Today clinical class included a presentation on cataracts. Cataracts is an important topic to discuss with the elderly especially because it appears to be an age related change most will experience although it can be caused by a number of other reasons. A cataract is a clouding of the lens inside the eye which leads to a decrease in vision. It is the most common cause of blindness and is usually treated with surgery. Vision loss occurs because opacity of the lens impedes light from passing and focusing on to the retina . The disease is usually detected by a visual acuity test where the Opthamologist place a Snellen chart and asks the patient to read the most visible line. In addition to the general knowledge, the main point that the presenter(Karla) place emphasis on was yearly eye examination especially in light of other co-morbidities such as diabetes. Recognizing that those with cataract commonly experience difficulty appreciating colors and changes in contrast, driving, reading, recognizing faces, and experience problems coping with glare from bright light were some of the other major points . Overall I thought this was useful presentation in that the residents were enthused and eager to learn as most of them had already had their lenses replaced. Furthermore, most of the residents verbalized that they would visit their eye doctor yearly and more frequently if they experience any vision loss.
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Today’s clinical discussion about pain and pain management was very informative and pertinent to practicing nurses. The research presented suggests that most facility (LTC and Acute Settings) does not perform a noteworthy job of pain management. The primary reason for the mismanagement of pain is a direct result of the lack of understanding regarding the 2 basic types of pain, nociceptive and neuropathic and the accompanying treatment. Furthermore, nurses, iu thses settings, administer pain medications without following up to determine efficacy. Examples of nociceptive pain includes sprains, bone fractures, burns, bumps, bruises, inflammation (from an infection or arthritic disorder), obstructions, and myofascial pain (which may indicate abnormal muscle stresses). Nociceptors are the nerves which senses and respond to parts of the body suffering from damage. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain. The pain is typically well localized, constant, and often with an aching or throbbing quality. Visceral pain is a subtype of nociceptive pain that involves the internal organs. It tends to be episodic and poorly localized. Conversely, neuropathic pain includes examples such as: post herpetic (or post-shingles) neuralgia, reflex sympathetic dystrophy / causalgia (nerve trauma), components of cancer pain, phantom limb pain, entrapment neuropathy (e.g., carpal tunnel syndrome), and peripheral neuropathy (widespread nerve damage). Among the many causes of peripheral neuropathy, diabetes is the most common, but the condition can also be caused by chronic alcohol use, exposure to other toxins (including many chemotherapies), vitamin deficiencies, and a large variety of other medical conditions. Neuropathic pain is usually the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. Nerves can be infiltrated or compressed by tumors, strangulated by scar tissue, or inflamed by infection. The pain frequently has burning, lancinating, or electric shock qualities. Persistent allodynia, pain resulting from a non-painful stimulus such as a light touch, is also a common characteristic of neuropathic pain. The pain may persist for months or years beyond the apparent healing of any damaged tissues. When this happens, pain signals no longer represent an alarm about ongoing or impending injury, instead the alarm system itself is malfunctioning. The research shows if pain management is to be successful then nurses must also play their part in documenting using pain scales after pain administration.
So as previously established in blog #1, Professor Stewart and his depiction of the course has continue to captivate and hold my attention. So during the last class we were all assigned to a patient and were given the opportunity to access our patient charts. The chart was filled with an array of information ranging from past medical hx, doctor appointments, follow ups, and a brief synopsis on the patient personal upbringing and life. The primary task of this assignment was to read the chart create a comprehensive image of the patient, meet the patient, and then compare the charted info with the oral information collected from the patient. So finally I met my patient and we spoke in depth about the community, her accessibility to the resources, children (daughter) grandchildren( 4 grandchildren), southern upbringing, life in the Big Apple, and how she was introduce to CNR. So the next time we meet I will be fine tuning my discussion to cover specific community related questions such as: who she lives with, where she lives–lower level / upper level apartment, private or apartment building, transportation, day-to-day living , friends or family member support system. The information collected is vital to understanding her accessibility to community resource, family support, and psychosocial development. It also helps to assess for potential and actual problems that may warrant further intervention. Based on one of her several diagnosis I am also in the process of developing a teaching model about NIDDM(Type II). Topics such as food substitution, blood glucose monitoring, and adhering to medication regiment will be presented in a manner that is elucidated and understandable.
Clinical for me has thus far been a very interesting experience. Professor Stewart knows how to bring the life to the party. He is informative, captivating, and best of all passionate about being a clinical instructor. He has been involved in many different areas of nursing such as: long term care, acute care, school nursing, case management; which enables him to explain the connection between the various fields of nursing. He explains community nursing as placing emphasis on the individuals and family within their natural setting in the communities. So one of the very first task the class did was to walk around and survey the community. The purpose of the community survey was to identify community resources, determine quality of life in the community, and assess the family structure. We were interested in things like: proximity to hospitals, nursing homes, parks, food stores, laundry mats, school, etc. The focal point of the exercise however, was much more profound than superficial. We simply look at the exterior of the buildings, scanned the environment directly proximal to the buildings, and were able to create a depiction of the interest of the people residing in the buildings and moreover, the community. For example, by looking at the buildings we saw that most of the buildings were equipped with fire escapes and window guards; indicating that fire and children safety were a concern amongst community residents.
So that was the first day of community clinical… being able to analyze what you see and defining it in terms of the overall community. Because each community is unique and has properties that are particular to itself and residents. Identifying those properties and how they facilitate, impede, or impact the delivery of nursing care to the community is the primary focus of this course.
