'Nurse`s Work\r'

'I am a staff concur work at ad ministration sector at hematology department. My service as a staff nurse al some 4 years. This is my semester 2 as stainment which is to write a crusade moot for my long-suffering. I choose a tolerant with diagnosis of aplastic anaemia as my subject field study for this semester.\r\nAplastic anemia is a one type of p arnthood disorder. The trunks bone marrow in which the soft meander in the center of bones doesnt make lavish line of merchandise cells. (Bennington-Castro, 2015) . Our root is composed of three types of root cells in a liquid called pitch root plasma which is red line of descent cells, white extraction cells and thrombocyte. scarlet parenthood cells help to carry fresh oxygen to the bodys cells and pick disclose carbon dioxide away from cells (and to the lungs to be exhaled).While the bring of white blood cells is help to fight infections and unconnected invaders. thrombocytes ar disk-shaped cell fragments w hich help to form blood c bundles to stop exhaust. These blood cells yield their own lifespan and die naturally, to be replaced by new blood cells formed in bone marrow.\r\nWith out(a) this replacement process, wellness issues involving the heart and lungs, hemorrhage, and infection ordure develop. As a nurse, we should be very business organisationful when taking sustenance of forbearing with aplastic anemia. The purpose of this composition is to examine an aplastic anemia tolerant with respect to review of subjective and bearing data, determination of breast feeding diagnosis, formation of outcomes with interventions, evaluation of the outcomes that shag be identified based on the affected roles scenario. This paper ordain further discuss near the chief(prenominal) pretend problem that patient give be develop and the treat intervention for the problem developed. (Knott, 2014)\r\nIn his article:Epidemiology?The annual incidence of aplastic anemia is virtually two cases per million population.?Aplastic anemia is 2-3 times more(prenominal) common in Asia than in the West.?Acquired aplastic anemia most comm besides presents between the ages of 15 years and 25 years merely there is a bit smaller peak in incidence later holds age 60 years.?Certain histocompatibility locus specificities, in particular HLA DR2, argon associated with an underlying predisposition to acquired aplastic anemia.Nursing assessmentSubjective dataMr. X is 57 years old gentleman, came from one of the island at Malaysia, was admitted from incident into ward on 17/11/17 with complained of subdued dizziness, gum haemorrhage the day before admitted but he stated that it resolve by and bywards brushing teeth. He denies both chest pain, palpitations, orthopnea, cough, fever, or chills.\r\nAccording to the Mr. X he has been diagnose as aplastic anemia since February 2016 from the BMAT result on Feb 2016. Patient too stated that he give birth cognize case of hypert ension since 2012. According to the patient again he realize previous admission on 17/5/17 till 10/6/17 for UGIB secondary to thrombocytopenia. On 20/7/17, he was admitted due to low-pitched platelet wager and exhaust at gum. He was again hospitalized on 9/9/17 due to lot platelet find out. Patient denies con essencee of alcohol and smoking. He claims that he has no family history of malignancy and haemorrhage disorder.\r\nAccording to the patient, he is allergy to the antibiotic penicillin which will make his body develop rashes and itchiness with mild short of breath but no known of food allergy. Currently patient claims that he staying with his married woman and son.Objective dataPatient is alert, awake and oriented to self, place, and time. Full Glasgow coma scale noted (15/15). Upon physical examination, noticed scattered petechiae (pinpoint hemorrhages from arterioles or venules) at the buccal mucosa and everyplace two-sided hurrying limb and lower limb.\r\n Vital theater taken during the admission (17/11/17)\r\nBlood mash: 110/60mmHg\r\nPulse rate: 100/min\r\nRespiratory rate: 20/min\r\n underhandedly temperature: 37 degree Celsius\r\nBlood oxygen colour (Spo2): 99% on room air\r\n painfulness score: 1\r\nWeight: 70kg\r\nHeight: 162cm\r\n eubstance green goddess index (BMI): 26\r\nDiagnostic research laboratory taken during the admission (17/11/17).\r\nTEST reply Unit NORMAL RANGEHemoglobin (HGB) 7.8 g/dl 13.0-17.0Hematocrit (HCT) 22.4 % 40.0-50.0 blood platelet 4 10^3/uL 150-410White Cell Count (WCC) 1.3 10^3/uL 4.00-10.00Clinical progressReviewed by doctor in the ward, proposal for 4 unit platelet transfusion and 1 pint packed cell transfusion, watch out for nail tendency and was started medical specialty iv tranexamic acidulent 1g TDS and mouthwash tranexamic acid 10mls TDS. On the 19/11/17, 4 unit platelet transfusion make and no re achievement noted during the transfusion. No theater and symptom of shed blood noted.