Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

Jobless nurses in Kenya to be offered ‘special route’ to work in NHS

Unemployed nurses in Kenya are to be offered work in health services across the UK, as part of a new arrangement between the two nations' governments. The deal, backed by Kenyan president Uhuru Kenyatta, will see nurses and health workers in the African country currently…

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Nurse reports to guardian scheme increased during year of pandemic

A record number of concerns were raised with Freedom to Speak Up Guardians during the year of the coronavirus pandemic, including nearly 6,000 from nurses and midwives. In 2020-21, 29% of all cases lodged were by nurses and midwives, making them the occupation most likely…

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New equipment to allow university to train more nurses in endoscopy

Cancer diagnosis training is set to open up to more nurses thanks to a programme being launched in Liverpool. The Liverpool John Moores University already offers endoscopy training as part of a partnership with Mersey School of Endoscopy at the Royal Liverpool University Hospital. “Our…

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London-based nurse to represent refugees in Olympic weightlifting

A weightlifter, who was inspired to become a nurse in London thanks to the support he received when seeking asylum from Cameroon, is set to compete at the Olympic Games in Tokyo this weekend. Cyrille Tchatchet II, a physical health lead nurse for Harrow inpatient…

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Midwives urged to encourage pregnant women to get Covid-19 jab

Midwives and priamry care nurses have been urged to ramp up efforts to encourage pregnant women to have the Covid-19 vaccine, following the release of concerning new data. The chief midwifery officer for England has written to midwives and GP practices calling on health professionals…

The post Midwives urged to encourage pregnant women to get Covid-19 jab appeared first on Nursing Times.



West Sussex trust appoints former RCN chief executive as new chair

Former Royal College of Nursing chief executive and general secretary Dr Peter Carter has been appointed as chair of an NHS trust in West Sussex. Dr Carter will take up the role at Queen Victoria Hospital NHS Foundation Trust in October 2021 following the retirement…

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Nurses to march to No 10 in protest against ‘underwhelming’ pay deal

Nurses and colleagues are gearing up to march to Downing Street and express their anger and disappointment over the government’s latest pay deal for those working in England’s NHS. Members of Unite’s Guy’s and St Thomas’ Hospital branch will assemble on Friday to show ministers…

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Hospice where nurses were ‘de-skilled’ is placed into special measures

A nurse-led hospice has been placed into special measures after an inspection by the Care Quality Commission found a number of “significant issues” that had put patients’ safety at risk. Barnsley Hospice in South Yorkshire has been given an overall “inadequate” rating by the CQC…

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Amanda Pritchard confirmed as first female head of NHS in England

Amanda Pritchard has been appointed chief executive of NHS England, making her the first woman to hold the top job in the 70 year history of the health service. Ms Pritchard is set to take over when Lord Stevens stands down at the end of…

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Mental health needs of frontline nurses ‘not met during pandemic’

Nursing staff working on the Covid-19 frontline needed more consistent mental health care, according to findings from a new UK study. The mental health support offered to respiratory nurses working with Covid-19 patients during the first wave of the pandemic was “inconsistent”, the study found.…

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RCN plannings protests against ‘inadequate’ nurse pay award

The Royal College of Nursing is planning a ‘summer of action’ to protest against the 3% pay increase that has been announced for nurses and other NHS workers in England. Last week’s annaouncement that, for their “extraordinary efforts” during the coronavirus pandemic, nurses and other…

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Foundation trust in North East appoints new chief nurse

Gateshead Health NHS Foundation Trust has announced the appointment of Gillian Findley as its new chief nurse. Ms Findley joins the Gateshead-based provider from County Durham Clinical Commissioning Group, where she has been director of nursing and quality for the last seven years. “I’m passionate…

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Plea for funding to support NHS through ‘hardest yet’ phase of pandemic

The NHS is under as much pressure now as at the height of the Covid-19 pandemic and will require continued emergency-levels of funding to get through the winter ahead, health service leaders have warned the government. In a letter addressed to the prime minister, the…

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Nurses facing investigation to be offered ‘buddy’ support through new pilot

A new buddy scheme pilot is being launched to support nurses and midwives whose fitness to practise is being investigated. The “Buddy – hold my hand” pilot will begin in September and is being run by the campaign organisation NMC Watch with funding from the…

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Chief nurse appointed across two London trusts in integration drive

An experienced senior nurse has been appointed as chief nurse across both a hospital and a community trust in London, as part of a drive to achieve more integrated ways of working. Nic Kane has accepted the position as chief nurse for Kingston Hospital NHS…

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Police investigating struck-off anti-vax nurse after likening NHS staff to Nazis

The police are investigating comments made at the weekend by a struck-off nurse at an anti-lockdown and anti-vaccine protest, where she likened Nazis executed after the Nuremberg trials to NHS staff giving Covid-19 jabs. Kay Shemirani, more commonly known as Kate, is a conspiracy theorist…

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More mental health nurses needed to meet proposed access guarantees

New government proposals on improving access to mental health services will require investment in the nursing workforce if they are to be realised, mental health leaders have warned. They said having “enough staff with the right training” would be a challenge to rolling out new…

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Nurses in Northern Ireland still ‘anxiously waiting’ for pay deal

Nurses in Northern Ireland deserve to know what pay award they will be receiving “as soon as possible”, the Royal College of Nursing has urged, as the wait for an announcement continues. Health staff on Agenda for Change contracts in Northern Ireland are yet to…

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First-of-its-kind study aims to support midwives with substance use

A new research project has been launched to identify the rate of problematic substance use among midwives in the UK and to try and help ensure appropriate support and intervention is in place. A midwifery academic at Coventry University, Dr Sally Pezaro, is leading work…

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Nurse brings Sepsis Six care bundle to life with creative characters

A nurse’s creative idea for educating colleagues about the management of sepsis has been rolled out by her trust. Jess Davies, critical care nurse and former sepsis champion at the Shrewsbury and Telford Hospital NHS Trust, has created characters to represent the Sepsis Six. The…

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Mental health survey of ITU staff reveals PPE and insomnia concerns

Insomnia was experienced by more than three-quarters of intensive care unit (ITU) staff who took part in a global mental health study during the early stages of the coronavirus pandemic. The study, published in the British Journal of Nursing, found that out of the 515…

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First-of-its-kind study shows hospital infections costing Scottish NHS £46m a year

