Different members of the multidisciplinary health team will be discussed in reference to these case studies as they are vital to a patients wellbeing and recovery. Eating and drinking is important for life (Holland et al, 2008). The body receives the essential nutrients from food for the body to work efficiently. Some of these necessary nutrients are proteins to give the body strength and to maintain muscle, bone, organ tissue (www. feedingminds. org) and carbohydrates to provide energy and minerals to help the bodys metabolism (Crisp & Taylor, 2009). A healthy diet is needed to prevent chronic disease and other health implications.
Fluid balance charts are a significant tool that nurses use document the input and output of fluids (Corrigan, 2009). They are commonly used in medical facilities such as hospitals and wards and measure the amount of food and liquid tolerated and the output amount of urine and faeces. This chart is based on a 24 hour time frame and provides important information for assessment of the patient. Water is extremely important to human life and keeps the body functioning and hydrated (Holland et al, 2008). 65% of the body is made up of water (www. australianbeverages. org).
The recommended daily intake of water is 6-8 glasses equivalent to two litres per day. A human cannot last more than 3 days without water (www. australianbeverages. org). Nursing skills are imperative to understand and assess an individuals situation and problems. These skills include interviewing, observing, documenting and listening. Interviewing a patient is a key principal to obtain crucial information. By using open and closed questions the patient can supply relevant information to the nurse giving background history and personal details for their assessment (Holland et al, 2008).
The nurse should use appropriate language that the person can understand and comprehend to avoid confusion. Nurses should be concise and speak clearly while conducting an interview. If the person does not understand any question or answer given it is the nurses role to ensure they understand completely. During the interview process it is necessary to check the correct information has been given by summarising what the person has stated and repeating it. Documenting information is essential for the completion of the nurses assessment.
Observation is another vital skill and provides the nurse with a more thorough background into the persons activities of living and health. The nurse should observe the persons verbal and non- verbal responses, body language, vital signs, swallowing reflex, mobility, anxiety and stress (Holland et al, 2008). This skill is necessary for nurses to collect information and to deliver a formal assessment, implementing the correct nursing actions accordingly. Listening is a skill that is also essential to nurses (Holland et al, 2008).
It establishes relationships and allows understanding between the nurse and patient based on a caring point of view. Listening creates a level of trust between the nurse and patient and encourages them to confide in the nurse, and more broadly the medical unit, which is important to safeguard the patients health and situation. There are many different nursing actions available to an individual. The multidisciplinary health team collaborate together to promote health and wellbeing (Crisp & Taylor, 2009).
Nursing actions provide assistance to a person and allow them to complete their activities of daily living easily. The help of other health care members is important to set and achieve goals for the individual and their situation. Some of these health care members include occupational therapist, physiotherapist, psychologist, social worker, psychiatrist and general practitioner. Other nursing actions include programs such as Meals on Wheels, community day care programs, community nurses and carers. Overall nursing actions are used to let the person become more independent and live their life to the fullest.
The following two case studies give examples of the nursing skills and actions that should be used in assessing and assisting the individual with the activity of living eating and drinking. The characters and situations in these case studies are fictional. These case studies outline biological, physiological and psychological factors. Case Study 1 An 89 year old woman, Mrs Green, was admitted to hospital three days ago after having a fall in her home. Falls are prevalent in people aged 65 and over (ref). Mrs Green complained of extreme pain in her chest on arrival and x-rays confirmed she had two broken ribs.
She was disorientated and distressed for the first day in hospital. When Mrs Green was stabilised the nurse could assess her properly and gather relevant information to assist her health and recovery. A nurse conducted an interview with Mrs Green asking general questions about her health and living situation. The nurse entered the room where Mrs Green was lying in a supported Fowlers position (Crisp & Taylor, 2009). Mrs Green agreed for the interview to take place after permission had been sought and the nurse introduced herself in a warm and friendly manner.
The nurse collected a chair in the room and positioned herself next to Mrs Green. It had been observed and documented on the fluid balance chart that Mrs Green had only eaten a small portion of her breakfast this morning and also had not completed her meal the night before. The nurse asked Mrs Green if she was in pain and if she had problems with eating and drinking. The reply was I dont have a lot of pain and it doesnt affect my eating and drinking. Mrs Green had been administered strong oral analgesics from admission to assist with pain relief and it was proved to be helping her.
The nurse queried her home life and family and Mrs Green stated that she lived alone and had no family or friends. Mrs Green admitted to not showering everyday and had difficulty washing areas of her body. After enquiring about her eating and drinking habits it was evident that Mrs Green did not like to prepare meals for herself because she lives alone and could not be troubled. She found it hard to shop as she does not drive and said it was a hassle to catch a bus and go to the shops to buy groceries. Mrs Green also said she sometimes just went to bed early and didnt worry about eating.