\r\nNur sing Diagnosis\r\nThe principal(prenominal) nursing problem concern for this patient is jeopardize of haemorrhage colligate to low platelet calculation follow by essay of magnetic inclination related to dizziness. This paper will focus on take chances of haemorrhage related to low platelet count based on the data collected. The nursing veneration plan will include intervention that is in general to provide health education for the patient, bleeding fear and bleeding reduction as well.Nursing Plan and InterventionFirstly, nurse should assess contract and symptom of bleeding. Assessment of clamber and mucous membrane for sign and symptom of petechial, brushing, hematoma formation, oozing of blood is great be s heath patient with low platelet count powerfulness experience bleeding into tissue. For my patient, I assess that he has scattered petechial (pinpoint hemorrhages from arterioles or venules) at the buccal mucosa and over reversible upper limb and lower limb on the day of his admission.\r\nAfter been transf utilizationd 4 unit of platelet on 19/11/17 no more petechial noted at patient buccal mucosa temporary hookup the petechial on the bilateral upper limb and lower limb is reducing. Beside this, admonisher patients full of life sign is valuable especially blood gouge and heart rate to tone for orthostatic hypotension. Tachycardia and hypotension are initial compensatory mechanisms endlessly evoke noted with bleeding (Wayne, 2016). Marc Hemeryck, a Medical advisor General practician ; Geriatrics besides state that hemorrhaging from internal and immaterial bed driving low blood pressure, so the heart needs to boost its output by pumping faster, thus this form of tachycardia is a necessary message for the body to compensate for the lower blood flow. (â€Å"What are possible causes of tachycardia and hypotension?” n.d.) This is patroniseed by â€Å"a major injury or internal bleeding base quickly deplete an individ uals body of blood and cause low blood pressure” (Saljoughian, 2014) which git support my statement.\r\nDuring the whole admission, 4 hourly vital sign was monitored and no ab regulation reading noticed. Stool and weewee should be inspect as well to look for any melena stool or hematuria. melena stool whitethorn be a sign of bleeding from upper gastrointestinal (Ansari, 2016). Whereas hematuria may indicate bleeding somewhere along the urinary tract (Mandal, 2014). Mr. x confuse a normal bowel open, no melena stool noted and normal urine output with amber emblazon urine noted. Lab result much(prenominal)(prenominal) as hematocrit and haemoglobin apprize be monitor because when bleeding is not visible, decrease of hematocrit and hemoglobin notify be an early sign of bleeding (Gil Wayne, 2016).\r\nDuring admission, Mr. X hemoglobin level noted is 7.8, after being transf apply of 1 pint packed cell hemoglobin subjoin to 9.0.Health anguish personnel should rid of intra venous or hypodermic injection or rectal procedure such as enema and rectal temperature as possible as this merchantman stimulate bleeding to patient and to depress inessential bleeding (â€Å"Risk for Bleeding | Bleeding | Platelet”, 2012).  [Should have been cited as www.scribd.com/doc/97160447 (2012)] H If hypodermic or intravenous procedure are necessary for the patient, apply pressure to the puncture site. No subcutaneous procedure one to Mr. X but solo intravenous procedure (set intravenous line) applied since medical specialty IV Tranexamic acid was ordered by doctor. Whereas, body temperature was taken on underarm for Mr. X and no rectal temperature taken.\r\nMaintaining safe environment for patient such as raise side rail for confound or restless patient, make sure outrage is dry and have enough light whoremonger delay patient from fall or injury. Mr. X is located at bed 12 which have adequate lighting and the floor at the ward invariably dry includin g the toilet. Medication adherence grass help to slim the take a chance of bleeding. Nurses should monitor patient to take his/her medication in the ward. I always make sure my patient to take his medication on time. Sometimes patient will postulate to take meal or to take john before taking his medication and I will monitor again if the patient already take the prescribe medication.