NVQ evidence

Peter was a 76 year old gentleman who had been admitted with increasing shortness of breath due to Congestive cariac failure. He had just been admitted via ambulance onto the ward.

I introduced myself to him and explained who I was.
I asked him if it would be ok for me to undertakes some tests and observations. I explained to him that the following tests/observations were important to be taken

= Temperature
= Pulse
= Respirations
= Blood pressure
= Oxygen saturations
= Weight
= Electrocardio gram

He agreed to all these.

Temperature
# I explained what was going to happen
# He agreed
# I chose to take Peter's temperature orally as he was not disorientated, complient, a nose breather rather than a mouth breather and had had neither oral surgery nor mouth infections.
# I showed him an oral thermochromic themometer. This had been seeled prior to opening and was in date as well had had intact packaging.
# I asked Peter to open his mouth and elevate his tounge. I placed the tip of the thermometer in the sublingal pocket then asked Peter to press down on it with his tounge as well as close his mouth
I waited one minute and removed the thermometer.
I waited better seconds for the colour changes to stabilise
I read her thermometer and found that Peter's temperature was 37.9 degrees centigrade.
As this was outside normal limits, as well as recording the temperature on the observations chart, I also informed my assessor.
With Peter's consent, I removed the top layers of clothing on the bed and found a fan. I also offered to wash Peter's had done face.

Pulse
I explain the procedure to Peter and gave his consent
I locate it because radial artery.
Using a my second and third fingers, I felt the the Pulse for one minute noting their rate, amplitude, and regularity.
As the Pulse was a 72, i recorded this on the observation chart.

Respirations
While Ra was taking because polls, after I had counted his polls for one minute, I'd then counted his respirations for a further minute. I counted complete breaths, noting rate, depth and regularity.
As the respiration rate was 26, as well as recording this on the the observations chart I also reported this to the qualified nurse

Blood pressure to
I explain the procedure to Peter and he gave his consent. I informed him that this could be uncomfortable however this would be transitory.
I it located Peter's brachial artery. I placed the cuff of observations machine over the upper arm centring the calf on the break your archery itself.
I then explain that I was going to initiate the Blood pressure taking process to Peter. I then did this. I recommended to Peter that it would be a good idea if he stayed really still. This is because if there is excess movement, the machine may not hear the blood-pressure correctly and then re inflate the cuff, to a much higher level, which can be quite painful.
As the result was 130/60, i recorded this on the observation sheet.















Midstream specimen of urine and urine dipstick testing.
Peter expressed a wish to pass water. As he was not very well, I a yeast with him and suggested that he used a urine bottle. He agreed. I obtained this as well as a sterile foil bawl. And a plastic apron I explain to him that he was necessary for him into commends passing water into the bottle. Stop, recommence passing water in the sterile portion of the bowl, or stop again, and finished passing water in the bottle. He did not need any help with this so are a withdrew and allowed him to pass water as necessary in the above prescribed manner. Still wearing my latex gloves and apron, I took the urine bottle and specimen to the sluice. I measured how much urine was in the bottle had discarded it down the sluice. I'd then placed the dirty bottle in the bedpan washer. I took a clean urine test stick from an in date contain air of sticks. I had also check a see that the the packaging was safe and not tampered with. I dipped the stick into the urine that was in the ball for one second. I tapped the stick on the side of the container to remove the excess urine. And I held the stick downwards for one minute. I'd then compared the Test trick against the tee on the container, not allowing the stick to touch the container itself thus preventing contamination of the container. The pH of Peter's urine was five. This was normal. There was all two plus protein and three plus Blood. This was abnormal. I therefore to inform my assessor who suggested that I send a midstream specimen of urine. The specimen that Peter had produced was a midstream specimen. The significance of this is that at the beginning of micturition and the end of micturition, epithelial cells from the lining of the bladder and urethra can contaminate during and give false readings in the laboratory. To help to reduce this, a midstream specimen is the ideal one batch a decent. If it is absolutely impossible to obtain a midstream specimen of urine, then a collection of urine that contains so start middle and end of the specimen is called a "clean catch" of urine. If a specimen is a clean catch, then this must be entered on the form that is sent to the lab. I placed 20 millilitres of urine in a specific midstream specimen of urine pot. This contains a set amount of boric acid. If an insufficient amount of urine is placed in the container, then this can invalidate the specimen due to over saturation with boric acid. The specimen will be rejected by the laboratory. I placed a client label on the pot and added the ward the date and the time. I filled out the form that a company does best when by sticking on a patient name label, adding that this was a midstream specimen of urine, asking for micros screen, Culture and sensitive . I also recorded the results of the urine dipstick test on the form and on the club's care plan. I liaised with my assessor as to there being anything else I needed and to perform before I sent it. I placed the specimen in the appropriate collection.. I recorded that I had sent a specimen of urine for this gentleman.

Weight.
One of the problems with congestive cardiac failure can be retention of fluid. This is due to the poor ability of the heart to pump fluid and around the body effectively. The doctors and nurses need to know what is the fluid status of any individual in this situation. This can be achieved by recording a fluid balance and weighing the patient daily at the same time each day with the same amount of clothing on.

I liaised with Alan to see if he could sit on a weighing scales while we wait him. He agreed. I showed him the equipment and shows him how it worked. He agreed to have his way taken. I helped him to sit on the scales was maximising his stillness and his comfort. I waited until he was totally steel then I took a reading of how much she weighed. I recorded this in his care plan on a weight chart.



Reflection

Feelings

In the rapid hum drum of thought, sometimes I can not concentrate as much as I should on doing observations. I stopped and thought about the observation process whilst doing this NVQ. But it can be all too easy to be rushing around and not explain fully what on loan to do. Making me do this slowly, has been nothing but good. It is given the time to reappraise how I do my job. Having one's blood pressure can be painful. In a hustle and bustle of a busy ward, it can be easy to forget this. Peter was feeling somewhat unwell. The he remained quite calm however the situation was quite stressful for him. At all we stages, I ensure that I told Peter what was going to happen. The this helped him to stay as calm as he did.


Evaluation

It is very important to remember that if patients are comfortable, they can be less stressed. the rushing of patients can backfire as they have things that have not been done properly. The so they require more things and in the long run. Also, rushing about, can be stressful for patients also. respirations are very important and should be done at all times. An increase or decrease in bees can be indicator of impending problems. Their recording is the most missedobservation. I have owned that I have not always recorded respirations in the past, through late on it from the person before who had not recorded them. I now realise how important it is to recall them. If they have not been recorded before, that makes even more important to record them recorded in the past. I feel that I undertook the observations correctly as far as I could know. I feel that it is very important to report as well as record any abnormalities that undetected. as a healthcare support worker, I have a supportive role and it is my responsibility to report any abnormalities. I have a limited role do with dealing with abnormalities. It is the qualified nurse who has to her greatest role in dealing with abnormalities. She is accountable practitioner. even though a support worker may believe that abnormality is within their scope and role, them may be aspects that are belonged the knowledge-based of the support worker so this is why should be done.

Analysis
this situation could have gone a lot worse. I could have not informed my assessor that there any abnormalities. This could have been detrimental to the client. Also, the qualified nurse could have faced disciplinary action as she would not have known at the observations and then not acted and the patient could have become a lot more poorly. Also, it had not remained calm, and flapped about, this could have made Peter agitated, which would not have had a beneficial effect to his health which, at the time, was very badly compromised.

Conclusion

Although the situation went well,