Clinical for Community and Public Health Nursing

0:00

Patient

0:00

You checked scene safety. It was correct to check scene safety in order to maintain your own safety.

0:06

You introduced yourself.

0:26

You washed your hands.

1:20

You identified the patient.

1:43

You asked the patient: Can you tell me a little bit more about what's going on with you today? It was appropriate to ask the patient what was going on with him to get an understanding of this.

1:59

The patient said: I don't think I can keep this up anymore. Everything is falling apart!\nYou answered: Of all the concerns you have, which is the most upsetting to you? \nYou used the therapeutic technique of focusing.

2:11

You asked the patient: Over the past year, when did you feel your best? It was appropriate to ask the patient about when he felt his best.

2:27

The patient said: I don't know. I have let down my congregation, my wife, and now the school board members. What should I do?\nYou answered: What do you think you should do? \nYou used the therapeutic technique of reflecting.

3:02

You assessed the respiration.

3:13

You checked the pulse oximetry.

3:31

You checked the radial pulse.

3:44

You measured the blood pressure.

4:02

You measured the temperature.

4:20

You asked the patient: Do you have any pain? The patient said: Yes, I have some pain.

4:29

You asked the patient: How would you rate your pain, on a scale of 0 to 10? The patient said: It's about a 4.

4:38

You asked the patient: Where is your pain located?

4:50

The patient said: I can't get rid of this headache.\nYou answered: A headache is a normal symptom of alcohol withdrawal. \nYou used the therapeutic technique of giving information.

6:12

You observed the appearance.

6:19

You assessed the attention.

6:26

You observed the motor activity.

6:32

You assessed the speech.

6:39

You assessed the thought processes.

6:46

You observed the patient's agitation.

6:56

You observed the patient's sweat.

7:24

You observed the patient's tremors.

8:15

You said: Alcohol withdrawal can cause a variety of symptoms, some of which can be dangerous to your overall health. I am going to ask you a series of questions to assess your current health status and your level of alcohol withdrawal symptoms. The assessment tool is called the Clinical Institute Withdrawal Assessment, or CIWA.

8:50

The patient said: Why are you asking me so many questions? You are making my headache worse.\nYou answered: I appreciate how difficult it is to answer so many questions; however, I need to complete an assessment of you today. \nYou used the therapeutic technique of giving information.

8:52

You said: Do you feel sick to your stomach? The patient said: Not really sick to my stomach. I just don't want to eat.

9:02

You said: Have you vomited? The patient said: No.

9:09

You said: Do you feel nervous?

9:25

The patient said: I don't know what to do with my hands.\nYou answered: Are you saying you feel anxious? \nYou used the therapeutic technique of translating to feelings.

9:33

You said: Have you had any itching? The patient said: No, I don't have any itching.

9:41

You said: Have you had any pins and needles sensations? The patient said: No.

9:49

You said: Have you had any burning sensations? The patient said: No.

9:57

You said: Have you had any numbness? The patient said: No.

10:06

You said: Do you feel bugs crawling under your skin? The patient said: No, I am not crazy.

10:15

You said: Are you more aware of sounds around you?

10:34

The patient said: Why is everyone so loud? I wish they would shut up!\nYou answered: Mr. Davis, no one here is loud. Sensitivity to sound is a common symptom of alcohol withdrawal. \nYou used the therapeutic technique of presenting reality and giving information.

10:36

You said: Are the sounds around you harsh?

10:53

The patient said: Ugh, it's so loud in here. I can't think straight with all this noise.\nYou answered: Some people in alcohol withdrawal are sensitive to sound. \nYou used the therapeutic technique of giving information.

10:55

You said: Are the sounds around you frightening? The patient said: No, I am not frightened.

11:05

You said: Are you hearing anything that is disturbing to you? The patient said: No. Just all of these questions.

11:14

You said: Are you hearing things you know are not there? The patient said: Oh, for god's sake, I am not hearing things. It's just too loud in here, if that's what you mean.

11:33

You said: Does the light appear to be too bright?

