Care Plan Development The patient mentioned at the beginning of this paper has a classical course of peptic ulcer: two potent mutually reinforcing risk factors for the peptic ulcer development, typical pains without evidence of any major complications (no occult blood in the rectum and normal hemoglobin in CBC, negative peritoneal symptoms, no data for obstructive bowel syndrome)

Care Plan Development The patient mentioned at the beginning of this paper has a classical course of peptic ulcer: two potent mutually reinforcing risk factors for the peptic ulcer development, typical pains without evidence of any major complications (no occult blood in the rectum and normal hemoglobin in CBC, negative peritoneal symptoms, no data for obstructive bowel syndrome)

Better yet, the aforementioned study points out that the bulk of overlapping effects (not to be confused with interactive coefficients as opposed to main or fixed ones) may have stemmed from skill transferability, with well-trained psychodynamics professionals likely to have rewarded areas adjacent and remote.

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Kinesthetic apraxia occurs in lesions of the parietal lobe, near the postcentral gyrus. With the violation of the left hemisphere, apraxia has a bilateral character. However, if the right hemisphere is damaged, it is manifested only in the left hand. The main defect is the violation of the proprioceptive kinesthetic afferent motor act in the preservation of the outer space organization of movements. Because of the brain damage, motions become undifferentiated and poorly controlled. Patients lose the ability of the right reproduction of various postures of hands. It is difficult to perform actions without objects. For example, it is hard to show how water is poured into a glass.

Constructional apraxia occurs in lesions of the parietal-occipital cortex at the border of the 19th and 39th fields, especially in lesions of the left hemisphere or bilateral foci. At the heart of this form of apraxia, there is the violation of visual-spatial synthesis and spatial representations. Thus, patients suffer from visual-spatial afferentation in movements. Constructive apraxia is a specific and common form of the violation of praxis, which mainly concern the construction of details and figures of a drawing. Patients find it difficult or cannot copy simple geometric figures, objects, animals, and human figures directly or from memory. The contours of an object are distorted. For example, a person draws an oval instead of a circle. It is especially difficult to copy complex geometric shapes, for example, a five-pointed star or a rhombus. Difficulties do not only occur in drawing, but also in the construction of figures from sticks (matches) or cubes according to a given sample. Disorders of constructive praxis appear very clearly when copying unfamiliar figures without a verbal designation. This technique is often used to detect hidden disorders of constructive praxis. A typical manifestation of the latter is also difficulties in choosing a place to draw on a sheet of paper.https://123helpme.me/essay-about-myself/

One more form of apraxia is kinetic, which will be associated with damage to the lower divisions of the premotor area of the cerebral cortex. It is included in the premotor syndrome. Kinetic apraxia is connected with violations of the automation of different mental functions. This type is manifested by means of the decay of “kinetic melodies”, the violation of the temporal organization of motor acts. At the same time, there are simple motor perseverations manifested in the uncontrolled continuation of a movement once started, especially serially performed.

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In regulatory apraxia, the lesion focus is localized in the region of the convexital prefrontal cortex anterior to the premotor areas. It proceeds as a result of the preservation of muscle strength and tone. At the heart of the disease, there is the violation of the arbitrary monitoring of movements, as well as the speech regulation of motor acts. It is manifested in the form of disorders in programming motions, disconnection of conscious control over the ones, and replacing associated with right movements with motor patterns and stereotypes. There are system perseverations of the entire motor program. The greatest challenges for the patient are really a change in driving programs and actions. In case of a breakdown of an arbitrary regulation of movements in patients, there are symptoms of echopraxia in the form of an imitative repetition of movements of the experimenter (Magill, 2011).

In addition, there is verbal apraxia, which occurs because of violations of the brain regions responsible for the control of speech. In case of this disease, a patient knows what he/she wants to say, but is physically unable to utter a few words or sounds. Nevertheless, a person understands other people’s speech perfectly. Verbal apraxia is a congenital disease, which appears in early childhood. “Childhood apraxia of speech is a condition that is calculated to occur in about one to 10 children per 1.000” (Velleman, 2003). Apraxia can also be a independent disease or observed together with other neurological disorders.123 money help If it is motor apraxia, it consists in the loss of coordination of individual limbs.

