Clinical Skills: Mouth Care

Hello again!
I'd like to add mor to clinical skills while I still can! I'm in the UCS library at the minute and I've had, like, a whole day of lectures which as some of you may know can be very tiring even though you are sitting down the whole day!! ^ ^
Someone in this library has KFC... I can smell it... It smells sooo good!!!!! -_-;
Anyway, here is mouth care! Enjoy!

Mouth Care

What you need:
* Towel and/or disposable soft cloths, disposable bowl, waste bag, mouthwash, toothbrush and toothpaste, jug and glass, drinking straw, gloves, goggles and apron, small, free-standing mirror, tongue depressor, pen torch.
* Fill a jug with water, bring it and other equipment to the patients bedside.
Wash hands thoroughly, put on gloves and an apron (you may wish to wear goggles to prevent splashing into your eyes.

Supervising mouth care

* If the patient is bed-ridden but capable of self-care, encourage him to perform his own mouth care
* If allowed, assist the patient into an upright position, place the over-bed table in front of him with the mirror angled to allow the patient to view his face; arrange the rest of equipment on the table, ensuring everything is within reach.
* Drape the towel over the patient’s chest to protect clothing.
* Mix mouthwash in a glass, place a straw in it if needed and position the disposable bowl nearby.
* Instruct him to brush his teeth and gums while looking into the mirror. Encourage him to rise frequently during brushing, and provide facial tissues or soft cloths for him to wipe his mouth.
* Ensure all areas of the mouth are cleaned – teeth, palate, buccal surfaces, gums and tongue.

Performing mouth care
* Perform mouth care on the patient if they are comatose or unable to do it themselves.
* If they wear dentures, clean them thoroughly.
* Raise the bed to a comfortable working height to prevent back strain.
* If a patient is unconscious then lower the head of the bed and position the patient on his side, with his face extended over the edge of the pillow to facilitate drainage and prevent fluid aspiration.
* The conscious patient should be assisted to an upright position.
* Arrange the equipment on the over-bed table or bed locker.
* Place a soft disposable cloth under the patients chin and a disposable kidney bowl near his cheek to absorb and catch drainage.
* Lubricate the patients lips with water or petroleum-free balm to prevent dryness and cracking. Reapply lubricant as needed, during oral care
* If necessary use a tongue depressor to hold the patients tongue flat during the procedure.
* Wet the toothbrush with water. If needed, use hot water to soften the bristles.
* Apply toothpaste and brush the patients lower teeth from the gum line up; the upper teeth, from the gum line down.
* Place the brush at a 45 degree angle to the gum line and press the bristles gently into the gingival sulcus. Using short gentle stroke to prevent gum damage, brush the buccal surfaces (toward the cheek) and the lingual surfaces (toward the tongue) of the bottom teeth. Using the same technique, brush the buccal and lingual surfaces of the top teeth. Brush the biting surfaces of the bottom and top teeth, using a back and forth motion.
* Hold the disposable kidney bowl steady under the patients cheek and wipe his mouth and cheecks with tissues/soft cloth as needed. Use suction as required.
* Follow up with a swab.
* After brushing the patients teeth, dip a cotton-tipped mouth swab into the mouthwash solution or warm water. Press the swab against the side of the glass to remove excess moisture. Gently stroke the gums, buccal surfaces, palate and tongue to clean the mucosa and stimulate circulation.

After mouth care
* Assess the patients mouth for cleanliness and tooth and tissue condition
* Rinse the toothbrush and glass, dispose of the kidney bowl
* Empty and clean the suction bottle, if used, and place a clean yanker suction catheter on the tubing
* Remove your gloves and apron, return reusable equipment to the appropriate storage location, and discard disposable equipment in the clinical waste or household waste as per local policy. Wash your hands.

Documenting mouth care
* In your nursing care plan document the time and date of mouth care and sign. Document the condition such as bleeding, dry, oedema, mouth odour, excessive secretions or plaque on the tongue.
* Document the care that your administered.


