Learning Aims:

Discuss the care of a patient who is experiencing an imbalance in fluids and electrolyte status
Interpret diagnostic test results as they apply to pathophysiology and care of the patient.
Identify appropriate communication with members of the health care team when reporting assessments/data using organized approach/tool such as SBAR
Discuss the assessments and interventions related to acute pain
Identify how the nurse can include the involvement of family members/significant others in the care of Mrs. Newman

SBAR

S – Situation

- Briefly describe the current situation

- Give a clear, succinct overview of pertinent issues

B – background

- Briefly state the pertinent history

- What got us to this point?

A –Assessment

- Summarize the fact and give your best assessment

- What is going on? Use your best judgement

R – Recommendation

- What actions are you asking for?

- What do you want to happen next?

SBAR technique provides a standardized framework for communication between members of the healthcare team about a patient’s condition. SBAR is an easy-to-remember mechanism useful for framing conversations, especially critical ones, requiring immediate attention and action.

Using the SBAR model allows for an easy and focused way to set expectations for what will be communicated between members of the team, which is essential for developing effective teamwork and fostering a culture of patient safety.

http://www.nursingcenter.com/journalarticle?Article_ID=715155

NG Tubes

- Candidates include patients who have adequate digestion and absorption but cannot ingest, chew, or swallow food safely or in adequate amounts

- A feeding tube is administered into the stomach or small intestine

- For short term feeding nasal or oral feeding tubes are appropriate

- NG feeding tubes are often inserted at the bedside without technological assistance

- Most serious complication is inadvertent pulmonary intubation – enter the airway undetected and can lead to serious pulmonary injury

- Feeding tubes are positioned into the small bowel to reduce the incidence of pulmonary aspiration of stomach contents

- Variation in colour and pH of fluid withdrawn from feeding tube can help indicate tubes positioned in the stomach from those in the small intestine but the best measure is an X-ray

- Carbon dioxide detectors can help locate the position of tubes during insertion by changing the colour of the sensor but X-ray is still more reliable

- Maintaining and monitoring tube location during feeding and keeping the head-of-bed elevation at a minimum of 30 degrees effectively reduces aspiration and subsequent pneumonia

- Measurement of gastric residual volumes is done routinely to identify risk for regurgitation and pulmonary aspiration of gastric contents; involves withdrawing and measuring the contents of the stomach at regular intervals

- Oral hygiene and care of the nasal passage or tube insertion site promote patient comfort during tube feeding and can reduce complications

Lewis, S.L., Heitkemper, M.M., Dirksen, S.R. (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems (3rd Canadian Ed.). Toronto, ON: Elsevier/Mosby.

	Created by D R about 9 years ago

Medsurg p 1192-95