Today there are several major reasons that explain the emergence of apraxia. The main one is the brain damage that occurs because of injuries. Apraxia is also caused by a heart attack, myocardial tumors or traumas, or the degenerative process with the localization of lesions usually in the parietal lobes or associated parts, where the programs of actions learned during life are stored. Less commonly, apraxia damages other parts of the brain (the premotor cortex, corpus callosum, or the frontal lobe) or causes diffuse processes, particularly, degenerative dementia.

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In the process of examination, the doctor asks the patient to perform or repeat familiar motor acts. In parallel, the former checks the muscle strength in all muscle groups involved to avoid muscle weakness or paresis as a reason for existing disorders. The neuropsychological research, as well as information from the physiotherapist and occupational therapist, enables to identify more complex options of apraxia. The doctor should ask the relatives of the patient about the extent to which the latter can do daily activities (for example, using cutlery, toothbrushes, utensils for cooking, a hammer and a pair of scissors) and discover whether the patient can write without assistance. CT or MRI (with or without angiography) helps clarify the presence and also the nature of lesions (heart attack, hemorrhage, mass effect, and focal atrophy). a physical examination usually reveals the main neuromuscular diseases or injuries that can be confused with apraxia.

Methods of treating apraxia depend on many different factors. The doctor takes into account the age of the patient, and also the nature and extent of a lesion. In general, nowadays, there is no specific treatment. Nevertheless, physical and occupational therapy can contribute to functional recovery notably. It is necessary to take into account the fact that the drugs used to inhibit the progression of dementia resulting from apraxia are not effective. After applying physiotherapy, the basic functions associated with body improve, additionally the patient’s life becomes safer.

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It is worth noting that apraxia is expressed through an impaired ability to move, of course motor skills are also damaged, the patient cannot even pour a cup of tea. Apraxia in children is especially difficult to treat as there is no opportunity to acquire necessary skills. Therefore, the treatment of apraxia is a long and difficult process, which will require patience and persistence. Having the first suspicions of apraxia, it is necessary to experience a neurologist or psychiatrist. What expert is required will depend on the cause and type of violations. In most cases, the patient with apraxia is prescribed individual therapeutic programs, namely, labor training, physiotherapy and work with a speech therapist. It should also be noted that patients with apraxia need constant care and concern. Therefore, they require a social worker, psychologist, and a nurse, as a person becomes disabled for a certain period of time. a struggle for improving health is extremely long and difficult (Tanner, 2010).

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Order Essay with this Title infection and developed evidence-based management strategies. Although a substantial improvement in the peptic ulcer treatment has been achieved in the recent decades, this condition still poses a serious medical and social danger. This paper studies peptic ulcer in a typical and most common way by analyzing a relevant case study, providing basic information on the disease, and developing a coherent care plan.

In the US, over 15 million of individuals suffer from the peptic ulcer disease today (Torpy, 2012). Up to 16% of all elderly patients with abdominal pains have a peptic ulcer (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013). The scenario study discusses the clinical situation and implies an explanation of the condition in brief. In the next paragraphs, data on pathophysiology, signs, diagnostics, and treatment options are presented. Finally, a discussion on the adverse effects of the disease on the patients and their family is made. Medical care suggestions and socio-economic aspects of this disorder are discussed at the end of the paper.

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Case Study Analysis

A 60-year-old Italian male suffers from abdominal pain that he has already had before. Although the case scenario does not verify the terms, one may assume that his abdominal problem is of chronic nature or has an acute-on-chronic course. It is also noteworthy that in the past, the man had heartburns that were managed by antacids; this fact strongly suggests that gastric acids refluxed into the esophagus and thus were indicating a gastro-esophageal reflux. Logically, hyper acidic exacerbations and upper abdominal pains can help diagnose some stomach conditions.