And that's it!!
Hope you enjoyed it!! (:

Emily

Clinical Skills: Eye care

hi guys! this is the second clinical skills post that i'm doing!! yey!! Today we had our first lecture on IPL which is 'Inter-professional learning'. I'll get to that stuff a bit later on...
For now though I'm gonna explain Eye care! Enjoy!!

Eye Care

For this you will need:

A sterile galley pot, gloves and apron, sterile towel, sterile normal saline solution, sterile low-linting gauze swabs, artificial tears or eye ointment.

How to do it

* Assemble the equipment at the patients bedside. Open the sterile towel and open all sterile equipment on to this.
* Pour a small amount of saline solution into the galley pot. Open the sterile gauze using an aseptic technique and place on the sterile towel.
* Wash your hands thoroughly, put gloves and an apron on and inform the patient of what you would like to do in order to gain consent, even if the patient is comatose or unresponsive.
* To remove secretions or crusts adhering to the eyelids and eyelashes, first soak gauze in sterile normal saline solution. Then gently wipe the patients eye with the moistened gauze, working from the inner canthus to the outer canthus to prevent debris and fluid from entering the nasolacrimal (tear) duct.
* After cleaning the eyes, instil artificial tears or apply eye ointment, as prescribed, to keep them moist.
* After giving eye care, dispose of the galley pot, apron and gloves. Use new equipment for each care episode.

Documenting eye care
* Record the time and type of eye care in your notes.
* If applicable, record administration of eye drops or ointment in the patient’s medication chart.
* Document unusual crusting or excessive or coloured drainage and report findings as appropriate

Hope you enjoyed it!

Emily

Nursing Practice: Pressure Ulcers

In this post I'm going to talk about what we covered in one of our first nursing practice lectures which was about pressure ulcers.

Nursing Practice

•Guideline – A general rule, principle or piece of advice
•Policy – A proposed or adopted course or principle of action. Something you must follow otherwise you may be disciplined
•Standards – A required or agreed level of quality. Recommended by regulating/professional bodies and must be followed EG The code of practice.

What is stroke?

A stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke also is sometimes called a brain attack or a cerebrovascular accident (CVA).

Pressure Ulcers
Pressure ulcers, also sometimes known as bedsores or pressure sores, are a type of injury that affects areas of the skin and underlying tissue. They are caused when the affected area of skin is placed under too much pressure.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

How pressure ulcers develop
Pressure ulcers develop when a large amount of pressure is applied to an area of skin over a short period of time. Or, they can occur when less force is applied but over a longer period of time. They can develop within two hours. So it is important to move a patient at least once every two hours.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected area of skin becomes starved of oxygen and nutrients. It begins to break down, leading to the formation of an ulcer.

Healthy people do not get pressure ulcers because they are continuously and subconsciously adjusting their posture and position so that no part of their body is subjected to excessive pressure.

However, people with health conditions that make it difficult for them to move their body often develop pressure ulcers. In addition, conditions that can affect the flow of blood through the body, such as type 2 diabetes, can make a person more vulnerable to pressure ulcers.


Preventing pressure Ulcers
•Change a patient’s position at least once every two hours
•Use equipment such as mattresses or pillows to relieve pressure on vulnerable areas

Vulnerable areas for pressure ulcers
If a patient is bedbound (unable to get out of bed) they are at risk of developing pressure ulcers on their:
•shoulders or shoulder blades
•elbows
•back of your head
•rims of your ears
•knees, ankles, heels or toes
•spine
•tail bone (the small bone at the bottom of your spine)

If they are sitting or they are a wheelchair user, they are at risk of developing pressure ulcers on:
•the buttocks
•the back of your arms and legs
•the back of your hip bone

Other reasons for patient discomfort:
•If a patient is incontinent, urine is acidic which may burn their skin
•Hospitals can also become very warm which may cause them to sweat which can in turn cause discomfort

Hygiene needs of a patient

Assessment
•Check the nail beds and the skin to check for capillary refill time and circulation – press on the skin and check how long the skin takes to return to its natural colour
•Skin can be an indication of dehydration – this is obvious if the skin is dry, if, when the skin on the back of the hand is pinched, the skin takes some time to return to its normal state. And also if the tongue is dry.
•Check the patient for ulcers
•Find out if the patient is diabetic – because you must not cut diabetics nails in case you catch the skin because of slow wound healing which could make them more prone to infection
•Is their skin a healthy colour?
•Check health of nails – are they yellow or horn-like?

