Nursing MSN

Juli (McGowan ’01) Boit

School of Nursing
Rationale Discrepancy between verbal and nonverbal cues may provide clues to degree of pain and need for and effectiveness of interventions. Currently Japan offers doctorate level degrees of nursing in a good number of its universities. The FNP program delivers a fully online curriculum which is available full or part-time. Students ready to complete this program and qualified to receive this APRN certification are needed to address the severe shortage of psychiatric and mental health care providers in Georgia. Go to the Ohio eLicense website at elicense. Throughout the remainder of the program, you can expect required trips to campus to be limited to 6 or less. See Reciprocity section below.

Obtaining CNA 1 Certification

Noisy respirations, rhonchi, and wheezes are indicative of retained secretions or airway obstruction. Assist client with and provide instruction in effective deep breathing, coughing in upright position sitting , and splinting of incision. Rationale Upright position favors maximal lung expansion, and splinting improves force of cough effort to mobilize and remove secretions.

Splinting may be done by nurse placing hands anteriorly and posterior over chest wall and by client, with pillows, as strength improves. Observe amount and character of sputum and aspirated secretions. Investigate changes, as indicated. Rationale Increased amounts of colorless or blood-streaked or watery secretions are normal initially and should decrease as recovery progresses. Presence of thick, tenacious, bloody, or purulent sputum suggests development of secondary problems for example, dehydration, pulmonary edema, local hemorrhage, or infection that require correction or treatment.

Suction if cough is weak or breathe sounds not cleared by cough effort. Avoid deep endotracheal and nasotracheal suctioning in client who has had pneumonectomy if possible. Rationale Suctioning increases risk of hypoxemia and mucosal damage.

Deep tracheal suctioning is generally contraindicated. If suctioning is unavoidable, it should be done gently and only to induce effective coughing. Encourage oral fluid intake, within cardiac tolerance. Rationale Adequate hydration aids in keeping secretions loose and enhances expectoration.

Assess for pain and discomfort and medicate on a routine basis and before breathing exercises. Rationale Encourages client to move, cough more effectively, and breathe more deeply to prevent respiratory insufficiency. Provide and assist client with incentive spirometer and postural drainage and percussion, as indicated. Rationale Improves lung expansion and ventilation and facilitates removal of secretions. Postural drainage may be contraindicated in some clients, and, in any event, must be performed cautiously to prevent respiratory embarrassment and incision discomfort.

Use humidified oxygen and ultrasonic nebulizer. Provide additional fluids intravenously IV , as indicated. Rationale Maximal hydration helps promote expectoration. Impaired oral intake necessitates IV supplementation to maintain hydration. Administer bronchodilators, expectorants, and analgesics, as indicated. Rationale Relieves bronchospasm to improve airflow.

Expectorants increase mucus production and liquefy and reduce viscosity facilitating removal of secretions. Nursing Diagnosis Acute Pain May be related to: Determine pain location and characteristics. Have client rate intensity on a scale of 0 to Rationale Helpful in evaluating cancer related pain symptoms, which may involve viscera, nerve, or bone tissue.

Use of rating scale aids client in assessing level of pain and provides tool for evaluating effectiveness of analgesics, enhancing client control of pain. Assess client verbal and nonverbal pain cues. Rationale Discrepancy between verbal and nonverbal cues may provide clues to degree of pain and need for and effectiveness of interventions.

Note possible pathophysiological and psychological causes of pain. Rationale Fear, distress, anxiety, and grief can impair ability to cope. Posterolateral incision is more uncomfortable for client than an anterolateral incision.

Discomfort can greatly increase with the presence of chest tubes. Evaluate effectiveness of pain control. Encourage sufficient medication to manage pain; change medication or time span as appropriate.

If client is unable to provide input, the nurse should observe physiological and nonverbal signs of pain and administer medications on a regular basis. Encourage verbalization of feelings about the pain. Rationale Fears and concerns can increase muscle tension and lower threshold of pain perception. Provide comfort measures such as frequent changes of position, back rubs, and support with pillows. Encourage use of relaxation techniques including visualization, guided imagery, and appropriate Diversional activities.

