FOUNDATIONS OF NURSING PRACTICUM

METHODICAL INSTRUCTION

FOR BSN STUDENTS

OF THE III COURSE

NURSING SCHOOL

LESSON ¹ 18 (PRACTICAL6 HOURS)

 

Theme: Acid-Based Balance.

Aim: To be able to perform nursing interventions according to nursing care plan and needs of the patient, to learn how properly evaluate the quality of care and outcomes for the patient. 

 

Professional orientation of students: Acid-base balance within the body is necessary to maintain health and function in all body systems. This balance is maintained by the intake and output of water and electrolytes and regulation by the renal and pulmonary systems. Imbalances may result from many factors, including illnesses, altered fluid intake, or prolonged episodes of vomiting or diarrhea. Acid-base balance is necessary for many physiological processes, and unbalances can alter respiration, metabolism, and the function of central nervous system. Knowledge and understanding of the mechanisms that contribute acid-base balance are essential.

 

Methodology of Practical Class: 9:00-12:00

Algorithm of students’ communication with patients with pathology in subject (communication skills)

 

During examination of the patient students have to use such communicative algorithm.

 

Complaints and anamnesis taking in patients.

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Take complaints and anamnesis in a patient.

5. Explain to the patient results of his/her lab tests correctly and accessibly.

6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.

7. Conversation accomplishment.

 

Objective examination:

Physical methods of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient, what examinations will be carried out and get his/her informed consent.

5. Find a contact with the patient and make an attempt to gain his/her trust.

6. Inform about the possibility of appearing of unpleasant feelings during the examination.

7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).

8. Examination (demonstration of clinical skill).

9. Explain to the patient results of his/her lab tests correctly and accessibly.

10. Conversation accomplishment.

 

Estimation of laboratory and instrumental investigations

Informing about the results of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient results of his/her lab tests correctly and clearly.

5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).

Planning and prognosis the results of the conservative treatment

Friendly facial expression and smile.

1. Gentle tone of speech.

2. Greeting and introducing.

3. Correct and clear explanation of necessary treatment directions.

4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.

5. Conversation accomplishment.

 

Work 1. Master the next practical skills

 Practical Skill Preparing an IV Solution

Practical Skill  Starting an IV

Practical Skill Inserting a Butterfly Needle

Practical Skill Preparing the IV Bag and Tubing

Practical Skill Setting the IV Flow Rate

Practical Skill Assessing and Maintaining an IV Insertion Site

Practical Skill Changing the IV Solution

Practical Skill Discontinuing the IV and Changing to a Heparin Lock

Practical Skill Administering a Blood Transfusion

 

Work 2:

Write a NCP for the following situational task:

Bobby Warder, 54 years old, is being admitted with Congestive Heart Failure (CHF). Upon assessment, the nurse finds the following data: has gained five pounds in the last two days, a bounding pulse rate of 110 and blood pressure of 160/100, and distended neck veins. Upon auscultation, the nurse discovers his lungs have crackles (rales) in the bases. Develop a nursing care plan for Mr. Warder.

Seminar discussion of theoretical issues: 12:30-14:00

1.                 Identify the variables affecting normal acid-based  balance.

2.                 Discuss the clinical assessment for the client for acid-based balance.

 

Individual Students Program

Test evaluation and situational tasks. 14:15-15:00

Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.

(the instructor has tests & situational tasks)

 

1. What is the best explanation for why changes in blood pH reflect the adequacy of acid-base homeostatic mechanisms?

A.   Body fluid pH is a measure of the blood hydrogen ion concentration, and the acid-base homeostatic mechanisms control this concentration.

B.   Body fluid pH is a measure of the blood bicarbonate concentration, and the acid-base homeostatic mechanisms control this concentration.

C.   When homeostatic mechanisms are functioning properly, the blood electrolyte concentrations are normal, as measured by pH.

D.   When body fluid pH is normal, acid-base homeostatic mechanisms are not needed.

2.      What is the most correct description of normal arterial blood pH with regard to acid-base balance?

A.   Arterial blood has a neutral pH.

B.   Arterial blood is slightly acidic.

C.   Arterial blood is slightly alkaline.

D.   Arterial blood maintains electroneutrality.

3.      When a client has an arterial blood pH of 7.48, what action by a buffer will bring the pH back to normal?

A.   Absorb bicarbonate ions from the blood

B.   Release bicarbonate ions into the blood

C.   Absorb hydrogen ions from the blood

D.   Release hydrogen ions into the blood

4.      Which statement most accurately describes the relationship between the hydrogen ion concentration and carbon dioxide concentration in extracellular fluids?

A.   Because carbon dioxide is a gas and hydrogen ions are electrolytes, these two substances have no relationship in extracellular fluids.

B.   The concentrations of hydrogen ions and carbon dioxide are directly related, with an increase or decrease in one always resulting in a corresponding increase or decrease in the other.

C.   Carbon dioxide buffers hydrogen ions; thus, these two concentrations are inversely related to each other. The higher the carbon dioxide concentration, the fewer hydrogen ions are present in that fluid.

D.   Hydrogen ions and carbon dioxide ions exist in a balanced relationship as a result of their charges. The positively charged hydrogen ions are attracted to the negatively charged carbon dioxide ions, forming an electrically neutral substance.