Abdominal pains become especially bad at night as it is the circadian time for the vagal overactivity and naturally occurring hyperacidity. The patient’s gnawing pains did not move and localized around the umbilical area. In few hours, the pain became less intensive; it might be an indication of visceral but not the peritoneal origin of the complaint.

The man’s past medical history is prominent for a long intake of NSAIDs in high doses with the aim to alleviate gout symptoms. As it is discussed later in the paper, NSAIDs are the strong damaging agents against gastric mucosa; thus, they help natural acids damage the underlying wall of the stomach/duodenum. He also had some history many years ago; it is another contributing factor. The issue is associated with the unbalanced gastric diseases. For ulcer, the inner lining of the stomach/duodenum, wine consumption can be another damaging factor to be considered.

Physical examination perfectly correlates utilizing the patient’s complaints and history. His anterior abdominal wall is tender and susceptible in the epigastrium. Negative peritoneal signs further prove the peritoneal origin associated with pain. Elevated BP can indicate possible arterial hypertension, but long-standing hypertension would result in left ventricular over-activity on EKG, so the arterial hypertension is either not very severe or well managed. The man’s arterial tension of 175/70 mmHg is associated with a stressful situation. His bradycardia of 64 BPM may indicate that the dose of propranolol (beta-blocker) is adequate for controlling tachycardia. Beta-blockers also alleviate hypertension; on examination, his blood pressure is elevated; thus, the pressure profile will need a further follow-up. His normal EKG (while pains continue) rejects heart attack. Out of all his lab investigations, positive test is of most importance for the gastrointestinal diagnosis.

In conclusion, according to the patient’s complaints, history, and examination data, he suffers from a peptic ulcer, induced by NSAIDs and . Until fibroscopy is performed, it is not definitely known whether it is a peptic ulcer of gastric or duodenal.

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Peptic Ulcer: General Information

Ventriculus is located in the epigastric and umbilical regions of the abdomen and followed by the duodenum that encircles the head of the pancreas to the right of the vertebral column (Standring, 2008). The fundus and body of the ventriculus are situated to the left of the midline even though the pylorus (containing the acid-producing parietal cells) is located to the right. The inner lining of the gastric wall is the mucous membrane covered with a single layer of column epithelium of submucous coat. As a rule, this coat, as well as muscular and serous coats, is common for the duodenum. In the case of peptic ulcer, the inner lining is damaged, and also the developing small sores penetrate into the lowermost limit of the mucosa (muscularis mucosae) (Anand, 2015; Torpy, 2012). a defect in peptic ulcer may spread further and affect submucosa or muscularis propria (Banerjee et al., 2010). Johnson classification of peptic ulcers divides lesions into four types: I – ulcers are found near the lesser curvature, acid secretion is normal, II – a combination of stomach and duodenal ulcers with increased secretion, III – prepyloric ulcers with increased secretion, IV – gastric ulcers with normal secretion (Anand, 2015).

Generally, the epithelial cells produce mucus, bicarbonate, and prostaglandins in order to protect the cavities of the body from the natural acids and acidic enzymes (Anand, 2015). Thus, on the inner surface of the stomach, there is a balance between the protective and aggressive factors. Peptic ulcer develops whenever balance is shifted towards the damaging agents. Gram-negative spirochete, produces urease around itself and alkalines the microenvironment causing mucosal inflammation. NSAIDs block the prostaglandin production and, thus, disrupt the mucosa. Consequently, up to 30% of those who take these drugs develop adverse effects (Anand, 2015). Moreover, the combination of and NSAIDs has an additive effect (Sostres et al., 2015). NSAIDS more commonly cause gastric ulcers than duodenal ulcers (Abramovicz, Zucotti, & Pflomm, 2010). Other contributing factors include previous history of peptic ulcer, smoking, alcohol abuse, stress (especially severe issues: burns, trauma, or surgery, for example), depression, social deprivation, intake of oral steroids, and genetics (Anand, 2015; Sondashi, Odimba, & Kelly, 2011; Torpy, 2012).