Rationale Promotes relaxation and redirects attention. Relieves discomfort and therapeutic effects of analgesia. Schedule rest periods, provide quiet environment. Rationale Decreases fatigue and conserves energy, enhancing coping abilities. Assist with self care activities, breathing, arm exercises, and ambulation.

Rationale Prevents undue fatigue and incision strain. Encouragement and physical assistance and support may be needed for some time before client is able or confident enough to perform these activities because of pain or fear of pain.

Assist with patient-controlled analgesia PCA or analgesia through epidural catheter. Administer intermittent analgesics routinely, as indicated, especially 45 to 60 minutes before respiratory treatments, and deep-breathing and coughing exercises. Rationale Maintaining a constant drug level avoids cyclic periods of pain, aids in muscle healing, and improves respiratory function and emotional comfort and coping.

Evaluate client and significant other SO level of understanding of diagnosis. Rationale Client and SO are hearing and assimilating new information that includes changes in self-image and lifestyle. Understanding perceptions of those involved sets the tone for individualizing care and provides information necessary for choosing appropriate interventions.

Rationale Support may enable client to begin exploring and dealing with the reality of cancer and its treatment. Client may need time to identify feelings and even more time to begin to express them. Provide opportunity for questions and answer them honestly. Be sure that client and care providers have the same understanding of terms used.

Rationale Establishes trust and reduces misperceptions or misinterpretation of information. Rationale When extreme denial or anxiety is interfering with progress of recovery, the issues facing client need to be explained and resolutions explored. Note comments and behaviors indicative of beginning acceptance or use of effective strategies to deal with situation. Rationale Fear and anxiety will diminish as client begins to accept and deal positively with reality.

Provide time to prepare for events and treatments. Rationale May help restore some feeling of control and independence to client who feels powerless in dealing with diagnosis and treatment. Rationale It is difficult to deal with emotional issues when experiencing extreme or persistent physical discomfort. Nursing Diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs Related to: Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs: Discuss diagnosis, current and planned therapies, and expected outcomes.

Rationale Provides individually specific information, creating knowledge base for subsequent learning regarding home management.

Radiation or chemotherapy may follow surgical intervention, and information is essential to enable the client and SO to make informed decisions.

Incorporate this information into discussion about short- and long-term recovery expectations. Rationale Length of rehabilitation and prognosis depend on type of surgical procedure, preoperative physical condition, and duration and degree of complications.

Discuss necessity of planning for follow-up care before discharge. Rationale Follow-up assessment of respiratory status and general health is imperative to assure optimal recovery. Also provides opportunity to readdress concerns or questions at a less stressful time.

Identify signs and symptoms requiring medical evaluations, such as changes in appearance of incision, development of respiratory difficulty, fever, increased chest pain, and changes in appearance of sputum.

Rationale Early detection and timely intervention may prevent or minimize complications. Stress importance of avoiding exposure to smoke, air pollution, and contact with individuals with upper respiratory infections URIs. Review nutritional and fluid needs. Suggest increasing protein and use of high-calorie snacks as appropriate.

Rationale Meeting cellular energy requirements and maintaining good circulating volume for tissue perfusion facilitate tissue regeneration and healing process.

Identify individually appropriate community resources, such as American Cancer Society, visiting nurse, social services, and home care. Rationale Agencies such as these offer a broad range of services that can be tailored to provide support and meet individual needs. Help client determine activity tolerance and set goals. Rationale Weakness and fatigue should decrease as lung heals and respiratory function improves during recovery period, especially if cancer was completely removed.

If cancer is advanced, it is emotionally helpful for client to be able to set realistic activity goals to achieve optimal independence. Evaluate availability and adequacy of support system s and necessity for assistance in self-care and home management. Encourage alternating rest periods with activity and light tasks with heavy tasks. Stress avoidance of heavy lifting and isometric or strenuous upper body exercise.

Rationale Generalized weakness and fatigue are usual in the early recovery period but should diminish as respiratory function improves and healing progresses. Rest and sleep enhance coping abilities, reduce nervousness common in this phase , and promote healing. Strenuous use of arms can place undue stress on incision because chest muscles may be weaker than normal for 3 to 6 months following surgery.

Recommend stopping any activity that causes undue fatigue or increased shortness of breath. Rationale Exhaustion aggravates respiratory insufficiency. Instruct and provide rationale for arm and shoulder exercises.

