Chapter 2 Patient Assessment and Communication
Earn their respect
Earn their respect - never assume their respect
act like you know what you are doing
develop effective methods of patient communication
Safety & security
Love & belonging
Desire empathy - they can be at the worst place in life
They are making the best out of a bad situation
They often receieve callous disreguard and the runaround
We remove the patients dignity
what to eat and how much to drink
ability to evaluate what a patient needs
Models of thinking
Eventually you will get to a point of knowing what to do (habit)
Planning & implementation
Data Collection Process
Is patient fasting - ask, exam can not be done otherwise
Be well groomed
sensitive to needs
Advance healthcare directives
calling code rules
self concept / self esteem
Who am I?
the idea or mental image one has of oneself and one's strengths, weaknesses, status, etc.; self-image.
How one feels about themselves
pauses / speech rate
non-english speaking - don't need loud tone
The unspoken messages can often indicate how the patient feels more quickly than any words spoken
read body language to see how patient feels
various forms of nonverbal communication, wherein a person may reveal clues as to some unspoken intention or feeling through their physical behavior. These behaviors can include body posture, gestures, facial expressions, and eye movements.
follow hospital policy for translator
Developing harmonious working relationships
the patient should be made to feel that he or she is a partner in the examination process. Indeed, the patient is the most important member of the health care team and should be made to feel that he or she is sharing in the process.
Be as nice as you can
explain what you are doing
Blocks of Therapeutic Comnuication
Changing the subject
Demanding an explanation
Judgmental statements place the patient in the position of feeling that he or she must gain the approval of the health care worker in order to receive care.
Use open ended questions
ask probing questions
avoid leading questions
reword for claification
Interaction with patients
Patients may need reassurance, understanding and guidance to help them adjust to their situation
proper communication and interaction is important and rewarding
Consider when interacting with patients
use simple terms
explain the procedure
gear patient toward having realistic expectations
Do not think of a patient in abstract terms
patients may be anxious about exam
treat patients with respect for their individuality and physical condition
Infections are acquired in hospitals and other healthcare facilities. To be classified as a nosocomial infection, the patient must have been admitted for reasons other than the infection. He or she must also have shown no signs of active or incubating infection.
Standard Precautions are also called
What is the most common Nosocomial infections?
Urinary tract infections
Colorless, minute, one-celled organisms with a typical nucleus
Cells that require an oxygenated environment to live; may be either yeasts or molds
One-celled organisms; often parasitic and are able to move by pseudopod formation, by action of flagella, or by cilia
Minute microbes that cannot be visualized under an ordinary microscope; the smallest microorganism known to produce disease
Characteristics of Infectious Agents
Extremely toxic - the ability to infect, acess to the body, over come host defense, produce toxin or hypersensitivity
The ability to cause disease, cell injury, or death
Qualities of a suitable reservoir
organic material that is suitable for the life processes of the organism
across mucous membranes
Fomites - indirect contact
inert surfaces that have live organisms on or in them
involves contact with infectious secretions that come from the conjunctiva, nose, or mouth of a host or disease carrier as the person coughs, sneezes, or talks.
Droplets can travel from approximately 3 to 5 feet
Vehicle route of transmission includes food, water, drugs,or blood contaminated with infectious microorganisms
indicates that residue from evaporated droplets of diseased microorganisms are suspended in air for long periods of time. This residue is infectious if inhaled by a susceptible host.
insect or animal carriers of disease.They deposit the diseased microbes by stinging orbiting the human host.
Lines of Defense #1
-coughing & sneezing
Lines of Defense #2
increased blood flow
-vomiting & diarrhea
Lines of Defense #3
-response to antigens
-produced when an antigen is detected
-remain afterwards decreasing future occurances
-found in tears, saliva, colostrum
The pathogen enters the body and may lie dormant for a short period, then begins to produce nonspeciﬁc symptoms of disease.
More speciﬁc symptoms of the particular disease are exhibited. The microorganisms increase, and the disease becomes highly infectious.
Full disease stage
The disease reaches its fullest extent or, in some cases, produces only vague, sub-clinical symptoms; however, the disease continues to be highly infectious.
The symptoms diminish and eventually disappear. Some diseases disappear, but the microbe that caused the disease goes into a latent phase.
Examples of these diseases are malaria, tuberculosis, and herpes infections.
Hepatitis B & C
Drug resistant organism - MERSA
HIV is a retrovirus.
This means that it converts itsviral material from RNA to DNA after it penetrates thehost cell. Retroviruses have an enzyme complex called reverse transcriptinase which boosts their ability to replicate and destroy the host cell.
Health care workers most often contract hepatitis B from needle-stick injuries.
Persons who share contaminated needles orhave multiple sex partners and hemophiliacs are mostsusceptible to blood-to-blood methods of contracting
Health care workers most often contract hepatitis B from needle-stick injuries.
prevalent in persons who share contaminated needles Persons who have multiple sexual partners, IV drug users, and persons needing multiple transfusions are most apt to contract this disease.
Tuberculosis is a recurrent, chronic disease caused by the spore-forming Mycobacterium tuberculosis. This disease most commonly affects the lungs, but is capable of infecting any part of the body. With the increasing immigrant population from third-world countries into the United States and the increase of HIV, tuberculosisis increasing in incidence in the United States.
Methicillin-resistant Staphylococcus aureus(MRSA): Shortly after penicillin was used to treat S. aureus it became resistant to it. The newer semi-synthetic penicillin (methicillin) was used success-fully for a time to treat these infections, but the war against S. aureusis being lost as it becomes resistant to this drug.
Prevention through Asepsis
Medical Asepsis - clean technique
Surgical Asepsis - sterile technique
Breaking the chain of infection
breaking any link in the chain of infection and you have stopped the transmission of the disease
-decrease the microrganism
-eliminate the modes of transmission
eliminate the susceptible host
How do we break the chain of infection?
Proper cleaning of surfaces
Early identification of potential hosts
Use personal protective Equipment
Maintain your physical and mental health
Personal Protective Equipment
patient care equipment
Inhibiting the growth of microorganisms
Only bacteriostatic (inhibit growth) eg. 70% ETOH
Destroy most bacteria and viruses eg. 10% solution of bleach, quaternary ammonia products, enzymatic cleaners
Destroys all microorganisms
Nurses can risk musculo-skeletal disorders from lifting incorrectly
lift as (or close to) the center of gravity
Use thigh muscles
Center of Mass/gravity
is the point at which the mass can be imaged to act
pelvic region near the base of the spine
for stability the force should act inside the base of support.
You must plan for the amount of assistance needed to complete the move safely
Be cautious - make sure the patient has orders to leave for exam
Lock all wheels before any transfer
give short and simple commands
sliding board transfer
non skid shoes
explain the move
ask the patient to help you
ask for help from a colleagues when you reach your destination