Nutritional assessment
•Is the patient overweight or underweight?
•Maintain holistic care whilst bathing – involve them in conversations by asking them how they are feeling, asking them what their name is. Make them feel at peace and comfortable.

However…
Allow them independence as much as possible. If they can, allow them to dress themselves or wash themselves without help. This also allows them to maintain dignity and self-respect

Social assessment
•Integrate them into the conversation if with another nurse and use a nice calming tone of voice

Evidence based practice
•Do not wear gloves unnecessarily (each box costs £8!!) and if there is no clinical reason to as this might frighten the patient or put up a psychological barrier between the nurse and the patient
•Do not touch intravenous infusions!!
•Pat a patient dry instead of rubbing – especially if the patient has dry skin as you do not want to aggravate the skin
•Check the skin for sores of ulcers
•You should work with your mentor approximately 40% of placement and you should have three meetings with them. One at the beginning, one two/three weeks in and one at the end.

Emily

Health and Wellbeing

Hi again!
Thought I'd continue to update while I'm still motivated.

Health and wellbeing

Health definition:
•“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” – World health organisation
•“Health arises from harmony with nature” – ‘Mirage of health’
•“Ill health is precisely located malfunctions of the body” – Greek God Ascelepius
•“Health is equilibrium, illness is an upset” – Hippocrates
•“Health is a combination of factors having a particular effect on an individual” – Ewles and simnett, 1991

Wellness
Definition – An active process of becoming aware of and making choices toward a more successful existence
Process – never arrive at a point where there is no possibility of improving
Aware – we are, by nature, continuously seeking new information so we can improve.
Choices – considered a variety of options and select those that seem to be in our best interest.
Success – determined by each individual to be their personal collection of accomplishments for their life

Health is…
•Achieving optimum function (Seedhouse, D. 1991)
•“I want to be all that I am capable of becoming” (Mansfield, K. 1977)
•A State of optimum capacity for an individual for the effective performance of the role(s) and task(s) for which they have been socialised (parsons, T. 1951)


Social health definition:
•Capability of individuals, families, groups and communities to cope successfully in the face of significant adversity or risk (Social indicators research, 1997)

Mental health definition:
•Feeling good about life and yourself and being able to get on with life in the way you want.
•Not about income but how you feel about your life

Medical model…
•Disease represents a crucial issue facing society
•Diseases are readily diagnosed and counted
•Approach is narrow and implies that people with disabilities are unhealthy and health is only about physical disease and mortality

When you are healthy, you feel…
•Happy
•Motivated
•Feel energetic
•Well

Bodily changes as you get older involve…
•Weight
•Skin/nails
•Hair
•Teeth and bones
•Sleep needs
•Eye sight
•Sexuality (due to physical changes)
•Spirituality and attitudes to life


Popular topics that patients may ask you about…
•Alcohol
•Fitness
•Food/diet
•Healthy eating
•On a budget
•Lose weight
•Military medicine
•Mental health
•Sexual health
•Smoking
•Class of 1948
•Get fit for 2012
•Five a day

Internet sources…
•NHS direct
•Health search engine
•Health direct
•Dh.gov.uk – elect a hospital

What affects your health?

Individual
•Physical health
•Healthy eating
•Motivation to go to the doctors/dentist

Immediate social/physical environment
•Job – is your job physical or sedentary? Is your income enough to afford ‘healthy’ foods?

Wider social/political
•Political – less funding for promoting health? Less funding for equipment or facilities?
•Social acceptance – men in general may not want to admit they are on a diet because of peer pressure or looking stupid (not ‘manly’)
•Petrol prices can influence whether we walk or drive


So there you have it!!
Hope you enjoyed!

Emily

Negotiated Care

Hi everyone!
I'm really sorry for the lack of posts!
I've been juggling quite a few things at the minute (but, hey, my aim is to keep this particular blog 'professional' so...)
Today I'm gonna be talking about negotiated care, so here goes...