Have client or SO demonstrate exercises. Encourage following graded increase in number and intensity of routine repetitions. Rationale Simple arm circles and lifting arms over the head or out to the affected side are initiated on the first or second postoperative day to restore normal range of motion ROM of shoulder and to prevent ankylosis of the affected shoulder.

Encourage inspection of incisions. Review expectations for healing with client. Rationale Healing begins immediately, but complete healing takes time. As healing progresses, incision lines may appear dry with crusty scabs.

Underlying tissue may look bruised and feel tense, warm, and lumpy resolving hematoma. Instruct client and SO to watch for and report places in incision that do not heal or reopening of healed incision, any drainage bloody or purulent , and localized area of swelling with redness or increased pain that is hot to touch. Rationale Signs and symptoms indicating failure to heal, development of complications requiring further medical evaluation and intervention.

Suggest wearing soft cotton shirts and loose-fitting clothing; cover portion of incision with pad, as indicated, and leave incision open to air as much as possible. Rationale Reduces suture line irritation and pressure from clothing.

Leaving incisions open to air promotes healing process and may reduce risk of infection. Shower in warm water, washing incision gently. Avoid tub baths until approved by physician.

Rationale Keeps incision clean and promotes circulation and healing. Support incision with butterfly bandages as needed when sutures and staples are removed. Rationale Aids in maintaining approximation of wound edges to promote healing.

Be sure the patient understands any medication prescribed, including dosage, route, action, and side effects. Teach the patient about medical procedure before surgery and post surgery. Teach the patient how to maximize her or his respiratory effort. Patient Teaching, Discharge and Home Healthcare Guidelines for Lung Cancer Before surgery, supplement and reinforce what the physician has told the patient about the disease and the operation.

Teach the patient about postoperative procedures and equipment. Discuss urinary catheterization, chest tubes, endotracheal tubes, dressing changes, and I. If the patient is receiving chemotherapy or radiation therapy, explain possible adverse effects of these treatments.

Teach him ways to avoid complications, such as infection. Also review reportable adverse effects. Educate high-risk patients about ways to reduce their chances of developing lung cancer or recurrent cancer. Refer smokers to local branches of the American Cancer Society or Smokenders. Provide information about group therapy, individual counseling, and hypnosis.

Urge all heavy smokers older than age 40 to have a chest X-ray annually and cytologic sputum analysis every 6 months. Also encourage patients who have recurring or chronic respiratory tract infections, chronic lung disease, or a nagging or changing cough to seek prompt medical evaluation. Explain the need to contact the physician immediately Warn an outpatient to avoid tight clothing, sunburn, and harsh ointments on his chest. Teach him exercises to prevent shoulder stiffness. Teach him how to cough and breathe deeply from the diaphragm and how to perform range-of-motion exercises.

Reassure him that analgesics and proper positioning will help to control postoperative pain. Cause for Lung Cancers. Carcinogenesis, Initiation by a carcinogen cancer-causing agent , for example, cigarette smoke, asbestos, or coal dust. Type of Lung Cancer. To categorize lung cancers visible Pathologic features on light microscopy, are used. Patients with SCLC often have widespread disease at the time of diagnosis.

Rapid clinical deterioration in patients with chest masses often indicates SCLC. Staging of Lung Cancer. Whether Lung Cancer cells have spread into the lymph nodes N whether the Lung Cancer has spread anywhere else in the body - secondary cancer or metastases M. Complications of Lung Cancer. Like many other neoplasm disease Complications of Lung Cancer occurs when lung cancer metastasized to other organ, outside the Lung.

Nursing Diagnosis for Lung Cancer. To determine nursing diagnosis for Lung cancer, Nurses use Nursing assessment as tools for collecting data from the patients. Establish a history of persistent cough, chest pain, Dyspnea, weight loss, or hemoptysis. The clinical findings of lung cancer may be localized to the lung or may result from the regional or distant spread of the disease.

The patient is faced with a psychological adjustment to the diagnosis of a chronic illness that frequently results in death. Common Nursing diagnosis found in nursing care plans for patient with Lung Cancer:.

