Many nurses see that tracheostomy care is difficult and frightening but it only needs to be well understood to be managed. Caring for patients with chest tubes needs confident nurses who realize the proper use and conditions relevant to it. Chest tubes are usually used for helping patients who suffer disrupt in their pleural space. Small amounts of fluids can be absorbed by the body and this can occur to air as well over time. Lung expansion can be limited by larger amounts and this can cause respiratory distress. When the patient suffers a tension pneumothorax, it is important to insert a needle to reduce pressure and insert a chest tube. (RCH, 2015)The current assignment is a case study of a patient who entered to the critical care unit after having a heart surgery as the patient had a history of obstructive pulmonary and he needed to have a tracheostomy as a decision made by him and his physician. The assignment will critically discuss the nursing care the patient needs and a nursing diagnosis with its related goal and nursing intervention, the assignment also includes a personal reasoning for choosing me for dealing with this type of care with an evaluation for the relevant literature.
Mr. X , a 60 years old patient who suffered a chronic obstructive pulmonary diseases, was admitted at the critical care unit for having a tracheostomy as he made an open heart surgery and after the operation, the patient was in need for prolonged mechanical ventilation as the first week after the operation was for recovery and the second week he tried to wean from the ventilator but he was suffering from the endotracheal tube (ET) so his physician decided to use a tracheostomy. The patient was in need for removing and checking the inner cannula as a first step of the nursing care. According to the MOH nursing clinical practice guidelines, (2010) the nursing care can include many care areas such as preventing any problems that may associate tracheostomy such as infection; this is really proved within the critical care unit experiences as I found this occurring many times and in some cases, infection can lead to the death of patients. Cleaning the tube is a very important matter as according to many researchers such as Timby, (2009) cleaning means cleaning the skin that surrounds the stoma, making sure the inner cannula is clean and cleaning the dressing; this view lacks some important procedures such as changing the dressing as according to (NHS, 2009)changing the dressing regularly ensures that the patient is away from infections by maintaining a clean and dry tracheal stoma. From my own experience, changing the dressing can also keep the patient's tissue from damage. Norton, (2009) added to the previous views that there are many types of nursing care that can be presented to a patient who has tracheostomy and this is observed through my experience in the critical care units as there are a variety of nursing interventions that are relevant to tracheostomy such as monitoring the airway to check the nutrition process and its safety, monitoring the way the patient is coughing, breathing and checking if the patient is suffering pains. Secretions should also be monitored to ensure the safety of suctioning process. Nursing care should include the cleanliness of the nurse such as using gloves that should be sterile when providing care of suctioning and inner cannula. Norton, (2009) also focused on more important care aspects that other researchers neglected which are the emotional and communicational care as the patient should have a pen and a paper to write when possible or even charts that contain alphabets. What was previously mentioned is very useful when a nurse is delivering care for a patient with tracheostomy but there are cases that the patient needs more nursing care that can be urgent and well chosen, from my experience, the case of having tracheostomy is surprising and needs continuous monitoring. Friedman, (2009)discussed the complications that can associate tracheostomy or follow it and they need nursing care regularly to prevent them; examples are bleeding, stomal infection and accidental decannulation.
Tracheostomy is a care procedure that is usually made in the intensive care unit for patients staying in hospital for treatment. It is a stoma that is done under the larynx in the trachea for reasons such as overcoming the obstruction of the upper airway, making the mechanical ventilation easy or for removing the secretions. (Brower and Cohn, 2012). This can be done for the patient as an emergency condition or permenantly and it is using a plastic tube which is hollow. Treatment and care for a patient with a tracheostomy should be planned and with the help of a multidisciplinary team that includes efficient nurses. There are different individual needs for each patient that should be considered when using tracheostomy by nurses and other caregivers in order to ensure the patient's safety and better outcomes and prevent any complications that can be resulting from tracheostomy. (Morris et al, 2013).