A major new study on hospital associated infections (HAIs) in Scotland will help the NHS “maximise every opportunity” to further reduce them, a nurse in the country’s government has said. Irene Barkby, associate chief nursing officer for healthcare infections at the Scottish Government, said preventing…

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Nursing unions pledge to give members their say on ‘enforced’ 3% pay deal

The 3% pay award for NHS nurses in England and Wales will do nothing to address the recruitment and retention problems facing the health service, and has shown “yet again” that ministers do not value the workforce, leading health unions have told Nursing Times. The…

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Pay body questions whether nurses have outgrown Agenda for Change

The current system for renumerating nurses in the NHS should be reviewed to ensure that it “accurately reflects” the profession’s skills and contribution, the NHS Pay Review Body has recommended. In a report to ministers, the independent body questioned whether the Agenda for Change (AfC)…

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Finalists announced for the Nursing Times Awards 2021

The nurses, teams, projects and employers that have made the shortlist for the 2021 Nursing Times Awards have been revealed today. Find out if your organisation, colleagues or someone you know has really impressed our judges and made it on to the shortlist in one…

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Defamation and dress reform: The first editor of Nursing Times

Journal rivalries that ended up in court, questions over her loyalty during wartime and the right to wear comfortable clothing were all battles fought by the first editor of Nursing Times. While recently updating the Nursing Times Wikipedia entry, I decided to add some historical…

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‘Disappointment’ as NHS nurses in Wales also offered 3% pay award

The Welsh Government has announced a 3% pay rise deal for NHS nurses in Wales, in line with the offer made in England. Welsh health minister Eluned Morgan said the wage increase “recognises the dedication and commitment” of staff. “Members are disappointed and upset that…

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Government backtracks with 3% pay offer for nurses in English NHS

The government has put forward a late-in-the-day offer of a 3% pay rise for nurses working in the NHS in England, after facing a backlash earlier today for further delaying the decision. In a statement issued this evening, health and social care secretary Sajid Javid…

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Nurses back appeal for national neonatal safety champion role

The government has been urged to appoint a national neonatal safety champion to help improve patient outcomes and enhance collaborative working across maternity, obstetric and neonatal services in the UK. An open letter, signed by the Neonatal Nurses Association and other key perinatal groups, has…

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‘An insult of the highest order’: Government fails to announce NHS pay offer

The government has been condemned for failing to make an announcement today on the pay rise it will be offering to NHS staff in England, which is already delayed by three months. It was anticipated that care minister Helen Whately was going to use her…

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Unions call for investment in workforce amid plans for extended flu jab drive

The seasonal influenza vaccination programme will be extended again this year to reach more people, in a bid to “limit the impact” on the NHS and social care this winter, especially amid Covid-19. Health officials have warned that the incoming flu season is “highly unpredictable”,…

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Female staff member stabbed at hospital in Wolverhampton

A man has been arrested in connection with the stabbing of a female hospital worker in Wolverhampton today. The victim is not believed to have sustained life-threatening injuries during the attack, which took place at New Cross Hospital around 11am. “Fortunately, the woman's injuries are not…

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Current acting RCN chief to remain as college leader until late 2022

The Royal College of Nursing has announced that Pat Cullen will continue to lead the college for the next 18 months, following the resignation of Dame Donna Kinnair. Ms Cullen has been chief executive and general secretary of the RCN in an acting capacity since…

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NHS asked to prepare Covid-19 vaccines for vulnerable children ‘as soon as possible’

Children aged 12 to 15 in the UK who are at increased risk of serious Covid-19 infection are to be offered vaccination against the virus, it has been confirmed. In addition, those aged 12 to 17 who live with an immunosuppressed individual are also set…

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Community nurses ‘felt isolated’ delivering end-of-life care during first wave

The increased need for end-of-life care and the way services changed during the first wave of the coronavirus pandemic has taken a “significant emotional toll” on community nurses, a first-of-its-kind study has found. New research from the University of Sheffield, published in BJGPOpen, revealed that…

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NMC chief urges public to continue to exercise Covid-19 caution

Continuing to be cautious to prevent the spread of Covid-19 is the best way people can thank nursing staff for their efforts during the pandemic, the head of UK nursing regulator has urged today as restrictions ease further. Andrea Sutcliffe, chief executive and registrar for…

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Government has ‘ignored’ more than 20 crucial workforce warnings, says RCN

The government has been accused of ignoring a catalogue of warnings about the nursing workforce crisis over the past five years and has been urged to use new legislation to fix nurse shortages once and for all. The Royal College of Nursing said ministers had…

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Blanket self-isolation rules dropped for nurses in England to ‘ease pressures’

Fully vaccinated nurses who are told to self-isolate will be allowed to continue to attend work in cases where their presence is deemed critical to the safe running of services, the government has announced today, amid concerns over staff shortages. The rule change applies to…

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On your side: A look back at campaigns run by Nursing Times

Nursing Times has a history of successfully campaigning on issues of importance to the nursing profession. Below you will find information on some of our more recent campaigns, their aims and achievements. During the last decade and more, Nursing Times has campaigned for protected time…

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History of Nursing Times: The 1990s and early 2000s

The 1990s and 2000s saw Nursing Times run many campaigns. In 1992 Nursing Times launched the Mind Your Back campaign, calling for nurses to have the right to be protected from back injury caused by inappropriate lifting and for full implementation of new EC rules…

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History of Nursing Times: The 1980s

Nursing Times’ decade started with a ‘Save It’ campaign aimed at nurses looking for ways to save the NHS money, so that more could be spent on better patient care. This prompted many interesting suggestions including dispensing with nurses’ paper caps, reducing spending on advertising…

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History of Nursing Times: The 1970s

In January 1971, then Nursing Times editor Peggy Nuttall asked readers to call her up with their thoughts and opinions rather than send the usual letters and all because of a postal strike. The UK joined the European Economic Community in January 1973. A Nursing…

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History of Nursing Times: The 1960s

A prophetic article was published in Nursing Times in 1960 by Claire Rayner, then an out-patient sister, who regretted the number of women forced to use backstreet abortionists. The solution, she proposed, was a change in the law ‘making performed therapeutic abortion available to these…

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History of Nursing Times: The 1950s

At the start of the decade Nursing Times reported on the RCN’s attempts to raise £500,000 to ensure finances for its service to provide further education and special preparation of trained nurses to become nurse teachers, managers and specialists of the future. Nursing Times published…

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Fears government will finish for summer break without announcing NHS pay deal