\r\nHeath education play an authorised routine in our nursing. â€Å"It is a much bump idea to avoid bleeding rather than having it and consequently trying to deal with it” (Naik, n.d.). For this case, nurses can educate patient about precautionary measures to prevent tissue accidental injury or disruption of the normal clotting mechanisms. In the Nurses lab risk of infection for bleeding, by giving data to patient regarding precaution measures can decrease the risk for bleeding (Wayne, 2016). To maintain an oral hygiene, patient can use a soft-bristled toothbrush and nonabrasive to othpaste and avoid the use of toothpicks and dental floss. Mouthwash tranexamic acid are decreed to Mr. X and he was advice to buy a soft-bristled toothbrush to use. Patient follow the advice given.\r\nEducate to the patient and family members about signs of bleeding such as petechial that need to be reported to a health care supplier are vital as the health care provider can take early action and treatment for the patient which can reduce the complicatedness from blood loss. Mr. X always been remind by staff nurses to inform if he notice any brushing in the body of gum bleeding while brush teeth. Educate to patient the important need to use water-soluble lubricants during sexual congress as lubricants are used to reduce abrasion and tissue detriment that profit the risk for bleeding. Mr. also being teach to use lubricants.\r\nTeach the patient about measures to reduce constipation such as increased fluid aspiration and dietary fiber. terrible and dry feces may cause t rauma to the mucous membranes of the colon and rectum. Increasing fluid intake and dietary fiber soften the fecal mass for easier defecation. I advised my patient to take more vegetables and fluid intake to get easier defecation and Mr. x total fluid intake was around 1.5 set per day. Educate patient not do sinister lifting, contact sports, or strenuous exercise as it may increase the bleeding tendency. Mr. X was always being advised not to do toilsome lifting or strenuous exercise and he construe about that. Patients effortless activity at radix include washing clothes and cooking. Patient should be informed to wear proper fitting topographic point all the time both in and out doors to avoid cuts on their feet (â€Å"Learn about Managing Your Chemotherapy”, 2016). Mr. X are told to wear proper shoes and I noticed that patient always wear slippers instead of wearing shoes.\r\nEducate the patient and family members about constricting the use of herbal remedies that can increased risk for bleeding like dongquai, feverfew, ginger, ginkgo biloba, and chamomile). Most herbal preparations interfere with platelet aggregation through inhibition of serotonin release from the platelet. Other herbs increase the consummation of antiplatelet and anticoagulant medications, thus increasing the risk for bleeding.\r\nThe adjacent herbs can increase the bleeding tendency to a low platelet patients (Peters, n.d.): GINGER- Ginger is for gastric, distress, migraines and headaches but it can interfere with platelet function.GINSENG- Use to treat colic, infections, aging, and stress. It can increase bleeding, and have side effects of nausea, headaches, and blood pressure changes.GINKO- Used to treat Alzheimers and other repositing disorders but it also been associated with excess perioperative bleeding.GARLIC- Garlic has been used as a medicine for centuries. It has been advocated for highschool blood pressure, fungal infections, heart attack and cancer. C onsumption of garlic in high doses resulting in bleeding, nausea and pass as well as low blood sugar.Besides from herbal remedies, patient with high risk of bleeding should be very careful about their daily diet. Some food can lead to increase bleeding tendency.The Platelet inconvenience oneself Support tie-in (PDSA) states that the most common offenders for low platelet patients are foods that contain quinine (tonic water, bitter lemon, bitter melon), aspartame (diet soda, sugar-free and low-fat candy and cakes) or alcohol such as beer, wine, hard booze (â€Å"Eating for Health”, n.d.). (Stein, 2017) Says â€Å" prickly-leafed green vegetables and dairy farm product can help to reduce the risk of bleeding” in which this can support my statement. Leafy green vegetables are the best sources of vitamin K. The Platelet Disorder Support Association also recommends foods like curly-leaved green vegetables rich in vitamin K which is important for blood clotting and platelet creation.