• Subject Name : Nursing

A Responsibility of Every Nurse

Introduction to Nursing Care and Management

Nursing intervention and nursing skills are the important factors that are responsible for the management of the health of the patient. With growing time and experience, the registered nurse able to learn new approaches and overcome their false or error based work. Thus, the essay describes the case study in which the negligence of the registered nurse resulted in the worst health condition of the patient. The essay depicts the action and inactions required for the management of health of Mrs. Ramirez. The essay will address the positive and negative cohesive developments associated with the case study. It demonstrates all the possible interventions that could be adopted while working with the critical ill patient.

Mrs. Ramirez is admitted in hospital because of her wrist surgery. She has developed wrist problem as the secondary output of her rheumatoid arthritis. Rheumatoid arthritis is the autoimmune disease that and is marked by the joint pain and swelling in feet and hands.it is the chronic systemic autoimmune disease which affects the lining of synovial joints and could result in disability, premature death, and socioeconomic burden (Guo et al., 2018). Patients who are suffering from joints problem and swelling issues must go for early diagnosis for rheumatoid arthritis, as early diagnosis is found to be the important index as the initial therapeutic optimal window. Early diagnosis and early monument of disease have the profound effect on health care. Moreover, early diagnosis help the patient by reducing the disease course, prevent the joint erosion, and also affect the disease outcome in remission state (Littlejohn & Monard, 2018). Mrs. Ramirez is suffering from rheumatoid arthritis from long time and has operated for her wrist surgery. After operation, she was fine and was transferred to the general surgery unit. The registered nurse was liable to take care of the health of Mrs. Ramirez and was given strict guidance to follow from the physician. However, the registered nurse fails to provide some of the medication to Mrs. Ramirez. The medication includes aspirin, prednisone, coversyl. The negligence of these medicine omissions is because of Mrs. Ramirez behaviour. According to Castner et al., (2016), registered nurses are responsible leader in the health care organisation to take care the health of the patient in respect to medication, hygiene, and health care management. The registered nurse is solely responsible for open communication with the team, physician, and health care provider regarding the status of the patient. However, the registered nurse neither informs the physician nor does no documentation on the chart lying on the bedside. Due to these issues, Mrs. Ramirez has started showing vital sign and symptoms comprising of increased blood pressure, degraded pulse rate, increased heartbeat. Along with this, she has develop the characteristics of fatigue, restless, dizziness, abdominal pain, and confused. The doctors ant he experienced professionals perceive that she has not receive prednisone for few days. Prednisone is the corticosteroid based medication that used by the patient to treat his/her symptoms related to rheumatoid arthritis. Mrs. Ramirez is taking the medicine from past five years. The prednisone are the anchor drug that has the therapeutic strategies in myositis, polymyalgia, rheumatic, and systemic vasculitis (Goes et al., 2014). The drug shows the promising health benefit in rheumatoid arthritis patient. Moreover, the registered nurse must ensure and adopt the preventive measure while using the prednisone medicine. Due to her current condition, doctors and physician started her treatment of acute adrenal insufficiency condition. Because of omission of prednisone medicine, the rheumatoid arthritis patient would start developing the adrenal insufficiency problem. The disease occur due to the imbalance in the hormonal level in patient and because of the improper medication scenario, she start developing the characteristics of adrenal insufficiency.

­­­­­­­­­­­­Ethically and legally, the registered nurse should not adopt this kind of habit of neglecting the medication to Mrs. Ramirez. Theoretically and practically Medication error is regarded as the malpractices, which is a result of individual and system (Bjorksten, 2016). To reduce the error the organisation must follow strict actions. The action includes medication error if accompanied must be directly report to the top organisation management, local reporting system should administer the error, regular screening of the patient and required nurse medication chart must be done, adoption of observational studies, adoption of qualitative study where health care personnel are interviewed properly (Bjorksten, 2016).

The registered nurse training and seminars need to be adopted on regular interval. Ongoing education and carer learning are some of the key parameters that help the registered nurse to use their skills in maintain the health of the patient. Healthy work environment are easily identified by the nurse through proper education and training, these will also help in developing the professional development and satisfaction (Price & Reichert, 2017). The registered nurse must seek the employment as the supportive nurse under the senior nurse, with the focus of developing quality patient-care. The senior nurse should provide appropriate reward to nurse so that the enthusiasm should generate and lead up. Moreover, the registered nurse must follow the proper code of conduct for the patient health and safety. Modified work arrangements, flexible work schedule, and professional development opportunistic approach are some of the considerable factors which help in maintain the work culture of the organisation. The registered nurse should follow the professional development opportunities to maintain, develop, practice, and experience the clinical skills in the organisation. These things need to be considered while dealing with the critical patients.

