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sally
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  • My name is Peter Foster and I'm 52 years old
  • Meeting Sally
  • Hi my name is Sam Renshaw and im 32
  • Hello my name is Sally Roberts
  • About Sally
  • Sally is 44 years old, she currently works in a garden centre. Sally rents a room in a house share.Where she shares communal areas with two others.Sally smokes 20 cigarettes a day.
  • Sallys Medical History
  • Long standing schizophrenia which is currently stable Sally sometimes hears voices but this causes her no distress, Sally attends a support group for this.Sally has asthma Sally takes Clozapine
  • Asthma
  • Asthma is defined as a chronic inflammatory condition which effects the airway (Lynn and Kushto-Reese, 2015). This disorder is marked by variable airflow obstruction and airway hyper responsiveness (Lynn and Kushto-Reese, 2015).
  • symptoms-Wheeze -Cough -Variable airflow obstruction -Chest tightness -Breathlessness (British Journal of School Nursing, 2011)
  • Asthma 
  • Pathophysiology of asthma
  • There are three main processes found in the pathophysiology of asthma: -Airway imflamanition-Bronchospasm -Increased mucous production (Sims, 2006)
  • When an individual is experiencing an asthma attack their airways have swollen and become inflamed because of this the muscles which surround the airways contract and extra mucus in the airway is produced causing restricted airflow (Mayo Clinic, 2019)
  • Pathophysiology of asthma
  • Epidemiology
  • According to the World Health Organisation (WHO) 235 million individuals suffer from asthma globally (WHO,2019)
  • Lancashire county council states that across Lancashire there is a higher prevalence with asthma than compared to England by 6.0% (Lancashire county council, 2020)
  • Across England there are 5.4 million individuals affected by asthma (Asthma,2020)
  • (NHS England, N.D)
  • Therapeutic Relationships
  • The 6 C's of Nursing
  • Care Compassion Courage
  • Communication Competence Commitment
  • Therapeutic Relationships
  • Therapeutic relationships are at the forefront of all healthcare interactions between healthcare professionals and patients (Kornbaber R, Walsh K, Duff J and Walker K, 2016). It can be defined as one of the primary components when interacting with patients to en-rich the patients experience with non-judgemental and supportive behaviour building trust and respect between the nurse and patient (Kornbaber R, Walsh K, Duff J and Walker K, 2016)
  • Skills needed for a therapeutic relationship
  • Hello Edith my names James, how are you feeling today?
  • Knowledge
  • The Code of Conduct
  • As part of the code of conduct as stated by the Nursing and Midwifery Council (NMC) for a nurse to register they need to be able to use their knowledge and skills while providing evidence based care, so that the needs of the patient can be met (NMC, 2018)
  • knowledge
  • when caring for sally its important that the nurse takes into account her medical history with schizophrenia and how this may effect her experience while in hospital, skills which will be beneficial while supporting Sally are good communication skills to provide knowledge based care in a patient friendly manner to support Sally in decision making (Clark WG, 2007)
  • Skills
  • All registered nurses have to follow a code set out by the NMC ensuring their skills and knowledge are kept up to date every 3 years (NMC, N.D)
  • Skills
  • Hi Sally, how are we feeling? I've brought you some of the quit smoking leaflets you asked for.
  • Values
  • Afternoon, ive read the leaflets but I enjoy smoking I may give up one day.
  • Sally is rushed to Hospital
  • An ambulance is called by one of Sallys house mates, she's struggling to breath, very wheezy and can't construct a sentence well to communicate. She's rushed to hospital.
  • When building a therapeutic relationship a nurse will have to gain knowledge about the patient though hands on care by making a meaningful connection with the patient while supporting them, learning their characteristics and gaining trust, by doing this they enable the patient to make decisions (Bridges etal.,2013)
  • Sally arrives at A&E
  • Supporting adults with acute health conditions
  • Sallys medical history
  • ABCDE approach
  • A-E Assessment
  • Sally has asthma and smokes 20 cigarettes a day, nurses are there to also promote well-being and healthy life style choices this enables them to advise Sally on how her smoking may affect her asthma and they can help her quit. 
  • Thankyou so much I will have a think about quitting and read over the leaflets, thanks for you're advice and support.
  • As a nurse a individual must practice in a holistic, caring and non-judgemental way which respects a patients life choices (NMC,ND). With Sally smoking daily this can really have a negative impact on her condition, nurses must use their knowledge and skills to communicate this to sally but also respect her choice to smoke and still treat her professionally as they would with any other patient.
  • A-E Assessment
  • Now they must access the patients circulation, are they bleeding, whats there capillary refill time, blood pressure, pluse, is the skin pale, mottled or red. (Jevon P, 2010). Sallys capillary refill time is normal, her pulse is a little fast and her blood pressure is a little high. Another nurse ensures sally has IV access by putting a canular in Sallys hand.
  • Afternoon Sally, that's fine keep the leaflets they may come in handy in the future.
  • A-E Assessment
  • As Sally arrives in the bay the nurse taking care of Sally introduces himself, this helps to start building the therapeutic relationship and trust between the nurse and Sally. (Podiatry Now, 2016)
  • Hello Sally, my name is..
  • As soon as Sally arrives in A&E she is given 10L of oxygen on a non-rebreathe mask to improve her oxygen levels to 94-98% as her current SPo2 levels show she is saturating at 90 Spo2 (British Thoracic Society(BTS), 2017). Sally is put onto oxygen straight away as guided by the BTS and a A-E assessment is conducted.
  • The ABCDE approach is an assessment tool used with critically ill and deteriorating patients, by using this tool it helps to determine the next steps to take, treatment and accesses the patient at the same time (Resuscitation Council, 2020). When using the ABCDE approach nurses must start at A and follow step by step until E they must not skip a step or evaluate in a different order, while using the tool they also must use their knowledge and be aware of different escalation protocols to follow if interacted (Jevron P, 2010).
  • Next they should follow on by looking at the patients breathing any signs of respiratory distress, how the patient is presenting themselves, count the resp rate, any sweating or use of accessory muscles to breathe (Jevon P, 2010).Sally's resp rate is 25, she's sweaty and complaining struggling to breath although she is on 15L of oxygen. The nurse ensures Sally is sat up in a up right postion to help with her breathing.
  • The nurse should start by assessing the airways for any obstruction, is the patient making any noises can they have a conversation. (Resuscitation Council, 2020)Sally has been rushed into A&E she was put onto oxygen as soon as she arrived due to the risk of her becoming hypoxic, Sally is able to communicate although she is very wheezy.
  • when the nurse gets to this stage they are assessing the patients nervous system and consciousness by using an additional tool AVPU, they need to look at the patients pupils are they equal and reacting? do they have any stiffness in their neck. (Jevon P, 2010)Sallys pupils are equal and reacting, she can communicate and is alert.
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