The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [136]
3 You are looking after a 75-year-old woman who had an abdominal hysterectomy 2 days ago. What would you do to reduce the risk of her developing a deep vein thrombosis (DVT)?
a Give regular analgesia to ensure she has adequate pain relief so she can mobilize as soon as possible. Advise her not to cross her legs.
a Make sure that she is fitted with properly fitting antiembolic pressure stockings that are removed daily.
a Ensure that she is wearing antiembolic stockings and that she is prescribed prophylactic anticoagulation and is doing hourly limb exercises.
a Give adequate analgesia so she can mobilize to the chair with assistance, give subcutaneous low molecular weight heparin as prescribed. Make sure that she is wearing antiembolic stockings.
4 You are looking after an emaciated 80-year-old man who has been admitted to your ward with acute exacerbation of chronic obstructive airways disease (COPD). He is currently so short of breath that it is difficult for him to mobilize. What are some of the actions you take to prevent him developing a pressure ulcer?
a He will be at high risk of developing a pressure ulcer so place him on a pressure-relieving mattress.
b Assess his risk of developing a pressure ulcer with a risk assessment tool. If indicated, procure an appropriate pressure-relieving mattress for his bed and cushion for his chair. Reassess the patient’s pressure areas at least twice a day and keep them clean and dry. Review his fluid and nutritional intake and support him to make changes as indicated.
c Assess his risk of developing a pressure ulcer with a risk assessment tool and reassess every week. Reduce his fluid intake to avoid him becoming incontinent and the pressure areas becoming damp with urine.
d He is at high risk of developing a pressure ulcer because of his recent acute illness, poor nutritional intake and reduced mobility. By giving him his prescribed antibiotic therapy, referring him to the dietician and physiotherapist, the risk will be reduced.
5 You are looking after a 76-year-old woman who has had a number of recent falls at home. What would you do to try and ensure her safety whilst she is in hospital?
a Refer her to the physiotherapist and provide her with lots of reassurance as she has lost a lot of confidence recently.
b Make sure that the bed area is free of clutter. Place the patient in a bed near the nurses’ station so that you can keep an eye on her. Put her on an hourly toileting chart. Obtain lying and standing blood pressures as postural hypotension may be contributing to her falls.
c Make sure that the bed area is free of clutter and that the patient can reach everything she needs, including the call bell. Check regularly to see if the patient needs assistance mobilizing to the toilet. Ensure that she has properly fitting slippers and appropriate walking aids.
d Refer her to the community falls team who will assess her when she gets home.
Answers to the multiple choice questions can be found in Appendix 3.
These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.
Part two
Supporting the Patient with Human Functioning
5 Communication
6 Elimination
7 Moving and positioning
8 Nutrition, fluid balance and blood transfusion
9 Patient comfort
10 Respiratory care
Chapter 5
Communication
Overview
The aim of this chapter is to define and describe effective communication.
It will consider the process of offering psychological support to patients and focus upon the management of factors that contribute to or compromise this process. The medium of communication can take many forms; this chapter is mostly concerned with interpersonal communication using language comprising verbal (including tone) and non-verbal expression.
There are specific sections on denial and collusion, anxiety, depression, anger