The application of negative pressure therapy to the wound bed helps draw wound edges together, remove infectious materials and draw wound edges together, remove infectious materials and actively promotes granulation tissue at the cellular level. Also, The negative pressure wound therapy provides a moist wound environment facilitating healing of acute or chronic wounds.(KCI company, 2012).
On day 98, the epidermal autograft (Epicel) that had exposed fascia. Wound care continued to be a significant challenge,requiring intense collaboration between nursing, general surgery, an enterostomal therapist and the nursing representative from genzyme (the company who produces the epicel graft). Over the next several weeks, approximately 80% 0f the graft had “taken”, however the infant was not improving clinically. K.A.’s cardio-respiratory support was escalating and he ultimately developed renal failure. On day 118, his parents decided to withdraw life support and he died in their arms.
K.A.’s family was deeply spiritual and believed that they needed to give their son every possible chance to survive. They were counseled early in his acute illness that his chances of survival were not good and they decided to pursue aggressive treatment. His mother was at the bedside almost every day. The was quiet and clearly became more distressed as he continued to decline. Primary nursing was vital to developing a relationship with her and in providing ongoing support to her and the entire family. Over time we were able o explore issues of quality of life as well as her hopes and dreams for her son. As K.A.’s condition deteriorated further and he was in multi-system failure the primary team was able to guide the family and assist them in making end of life decisions;decisions that they could come to terms with. During the final few days of his life the family was able to spend time with their son and their extended family. They were able to make memories, hold him and being the grieving process. Our social work and chaplaincy services were instrumental in providing them the continued support they needed though this very difficult time.
In following up with K.A.’s family after his death they were able to verbalize how grateful they were for our support. Especially the support of the decisions made for their son over the course of his illness and in his death. They were at peace in knowing they had given him every opportunity to heal, overcome his overwhelming illness, And ultimately did what was for him in removing his life support
Discussion
A primary role of the nurse is to serve as an advocate for their patient. Positioned at bedside, nurse has firsthand knowledge of their patient’s status and needs. As advocates, nurse conveys vital information they have gathered about their patients to the entire healthcare team. In the critical care environment, this information often includes continuous patient assessment, response to treatment and constant surveillance through assessment and monitoring for changes as well as family education, support and multidisciplinary care coordination
Patients with NF have significant pain and wound management requirements. Thus, to advocate these needs, nurse on K.A’s team had to remain vigilant, assessing and reassessing pain and wound needs. To ensure that K.A.’s nurses were well positioned to serve as his advocates, a primary team of nurses was developed. It was clear that with K.A.’s complex medical needs a multidisciplinary group of healthcare providers was necessary. K.A.’s team included a group of expert leadership nurses, nurse practitioners, neonatologists, anesthesiologists enterostomal therapist , clinical nurse specialist and a nurse from Genzyme.
The application of negative pressure therapy to the wound bed helps draw wound edges together, remove infectious materials and draw wound edges together, remove infectious materials and actively promotes granulation tissue at the cellular level. Also, The negative pressure wound therapy provides a moist wound environment facilitating healing of acute or chronic wounds.(KCI company, 2012).
On day 98, the epidermal autograft (Epicel) that had exposed fascia. Wound care continued to be a significant challenge,requiring intense collaboration between nursing, general surgery, an enterostomal therapist and the nursing representative from genzyme (the company who produces the epicel graft). Over the next several weeks, approximately 80% 0f the graft had “taken”, however the infant was not improving clinically. K.A.’s cardio-respiratory support was escalating and he ultimately developed renal failure. On day 118, his parents decided to withdraw life support and he died in their arms.
K.A.’s family was deeply spiritual and believed that they needed to give their son every possible chance to survive. They were counseled early in his acute illness that his chances of survival were not good and they decided to pursue aggressive treatment. His mother was at the bedside almost every day. The was quiet and clearly became more distressed as he continued to decline. Primary nursing was vital to developing a relationship with her and in providing ongoing support to her and the entire family. Over time we were able o explore issues of quality of life as well as her hopes and dreams for her son. As K.A.’s condition deteriorated further and he was in multi-system failure the primary team was able to guide the family and assist them in making end of life decisions;decisions that they could come to terms with. During the final few days of his life the family was able to spend time with their son and their extended family. They were able to make memories, hold him and being the grieving process. Our social work and chaplaincy services were instrumental in providing them the continued support they needed though this very difficult time.
In following up with K.A.’s family after his death they were able to verbalize how grateful they were for our support. Especially the support of the decisions made for their son over the course of his illness and in his death. They were at peace in knowing they had given him every opportunity to heal, overcome his overwhelming illness, And ultimately did what was for him in removing his life support
Discussion
A primary role of the nurse is to serve as an advocate for their patient. Positioned at bedside, nurse has firsthand knowledge of their patient’s status and needs. As advocates, nurse conveys vital information they have gathered about their patients to the entire healthcare team. In the critical care environment, this information often includes continuous patient assessment, response to treatment and constant surveillance through assessment and monitoring for changes as well as family education, support and multidisciplinary care coordination
Patients with NF have significant pain and wound management requirements. Thus, to advocate these needs, nurse on K.A’s team had to remain vigilant, assessing and reassessing pain and wound needs. To ensure that K.A.’s nurses were well positioned to serve as his advocates, a primary team of nurses was developed. It was clear that with K.A.’s complex medical needs a multidisciplinary group of healthcare providers was necessary. K.A.’s team included a group of expert leadership nurses, nurse practitioners, neonatologists, anesthesiologists enterostomal therapist , clinical nurse specialist and a nurse from Genzyme.
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