Nurses and health workers are becoming “increasingly concerned” around the stalling of the government’s pay announcement, with fears they could be waiting until September to receive a decision, a leading union has warned. Unison has accused the government of treating NHS staff as an “afterthought”…

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High Court asked to review case of nurse who was racist about colleagues

The decision to only suspend a nurse who admitted saying racist remarks about colleagues has been referred to the High Court following a review by the super-regulator. The Professional Standards Authority (PSA) determined that the Nursing and Midwifery Council’s ruling in the case of mental…

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Former president among recipients of RCN fellowships and awards

Former Royal College of Nursing president Dr Cecilia Anim is among the organisation’s members recognised this year with fellowships, honorary fellowships, merit awards and other. Dr Anim, a clinical nurse specialist in sexual and reproductive health, was the first president of the RCN from a…

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Fresh safety concerns aired over NMC review of community qualifications

The Nursing and Midwifery Council’s controversial review of post-registration standards has received a major blow through the resignation of a high-profile nurse from the steering group. Workforce academic Professor Alison Leary told Nursing Times she had stepped down because the NMC’s proposals were “incompatible” with…

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History of Nursing Times: The 1940s

War brings new clinical challenges to health professionals – mainly in the shape of traumatic injuries they would rarely if ever see in peacetime. Like their medical colleagues nurses needed to learn quickly how to care for these injuries, and Nursing Times was on hand…

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History of Nursing Times: The 1930s

After 35 years in which its appearance had barely changed, Nursing Times updated its look in 1939. The staid front covers filled with long editorial comment and full-page advertisements were replaced by a black and white photograph and blue surround. An editorial comment in 1932…

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New survey seeks nurse views on 12-hour shift patterns

A new survey has been launched to uncover what it is that nurses value about 12-hour shifts and what push back they may have against changing these work patterns. Nurse researchers at the University of Southampton have been studying nurse shift patterns for the past…

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History of Nursing Times: The 1920s

In the 1920s Nursing Times had changed little since its launch, and provided an eclectic mix of news, clinical information and articles of general interest and kept readers updated on professional issues. However, true to form, when asked to give a lead in voting for…

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History of Nursing Times: Its second decade 1911 to 20

Recognising the practical nature of its readers, in 1912 Nursing Times organised one of its earliest competitions – for inventions and ideas. The journal had a stall at the London Nursing and Midwifery Exhibition, on which it planned to display inventions by nurses, midwives, masseuses…

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History of Nursing Times: The early years 1905 to 1910

Nursing Times did not so much burst on the scene as tap on the door and wait to be invited in. Publishing was a genteel business in 1905, and this was very much the tone of the early Nursing Times. The editor for the first…

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Nurse’s dementia therapy dog gets hospital patients talking and walking

A nurse in the North of England has told how patients with dementia are reaping the physiological and psychological benefits of animal assisted therapy thanks to her specially trained Labrador retriever. Julie Young, an advanced nurse practitioner at Cumbria, Northumberland, Tyne and Wear NHS Foundation…

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CNO confirms masks and distancing will continue in English health settings

Mask wearing and social distancing will remain across health and care settings in England beyond the easing of Covid-19 restrictions elsewhere to protect both staff and patients, the country’s chief nurse has confirmed. The move has been welcomed by nursing and health leaders who stressed…

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Review to look at long-term workforce needs for health and social care  

A review is set to take place into the future workforce needs of the health and social care sectors in England, fuelled by rising demand for services and current staffing shortages. Health Education England announced today that it had been commissioned by the government to…

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RCN temporarily suspends council member pending conduct investigation

The Royal College of Nursing has announced that Dave Dawes has now been formally suspended from his council positions pending an investigation into his conduct. It was revealed yesterday that Mr Dawes would be voluntarily stepping aside as chair of the RCN's governing body while…

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Government urged to fix workforce planning ‘omission’ from Health and Care Bill

The lack of provisions in the new Health and Care Bill for addressing the current shortages of nurses and other key staff is a "glaring omission" and must be redressed, nursing and health bodies have urged in an open letter. The groups, which include the…

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Caution urged over proposals to drop self-isolation rules for nurses early

Ministers in England and Scotland are considering scrapping self-isolation rules for double-vaccinated nurses ahead of the rest of the population to ease workforce pressures amid high Covid-19 cases and rising hospitalisations. But some groups, including the Royal College of Nursing, have urged caution and want…

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Student nurses surveyed about confidence in delivering respiratory care

Nurse academics in Scotland have launched a study to explore the extent to which the nursing workforce of the future will be equipped to deal with the rising incidence of respiratory disease. Dr Nicola Roberts and Maria Renwick, from the nursing department at Glasgow Caledonian…

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New framework seeks to boost nurse skill and knowledge in rare cancer

Nurse specialists in neuroendocrine cancer have developed a first-of-its-kind competency framework for fellow nurses caring for patients with the rare disease. The framework aims to address an “identified gap in nurse education” relating to this group of cancers, which affect the cells that release hormones…

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RCN Council chair steps down as investigation launched into conduct

The chair of the Royal College of Nursing’s governing council has stepped down from his role while an investigation looks into a "number of complaints" about his conduct. Dave Dawes, who has been in the role for less than a year, will be replaced on…

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Nurses ‘perplexed’ by RCN Council’s stance on protecting ‘nurse’ title

Members of the nursing profession have expressed disappointment and confusion over the stance taken by the Royal College of Nursing on a movement to protect the job title “nurse” in UK law. A petition calling for protection of "nurse" was launched by nursing workforce academic…

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Nurse academic recognised as one of profession’s ‘most accomplished leaders’

Leading nurse professor Laura Serrant has been appointed to a prestigious role with the American Academy of Nursing (ANN). Professor Serrant, a regional head of nursing and midwifery at Health Education England, has been inducted as a fellow to the ANN. "One thing we have…

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Checklist launched for nurses on avoiding childhood vaccination errors

A new best practice checklist has been released for general practice nurses managing and delivering childhood immunisation programmes in the UK. Based around eight rules, the guidelines have been published by the Royal College of Nursing and provide tips for nurses on how to avoid…

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University honours student response to Covid-19 with new rainbow mural

A new commemorative mural featuring the names of nursing, paramedic and midwifery students who helped respond to the Covid-19 emergency has been unveiled at the University of Surrey. The display includes an image of a rainbow and is emblazoned with the words: “Your efforts will…

