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Bleeding esophageal avarice comes from Scarring (cirrhosis) of the liver is the most common cause of esophageal avarice. This scarring reduces blood flowing through the liver. As a result, more blood flows through the veins of the esophagi. This extra blood flow causes the veins in the esophagi to balloon outward. If these veins break open, they can bleed severely. Any type of chronic liver disease can cause esophageal avarice. Avarice can also occur in the upper part of the stomach (Degrade, 2014). The amount of blood was about AL and still bleeding.
He had about 6 pints of blood, plasma, OFF, and other meds to help with clotting. The IV pumps were all around him; blood was being suctioned out of his mouth by an GO tube; and more blood was oozing out of his mouth with a ventilation tube also in his mouth. He was pale, Jaundice, and sedated. The lab work indicates that the patient’s systems are not functioning properly and are shutting own. When he coded, his family was on the way to the hospital and was told on the phone that patient was not doing well. While he was being cleaned up so that he was presentable for the family, they were waiting in the hallway and the waiting room.
Several doctors came into the room and update the family members about the patient’s status. They said the he was not stable and that the bleeding needed to be controlled before they could do anything else. The family members asked it patient was going to come out of this, and doctor told them no; he might not survive the night. 3. Define the problem statement. The family was not expecting to see all the tubes, blood, and machines in the room. They were not prepared for this picture or what the doctors were telling them.
They met with the doctor and were told that he coded and what was happening at that moment. Then several other doctors came and told them that his chances of surviving the night were slim. They were coming into the room crying, telling patient to wake up and talk to them. This is the beginning signs and symptoms of anticipatory grieving. B. 1. Identify a theory base and state the reasons that led o to believe the problem is significant for intervention. According to Cordon’s Functional Health Patterns, role-relationship patterns, anticipatory grieving, is where this family is psychological.
The family was not excepting this outcome when their family member went into the hospital last night. Anticipatory grieving is knowing in advance that a loved one who is seriously ill is dying. This is common and generally induces psychological and/or physical distress. There is a wide range of feelings and symptoms that are common during grieving. There are feelings of shock, numbness, deadness, anger, guilt, anxiety, or fear. At times, there may also moments of relief, peace, or happiness that can be found.
Anticipatory grieving is not merely sadness, “the blues,” or depression, becoming depressed or overly anxious during the grieving process is a possibility. The stress of grief and grieving can take a physical toll on the body (Chief of Navy Chaplains Public Affairs). The goal is to prevent unpleasant psychological symptoms of anxiety, depression, and POTS (Davidson, 2010). 2. Which aspects of “caring’ did you apply? The foundation for nursing practice is caring. Caring is the interaction between nurses, the patients, and family members who can assist them to cope with their sick and dying family member.
During this time of the patient’s family members anticipatory grieving, I applied several aspects of roach’s concepts of “Caring. ” I demonstrated compassion when talking with the family members and with my presence. Seeing blood come out of your family members’ mouth can be frightening, so I proven my competence by suctioning the blood out of the patient’s mouth. Before the family came into the room, I made sure that the patient was presentable to the Emily members, establishing my confidence in my ability to create a caring environment.
I did not want them to see all the blood and trash from the intubations and insertion of the central, arterial, and dialysis lines. I demonstrated comportment in my professional presentation as a nurse to others by my attitude, appearance, behavior, dress, and language. Commitment was shown when I stayed with the patient throughout the entire process during my clinical day to help ensure the safety and welfare of the patient (“S. Roach,” 2013). 3. What assumptions (scientific & personal) did you make about the problem? What did you assume (Personal & Scientific) about the problem?
My assumption of the problem with this patient was that he probably would not recover due to extent of abusing alcohol, having renal failure, cirrhosis, and respiratory distress, and not doing well on the ventilator. Alcoholism eats up the liver and the body fails. This patient had a hard and difficult life, working manual labor. Scientifically this patient had decrease tissue perfusion and impaired oxygen utilization at the cellular level seen in shock. Impaired function of this system can significantly affect our ability to reheat, transport gases and participate in everyday activities (Barman, 2011).
Respiration is the process of gas exchange between individual and the environment and involves four components: ventilation or breathing, alveolar-capillary gas exchange, transport of oxygen and carbon dioxide between the tissues and lungs, and the movement of oxygen and carbon dioxide between the systemic capillaries and tissue (Barman, 2011). Scarring (cirrhosis) of the liver is the most common cause of esophageal avarice. This scarring reduces blood flowing through the liver. As a result, more blood flows through the veins of the esophagi. This extra blood flow causes the veins in the esophagi to balloon outward.
If these veins break open, they can bleed severely. Any type of chronic liver disease can cause esophageal avarice. Avarice can also occur in the upper part of the stomach (Degrade, 2014). Bleeding, shock, sepsis, acidosis, respiratory failure, and death are all possible outcome for patient. From all these medial problems, the family members would eventually have to make decisions about continuing care or withdrawing care. Anticipatory grieving started when patient enters the hospital and admitted onto the ICC and has continued throughout the day.