Negotiated Care

Pearson, 1989. P.141:

‘The power to heal lies within the patient and not the nurse'

Who are your caring for? What do we call those we care for?
•Service user
•Patient
•Client
•Individuals – nursing is about holistic care
•Customer
•Consumer

Terminology
•Patient – A person receiving or required to receive medical treatment - (concise oxford dictionary, 2010)
•Client – refers to all groups or individuals who have direct or indirect contact with nurses or midwives in professional capacity (used in mental health a lot) – (NMC, 2002)
•Customer – one that buys goods or services
•Consumer – recipient of health care such as a patient in a hospital
•Service user – a person who uses health services

Patient
•Have some form of treatment to improve their own health or wellbeing
•Are expected to co-operate and trust the nurse
•Patients can behave anxious, distress or nervous and tend to have ‘blind faith’ in doctors or nurses. They can become quite passive and may not ask questions as they do not want to make a fuss.
•Department of health, 1996 – patient or carer involvement is essential to help people make informed decisions about their own health care
•NHS plan, 2000 – patients must have more say in their own treatment and more influence over the way the NHS works.
•DH, 2008 – high quality care for all:
•“set new foundation for health services – giving patients more choice and thei healthcare is more personalised and fair”.
•Emphasis is on a partnership between healthcare professional and the patients. Focus is on meeting and exceeding the expectations of patients.
•NHS constitution, 2010: Includes rights to choose both treatment and providers and information on quality so that where relevant patients are able to make informed choices.

High quality care – what does it involve?
•Negotiation
•Patient choice
•Shared decision making
•Active participation in care
•What do we mean by negotiation?
•Working together
•Principles of decision making

For patients to make a decision they must be able to…
•Understand
•Know the risks
•Given enough information to enable them to make the right decision (DH, 2001)

A person is unable to make a decision if they…
•Are unconscious
•Are not active in the decision making process
•Cannot understand the information
•Cannot retain formation
•Cannot communicate the decision

Mental capacity act 2005
•Protect people who cannot make decisions for themselves
•Could have a brain injury, a stroke or a severe learning disability
•A person is presumed to make their own decisions

Children or young people
•16-17 year olds can legally consent to treatment
•Under 16 year olds can consent to treatment is deemed ‘gillick competent’

Children act 1989
•Those with parental responsibility can make decisions for a young person or child
•Children or young people have the right to be involved in decisions, be heard or have their views taken into account

What information do patients need?
•Who you are
•Information about the treatment including the pros and cons and side effects
•After care
•Up to date information
•Nurses to be honest to patients and use limited jargon
•What the treatment involves
•The role of the nurse is to inform and interpret for the patient

Benefits
•Can make quicker decisions
•Feel more in control of decision making
•Prevent further problems and issues in the future
•Confidence
•Helps them to plan their lives
•Makes people feel more respected and valued

Difficulties
•May think we do not have enough knowledge as a student nurse
•May take anger out on HCPs
•Can refuse treatment
•Can be difficult to communicate decisions
•Religious beliefs

Examples of when service users/carer might become active participants in care planning…
•Rehab
•Palliative care
•Support plans
•Medications
•Four levels of involving them in decision making…
•Give information about decision
•Consultation
•Joint decision making
•Giving responsibility for users to decide or act themselves

User involvement
+VE
•Can tell you things you don’t already know
•Aids recovery
•Builds rapor
•Greater sense of control

-VE
•Lack of co-operation
•May not understand or think they are not ill

Empowerment
•“Social process of recognising, promoting and enhancing people abilities to meet their own needs, solve their own problems and mobilise the necessary resources in order to feel in control of their lives.” – Gibson, 1991
•Nurses’ role is to empower and help patients to consider options and consequences in order to make informed decisions. Nurses must allow patients to participate in their own care.

Again, so sorry for the lack of updates. I know i did promise i'd update a lot. It's just a lot is going on for me now. Please bear with me! Keep checking for updates! I love my readers!

'Til next time.

Emily