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Report highlights nurse workforce challenges in drug addiction services

Urgent action is needed to boost the number of nurses and other key health professionals working within substance misuse teams to ensure people with drug addiction can receive a higher quality service, a new report has warned. An independent review into the illegal use of…

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RCN members working for end-of-life care charity reject pay offer

The Royal College of Nursing is launching formal pay negotiations with Marie Curie after its members who work for the charity voted to reject an offer of a 2% wage increase. The offer from the charity, whose nursing staff provide end-of-life care to patients across…

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Diabetes specialist nurses to share expertise with peers in South East Asia

A pair of leading diabetes specialist nurses have become the first UK nurses to join a new charity initiative that is seeking to improve outcomes for children and young people with type 1 diabetes in South East Asia. Bethany Kelly and Amanda Epps, the nurses…

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UK studies find ‘very low’ risk of severe Covid-19 illness in children

The risk of severe illness and death from coronavirus is extremely low in children and teenagers, according to those behind the UK’s most comprehensive analysis of public health data yet. The risk is slightly higher, but remains low overall, for the most vulnerable young people,…

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Pioneering fast-track practice nursing course underway in Leeds

What is thought to be the first ever fast-track programme for aspiring general practice nurses is underway in West Yorkshire. Leeds City College is delivering the course as part of a fully-funded pilot in partnership with the West Yorkshire Consortium of Colleges (WYCC) and Practicum,…

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Specialist nurse to support asbestos-related cancer patients in east Yorkshire  

Ian Collins has been appointed by Mesothelioma UK as its new clinical nurse specialist for Hull and will be based at the Hull University Teaching Hospitals NHS Trust. He will provide nursing care and support for mesothelioma patients in Hull and Humber catchment areas, said…

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Care home provider begins consultation on mandatary Covid-19 jabs

A care home provider has started a consultation with staff and unions over the controversial move of making having had the Covid-19 vaccine a condition of its employment throughout the UK. HC-One said today it was entering into consultation with its staff and their recognised…

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Commemorative coin marks year of the nurse and pandemic effort

A commemorative coin and certificate have been issued by the International Council of Nurses (ICN) and the World Health Organization (WHO) to mark the recent efforts of the profession. They are intended as a thank you to ICN member national nursing associations for their service…

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Warning NHS ‘buckling’ under strain of winter pressures during summer

Overwhelming demand is putting “severe and unprecedented strain” on the health service’s urgent care system, health sector leaders are warning, as new figures show record levels of demand. They highlighted that unsustainable numbers of people were now visiting accident and emergency departments, seeking primary care…

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Nurse draws on own experience to launch ‘rainbow babies’ book series

A nurse who lost her son 12 days after birth has written a series of books to help parents navigate "difficult conversations" with children about miscarriage, stillborn or neonatal death. Amy Draper was 18 years old when her first child Charlie died at Liverpool Women’s…

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Nursing tartan range created by nurses in Scotland launches to public

A new tartan created to celebrate nursing has been officially launched, and it has been announced that all profits made from sales will be invested back into the profession. The Nursing Tartan was conceived by nurses in Scotland and features the colours of blue and…

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New study with Chilean hospitals adds to evidence on safe nurse staffing

Patients in hospitals where nurses have high caseloads are 41% more likely to die and 20% more likely to be readmitted than those in facilities where nurses are less burdened, according to a new study in South America. Published in The Lancet Global Health and…

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‘Reckless’: Nurses sound alarm over plans to scrap Covid-19 rules on 19 July

Nurses have told Nursing Times that plans to remove Covid-19 restrictions, such as social distancing and mask wearing, while cases and hospital admissions are on the rise have left them feeling “nervous” and “extremely worried". Some nurses described the proposals as “reckless”, while others feared…

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Leading nurse resigns from RCN role and urges ‘sweeping changes’

An influential nurse has resigned from her position on the governing council of the Royal College of Nursing with immediate effect. Dr Joan Myers, a Queen’s Nurse and trustee of the Florence Nightingale Foundation, has stepped down from her role as RCN Council member for…

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Congestive Heart Failure (CHF)

 Description

  • Congestive Heart Failure or CHF is a severe circulatory congestion due to decreased myocardial contractility, which results in the heart’s inability to pump sufficient blood to meet the body’s needs.
  • CHFAbout 80% of CHF cases occur before 1 year of age
Etiology
  1. The primary cause of CHF in the first 3 years of life is CHD.
  2. Other causes in children include:
  • Other myocardial disorders, such as cardiomyopathies, arrhythmias, and hypertension
  • Pulmonary embolism or chronic lung disease
  • Severe hemorrhage or anemia
  • Adverse effects of anesthesia or surgery
  • Adverse effects of transfusions or infusions
  • Increased body demands resulting from conditions such as fever, infection and arteriovenous fistula
  • Adverse effects of drugs, such as doxorubicin
  • Severe physical or emotional stress
  • Excessive sodium intake
                  1. In general, causes can be classified according to the following:
                  • Volume overload may cause the right ventricle to hypertrophy to compensate for added volume.
                  • Pressure overload usually results from an obstructive lesion, such as COA
                  • Decrease contractility can result from problems such as sever anemia, asphyxia, heart block and acidemia.
                  • High cardiac output demands occur when the body’s need for oxygen exceeds the heart’s output s seen in sepsis and hyperthyroidism.
                  Pathophysiology
                  • Right ventricular failure occurs when the right ventricle is unable to pump blood into the pulmonary circulation. Less blood is oxygenated and pressure increases in the right atrium and systemic venous circulation, which results in edema of the extremities.
                  • Left ventricular failure occurs when the left ventricle in unable to pump blood into systemic circulation. Pressure increases in the left atrium and pulmonary veins; then the lungs become congested with blood, causing elevated pulmonary pressure and pulmonary edema.
                  • To compensate, the cardiac muscle hypertrophies eventually resulting in decreased ventricular compliance. Decreased compliance requires higher filling pressure to produce the same stroke volume. Increased muscle mass impedes oxygenation of the heart muscle, which leads to decreased contraction force and heart failure.
                  • As cardiac output fails, stretch receptors and baroreceptors stimulate the sympathetic nervous system, releasing catecholamines that increase the force and rate of myocardial contraction.
                  • This causes increased systemic resistance, increased venous return, and reduced blood flow to the limbs, viscera and kidneys.
                  • Sweating results from sympathetic cholinergic fibers, there is extra work for the heart muscle, and there is less systemic blood flow.
                  • The renal system responds by releasing renin-angiotensin, which sets off a chain of events – vasoconstriction, leading to increased aldosterone release, causing sodium and water retention and, in turn, increasing preload. Finally, sodium and water retention becomes excessive, resulting in signs of systemic venous congestion and fluid overload.