This family has some major and difficult decisions ahead of them which will precipitate grieving. The family members are trying to process the situation and come to terms with the possibility of the patient’s death. Need to prevent negative psychological outcomes (Davidson, 2010). C. List three plausible interventions to correct the problem and explain why each is a reasonable and valid intervention. One of the interventions is to have an environment that is conducive for the family to be able to care for and touch the family member to communicate their feelings, and feel secure in asking questions.
The family members play an important role and helping care for the patient helps them with the grieving process while providing a supportive environment to express their grief while coping with their feelings (Davidson, 2010). The second intervention would to have been to take a moment to request a chaplain or ask some one to request one for the family to talk to them about what is happening and how they are coping with this situation and if there is a need for spiritual counseling for them or the patient.
This gives the family members a chance to express the desire to have any rituals performed for the attain. Also, to help them cope more effectively with the psychological and emotional stain of their family member’s illness and the dying process (Davidson, 2010). Last, the third intervention would be getting the family a list of some activities that the family members can do that will help facilitate with the anticipatory grieving and dealing with the feelings of grief. Being active gives the family members a purpose and helps them to make sense of what is happening.
This helps with reshaping their lives and find new meaning in life without their family member (Davidson, 2010). D. 1 . Analyze and evaluate the advantage and disadvantage of each intervention One of the interventions is to have an environment that is conducive for the family to be able to care for the family member and feel secure in asking questions an advantage to a caring environment is that it would allow the family members to understand what the machines are doing, what the noises and values are, and the importance of them.
Having their physical presence in the room, helps with healing for the patient. Talking with the patient, caring for him, and being with him also helps the family members with their grieving. They were able to see how the nursing staff and doctors were taking care of their loved one. The disadvantage at this time was there were about eight IV machines and a ventilator in the room. There was no room for the family in the room; plus the whole family consisted of about 12 people. The nurse was focused on the patient.
She sent others to get medication, blood, plasma and equipment for patient. She was continuously present for the patient. The family came in and out of the room four or five at a time. She informed the family as they asked questions but she was unable to give them an explanation of the equipment, noises, values or their importance since the patient was not in a stable condition where she could spend the time with them. Unfortunately the only involvement that the family could participate in was to pray.
Second intervention would to have been to take a moment to request a chaplain or ask some one to request one for the family to talk to them about what is happening and how they are coping with this situation. An advantage of having a chaplain there, he would be able to help them in the process of coping and grieving so that this does to become a horrifying experience and an undo amount of anxiety or depression. He could help them with their spiritual needs. The chaplain could contact their place of worship so that the family could have access to some extra support.
The disadvantage of calling the chaplain is that is should have been done at the onset of the situation. It is never too late; but, earlier is better so that the family members’ place of worship could have been contacted for them so that their services could have been set in motion (Davidson, 2010). The third intervention would be to provide he family with a list of some activities to help with the patient so it that can help with grieving and dealing with the feelings of grief.
An advantage of this would be the activities create a sense of purpose for the family members which contribute the understanding of the crisis. The disadvantage would be that the activities are futile and there is not any time for them to be preformed or the nurse is unable to provide a list for them. If they had this list and were unable to accomplish them they might have a feeling of regret; if I only had done this, it might have helped or done more he he might not have died (Davidson, 2010). 2. Which intervention did you select for implementation?
At the time, we Just continued to try to stabilize the patient and only acknowledging the family members as they ask questions or when they needed to comfort themselves by standing near the patient. The patient was the main focus at the tine, but clearly the family members were experiencing anticipatory grieving as they watched what was being done to the patient. I selected to implement the intervention to get a chaplain for the family. A referral to the chaplain for spiritual purport can help with the anticipatory grieving and other needs. Allows family members, gives permission, to begin the grieving process.
A healthy grieving is making sure the family has the extra external support for their spiritual advisor. Do not wait too long for their spiritual needs to be met and the anticipatory grieving process can begin so they can heal. The family will be supported in their own place of worship because of the many different services each one provides to its members. Having a chaplain there helps to prevent the psychological effects of anxiety and/or depression. The brain needs to be engaged to minimize the stress hormones and having this becoming a terrible experience. Davidson, 2010). E. Justify your decision based on a theoretical framework Psychological, requesting a chaplain can help support the family members as they begin the process of grieving. The chaplain will be able to offer perspective and insight to help the family members to understand grief associated with an anticipated loss. A chaplain can assist in validating an individual’s experiences throughout the grieving process. The chaplain will often have the time needed to process the grief. There is no set timeshare when grieving. Every individual is different.
F. Reflecting back on your intervention, would you have made the same decision? Did you need more data? Reflecting back on my decision, I would do it differently. We did ask the family to be present and encouraged them to pray for the patient if it looked like they were praying for the patient. Other than that, we did not intervene like we should. I would like to have called a chaplain for them. They were clearly in anticipatory grieving and could have used some comfort. We were not able to provide this comfort because of ring to stabilize the patient.