\r\nChairman Tan, registered dietician at Seventeen Nutrition Consultants advises: â€Å"Green fan-leaved vegetables such as broccoli, spinach, kale, Chinese vegetables like choi sum and kai lan are rich with antioxidants and rich in vitamins and minerals which are believed to reduce inflammation and help increase platelet count. (South China Morning Post, 2018) Dairy products such as milk can help your blood clot because of their calcium. Calcium is an essential mineral at seven different points in the coagulation go down that results in blood clotting when youve cut yourself, The Platelet Disorder Support Association recommends following an anti-inflammatory or macrobiotic diet to increase platelet counts. This diet focuses on whole grains, beans and vegetables and reduces animal foods.\r\n sesame oil has properties that can increase the platelet levels. 2 tablespoons of a natural sesame oil when taken orally twice a day, and even rub some externally on l ymph node areas can help to increase platelet counts over a period of several weeks (SINGLETON, 2017). I have told MR. X to consume more leafy green vegetables and beverage more milk at home and I strongly remind him not to take herbs as it efficiency increase the bleeding tendency and he claimed that he didnt take any herbs from others.EvaluationPatient being discharge on 20/11/17 with prescribed medication. Patient manage to get well and reduce bleeding tendency by adhere to the medication prescribed. and then from here, nurses play an importance role in ensure patient is adherence to their medication to prevent bleeding for deteriorate. Beside for adherence to the medication, patient supposed to be advice to strictly follow the date given by doctor for their To Come Again (TCA) appointment to have regular blood checkup as this can detect early sign of bleeding.\r\nDuring the admission, patient not receive any injury like fall because the environment provided is safe for the patient. Patient aware that he cannot do any hard activities that might cause bleeding. This case study can managed to meet the craved goal.ConclusionAlthough aplastic anemia is consider incurable but the measure of bleeding form aplastic anemia can reduce a lot of complication that can flagellum ones life. Hence patient must be inculcate clearly about the adherence to the medication prescribed. sustenance also play a vital role in reducing the bleeding tendency hence must be strictly implemented. Continuous of blood checkup must be strictly follow.\r\nThus it is important to the nurses to provide a good heath education to the patient to increase patient consciousness regarding the prevention of the bleeding that will take patients life. barroom is better can cure. We may never control illnesses such as cancer. In fact, we may never cure it. But an ounce of prevention is worthy more than a million pounds of cure. (Agus, n.d.). In makeup of this case study, I palpate happy that this pen meet the desired outcome. No further bleeding noted for my patient and no further worsening condition developed. I have learnt many things after writing this case study and I apprehend that I can use it to others patient as well to increase their health and living. I have learn what intervention I should do while patient in the ward and what education I can give to patient when he discharge.\r\nI manage to know what diet are recommended to the patient and what diet are not recommended to the patient. I feel glad to write this case study because I able to use this knowledge from what I have learnt not only to teach my patient but also to share the knowledge among my colleagues to repair our nursing care. In future, to improve the nursing care and practice, nurses might can put a sign over the patients bed as a reminder of bleeding precaution. This will make all the health care provider be more alert when use to the patient. Besides that, those patient with high ris k of bleeding can wear a bracelet as a sign of bleeding precaution to others as well.\r\nEnvironment also take a vital role in patients safety. Nurses can advise patient and patients family to create a safety environment such as put a holder in the bathroom as the floor wet and might easily fall down and not only focuses on the dry floor and adequate lighting. Creating a group of patient will high risk of bleeding can be consider as well. Nurses can gather them all and provide a health education to the patient. This can increase their sentiency of the bleeding precaution.\r\nAt the same time they can communicate and share their experience to reduce the risk of bleeding. I hope this will improve our nursing care and practice with a patient with high risk of bleeding tendency. Together we work to improve our patients well-being and our nursing care practice as a professional nurse.\r\n'