                  chf-pathophysiology_5

                  Assessment
                  1. Right ventricular failure
                  • Signs of right ventricular failure are evident in the systemic circulation
                  • Pitting, dependent edema in the feet, legs, sacrum, back, and buttocks
                  • Ascites from portal hypertension
                  • Tenderness of right upper quadrant, organomegaly
                  • Distended neck veins
                  • Pulsus alternans (regular alteration of weak and strong beats noted in the pulse)
                  • Abdominal pain, bloating
                  • Anorexia, nausea
                  • Fatigue
                  • Weight gain
                  • Nocturnal diuresis
                      2. Left ventricular failure
                  • Signs of left ventricular failure are evident in the pulmonary system
                  • Cough, which may become productive with frothy sputum
                  • Dyspnea on exertion
                  • Orthopnea
                  • Paroxysmal nocturnal dyspnea
                  • Presence of crackles on auscultation
                  • Tachycardia
                  • Pulsus alternans
                  • Fatigue
                  • Pallor
                  • Cyanosis
                  • Confusion and disorientation
                  • Signs of cerebral anoxia
                      3. Acute pulmonary edema
                  • Severe dyspnea and orthopnea
                  • Pallor
                  • Tachycardia
                  • Expectoration of large amounts of blood-tinged, frothy sputum
                  • Wheezing and crackles on auscultation
                  • Bubbling respirations
                  • Acute anxiety, apprehension, restlessness
                  • Profuse sweating
                  • Cold, clammy skin
                  • Cyanosis
                  • Nasal flaring
                  • Use of accessory breathing muscles
                  • Tachypnea
                  • Hypocapnia, evidenced by muscle cramps, weakness, dizziness, and paresthesias
                  Diagnostic Evaluation
                  1. Chest radiography reveals cardiomegaly and pulmonary congestion
                  2. CBC reveals dilution hyponatremia, hypochloremia, and hyperkalemia
                  3. ECG reveals ventricular hypertrophy
                  Primary Nursing Diagnosis
                  • Decreased CO related to an ineffective ventricular pump
                  Medical Management
                  • Initial management of the patient with HF depends on severity of HF, seriousness of symptoms, etiology, presence of other illnesses, and precipitating factors. Medication management is paramount in patients with HF. The general principles for management are treatment of any precipitating causes, control of fluid and sodium retention, increasing myocardial contractility, decreasing cardiac workload, and reducing pulmonary and systemic venous congestion. The physician may also prescribe fluid and sodium restriction in an attempt to reduce volume and thereby reduce preload.
                  Surgical Management
                  • Coronary bypass surgery, PTCA, other innovative therapies as indicated (e.g, mechanical assist devices , transplantation)
                  Pharmacologic Intervention

                  Alone or in combination: vasodilator therapy (angiotensin-converting enzyme (ACE) inhibitors), angiotensin II receptor blockers (ARBs), select beta-blockers, calcium channel blockers, diuretic therapy, cardiac glycosides (digitalis), and others

                  • Dobutamine, milrinone, anticoagulants, beta-blockers, as indicated
                  • Possibly antihypertensives or antianginal medications and anticoagulants
                  Nursing Intervention
                  1. Monitor for signs of respiratory distress
                    • Provide pulmonary hygiene as needed
                    • Administer oxygen as prescribed
                    • Keep the head of the bed elevated
                    • Monitor ABG values.
                  2. Monitor for signs of altered cardiac output, including
                    • Pulmonary edema
                    • Arrhythmias, including extreme tachycardia and bradycardia
                    • Characteristic ECG and heart sound changes
                  3. Evaluate fluid status
                    • Maintain strict fluid intake and output measurements
                    • Monitor daily weights
                    • Assess for edema and severe diaphoresis
                    • Monitor electrolyte values and hematocrit level
                    • Maintain strict fluid restrictions as prescribed
                  4. Administer prescribed medications which may include:
                    • Antiarrhythmias to increase cardiac performance
                    • Diuretics, to reduce venous and systemic congestion
                    • Iron and folic acid supplements to improve nutritional status.
                  5. Prevent Infection
                  6. Reduce cardiac demands
                    • Keep the child warm
                    • Schedule nursing interventions to allow for rest
                    • Do not allow an infant to feed for more than 45 minutes at a time
                    • Provide gavage feedings if the infant becomes fatigued before ingesting an adequate amount
                  7. Promote adequate nutrition. Maintain a high-calorie, low-sodium as prescribed.
                  8. Promote optimal growth and development
                  9. As appropriate, refer the family to a community health nurse for follow up care after discharge.
                  Documentation Guidelines
                  • Physical findings indicative of HF:Mental confusion,pale,cyanotic,clammy skin,presence of jugular vein distension and HJR,ascites,edema,pulmonary crackles or wheezes,adventitious heart sounds
                  • Fluid intake and output,daily weights
                  • Response to medications such as diuretics,nitrates,dopamine,dobutamine,and oxygen
                  • Psychosocial response to illness
                  Discharge and Home Healthcare Guidelines
                  • PREVENTION. To prevent exacerbations, teach the patient and family to monitor for an increase in shortness of breath or edema. Tell the patient to restrict fluid intake to 2 to 2.5 L per day and restrict sodium intake as prescribed. Teach the patient to monitor daily weights and report weight gain of more than 4 pounds in 2 days.
                  • MEDICATIONS. Be sure the patient and family understand all medications, including effect, dosage, route, adverse effects, and the need for routine laboratory monitoring for drugs such as digoxin.
                  • COMPLICATIONS OF HF. Tell the patient to call for emergency assistance for acute shortness of breath or chest discomfort that is not alleviated with rest.