The registered nurse found that Mrs. Ramirez bleeding from the operation site and the dressing was removed from the site. This create the shocking situation to the registered nurse, thus RN immediately inform the other team members and call the doctors. The reason for her falling is that she has not taken her medicine properly including prednisone. Prednisone act as a bridging the gap for the disease management and recovery. Many research papers state that corticosteroid including prednisone help in controlling the inflammation and regulating the human body’s normal function. These medicines have the profound effect on the joint swelling, inflammation, pain, and reducing disease problem (Goes et al., 2014). These medicines are potent in reducing the effect of rheumatoid arthritis, act as immunosuppressive actions and medicate immune action in vascultides and systemic lupus erthematosus (Goes et al., 2014). Mrs. Ramirez complains about the dizziness, fatigueless, abdominal pain, and severe weakness. Thus, registered nurse should follow various strategic approaches to relieve her from pain, discomfort, fatigue, and weakness. Thus, her condition needs to be critically reviewed and addressed.

The prednisone are the anchor drug that has the therapeutic strategies in myositis, polymyalgia, rheumatic, and systemic vasculitis. The drug shows the promising health benefit in rheumatoid arthritis patient. Moreover, the registered nurse must ensure and adopt the preventive measure while using the prednisone medicine.

With the help of medical care practitioner, the registered nurse immediately pick Mrs. Ramirez and lye them on the bed. Initially her bandages were removed and fresh bandages were used on her stitches. The vital sign such as heart rate, blood pressure, respiratory rate, and saturated oxygen rate was analysed and monitored. Screening of her antinuclear antibody titter was done and analysed. The test helps in determining the pathological condition of Mrs. Ramirez. The test help in identifying the antibody pathogenic level, nephritogenic level, and interferonogenic level (Balvera et al., 2018). These analysis help the registered nurse in understanding the immune complex deposition, cytokine stimulation, receptor binding, also inhibition of immunological activity of nuclear antigen. These characteristics features help in determining the state of disease. Simultaneous biologic response modifier must be administering the Mrs. Ramirez. Biologic response modifiers are the alternative and efficient treatment approach for the patient suffering with rheumatoid arthritis. The modifier comprises of the gents that consist of molecules produced by the cells and help in reducing the inflammatory reactions. These therapies provide the random and instant treatment in reducing the inflammation caused by the various inflammatory cascades (Tank, 2017).

Mrs., Ramirez complain about the dizziness, fatigueless, abdominal pain, and sever weakness. Thus, registered nurse should follow various strategic approaches to relieve her from pain, discomfort, fatigue, and weakness. The registered nurse must provide her with the variety of comfort measures so as to reduce her pain. The measures include the adoption of supportive mattress, pillows, splints, and divisional activities. These provide her the sense of comfort and relaxation. The registered nurse must administer Mrs. Ramirez with analgesic, anti-inflammatory, ant rheumatic medicines she should strictly follow the medication as prescribed without any missing. The registered nurse must teach the patient about the importance of medicine and its implications in pain reduction (Tank, 2017).

The registered nurse should follow various activities to reduce the fatigue level in patient suffering from rheumatoid arthritis. The fatigue can be reduced by providing Mrs. Ramirez with the approachable comfort measures, develop and encourage her sleep routines, and encourage her to take proper rest and sleep. The registered nurse must also provide the physiotherapist that will assist Mrs. Ramirezin reducing her inflammation level. The physiotherapist incorporation will help her to be on track of doing exercise, enhanced energy, and self-confidence. The registered nurse should maintain her appropriate activity, resting, and exercise scheduling. The registered nurse must educate the patient in energy conservation techniques as it may help the patient to conserve her energy so as to prevent herself from fatigue feeling. The energy conversation technique includes pacing, delegations, setting, and priorities setting. These are the four principles through which she can save her energy. Along with the proper exercise scheduling, the registered nurse must follow proper nutritious diet including high amount of iron based food supplements. The good diet helps Mrs. Ramirez to recover faster. The nutritious diet reported to show the substantial benefit in reducing disease symptoms of joint pain, stiffness, swelling, tenderness, and other disability associated with the disease (Khanna, 2017). From the study, it was found that dietary protein components have the potential effect on triggering rheumatoid arthritis (Skoczynska & Swierkot, 2018). Moreover, in the paper (Skoczynska & Swierkot, 2018), the study was conducted with 76, 597 women participants suffering from rheumatoid arthritis. According to the study, the women have shown considerable health benefits along with reduction in symptoms associated with rheumatoid arthritis disease. These findings suggest that, the proper diet introduction could also prevent the vital signals of Mrs. Ramirez.