The nurse listened and documented what was said during this interview and showed interest in Mrs Greens situation. When asked about how much water and liquids Mrs Green consumes a day she replied by saying she enjoyed a cup of tea in the morning and night and drank a small glass of juice at lunch time. She stated if it was a hot day she would drink a cold glass of water but apart from that she did not drink a lot of water. On the arrival of morning tea, during the interview, Mrs Green was brought a cup of tea and cake, but she told the kitchen staff she had already eaten and showed no interest in having tea and cake.
The nurse was concerned and asked the other staff member to leave the morning tea anyway. It was realised by the nurse that Mrs Green had not eaten since breakfast a few hours earlier but Mrs Green thought that she had. After a few minutes Mrs Green proceeded to eat her cake and drink her cup of tea. The nurse noted the situation about morning tea and thought she may have dementia. Mrs Green would be monitored over several days to ascertain whether she had memory deficiency regarding her food and drink intake. The interview concluded and the nurse returned to the station to consider the nursing actions that should be implemented.
The nursing actions organised by the nurse was to have Mrs Greens mental status assessed by a doctor to find out if Mrs Green had an onset or form of dementia. The nurse spoke to Mrs Green about the importance of eating and drinking and educated her about the services available to assist her. Mrs Green was happy to receive help. The nurse arranged for community home care ensuring that when Mrs Green was discharged she had community nurses to visit her home and help her with personal care, shopping and cleaning. Meals on Wheels was also arranged to relieve Mrs Greens issue of not
wanting to cook and to provide her with a healthy meal each day. Case Study 2- Mr Hills a 65 year old man was brought to hospital by ambulance 4 weeks ago. He had suffered a severe Cardiovascular Accident (CVA) and had right sided paralysis. Mr Hills is a fit and active man with a wife and family. His stroke has left him with problems with his swallowing reflex and had been on a puree diet with the nurse and his wife feeding him for every meal. Liquids were thickened to help him swallow so he does not aspirate. Aspiration is where food particles or liquid travel into the trachea and into the lungs accidentally (www.
medterms. com). Mr Hills has been extremely emotional and irritated about his health situation and is frustrated about the loss of his mobility and independence. His speech has been affected but he is still able to communicate and answer questions slowly although at times he could not be understood properly. A fluid balance chart has been used to document the input and output for Mr Hills. The nursing skills used for this case study was that the nurse interviewed Mrs Hills in a quiet room reassuring her it was confidential and answering any questions or concerns she had for her husbands health.
The nurse educated her about Mr Hills health and future care and gave her words of support about this situation. The nurse observed how upset Mrs Hills was and offered to arrange a psychologist or counsellor to deal with her emotions and to provide suggestions on coping with her husbands trauma. The nurse interviewed and assessed Mr Hills and listened to the frustration he felt that he could not do the simple things he could do before such as eating and drinking. The nurse observed Mr Hills trying to pick up a spoon with his non dominant hand and feed himself on his own.
This was difficult and irritating for him. Nursing actions organised by the nurse included arranging for an occupational therapist who could implement special utensils, mugs and plates to assist him with eating and drinking. An occupational therapist is a qualified health member who can assess a person for specialised equipment to make daily activities of living easier (www. austot. com. au). This would be beneficial for Mr Hills by supplying the correct equipment not only for eating and drinking but for his home environment.
A left handed right angled spoon was given to Mr Hills by the occupational therapist to assist him with eating, as well as a handled mug with a spout to use when he was able to drink normal liquids. A rimmed edge plate was also introduced to help Mr Hills with collecting food onto his spoon to eat. A psychologist was called in to help Mr Hills cope with his problems and talk openly about the emotional issues he was dealing with. Regular visits with the psychologist at Mr Hills discretion would be advisable and could provide strategies to assist him with his anger and frustration and learn how to accept his current medical status.
A dietician would also prove to be helpful to Mr and Mrs Hills recommending what types of food and the portion size to suit Mr Hills eating regime. Mr Hills is currently on puree food and when he is able to eat semi-formed food the dietician can suggest how to prepare food and what is necessary to keep a healthy balanced lifestyle. Rehabilitation is extremely important for Mr Hills recovery. Physiotherapy would be implemented to rebuild muscle strength, improve mobility and retrain him to do basic skills confidently such as eating with specialised utensils (www.
physiotherapy. asn. au). With time and perseverance Mr Hills may be able to make a partial or full recovery and live a fulfilling life. After discharge community services will be needed to help Mr Hills with personal care. Respite may also be an option for Mrs Hills depending on how Mr Hills is recovering to give her relief. This is entirely at their own discretion but there are services available if in need of this. Eating and drinking is essential to the basic maintenance of life.
Nurses have an important role in identifying any problems related to this life activity and embody a wide range of skills to assist these concerns including listening, observing, interviewing, taking history both medical and lifestyle. Nurses are also trained to care, counsel and give emotional support to patient and family members. With the help from the multidisciplinary health team it is necessary for nurses to ensure all guidelines are met and followed using appropriate nursing actions to provide sufficient care for the health of all patients.