                  Nursing Care Plan

                  Decreased Cardiac Output
                  Assessment

                  The patient may manifest the following:

                  • Pale conjunctiva, nail beds, and buccal mucosa
                  • irregular rhythm of pulse
                  • bradycardia
                  • generalized weakness
                  Diagnosis
                  • Decreased cardiac output r/t [altered heart rate and rhythm] AEB [bradycardia]
                  Planning
                  • Short Term: After 3-4 hours of nursing interventions, the patient will participate in activities that reduce the workload of the heart.
                  • Long Term: After 2-3 days of nursing interventions, the patient will be able to display hemodynamic stability.
                  Nursing Interventions
                  • Assess for abnormal heart and lung sounds.
                    • Rationale: Allows detection of left-sided heart failure that may occur with chronic renal failure patients due to fluid volume excess as the diseased kidneys are unable to excrete water.
                  • Monitor blood pressure and pulse.
                    • Rationale: Patients with renal failure are most often hypertensive, which is attributable to excess fluid and the initiation of the rennin-angiotensin mechanism.
                  • Assess mental status and level of consciousness.
                    • Rationale: The accumulation of waste products in the bloodstream impairs oxygen transport and intake by cerebral tissues, which may manifest itself as confusion, lethargy, and altered consciousness.
                  • Assess patient’s skin temperature and peripheral pulses.
                    • Rationale: Decreased perfusion and oxygenation of tissues secondary to anemia and pump ineffectiveness may lead to decreased in temperature and peripheral pulses that are diminished and difficult to palpate.
                  • Monitor results of laboratory and diagnostic tests.
                    • Rationale: Results of the test provide clues to the status of the disease and response to treatments.
                  • Monitor oxygen saturation and ABGs.
                    • Rationale: Provides information regarding the heart’s ability to perfuse distal tissues with oxygenated blood
                  • Give oxygen as indicated by patient symptoms, oxygen saturation and ABGs.
                    • Rationale: Makes more oxygen available for gas exchange, assisting to alleviate signs of hypoxia and subsequent activity intolerance.
                  • Implement strategies to treat fluid and electrolyte imbalances.
                    • Rationale: Decreases the risk for development of cardiac output due to imbalances.
                  • Administer cardiac glycoside agents, as ordered, for signs of left sided failure, and monitor for toxicity.
                    • Rationale: Digitalis has a positive isotropic effect on the myocardium that strengthens contractility, thus improving cardiac output.
                  • Encourage periods of rest and assist with all activities.
                    • Rationale: Reduces cardiac workload and minimizes myocardial oxygen consumption.
                  • Assist the patient in assuming a high Fowler’s position.
                    • Rationale: Allows for better chest expansion, thereby improving pulmonary capacity.
                  • Teach patient the pathophysiology of disease, medications
                    • Rationale: Provides the patient with needed information for management of disease and for compliance.
                  • Reposition patient every 2 hours
                    • Rationale: To prevent occurrence of bed sores
                  • Instruct patient to get adequate bed rest and sleep
                    • Rationale: To promote relaxation to the body
                  • Instruct the SO not to leave the client unattended
                    • Rationale: To ensure safety and reduce risk for falls that may lead to injury
                  Evaluation
                  • After nursing interventions, the patient shall have participated in activities that reduce the workload of the heart.
                  • After 2-3 days of nursing interventions, the patient shall have been able to display hemodynamic stability.

                  Excess Fluid Volume
                  Assessment

                  The patient may manifest the following:

                  • Edema of extremities
                  • Difficulty of breathing
                  • Crackles
                  • Change in mental status
                  • Restlessness and anxiety
                  Diagnosis
                  • Excessive Fluid volume related to decreased cardiac output and sodium and water retention
                  Planning & Desired Outcomes
                  • Patient will verbalize understanding of causative factors and demonstrate behaviors to resolve excess fluid volume.
                  • Patient will demonstrate adequate fluid balanced AEB output equal to exceeding intake, clearing breath sounds, and decreasing edema.
                  Nursing Interventions
                  • Establish rapport
                    • Rationale: To gain patient’s trust and cooperation
                  • Monitor and record VS
                    • Rationale: To obtain baseline data
                  • Assess patient’s general condition
                    • Rationale: To determine what approach to use in treatment
                  • Monitor I&O every 4 hours
                    • Rationale: I&O balance reflects fluid status
                  • Weigh patient daily and compare to previous weights.
                    • Rationale: Body weight is a sensitive indicator of fluid balance and an increase indicates fluid volume excess.
                  • Auscultate breath sounds q 2hr and pm for the presence of crackles and monitor for frothy sputum production
                    • Rationale: When increased pulmonary capillary hydrostatic pressure exceeds oncotic pressure, fluid moves within the alveolar septum and is evidenced by the auscultation of crackles. Frothy, pink-tinged sputum is an indicator that the client is developing pulmonary edema
                  • Assess for presence of peripheral edema. Do not elevate legs if the client is dyspneic.
                    • Rationale: Decreased systemic blood pressure to stimulation of aldosterone, which causes increased renal tubular absorption of sodium Low-sodium diet helps prevent increased sodium retention, which decreases water retention. Fluid restriction may be used to decrease fluid intake, hence decreasing fluid volume excess.
                  • Follow low-sodium diet and/or fluid restriction
                    • Rationale: The client senses thirst because the body senses dehydration. Oral care can alleviate the sensation without an increase in fluid intake.
                  • Encourage or provide oral care q2
                    • Rationale: Heart failure causes venous congestion, resulting in increased capillary pressure. When hydrostatis pressure exceeds interstitial pressure, fluids leak out of ht ecpaillaries and present as edema in the legs, and sacrum. Elevation of legs increases venous return to the heart.
                  • Obtain patient history to ascertain the probable cause of the fluid disturbance.
                    • Rationale: May include increased fluids or sodium intake, or compromised regulatory mechanisms.
                  • Monitor  for distended neck veins and ascites
                    • Rationale: Indicates fluid overload
                  • Evaluate urine output in response to diuretic therapy.
                    • Rationale: Focus is on monitoring the response to the diuretics, rather than the actual amount voided
                  • Assess the need for an indwelling urinary catheter.
                    • Rationale: Treatment focuses on diuresis of excess fluid.
                  • Institute/instruct patient regarding fluid restrictions as appropriate.
                    • Rationale: This helps reduce extracellular volume.

