speed or intended purpose.

You have the option of taking them quickly, slow, intermediately, long acting or pre-mixed.

The patient must make some lifestyle changes to get better (Hayashino, 2012).

Brown should consume small quantities of food, switch high-calorie food to vegetables and fruits, eat whole grains as well as beans, pulses, and beans, and avoid added sugars and salt (Mohamed (2014)

An integral part of the patient’s care is exercise.

It is important that the patient does both strength and aerobic exercise.

Aerobic exercises can include swimming, dancing, jogging, and walking briskly.

Strength training is about lifting weights and using resistance machines.

Before starting exercise, the patient should test his blood glucose levels.

Patient and Family-Centered Care

Family care is slowly becoming more popular. Communication plays a significant role in this.

It is a two way system.

On one side, the patient’s choice is important and relatives are considered as advisors regarding health care practices (Flynn & Preuster 2014.

The patient’s relatives or family members can share their views regarding the treatment of their relative.

Families of patients are encouraged to be involved in helping nurses in times of need.

These relatives are called caregivers. They interact with the nurses and doctors to provide proper care (Reinhard Levine, Samis, 2012).

Caregiver spends a lot time with the patient, and they are also educated about how to treat them after discharge.

An educational program on pain management is offered to caregivers. It teaches them how to assess pain and what pharmacologic or non-pharmacologic options are available.

Also, nurses teach caregivers problem solving skills as well as safe medication management.

The caregivers are trained on how to manage the patient’s behavior changes.

This methodology was created by Anthony M.DiGioia at the University of Pittsburgh Medicine Centre.

It is a six step process. The first step is to describe the entire program and its beginning and end. The next step is to create a council that will lead the process.

The third and fourth steps are to describe the current state of the process. Finally, the fourth step is to make the council a larger group.

The fifth step is creating an ideal story from both the patient’s and their families’ perspective. The sixth step is the creation of teams to bridge the differences between the current and ideal situations.

This process allows the patient and family to remain accountable and to have ethical values, since they are considered to be part of the care system (Gillick (2013)).

Conclusion

It can be concluded from the above discussion that nurses should follow a set of protocols to help their patients.

As Mr. Brown has been suffering from type 2 diabetes and cardiovascular disease due to his unhealthy eating habits and obesity, it is clear that he needs to be treated.

He will require holistic nursing care.

A nurse will devise a plan of diet and exercise for patients. She will also work with the family to build a good relationship.

Nursing professionals take various measures to care for patients. These include new ways of injecting insulin and a consistent glucose check.

Nursing is both science, art and science.

The nurses must teach the patients how to properly use insulin and how to monitor their blood sugar levels.

Family members are included in the care of patients and their opinions are taken into consideration.

The healthcare system is dependent on caregivers. They must communicate with the nurses to receive information, equipment and services.

This will build trust between the nurse and patient’s family members.

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