Loss strength endocrine system hormone imbalance psychosocial anxiety

Week 1

Introduction to Acute Care Nursing 1

Private day hospitals

– Diagnostics and treatment e.g. colonoscopy & removal of polyps

– Pharmacies, optometrists, dentists

In general

Types of procedures

Diagnostic

• Remove diseased tissue e.g. bowel resection

Reconstruction
• Build or rebuild damaged or absent tissue and organs

Aids to diagnosis

Pathology
• Blood tests, tissue analysis,

Older adult – considerations

Even in healthy older age, physiological changes occur which may affect the person having surgery. E.g.

Postanaesthetic observations

Monitor (every 15 minutes) & manage

• Anxiety, depression, altered body image, anger

Metabolic

• Knowledge e.g. understand the drugs you are administering

• Consult pain management teams/anaesthetists

• PCA/epidural

• Adjuvants

• uses mild electrical impulses as an alternative to drugs.

• Educate:

– Wound care/pain management/medications/exercise, work, lifting, driving, sexual

Key Points / Summary

• NRSG258 explores perioperative care including pathophysiology & pharmacology &

– have a broad knowledge of patients’ conditions and how to manage them safely

– be able to plan patient specific discharge for safe transfer of care.

Essential elements of a valid consent:

• Voluntary

– nurses on the wards are discouraged from witnessing documents due to potential

future legal implications

• The law about consent involves understanding & comprehension

Legal capacity

• The patient has an Advance Care Directive

– This document outlines the care they wish to receive if they no longer have the

• The person is:

– Unconscious

– A child

• 18 & over full legal capacity

• Common Law will deem a consent for the treatment given, if the treatment was necessary,

reasonable and given in good faith

reasonable, given in good faith

• Further state by state information available in Forrester & Griffiths (2010) p.146

necessary in the circumstances

• Same applies to children is parent not available

• Emergency is not defined in common law but is accepted to be ‘treatment to save life’ or

‘prevent serious injury or death’ & is the same for adults or children where parents cannot

Age of consent (NSW)

• Child defined as under 16years

Contracts) Act 1970 NSW)

– NB: Ages differ between states so use your state’s policies for rules about age and

– Gillick Competency

– If a child is of an age and intelligence where they can understand and comprehend

• Anyone under the age of 18 is considered a ‘minor’.

• When a child or young person under the age of 18 does not have capacity to consent,

• Presumed to not have capacity to give their own consent, unless there is sufficient evidence

they have such capacity (refer Gillick’s competency).

• They must understand and appreciate the nature and consequences of the

procedure/treatment.

• Children under 18years can consent if it is deemed they are competent to consent.

• The individual must understand and appreciate the nature and consequences of the

the High Court

Consent issues

Assault – cause fear of injury in another person & does not need to be explicitly expressed

e.g. threaten to medicate a patient if they do not cooperate

• Other than specific situations e.g. enduring guardianship no other person has the legal ability

to consent to the treatment of another adult

• If all the information had been given, would the patient have not consented to

treatment/procedure?

decisions related to business affairs e.g. manage investments, sell a house (can be

restricted activity e.g. pay bills from an account)

• Specific to medical treatments (not finances)

• Can be revoked at any time as long as the person has the legal capacity to do so

• Legislation in all states & territories which protects people who are incompetent or

disabled

• Person does not usually have control of finances but must be someone who has no conflict

of interest & must act as an advocate

• Unexpected; violent or unnatural (e.g. homicide; suicide); due accident or injury (e.g.

drowning; MVA; fire)

• Had not been attended by a doctor in the last six months

• Is of unknown identity

– Most agencies have guidelines when a death is reportable.

• Minimum interference with the body

• A health professional undertaking the procedure must obtain the consent

• All health professionals may witness a signature but witnessing is not agreeing to the patient

• Any outstanding issues of concern to the patient should be brought to the attention of the

Doctor may inform the patient and obtain verbal consent and then ask a hospital staff

• You are responsible for advice you give to patients.

• You need to be aware you have a duty to exercise reasonable care where providing any

Duty of care

• A person must take reasonable care to avoid acts or omissions that a reasonable person in a

• Educating the public & professionals about appropriate standards of care

• Negligence occurs when a professional fails to provide the quality of care that should be

• Harm that was reasonably foreseeable

Breach of Duty of Care

exercised by the practitioner – this is NOT negligence e.g.

• A patient has brain surgery to remove a tumour and wakes up with a neurological

• Employer policy

• The law

Australia’s medical indemnity claims (2012-2013)

• Average length of time between incident & claim = 2yrs but can be longer

procedure

Reflection

Death of patient – lack of duty of care from all staff caring for the patient as they did not recognise

the symptoms of septic shock in this patient. (This was an actual case & the family sued the hospital

• Evidence based care/practice

– Your care should be based on the best & most current evidence

• Brief, accurate & complete, legible, objective

• Use only accepted medical abbreviations

• They communicate the patient’s treatment, condition & progress with other nurses & the

MDT

• Lawyers, accreditors, auditors, insurance companies & the patient can read the notes

• Should be read at beginning of shift, after days off or if the patient is new to you

• Wound

• Fluid balance e.g. intake, output

• Discharge plan

Documentation – structure

• A = Assessment

• P = Plan

• A – Airway

• B – Breathing

• G – Glucose (or Give comfort measures)

• H – Head to toe assessment

– Present conditions or diseases

– Medical test results

Inadequate documentation – consequences

• For the patient

• Nurse may:

– Be dismissed

Your notes may be read by a range of people including the patient

Be non-judgemental

• Maintain confidentiality

Documentation – barriers

– Unfamiliarity with medical terminology

– Lack of knowledge about abbreviations

• Enables standardisation of some types of information – test results, medications

• Does not improve time efficiency when delivering nursing care

• Various types of POA can be appointed by a person to care for finances and/or medical

treatment but rules apply

and their progress during their hospitalisation