                  Acute Pain
                  Assessment

                  Patient may manifest the following

                  • Difficulty of breathing
                  • Chest pain
                  • Restlessness
                  Diagnosis
                  • Acute Pain
                  Planning & Desired Outcomes
                  • Patient’s pain will be decreased.
                  • Patient will demonstrate activities and behaviors that will prevent the recurrence of pain.
                  Nursing Interventions
                  • Assess patient pain for intensity using a pain rating scale, for location and for precipitating factors.
                    • Rationale: To identify intensity, precipitating factors and location to assist in accurate diagnosis.
                  • Administer or assist with self-administration of vasodilators, as ordered.
                    • Rationale: The vasodilator nitroglycerin enhances blood flow to the myocardium. It reduces the amount of blood returning to the heart, decreasing preload which in turn decreases the workload of the heart.
                  • Assess the response to medications every 5 minutes
                    • Rationale: Assessing response determines effectiveness of medication and whether further interventions are required.
                  • Provide comfort measures.
                    • Rationale: To provide nonpharmacological pain management.
                  • Establish a quiet environment.
                    • Rationale: A quiet environment reduces the energy demands on the patient.
                  • Elevate head of bed.
                    • Rationale: Elevation improves chest expansion and oxygenation.
                  • Monitor vital signs, especially pulse and blood pressure, every 5 minutes until pain subsides.
                    • Rationale: Tachycardia and elevated blood pressure usually occur with angina and reflect compensatory mechanisms secondary to sympathetic nervous system stimulation.
                  • Teach patient relaxation techniques and how to use them to reduce stress.
                    • Rationale: Anginal pain is often precipitated by emotional stress that can be relieved non-pharmacological measures such as relaxation.
                  • Teach the patient how to distinguish between angina pain and signs and symptoms of myocardial infarction.
                    • Rationale: In some case, the chest pain may be more serious than stable angina. The patient needs to understand the differences in order to seek emergency care in a timely fashion.

                  Ineffective Tissue Perfusion
                  Assessment
                  • Pale conjunctiva, nail beds, and buccal mucosa
                  • Generalized weakness
                  • Chest pain
                  • Difficulty of breathing
                  • Abnormal pulse rate and rhythm
                  • Bradycardia
                  • Altered BP readings
                  • With pitting edema on both forearms and hands
                  • Bipedal pitting edema
                  Diagnosis
                  • Ineffective tissue perfusion related to decreased cardiac output.
                  Planning & Desired Outcomes
                  • Patient will demonstrate behaviors to improve circulation.
                  • Display vital signs within acceptable limits, dysrhythmias absent/controlled, and no symptoms of failure
                  Nursing Interventions
                  • Assess patient pain for intensity using a pain rating scale, for location and for precipitating factors.
                    • Rationale: To identify intensity, precipitating factors and location to assist in accurate diagnosis.
                  • Administer or assist with self administration of vasodilators, as ordered.
                    • Rationale: The vasodilator nitroglycerin enhances blood flow to the myocardium. It reduces the amount of blood returning to the heart, decreasing preload which in turn decreases the workload of the heart.
                  • Assess the response to medications every 5 minutes.
                    • Rationale: Assessing response determines effectiveness of medication and whether further interventions are required.
                  • Give beta blockers as ordered.
                    • Rationale: Beta blockers decrease oxygen consumption by the myocardium and are given to prevent subsequent angina episodes.
                  • Establish a quiet environment.
                    • Rationale: A quiet environment reduces the energy demands on the patient.
                  • Elevate head of bed.
                    • Rationale: Elevation improves chest expansion and oxygenation.
                  • Monitor vital signs, especially pulse and blood pressure, every 5 minutes until pain subsides.
                    • Rationale: Tachycardia and elevated blood pressure usually occur with angina and reflect compensatory mechanisms secondary to sympathetic nervous system stimulation.
                  • Provide oxygen and monitor oxygen saturation via pulse oximetry, as ordered.
                    • Rationale: Oxygenation increases the amount of oxygen circulating in the blood and, therefore, increases the amount of available oxygen to the myocardium, decreasing myocardial ischemia and pain.
                  • Assess results of cardiac markers—creatinine phosphokinase, CK- MB, total LDH, LDH-1, LDH-2, troponin, and myoglobin ordered by physician.
                    • Rationale: These enzymes elevate in the presence of myocardial infarction at differing times and assist in ruling out a myocardial infarction as the cause of chest pain.
                  • Assess cardiac and circulatory status.
                    • Rationale: Assessment establishes a baseline and detects changes that may indicate a change in cardiac output or perfusion.
                  • Monitor cardiac rhythms on patient monitor and results of 12 lead ECG.
                    • Rationale: Notes abnormal tracings that would indicate ischemia.
                  • Teach patient relaxation techniques and how to use them to reduce stress.
                    • Rationale: Anginal pain is often precipitated by emotional stress that can be relieved non-pharmacological measures such as relaxation.
                  • Teach the patient how to distinguish between angina pain and signs and symptoms of myocardial infarction.
                    • Rationale: In some case, the chest pain may be more serious than stable angina. The patient needs to understand the differences in order to seek emergency care in a timely fashion.
                  • Reposition the patient every 2 hours
                    • Rationale: To prevent bedsores
                  • Instruct patient on eating a small frequent feedings
                    • Rationale: To prevent heartburn and acid indigestion

                  Hyperthermia
                  Assessment

                  Patient may manifest the following:

                  • Pale palpebral
                  • Conjunctiva and nail beds
                  • Warm to touch
                  • Weakness
                  • Increased in body temperature
                  • Fluid or electrolyte imbalance
                  • Diaphoresis
                  • Hot flushed skin
                  Diagnosis
                  • Hyperthermia RT increased metabolic rate secondary to pneumonia
                  Planning & Desired Outcomes
                  • Patient’s temperature will  be on normal level.
                  Nursing Interventions
                  • Assess vital signs, the temperature.
                    • Rationale: Vital signs provide more accurate indication.
                  • Monitor and record all sources of fluid loss such as urine, vomiting and diarrhea.
                    • Rationale: For potential fluid and electrolyte losses.
                  • Performed tepid sponge bath.
                    • Rationale: To promote heat loss by evaporation and conduction.
                  • Maintain bed rest.
                    • Rationale: To reduce metabolic demands and oxygen consumption.
                  • Remove excess clothing and covers.
                    • Rationale: Decreases warmth and increase evaporative cooling.
                  • Increase fluid intake.
                    • Rationale: To prevent dehydration.
                  • Provide adequate nutrition, a high caloric diet.
                    • Rationale: The meet the metabolic demands.
                  • Control environmental temperature.
                    • Rationale: To prevent an increase in body temperature and prevent shivering of the patient.
                  • Adjust cooling measures on the basis of physical response.
                    • Rationale: Shivering, which burns calories and increases metabolic rate in order to produce heat.
                  • Provide information regarding normal temperature and control.
                    • Rationale: This is especially necessary for patients with conditions at risk for hyperthermia.
                  • Explain all treatments.
                    • Rationale: Patients’ S.O. needs to be oriented.
                  • Administer antipyretics as ordered.
                    • Rationale: To decrease body temperature.
                  • Control excessive shivering with medications such as Chlorpromazine and Diazepam if necessary.
                    • Rationale: Shivering increases metabolic rate and body temperature.
                  • Provide ample fluids by mouth or intravenously as ordered.
                    • Rationale: If the patient is dehydrated or diaphoretic, fluid loss contributes to fever.
                  • Provide oxygen therapy in extreme cases as ordered.
                    • Rationale: Hyperthermia increases metabolism.

