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This is a solution of nursing schedule planning assignment help in which we discuss planning of shift timing and duties of nurses who worked in medical ward
Patient’s clinical details
The concerned patient is Nicholas Soprano is male and 76 years old. The medical history of this patient reveal cardiac failure with stage 2 retinal impairment, high blood pressure along with diagnosed AMI in the year 2004 and Gastro Esophageal Reflux Disease or GORD. The patient was also diagnosed with an exacerbated congestive cardiac failure. Breathlessness with an elevated peripheral oedema was also indicated. The patient has also gained 3 kilogram of body weight in the last 15 days. The patient was also administered with 40% humidified oxygen through high flow nasal cannula. It was also observed that the concerned patient has an IVC inserted in his right arm 2 days before the admission to hospital. Nicholas was kept on 1.2 litres of fluid restriction according to the Fluid Balance Chart.
The oral medicine taken by the concerned patient are 80g Lasix before dinner, 2 tablets of Slow K , 5mg Ramipril, 100 mg Aspirin and 40m Pantoprazole on daily basis. Apart from this Nicholas was prescribed with 50mg of Metoprolol, 5mg Apixaban BD.
Nursing Shift plan
In accordance to the requirement of the given assignment a nursing shift plan has to be developed in consideration with the time interval of 0700-1530 hrs.
Below the nursing shift plan is produced:
Time: 0700 hrs-0800hrs.
Intervention: Check all the vital statistics like patient’s heart rate, pulse beat, pressure, consciousness level and breathing followed with monitoring of the oxygen supply of the patient and consider the application of vasopressin to elevate the contractility and support blood pressure. If required administer ventricular ejection to the concerned patient. The patient should be given Pantoprazole as per prescription (Watson & Bowling, 2004).
Rationale: It is important to check with the oxygen level of the concerned patients as he was diagnosed with congestive cardiac failure and oxygen supply is essential to relive the patent from ischemia and breathlessness condition. Also as the patient had a medical history of Gastro Esophageal Reflux Disease the administration of Pantoprazole is required to prevent the formation of excessive stomach acid and to prevent the development of symptoms like heartburn, acid reflux. Pantoprazole is given to the patient as a treatment to excessive esophagitis (Strickland, 2007)
Time: 0800 hrs-0900hrs
Intervention: Measuring of the blood pressure level of the concerned patient and also to check with the presence of symptoms like distended neck veins, peripheral edema, dispend, orthopenea. Measurement of the output volume is considered as the input volume has been restricted at 1.2 liters.
Rationale: As the patient with kept under a Fluid Restriction Chart and also has a high blood pressure level it is important to perform the above mentioned intervention. Measurement of blood pressure and checking the symptoms of dyspnea and orthopenea have been considered because these signs indicate an excess of fluid volume. Hence to control the fluid volume the above mentioned interventions are made. Also if intake is greater than the output volume, excess accumulation of body fluid is indicated (Hoist, Stromberg &Willenheimer, 2003).
Time: 0900 hrs-1000hrs
Intervention: Regular documentation of the continuous ECG rhythm, monitoring of the vital signs and mental status of the concerned patient has to be considered. Nursing intervention is also required to restrict the activity of the patients. The patient is also given the prescribed dose of Slow K tablet.
Rationale: In order to control the exacerbated congestive cardiac failure the monitoring of the ECG data has been considered. The rationale behind nursing intervention to restrict the physical activity of the concerned patient is to lower the myocardial oxygen requirement (Westward, 2011).
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Time: 1000 hrs-1100hrs
Intervention: Monitoring of the serum potassium level of the concerned patients. Administration of the prescribed dose of Lasik and Metoprolol to the concerned patient should also be a part of the nursing shift plan.
Rationale: Monitoring serum potassium level of the patient by taking digitalis and diuretics are considered in order to prevent the hypoleukamia that may occur as a result of excessive potassium loss followed with an increased aldosterone level ("EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Altered fluid and electrolyte balance", 2016).
Time: 1100 hrs-1200hrs
Intervention: Assisting the patient in self care activities and allowing the patient to take periodic uninterrupted rest and emphasis to lower the noise level of the surrounding should also be considered within the nursing plan.
Rationale: As the patient was diagnosed with shortness of breath on exertion the above mentioned interventions are justified in order to gradually improve the level of activity tolerance of the patient ("EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Activity intolerance", 2016).
Time 1200 hrs-1300hrs
Intervention: Monitoring and maintaining of the fluid and electrolyte balance, with monitoring the input and output volume of fluid can be considered as intervention in the nursing shift plan for the concerned patient. Daily record of body weight of the patient should also be considered in this respect (Woods, 2010).
Rationale: As the concerned patient was admitted with a clinical history of stage two or moderate renal impairment the above mentioned interventions are considered in order to prevent the occurrence of acute renal failure that may subsequently result in abrupt loss of kidney function (Bennett-Jones, 2006).
Time: 1300 hrs-1400hrs
Intervention: Administration of the prescribed dose of Apixaban in order to prevent the formation of blood clots that may form due to irregular heartbeats. Monitoring of the occurrence of hypersensitivity reactions, indications of pathological bleeding and considered as part of nursing intervention ("Nursing Central | apixaban", 2016).
Rationale: As Apixaban is found to bear side effects like hypersensitivity reactions, hepatic malfunctioning, pathological bleeding it is required to include the above mentioned intervention within the nursing shift plan (Cicconeet al.,2015).
Time: 1400 hrs-1530hrs
Intervention: Monitoring the body extremities of the concerned patient along with encouraging the patient to reduce salt intake should be included within the nursing intervention plan as the patient was diagnose with peripheral edema. Also it is required to keep the limbs as high above the heart if possible.
Rationale:The rationale behind the above mentioned nursing intervention is to prevent the symptoms of peripheral edema as this a life threatening situations like fatal respiratory distress, leg ulcers and dispend (Wang, 2015).
Intervention: Apart from the above mentioned timely interventions that is essential with respect to the clinical status of the concerned patient hourly monitoring of the patient’s conscious level, vision, colour and nature of the urine output, body temperature and breathing condition of the patient is required ("Simvastatin Side Effects in Detail - Drugs.com", 2016). It is also important to note down the observation data after monitoring the concerned patient.
Rationale: As the concerned patient was prescribed with a nocturnal dose of Simvastatin, this medicine is subjected to many side effects like dizziness, fever and headache, loss of consciousness, nasal congestion, blurred vision, dark coloured urine, dry skin, ear congestion and short of breath (Baliga, 2010). Maintaining the regular records of the concerned patient is required in order to evaluate the progress or deterioration rate of the concerned patient and take action accordingly.
- Baliga, R. (2010). Statin prescribing guide. Oxford: Oxford University Press. Bennett-Jones, D. (2006). Early intervention in acute renal failure. BMJ, 333(7565), 406-407. http://dx.doi.org/10.1136/bmj.38945.596215.80
- Ciccone, M., Zito, A., Devito, F., Maiello, M., &Palmiero, P. (2015). TO BLEED OR NOT TO BLEED: THAT IS THE QUESTION. THE SIDE EFFECTS OF APIXABAN.Current Drug Targets, 16(999), 1-1.http://dx.doi.org/10.2174/1389450116666151001113932
- EHS:Nursing CarePlanning Guides - Care Planner: Diagnosis: Altered fluid and electrolyte balance. (2016). Www1.us.elsevierhealth.com. Retrieved 31 March 2016, from http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=321%7C322%7C323%7C