Instructed patient and caregiver what not do with her LVAD. Kink, bend or pull your driveline, disconnect the driveline from the controller (under normal circumstances), Sleep on your stomach, Take a bath or swim, Play contact sports, Have an MRI (CT Scans or X-Rays are OK), Attempt to repair LVAD equipment yourself, Leave the house without backup equipment. understanding was verbalized.
SN instructed patient / caregiver on proper incontinence care as to check every 2-3 hours if needed. Educated on pressure reduction measures as to change patient's position in bed/chair every 2-3 hours, avoid positioning on affected areas and use pressure reduction mattress or chair cushion.
SN instructed on the need for adequate fluid intake, establishing a toilet schedule such as every 2 hours, or before or after activities, meals, sleep, and rest periods.
SN instructed pt on hygiene r/t wound care. It is very important to maintain a clean environment as well as clean , dry skin. Do not pick at wounds, or at other areas of the skin. Our fingernails harbor bacteria under them, wash hands throughly and often throughout the the day with soap and water, hand sanitizer can be used in between but are not a substitute for proper hand washing.
Skilled nurse developed patient plan of care with patient/caregiver involvement to be countersigned by physician. SN to perform complete physical assessment each visit with emphasis on disease process. SN to assess other co-morbidities including list diseases and other conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications; notify physician immediately of any potential problems that impede completion of patient recovery and desired goals.
SN educated patient on some ways to cope with stress and anxiety. explained to the patient that anxiety can be a normal part of life when faced with stressors such as changes in relationships, presenting in front of a crowd, or making decisions. There is no one right answer to eliminate anxiety. It is important to find healthy coping skills that will work for you. Consult with your primary care physician when anxiety becomes persistent or unmanageable. SN Instructed patient about some coping skills to consider when struggling with anxiety include: Reaching out to support system (i.e. family/friends, counselors, psychiatrists, or support groups). Deep breathing Meditation, Yoga, Avoiding caffeinated beverages, Healthy diet, and Calming music. Patient Verbalized fair understanding of anxiety teaching.
SN educated patient on the importance of daily vital sign monitoring. Due to patients disease processes it is important to monitor blood pressure, weight, pulse and oxygen daily if equipment is available. SN instructed patient to weigh correctly they need to wake up, pee and than weigh daily at the same time if possible, same amount of clothing, same area. Patient is to weigh prior to eating/drinking in the morning. Notify home health or PCP if -/+ 3 lbs in a day or +/-5 lbs in a week is seen. SN educated patient to monitor blood pressure and pulse, and instructed to check before medications and if elevated/low recheck in 1-2 hours. SN educated patient to always log vitals so patients MD has a larger snap shot on what is going on.Patient/CG verbalized understanding
Patient instructed on fall safety precautions to include: locking w/c before transfers, use assistive device for mobility at all times, make sure walkways are free of clutter, & well lit, do not walk around barefoot or in socks, avoid using rugs, use non slip rug in bath tub & use shower chair for bathing.
SN instructed patient/ CG about thickened liquids. SN explained that thickened liquids are used to treat patients with Dysphagia. Thick liquids decrease aspiration. Thick liquids may give the patient more time to perform additional swallows or other swallowing strategies. Thickened liquids slow down the bolus flow to compensate for a delayed swallow and reduced airway closure.
Nephrostomy tube Instructed patient observe for continuous urine flow and signs of infection.