How to give good management to my patient

ArwenEvenstar · Sep 12, 2008

Hi! What do you mean by "good management" to your patient?

Lorie P. · Sep 12, 2008

first of all welcome to all nurses!

i just don't quite understand the question, " good management" could you please explain?

thanks!

precious_nurse · Sep 13, 2008

well i just want to know how can i take care of him he is connected with the ventilator with muscle myopathy.The progression of his disease are present.

before i came he was 5 months at the hospital and that time the doctors put him tracheo.before we go home they take him chest x ray and so other laboratory examinations.last august he was admitted for the reasons of pneumonia.he was admitted for 1 month.and 1 week after we go home he verbalized that he could not breath good and so i takre his spo2 with rebelled 72 persent suction was done and and oxygen for 100% was given.slowly he became ok.and sometime im worried of what will happen next?

what will i expect more or what other things can be associated with myesthenia gravis?

thank you for answer and im sorry if my question that you dont understand.every answer will be a great help for me....:loveya:

neonatal3 · Nov 8, 2008

Hello!

Your question about "good patient management" seems to be about what are priorities of care as your patient continues to loose ground. Though I have worked as a nurse for 35 years, I have just started doing private duty home health and it seems that the definition of "good patient management" is somewhat different for each nursing specialty. In the case of home health nursing, to me one priority of "good patient management" of some of these patients with a poor diagnosis is to focus on avoiding as many new complications as possible(such as avoiding infection). Unfortunately, we know we cannot help with a cure for many of these patients---when the medically expected downturns develop, to me other "good patient management" priorities are comfort measures for patients and referrals to grief counseling resources for patient and family as needed.

Good luck with your home health adventures!

precious_nurse · Nov 8, 2008

well actually now my patient were in hospital diagnose with sepsis.he have thrombocytopenia his platelet are very low.

neonatal3 · Nov 8, 2008

Hello again!

In the situation where a home health patient is admitted to a hospital with sepsis, is your latest question what are "good patient management" priorities for a private duty nurse who stays in the hospital room with this patient? The prioritiy of care by private duty nurses in hospitals where I have worked was to focus on helping the patient with activities of daily living(such as bath,assistance to bathroom or with bedpan, grooming, assistance with meals). As you probably know, while patients are in a hospital the responsibilities for medications and treatments are usually handed over to the hospital staff nurses.

Or is your latest question what are "good patient management" priorities in general for patients who have sepsis and thrombocytopenia? If that is your question, maybe a good resource for you would be a good quality professional nurse reference book which includes standard nursing care plans for patients with various medical conditions. Your honesty as a younger nurse in looking for nursing goals to help your patient is very refreshing! (Us "oldsters" have taken care of just about every medical condition under the sun for decades, so education and experience has taught us quick ways to zoom in on "good patient management"---good for you for asking questions as an advocate for your patients!)

Peace to you.

jlcole45 · Nov 9, 2008

precious nurse -

You are asking questions that you should really know the answers too, and I find this quite alarming. I know this sounds harsh, but you are a trained & licensed nurse? What is your degree? And how much experience do you have?

You sound like you're either new or very unsure of your skills as

a nurse. Were you properly trained on how to manage a patient on a ventilator? If not, then you need to either be trained (asap) by one of the other nurses or decline the assignment.

This type of patient can suffer from a variety of complications, but many can be prevented by good, competent nursing care. If you don't know how to manage the care of this patient then you are putting his safety and your license at risk.

I would suggest that you contact your agency and let them know you are having issues and that you need more training or a different assignment.

Please don't take the above as an attack, but from what I read I am VERY concerned about this patient.

caliotter3 · Nov 25, 2008

I have found that infection control can be an issue for vent patients. You should find out if there is a schedule for cleaning the vent circuits on a weekly basis, or for changing out the circuits if disposable circuits are used instead of cleaning and reusing. Good pulmonary toilet. Meds given as ordered, chest percussion, postural drainage as ordered. Also trach care, is it being done on a consistent basis? The requirements for taking care of bedbound patients comes to mind. Is your patient turned and repositioned every two hours around the clock? You need to look at each system, identify the problems, consult a good care plan book for appropriate interventions, and write up a care plan if one is not in place already. Then insure that you are following the care plan. Besides the nursing care plan, you need to pay attention to, and follow the doctor's orders as listed on the 485. All of this should already be clear to you. If it is not, then you need to have a meeting with your supervisor and get some guidance about your duties to this patient.