Common Treatment Methods of Lung Cancer. A common treatment method of Lung Cancer is Surgery, chemotherapy and radiotherapy is all classified as a treatment for lung cancer.

Before surgery patient must know the risk factor from Lung Cancer Surgery; Risks from lung cancer surgery include damage to structures in or near the lungs, general risks related to surgery, and risks from general anesthesia. Patient education before surgery: Researchers are continually looking at different ways of combining new and old drugs for advanced non-small cell lung cancer.

Chemotherapy treatment Complications, Myelosuppression infection, anemia, bleeding , nephrotoxicity, nausea and vomiting, mucositis inflammation of the mucous membranes , fatigue, SIADH and hyponatremia, hypotension, anaphylaxis, alopecia hair loss , neurotoxicity peripheral neuropathies, central nervous system toxicity , cardiomyopathy, arrhythmias, congestive heart failure, myocardial infarction, pneumonitis or pulmonary fibrosis, taste changes.

Neoadjuvant is therapy given before the primary therapy to improve effectiveness e. Lack of exposure, unfamiliarity with information or resources, Information misinterpretation, Lack of recall. Sample Nursing care Plan for Lung Cancer with interventions and rationale. Nursing Diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs. Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs:.

Patient Teaching, Discharge and Home Healthcare Guidelines for patient with Lung Cancer usually divide in to before surgery and post surgery. Newer Post Older Post Home. Subscribe to our RSS Feed. Follow Us on Twitter. Be Our Fan on Facebook. Nursing Care Plan for Inguinal Hernia. Hernia is a protrusion or projection of an organ or organ part through an abnormal opening in the co Lung cancer is the uncontrolled growth of abnormal cells, which may occur in the lining of the tra Although almost men older than 50 have some prostatic enlargement, with benign prostatic hyperplasia BPH , the prostate gland enlarges suf Side Effects Of Swallowing Toothpaste.

Sometimes someone accidentally swallow toothpaste toothpaste that is being used. But this should not become a habit, because swallowing Despite the normalcy of childbirth, complications may arise that will have detrimental effects on the postpartum client.

US State Boards of Nursing. Our bodies, based on its physical form composition, can be divided into 5 parts. All applicants must satisfy the general requirements of the University of Maryland Graduate School and submit the following materials:. Official Transcript s in English or native language transcript or mark sheets if applicable from your undergraduate and graduate schools listing subjects studied or marks received and rank in class or division.

Transcripts should delineate a cumulative grade point average of at least 3. If the GRE is required you must have taken the test within five years of application date. The Admission Committee will review completed applications on a rolling basis and release decisions throughout the admission cycle. Space may be limited so applicants are highly encouraged to apply early and well in advance of the deadline. If you are accepted, you will receive notification and more details on course registration, tuition status, compliance requirements, etc.

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Based on your professional experience, specify qualities that you feel are essential to nursing. Address the specific specialty area you would like to pursue as well as the population you plan to serve.

Describe your specific research interests in this specialty area. Spring We are currently accepting applications and will continue to review complete applications based on class space availability. Fall Application Opens: Baccalaureate degree in a major other than nursing with an overall cumulative GPA of 3. Please submit a ,word essay that addresses the following: Discuss your motivation to pursue the profession of nursing and why you have chosen the Clinical Nurse Leader option for your nursing education.

Identify at least one important role of the Clinical Nurse Leader that you find interesting or compelling and provide examples of how you see yourself practicing as a Clinical Nurse Leader. Describe the population of interest or the area of health care in which you would like to work after graduation. Briefly summarize what you hope to be doing professionally five years from now. The population you would like to service or the area of health care in which you would like to work after graduation.

The qualities you feel are essential to the advanced nursing profession that you bring with you. What are your research interests or your practice issues in this specialty area?

Admissions Decisions Announced late Nov. Post-Doctoral Certificates are available for the following specialty areas: Fall Admission Priority Deadline: June 1 Spring Admission: Deadline Qualifications Application Materials Deadline: All applicants must satisfy the general requirements of the University of Maryland Graduate School and submit the following materials: Send by mail to: Use code for the Graduate School. Three letters of recommendation providing evidence of personal and professional qualifications from three doctoral-prepared professionals familiar with the applicant's ability, work experience, contributions to nursing, and potential for success in the PhD program.

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