                  Ineffective Breathing Pattern
                  Assessment

                  Patient may manifest the following:

                  • weakness
                  • rales on BLF
                  • productive cough
                  • frothy sputum
                  • pursed lip breathing
                  • tachypnea
                  Diagnosis
                  • Ineffective breathing pattern related to fatigue and decreased lung expansion and pulmonary congestion secondary to CHF
                  Planning & Desired Outcomes
                  • Patient’s respiratory pattern will be effective without causing fatigue
                  Nursing Interventions
                  • Establish rapport
                    • Rationale: To gain comfort feelings form the pt and pts SO
                  • Monitor VS
                    • Rationale: To gain baseline data
                  • Inspect thorax for symmetry of respiratory movement
                    • Rationale: Determines adequacy of breathing
                  • Observe breathing pattern for SOB, nasal flaring, pursed-lip breathing or prolonged expiratory phase and use of accessory muscles
                    • Rationale: Identifies increased work of breathing
                  • Measure tidal volume and vital capacity
                    • Rationale: Indicates volume of air moving in and out of lungs
                  • Assess emotional response
                    • Rationale: Detects use of hyperventilation as a causative factor
                  • Position patient in optimal body alignment in semi- fowler’s position for breathing
                  • Assist patient to use relaxation techniques
                    • Rationale: Reduces muscle tension, decreases work of breathing

                  Activity Intolerance
                  Assessment
                  • Weakness
                  • Limited range of motion
                  • Abnormal pulse rate and rhythm
                  Diagnosis
                  • Activity intolerance r/t imbalance O2 supply and demand
                  Planning & Desired Outcomes
                  • Patient will use identified techniques to improve activity intolerance
                  • Patient will report measurable increase in activity intolerance
                  Nursing Interventions
                  • Establish Rapport
                    • Rationale: To gain clients participation and cooperation in the nurse patient interaction
                  • Monitor and record Vital Signs
                    • Rationale: To obtain baseline data
                  • Assess patient’s general condition
                    • Rationale: To note for any abnormalities and deformities present within the body
                  • Adjust client’s daily activities and reduce intensity of level. Discontinue  activities that cause undesired psychological changes
                    • Rationale: To prevent strain and overexertion
                  • Instruct client in unfamiliar activities and in alternate ways of conserve energy
                    • Rationale: To conserve energy and promote safety
                  • Encourage patient to have adequate bed rest and sleep
                    • Rationale: to relax the body
                  • Provide the patient with a calm and quiet environment
                    • Rationale: to provide relaxation
                  • Assist the client in ambulation
                    • Rationale: to prevent risk for falls that could lead to injury
                  • Note presence of factors that could contribute to fatigue
                    • Rationale: fatigue affects both the client’s actual and perceived ability to participate in activities
                  • Ascertain client’s ability to stand and move about and degree of assistance needed or use of equipment
                    • Rationale: to determine current status and needs associated with participation in needed or desired activities
                  • Give client information that provides evidence of daily or weekly progress
                    • Rationale: to sustain motivation of client
                  • Encourage the client to maintain a positive attitude
                    • Rationale: to enhance sense of well being
                  • Assist the client in a semi-fowlers position
                    • Rationale: to promote easy breathing
                  • Elevate the head of the bed
                    • Rationale: to maintain an open airway
                  • Assist the client in learning and demonstrating appropriate safety measures
                    • Rationale: to prevent injuries
                  • Instruct the SO not to leave the client unattended
                    • Rationale: to avoid risk for falls
                  • Provide client with a positive atmosphere
                    • Rationale: to help minimize frustration and rechannel energy
                  • Instruct the SO to monitor response of patient to an activity and recognize the signs and symptoms
                    • Rationale: to indicate need to alter activity level

                  QUIZ

                  Q.1. Which of the following is the most common symptom of myocardial infarction?

                  A. Chest pain
                  B. Dyspnea
                  C. Edema
                  D. Palpitations

                  Answer: A
                  Explanation:
                  The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

                  Q.2. Which of the following symptoms is most commonly associated with left-sided heart failure?
                  A. Crackles
                  B. Arrhythmias
                  C. Hepatic engorgement
                  D. Hypotension

                  Answer: A
                  Explanation:
                  Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system.

                  Option B: Arrhythmias can be associated with both right- and left-sided heart failure.

                  Option D: Left-sided heart failure causes hypertension secondary to an increased workload on the system.


                  Q. 3. Which of the following arteries primarily feeds the anterior wall of the heart?
                  A. Circumflex artery
                  B. Internal mammary artery
                  C. Left anterior descending artery
                  D. Right coronary artery

                  Answer: C
                  Explanation:
                  The left anterior descending artery is the primary source of blood for the anterior wall of the heart.

                  Options A, B, and D: The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.


                  Q.4. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because:
                  A. It is uncomfortable for the client, giving a sense of impending doom.
                  B. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.
                  C. It is almost impossible to convert to a normal sinus rhythm.
                  D. It can develop into ventricular fibrillation at any time.
                  Answer: D
                  Explanation:
                  Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart.

                  Option A: Client’s frequently experienced a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness).

                  Option B: The low cardiac output that results can lead quickly to cerebral and myocardial ischemia.

                  Option D: Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

                  Q.5. A 23 year old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms?

                  A. Myocardial infarction due to a history of atherosclerosis.
                  B. Pulmonary embolism due to deep vein thrombosis (DVT).
                  C. Anxiety attack due to worries about her baby's health.
                  D. Congestive heart failure due to fluid overload.

                  Answer: B
                  Explanation:
                  In a hospitalized patient on prolonged bed rest, he most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.