General Nursing Management of Patients with Medical Pathology

Irrespective of the disease condition, the patient should be managed on the following cardinal points:

1. Administration of medication

2. Personal hygiene

3. Rest and Comfort

4. Nutrition

5. Observation

6. Elimination

7. Psychotherapy/Psychological care

8. Health education

9. Protection from injury

10. Barrier Nursing (this is applicable in communicable diseases)

ADMINISTRATION OF MEDICATION

Diseases are often managed with medication, even if it is chronic or has no specific cure, the signs and symptoms are managed medically.

a. Take accurate history of any drug allergy, precautions must be taken before giving the drug. If you cannot find any history on drug allergy, you can start by administering a test dose.

b. Explain the rationale for the drug to gain patient cooperation and to ensure drug compliance.

c. Educate patient on the mechanism of action and the side effects of the drug. Encourage the patient to report any adverse effect that might occur from taking the medication.

d. Ensure you observe the 5Rs of drug administration. These are 1. The right PATIENT, 2. The right DRUG, 3. The right DOSE, 4. The right TIME and 5. The right ROUTE.

Missing a single one of these could cause serious reactions or problems. Seek immediate help from a college or a doctor if this happens and explain exactly what happened.

e. Document/chart all medication given. In case your client decides to sue you, this will be your savior. Do NOT forget to document your procedures.

PERSONAL HYGIENE

Leaving your client unkept can lead to other nosocomial and hygiene related infections. Explain the rationale for the need for good personal hygiene, this helps to maintain the dignity of your patient and also boost up the patient's morale.

a. Ensure patient baths daily (this stimulates circulation in the tissues thus preventing bed sores).

b. Care for patient mouth to stimulate appetite

c. Care for the hair particularly in females

d. Provide vulva toileting if the patient is a female and bed ridden.

e. Patient's clothing and bed linen must be clean and dry all the time.

f. Assist patient to tidy up after passing stool or when soiled.

REST AND COMFORT

Rest is essential for the client to regain energy and for physiological and psychological healing. Some patients who feel strong do not see the need for rest, tell your patients why they need rest.

a. Visitors should be restricted.

b. Make bed devoid of creases and crumbs.

c. Bed should be clean and dry.

d. Position or assist patient to maintain a comfortable position.

e. Ensure the room is well ventilated.

f. Minimize both human traffic and noise on the ward.

g. Cluster nursing procedures or activities and perform at a time.

h. Administer prescribed medications that are meant to induce sleep.

NUTRITION

Your patient need food to recover, not just food but a balanced diet. Sick people usually lose appetite which could lead to malnutrition. In order to facilitate the recovery process of the patient, implement improving measures to boost the appetite of your client.

a. Explain the rational behind meals.

b. Give oral care before and after meals. Example, Rinsing the mouth with water.

c. Tidy the ward by clearing all bedpans, urinals, sputum mugs, vomiting bowls, etc.

d. Serve food in bits and in attractive manner and at regular intervals. You could decorate the tray with flowers.

e. Ensure the meal contains adequate amounts of all the nutrients. Example, Protein, vitamins, carbohydrates etc.

f. Feed through NG tube in patients who cannot eat by mouth and if necessary, administer prescribed intravenous fluids.

g. Document every procedure (feeding for this matter) and record all observations made.

OBSERVATION

This is done to monitor the progress of your patient. You need to keep an accurate observation chart to enable you evaluate the responses to treatment to be able to early detect any problems.

a. Monitor vital signs, record and report any abnormalities.

b. Keep accurate intake and output chart and balance it every 24 hours.

c. Observed for signs of complications of the condition.

d. Weigh patient daily and record where necessary.

e. If the patient is on IV fluids, observe the venepucture site for tissue infiltration (some clients will not tell you when this happens) and phlebitis.

f. Observe the type of fluid, any changes in colour and the presence of foreign bodies.

g. Observe dietary and bowel movement habits.

ELIMINATION

For adequate elimination, ensure the intake of high fibre diet, adequate amounts of fluids and green leafy vegetable if not contraindicated (prohibited) in the disease condition.

a. Encourage patient to respond to the urge to void or defecate. Observe the effort the patient makes during bowel movement and its frequency.

b. Observe the stool or urine for color, consistency, and odour.

c. Offer bedpan or urinal routinely and on demand and remember not to embarrass the patient.

d. Assist patient to tidy up if unable to do it by himself.

e. If patient has cardiac or renal problems, then keep accurate intake and output chart.

ISOLATION/BARRIER NURSING

This should be practiced if it is a communicable disease.  Explain to patient and relatives the need for the isolation, this will allay fear and panic ensuring cooperation.

a. The patient should have separate equipment and they need not to share fomites.

b. The use of personal protective equipment by health staff. Examples, Gloves, masks, waterproof aprons etc. This is not to protect the health provider only but the other clients as well.

c. Patient equipment should be disinfected after each use.

d. Disinfect bed linen before sending it to the laundry.

e. Disinfect his excreta and all bodily fluids before discarding it.

f. Restrict all visitors to the unit and if necessary ensure visitors observe the necessary infection prevention and control protocols.

g. If necessary, you need to notify the appropriate authorities.

h. The nurse should ensure proper hand washing and special handling of needles during injection and capping of needles.

PSYCHOTHERAPY

Illness is usually accompanied by fear and anxiety to both patient and his relatives. Some receives the diagnosis with a shock. Psychological care is necessary to allay the fear and anxiety.

a. Explain the aetiology and signs of the condition.

b. All procedures to be performed on the patient must be explained to gain his cooperation.

c. Introduce the health team members to the patient.

d. Introduce to him other patients with the same condition who have been treated and cured.

e. Give opportunity to patient to ask questions and respond to his questions appropriately. For questions you have no answer to, tell them you'll get them an answer later and do so.

f. Educate him on the disease process and the treatment regimen.

HEALTH EDUCATION

If your patient knows his condition and understands the need for regimen, it reduces the risk of propagation into complications of the said condition.

a. Find out the level of knowledge of the patient on the condition. This is because some clients take time to learn about their condition, letting them say what they know refreshes their mind of what they learnt. You can then build up on their knowledge.

b. Educate patient on the causes and predisposing factors of the condition.

c. Educate the patient on the need for him to follow the treatment regimen.

d. Educate him on the need for follow up care to prevent relapses.

e. Diet modification and refrain from certain habits. Example Stop smoking, drinking of alcohol etc.

PROTECTION FROM INJURY

Your patient are in your care, note that the hospital is not their home so in a strange environment, your patient might sustain an injury.

a. Provide good lightening in the ward.

b. Nurse restless patients in low beds and in beds with side rails.

c. Keep sharps and ropes away from the reach of patient.

d. Keep all drugs away from the reach of patients.

e. Use physical restrains if necessary.

DISCHARGE PLANNING

Discharge planning begins from the day patient reports to the hospital. Instructions for continuing care are given to the patient and the family members or significant others. These instructions should not be given only verbally but also in writing and should be individualized for each patient. Instruction for continuing care should be given about prescribed medication, treatment, diet, activity, and when to contact a health care provider or schedule follow-up appointments.

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