5.      In what ways do changes in oxygen concentration affect acid-base balance?

a.     Oxygen deficiency results in increased carbon dioxide production and acidosis.

b.     Oxygen deficiency results in increased carbon dioxide production and alkalosis.

c.      Oxygen excess results in decreased carbon dioxide production and acidosis.

d.     Oxygen excess results in decreased carbon dioxide production and alkalosis.

6.      How would acid-base balance be affected in a person who has low levels of hemoglobin?

A.   Acid-base balance would be unaffected, because hemoglobin has no role in acid-base balance.

B.   Low levels of hemoglobin would reduce the amount of oxygen available to tissues and increase the formation of hydrogen ions.

C.   Because hemoglobin and bicarbonate have opposite actions, low levels of hemoglobin would result in a slightly more alkaline environment of the blood.

D.   Because hemoglobin serves as a major intracellular protein buffer, the person with low hemoglobin levels would be less able to compensate for mild acidosis.

7.      The client has an arterial blood gas pH of 7.42. How should the nurse interpret this client’s acid-base status?

A.   The client has no blood hydrogen ions.

B.   The client has a normal blood hydrogen ion concentration.

C.   The client has a deficit in the blood hydrogen ion concentration.

D.   The client has an excess in the blood hydrogen ion concentration.

8.      What type of acid-base imbalance should the nurse be most alert for in the client who has hypoxemia?

A.   Reduced carbon dioxide production, alkalosis

B.   Reduced carbon dioxide retention, alkalosis

C.   Excess carbon dioxide production, acidosis

D.   Excess carbon dioxide retention, acidosis

9.      Which client is at greatest risk for acidosis?

A.   The 78-year-old client on diuretic therapy with furosemide (Lasix, Furoside)

B.   The 62-year-old client with moderate hypertension

C.   The 75-year-old client with peptic ulcer disease

D.   The 45-year-old client with pneumonia

10.    Which acid-base imbalance should the nurse be prepared for in a client who has acute pancreatitis?

A.   Metabolic acidosis

B.   Metabolic alkalosis

C.   Respiratory acidosis

D.   Respiratory alkalosis

 

Student should know:

1.     Differences between:

·        metabolic acidosis,

·        respiratory acidosis,

·        metabolic alkalosis,     

·         respiratory alkalosis,                                               

2.     What type of nursing interventions to perform for particular patient with acid-based imbalance.

 

Student should be able to:

1.     Describe the regulation of acid–base balance in the body, including the roles of the lungs, the kidneys, and buffers.

2.     Identify factors affecting normal body acid–base balance.

3.     Discuss the risk factors for and the causes and effects of acid–base imbalance.

4.     Collect assessment data related to the client’s acid–base balance.

5.     Identify examples of nursing diagnoses, outcomes, and interventions for clients with altered acid–base balance.

6.     Implement measures to correct imbalances of acids and bases such as enteral or parenteral replacements and blood transfusions.

7.     Evaluate the effect of nursing and collaborative interventions on the client’s acid–base balance.

Correct answers of test evaluations and situational tasks:

1.      A

2.     C

3.     D

4.     B

5.     A

6.     D

7.     B

8.     C

9.     D

10.           A

References:

Basic:

1.     Ternopil State Medical University http://intranet.tdmu.edu.ua/data/kafedra/internal/i_nurse/classes_stud/en/BSN-%284y%29/3%20year/1%20sem/Foundations%20of%20Nursing%20Practicum/18.%20Acid-Base%20Balance.htm

2.     Potter & Perry, Chapter 38, pp. 959-999.

3.     Study Guide: Chapter 38Altman G. Delmar’s fundamental and advanced nursing skills book, pp. 121-234.

4.     Kozier & Erb's Fundamentals Of Nursing: Concepts, Process, And Practice Eighth Edition Audrey Berman, Shirlee Snyder, Barbara Kozier, Glenora Erb,

 

 

Additional:

1.     Potter and Perry. Fundamentals of Nursing. – 6th edition. – Mosby, Inc.

2.     Study Guide and Skills Performance Checklist to Accompany Potter and Perry’s Fundamentals of Nursing. – 6th edition. – Mosby, Inc.

3.     Altman G. Delmar’s fundamental and advanced nursing skills book / G.Altman, P. Buschel, V.Coxon. – Thomson Learning ©

 

WEB RESOURCES

National Health Information Center http://nhic-nt.health.org

American Nurses Association http://www.nursingworld.org

Certification Board of Infection Control and Epidemiology www.cbic.org

HealthCare Report Cards www.healthcarereportcards.com

Hospital Infections Program, Centres for Disease Control and Prevention www.cdc.gov

 

Methodical instruction has been worked out by: T. Yu. Rybalka

 

Methodical instruction was discussed and adopted at the Department sitting

11 June 2012. Minute ¹ 13

Methodical instruction was adopted and reviewed at the Department sitting

12 June 2013. Minute ¹ 13

 

The Head of Clinical Immunology,

 Alergology and General Patients Care                             Prof. I. Ya. Hospodarsky, MD, D.M.

The Head of Institute Of Nursing                                    As. Prof. S.O. Yastremska, Ph.D, MSN

Assistant of Clinical Immunology,

 Alergology and General Patients Care Department                      T.Yu. Rybalka BSN, MSN