Mrs, Ramirez has fallen because of lack of activities and may also be due to limited scope of walking habit. Thus, the registered nurse should emphasise her range of motion of her affected joints, promote the use of assistive ambulatory devices the registered nurse should also encourage her to use appropriate positioning and posture exercise. With day-to-day activities, Mrs, Ramirez had developed the beliefs of self-confidence, self-working, and self-are. Thus, these factors need to be regularly maintained .the self-care abilities includes making patient to identify the elements of control over disease symptom, treatment, follow-up, and management of disease. The patient should be encouraged with respect to verbalisation of feelings, fears, perceptions, beliefs, family support. Patient must be educate on the disease, its implications, treatment options available, patient-initiatives to take care, strategies to maintain independence and function, home safety, and many other valuable points. These factors provide long-term benefit to patient and his family in terms of safety, efficacy, and efficiency.

Conclusion on Nursing Care and Management

From the above discussion it can be concluded that Mrs. Ramirez health degraded due to negligence factor of registered nurse who has missed her medicine. Ethically and legally the health care provider in any health care organisation should not adopt this kind of practice. However, with the adoption of nursing care and management, the health of Mrs. Ramirez can be maintained. The nursing management care includes good decision-making, proper caring skills, good management skill, and positive approach toward patient health. The registered nurses are solely responsible for maintaining the health of the patient postoperatively, thus need to consider importance of medication, diet, and health care procedures. However, with the good approach and clinical skills, the patient is able to recover faster.

References for Nursing Care and Management

Balaver, M., Lesichkova, S., esheva, N., Kojuharova, N. (2018).Diagnostic significance f the titer of anti-nuclear antibodes. Research Gate, 12, 1-15.

Bjorksten, K., Bergqvist, M., &Fvarson, J. (2016).BMC Healthcare Service Research, 16, 1-20. doi: 10.1186/s12913-016-1695-9

Castner, J., Fen, R., Sullivan, S., Titus, A., Klingman, K. (2016). Strengthening the roe of nurses in medical device development. Journal of Professional Nursing, 32, 1-15. DOI: 10.1016/j.profnurs.2016.01.002

Guo, Q.,Wang, Y., Xu, D., Nossent, J., Pavlos, N., &Xu, J. (2018). Rheumatoid arthritis: Pathological mechanisms and modern pharmacological therapies. Bone Research, 6, 1-52. ; https://doi.org/10.1038/s41413-018-0016-9

Goes, M., Jacobs, J. Bijlsma, J. (2014).The value of glucorticoid co-therapy in different rheumatic disease – positive and adverse effects. Arthritis Research Therapy, 16, 1-10.

Littlejohn, E. & Monard, S. (2018). Early diagnosis and treatment of rheumatoid arthritis. Primary care, 45, 237-255.DOI:https://doi.org/10.1016/j.pop.2018.02.010

Khanna, S., Sagar, K., Gupta, B. (2017). Managing rheumatoid arthritis with dietary interventions.Frontiers in Nutrition, 4, 1-51.doi: 10.3389/fnut.2017.00052

Price, S. & Reichert, C. (2017). The importance of continuing professional development to career satisfaction and patient care: Meeting the needs of novice to mid-late-carrier nurses through their career spam. Administrative Science, 7, 1-13. doi:10.3390/admsci7020017

Skoczynska, M., &Swierkot, J. (2018).The role diet in rheumatoid arthritis.Rheumatologia,58, 259-267

Smolen, J., Landewe, R., Breedveld, F., Buch, M., Burmester, G., Dougados, M., Emery, P., Gaujoux-Viala, C., Gossec, L., Nam, J., Ramiro, S., Winthrop, K., de Wit, M., Aletaha, D., Betteridge, N., Bijlsma, J., Boers, M., Buttgereit, F., Combe, B., Cutolo, M., Damjanov, N., Hazes, J., Kouloumas, M., Kvien, T., Mariette, X., Pavelka, K., van Riel, P., Rubbert-Roth, A., Scholte-Voshaar, M., & Scott, D. (2014). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis, 73, 492-509.

Tank, N., Karelia, B., & Vagada, N. (2017). Biologic response modifiers in rheumatoid arthritis: Systematic review and meta-analysis of safety. Journal of Pharmacology and Pharmacotherapeutics, 8, 92-105. doi: 10.4103/jpp.JPP_155_16

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