11:50

The patient said: The lights in here are too bright; they are hurting my head.\nYou answered: You appear upset. \nYou used the therapeutic technique of making observations.

11:56

You said: Is the light's color different? The patient said: No, it's just light.

12:08

You said: Does the light hurt your eyes? The patient said: No.

12:16

You dimmed the lights.

12:28

You said: Are you seeing anything that is disturbing to you? The patient said: No.

12:37

You said: Are you seeing things you know are not there? The patient said: No, I am not seeing things that are not there. Do you think I'm nuts?!

12:49

You said: Does your head feel different? The patient said: Yeah, I've got a headache. Why don't you go get me some Tylenol instead of asking all these questions?

13:02

You said: Does it feel like there is a band around your head? The patient said: Just a normal headache.

13:12

You said: What is today's date? The patient said: It is the 15th.

13:19

You said: Where are you? The patient said: Some sort of hospital facility.

13:27

You said: Who am I? The patient said: You are the nurse here.

13:35

You said: Can you please add 7 to 5 and continue to add 7 to the results until I say stop? The patient said: OK. Math problems too? ...12...19...26...umm...33...

17:49

You completed the CIWA-Ar assessment tool. Some of your assessment answers were incorrect.Regarding the indicator "Auditory disturbances - Observation": You should have indicated "1 very mild harshness or ability to frighten," "2 mild harshness or ability to frighten," or "3 moderate harshness or ability to frighten."Regarding the indicator 'Visual disturbances - Observation' You should have indicated '2 mild sensitivity' or '3. moderate sensitivity'.\n\nRegarding the indicator "Headache, Fullness in head": You should have indicated "3 moderate," "4 moderately severe," or "5 severe."

18:14

You educated about CIWA results.

18:48

You educated about medications.

19:33

You performed medication reconciliation.

19:55

You administered diazepam. This is correct.

You should have educated about substance abuse.

20:12

You educated about short-term goals.

20:59

You educated about substance abuse.

Alcohol use disorder is a disease that carries social stigma. Students should clarify their own feelings and values related to individuals with substance use disorders, as well as their world view of alcohol. Experiences students may have had with friends or family with substance use disorder will affect these perceptions. They need to be aware of how this can impact caring for patients with this diagnosis.lt;/p>lt;p>Alcohol withdrawal has physical symptoms that begin 4 to 12 hours after cessation of alcohol intake. The symptoms can be mild (headache, tremor) to severe (hallucinations, delirium tremens, seizures). It is imperative that nurses recognize symptoms and provide early pharmacologic interventions.lt;/p>lt;p>Alcohol use disorder is a disease that requires treatment. It is important that nurses communicate in a nonjudgmental manner. Motivational interviewing is a good intervention with alcohol use disorder as it promotes a collaborative approach rather than a patriarchal/matriarchal approach to care. Nurses interface with patients at different levels of readiness to access treatment. Denial is a common defense mechanism, as is the cycle of abuse, remission, and relapse. The nurse needs to work with the patient to address consequences of actions without judgment.lt;/p>lt;p>Alcohol use disorder is marked by the dysfunctional use of alcohol. There is a biological basis to dysfunctional alcohol use that makes some patients more susceptible to having diminished self-control over use. The activation of the dopamine reward system is a primary source of addiction. This system is more intensely activated in patients with a vulnerability to addiction. This activation can be so overpowering that the alcohol becomes the priority in the patient’s life, to the exclusion of family, work, self-care, and often safety.lt;/p>lt;p>There is not a defined amount of alcohol that designates a diagnosis of alcohol use disorder. There are guidelines for low-risk use of alcohol: for men, this means 4 or fewer standard drinks on any single day and fewer than 14 drinks during any given week, and for women, this means 3 or fewer standard drinks on a single day and fewer than 7 drinks in a week. However, the diagnosis of substance use disorder is more focused on functional and relationship challenges secondary to the use of the substance, as well as cravings and difficulty stopping the use of the substance. Students need to be self-aware of frustrations and expectations in working with this population.lt;/p>

You got 93%