I apologize that this issue is late. Yesterday I had two funeral visitations to attend, the week before that I had two, and tomorrow (Friday) I have another. It’s been a bad week around here. All of them were friends or relatives of friends, so I’m just thankful that it wasn’t any immediate family.
Someone had asked if my niece used any specific study guide to study from the time she finished her last class, till she took the NCLEX. I asked her about it and she did. The Hurst critical thinking application NCLEX review, while the book she used came with the class, she asked about a book that was similar and this http://amzn.to/1eDpy0Q was the book they recommended.
We’ve been working on tweaking our website, to make it easier to use and more useful, but we did manage to write a couple of articles – a couple of our favorites are below.
THINGS ON THE NCLEX
This section will have a couple of subjects / items that were on the NCLEX. Today we’ll be talking about After Death Care, and teaching about radiation as a cancer treatment (side effects / after care). Both of these items were on a test that was given in June.
After death care –
One of the hardest parts of being a nurse is dealing with friends and family after a patient dies. I think there are at least two variations of this – the first, it was unexpected and happened because of an accident / sudden onset of illness. The second is when it is expected, they might have had a long illness that has progressively gotten worse. Both are different, and you’ll learn how to deal with them in your own way. It is more about feeling than it is about reading something from a book. The really awesome part is when family members return a few weeks or months later and thank you for doing a job. When they do that, take some time to enjoy it, write how you feel down in a journal, because there will be days when everything goes wrong, you go home, sit down and cry. Reading those memories can help you remember why you enjoy your job.
Respect the patient’s culture and / or religion. You don’t have to agree with them, but as a nurse you need to respect them. Here is a sample question dealing with that.
A nurse is caring for an elderly Vietnamese patient in the terminal stages of lung cancer. Many family members are in the room around the clock performing unusual rituals and bringing ethnic foods. Which of the following actions should the nurse take?
- Restrict visiting hours and ask the family to limit visitors to two at a time.
B. Notify visitors with a sign on the door that the patient is limited to clear fluids only with no solid food allowed.
C. If possible, keep the other bed in the room unassigned to provide privacy and comfort to the family.
D. Contact the physician to report the unusual rituals and activities.
Correct answer is C – When a family member is dying, it is most helpful for nursing staff to provide a culturally sensitive environment to the degree possible within the hospital routine. In the Vietnamese culture, it is important that the dying be surrounded by loved ones and not left alone. Traditional rituals and foods are thought to ease the transition to the next life. When possible, allowing the family privacy for this traditional behavior is best for them and the patient. Answers A, B, and D are incorrect because they create unnecessary conflict with the patient and family.
The nurse is the only professional whose care extends beyond death.
Before the patient dies, if they have family visiting, make sure to speak with them and ask if anything special needs to be done. They may be shocked you are asking them about it, but just tell them that you need to know, to make sure the patient has dignity with their passing. When you find out about it, make some notes in the chart about your conversation and then make sure that you pass that on to the next nurse in your end of shift report.
Changes in body after death:
Rigor Mortis: body becomes stiff within 4 hours after death as a result of decreased ATP production. ATP keeps muscles soft and supple.
Algor Mortis: Temperature decreases by a few degrees each hour. The skin loses its elasticity and will tear easily.
Livor Mortis: Dependant parts of body become discolored. The patient will likely be lying on their back, their backside being the ‘dependant’ body part. The discoloration is a result of blood pooling, as the hemoglobin breaks down.
Every facility has different guidelines for After Death care. They all involve following the families wishes, cleaning the body, removing tubes (unless the body is to be released to the coroner) and getting the body ready to transport to the funeral home or morgue.
The NCLEX related questions normally have to do with certain religious and cultural beliefs. Normally if you read the question carefully, the answer will be in there. Just remember that it is your job as a nurse to respect the patients and their family wishes.
Some end of life care plans – http://nurseslabs.com/4-end-of-life-care-hospice-care-nursing-care-plans/
A great resource to give to your patients, if they are going home with a critically ill family member, this is a link you can share with them. https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/things-do-after-someone-dies
radiation as a cancer treatment (aftercare) –
Radiation is an effective treatment for cancer since it passes through normal organs and tissues to reach tumors. It can also be focused narrowly so that it only hits the tumor.
Make sure that your patient understands they need to take all of the medications that are prescribed to them. Some are given before a treatment, others after. Radiation is normally given more frequently than chemotherapy, so it is important that the patient understands they need to keep their appointment if at all possible.
Explain the side effects. Radiation therapy can make the skin red (like a sun burn) and very dry. It can slo become moist. As treatments progress the skin may peel and bleed.
Remind the patient when they’re taking a bath they want to treat their skin delicately. Short showers with warm water. Use a mild soap, don’t scrub, pat instead of rubbing your skin. The doctor may prescribe the patient some skin cream to use. Make sure the patient knows how and when to use it.
PRN meds are given if needed. Teach the patient when / how they may need to use it. Tell them when to contact the office. If they have a fever, questions, or can’t make an appointment. They should call 911 (or their family), if they have chest pain, trouble breathing, and/or trouble seeing, talking, thinking or remembering.
Personal note: One of my best friends is undergoing radiation and chemotherapy for neck cancer. He is doing daily radiation (2 weeks so far, 2 weeks to go) and two or three rounds of chemo. I spoke with him at some length about his side effects. The worst one he mentioned was that he is getting sores in his mouth, and he constantly has a sore throat now and it is difficult to swallow. I mentioned to him that next time he takes a rad treatment (he does them every week day morning) to tell his nurse about what was going on. There are medications that will help him deal with things.
As a nurse, remember to dig a little deeper. Some people don’t like to talk about things that are hurting them or bringing them discomfort.
NCLEX Drug Review –
Acyclovir (Zovirax) Antiviral
Treatment of herpes. Available PO and IV. Do not crush, chew, break capsules. Take with a full glass of water. May cause acute renal failure. Monitor renal function.
Side effects – Headache, blood dyscrasias, nausea and vomiting, diarrhea
TRIVIA / Q AND A
True a large gauge needle is used when giving blood, so that the blood isn’t harmed. 18 gauge is larger than 24. I used a 24 to start IVs on babies when I worked in peds. If you have trouble remembering, next time you do a clinical ask the nurse you’re with to show you the difference. Sometimes seeing them will help you remember better.
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