Mr. X remained in the hospital for 15 days, his wife was with him, during this period, a multidisciplinary team was responsible for him, I was asked to provide him with interventions related to the diagnosis of his anxiety and communication level because my preceptor reported that the patient refuses to receive tracheostomy care and this can affect the patient physiologically and psychologically as this is able to delay the healing and may also lead to complications. (Tate et al, 2013). The patient was anxious since the first day of having the tracheostomy tube and he refused to communicate with me at first, then I tried to assess how far he understands the care required for the tracheostomy tube by monitoring the symptoms of fear and nervousness of the patient and I tried to ask his wife to get his consent on the intervention. His wife convinced him to receive the intervention and I tried to inform him simply about the importance of the care and how it can reduce any infections and complications. His blood pressure was measured and his heart rate and slightly higher rates were found so it was important to inform him how to keep relaxed. I informed the patient about the importance of the treachestomy care and the problems he may suffer if he refuses it, the patient was relaxed and expressed his fears using cards and paper and pens. I tried to reduce his anxiety by telling him all information he needed to know about his condition and how to care for himself after discharge. On the discharge day, I informed the patient and his wife about basics of changing the cannula and the way of cleansing the stoma, redressing it and how to flush water into the feeding tube as well as telling them about the means of Jackson-Prat drain emptying. I assured to them that there is a home nursing care as there are special nurses authorized by the hospital to visit the patient at home for the purposes of tube feeding. I taught the patient how to cough correctly and I taught the patient basics of self suctioning to avoid infections resulting from sputum that hinders the work of the tube. In a study made by Breckenridge et al, (2014) tracheostomy placement impact on patients' anxiety was discussed and they reported that many of the study participants suffered before the trachesostomy as the mechanical ventilation was tiring to them but using tracheostomy didn't relieve them as they also suffered verbal communication, pain, fatigue, difficulty in coughing and being thirsty; the study reports that there aren't many patients reported feeling comfort after having the tracheostomy while other studies such as that conducted by Silveira, (2009) reported that most patients stated that they felt more comfort after having tracheostomy especially with the nursing interventions meant to relieve their fears and anxiety as well as the education they received during the nursing interventions as the information they had helped them feel more confident in the medical procedures they should receive during other care interventions for tube care. Anxiety is referred to as a condition that is characterized with an increased tension activity and prolonged apprehension case that makes the patient have fears and hypertensive attitude. Anxiety is said to accompany many illnesses and medical conditions such as tracheostomy and the relevant care procedures. (Myers and Gulanick, 2010).
Crosby, (2012) evaluated trachesostomy care anxiety relief and how it can occur via nurses who are well trained on informing the patient's family and carers about the right home care procedures for helping the patient get rid of his anxiety, he stated that it is not good to wait till the day of discharge in order to inform the family about the care procedures required for helping the patient as this raises the anxiety of the patient and makes him worry about the care he will receive at home but it is better to provide families with training and involve them into programs for relieving the anxiety of the patient using many ways; in my care experience for Mr. X, I didn't follow this step but I waited till the day of discharge and provided the wife with a paper that includes instructions for care which may not be very helpful for the patient as the study confirms that the families who were engaged in training courses for relieving anxiety reported that their patients were very comfortable and got rid of their fears and anxiety better than other families who received the education and training very late. Hughson et al, (2012) discussed how patients lose the ability to talk with the use of tracheostomy so it is important for the nurse to focus on means for communicating with the patient, the nurse should provide the patient with cards to use when they need something such as pictured cards with water, toilets, family members, noise or others. They also referred to anxiety and that there is a nursing intervention for managing it which is providing the patient with privacy and informing the patient about the side effects that suctioning may lead to such as coughing but during my nursing experience with my patient, I found this may increase the patient's anxiety and he may refuse the nursing interventions for tracheostomy as the culture of the patient plays a role, instead I decided to tell the wife of Mr. X about coughing effect and she in turn told her husband and relaxed him but Murr et al, (2014). Asserted on informing the patient with all side effects and not informing him that everything is ok or let family tell him as the information may be changed by the family members and it is the nurse responsibility to relieve the patient's anxiety and to choose the correct simple words that don't bear scientific terms to inform him.
Conclusion
In conclusion, it is necessary to focus on the learning I gained from the nursing experience with the patient with tracheostomy as I learnt that it is important to provide the patient with the proper education needed for managing any problem resulting from the tube and I learned to provide the information for the patient with myself. Another learnt experience is to informing the patient's family with information about home care since the admittion day of the patient and it is wrong to wait till discharge day and give the information as instructions only because this may increase the patient's anxiety. Relieving the patient's anxiety can also be done by using music as a therapy that is able to reduce the patient's anxiety and help him get relaxed sleep and overcome his stress as it is recommended that music becomes a part of the care provided within the critical care unit and to equip it with musical instruments. (Ciftci and Oztunc, 2015). Music interventions are proved by many researchers to provide the patient with more opportunities for healing faster than traditional techniques and music therapy can be associated with relaxation exercises to fasten healing and improving patient's outcomes. (Miller, 2009).
No comments:
Post a Comment