Typical signs of a peptic ulcer include abdominal pains, dyspepsia, and heartburn (Anand, 2015; Buttaro et al., 2013; Torpy, 2012). Abdominal pains usually develop at night or are associated with meals. Dyspepsia is a common issue even in healthy individuals, but the recent tips suggest that new onset of dyspepsia in adults older than 50 years is an indication of esophagogastroduodenoscopy (Banerjee et al., 2010). Heartburn, especially in relation to dyspepsia, is infrequently related to gastroesophageal reflux, which often accompanies peptic ulcer and infection (NICE, 2014).

a peptic ulcer is dangerous for its major complications: perforation, obstruction, and bleeding (Banerjee et al., 2010; Buttaro et al., 2013). Bleeding occurs in the case of vessel erosion; it is the most common complication of peptic ulcer. Perforation is a surgical emergency because the gastric contents escape into the peritoneal cavity (especially, if the anterior wall is damaged) or surrounding structures (especially, if posterior wall is damaged) (Buttaro et al., 2013). The outlet obstruction syndrome develops in the case severe scars of pylorus or duodenum cause lumen narrowing or obliteration; consequently, these patients suffer from severe vomiting, bloating, and weight reduction (Banerjee et al., 2010).

Upper endoscopy is a golden standard for peptic ulcer diagnostics. During esophagogastroduodenoscopy, the mucosa of the esophagus, stomach, and duodenum is visualized; consequently, biopsy may be taken and samples checked for (Buttaro et al., 2013; Torpy, 2012). Peptic ulcers appear as mucosal lesions with smooth base, which are often filled with fibrinoid exudate that usually are 0.5-2.5 cm in diameter (Anand, 2015). evaluating is recommended for all individuals who undergo fibroscopy (Buttaro et al., 2013). Urease activity, histopathology, and serum antibodies is checked in order to obtain reliable information on the infection presence (Anand, 2015).

In the recent decades, the introduction of antibiotics into the peptic ulcer treatment strategy, as supported by positive tests, has considerably reduced the incidence, morbidity, and mortality rates from peptic ulcer (Bashinskaya, Nahed, Redjal, Kahle, & Walcott., 2011). The current treatment schemes include non-pharmacologic and pharmacologic interventions. The former include avoiding alcohol and smoking, allaying stress, and NSAIDs cessation. The latter comprises antisecretory therapy and empiric triple therapy for eradication. For example, esomeprazole + amoxicillin + clarithromycin + metronidazole is a recognized combination (Ghana Ministry of Health, 2010). Endoscopy must be repeated after a course of treatment in order to prove the eradication efficacy (Anand, 2015; Torpy, 2012). It is also recommended for individuals without who take NSAIDs in order to introduce antisecretory agents for eight weeks if a peptic ulcer is diagnosed (NICE, 2014). Taking proton pump inhibitors with NSAIDs prevents the peptic ulcer formation (Abramovicz et al., 2010).

Care Plan Development

The patient mentioned at the beginning of this paper has a classical course of peptic ulcer: two potent mutually reinforcing risk factors for the peptic ulcer development, typical pains without evidence of any major complications (no occult blood in the rectum and normal hemoglobin in CBC, negative peritoneal symptoms, no data for obstructive bowel syndrome). Thus, this man needs assurance and support against his fears of the heart attack. Moreover, his EKG is normal; this instrumental result must be clearly explained and normal finding emphasized to him. As soon as both risk factors are modifiable, the patient has optimistic prognosis concerning his pains, general medical perspective, and social activity. It is strongly advised to prevent wine abuse as this damaging factor may interfere with the mucosa healing of his stomach. His NSAIDs intake must be also stopped; non-NSAIDs painkillers and other groups of drugs for controlling gout should be considered, at least for the period of ulcer treatment. On the other hand, his eradication therapy must be taken at hours as prescribed in order to achieve the greatest pharmacological effect.

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The uncomplicated peptic ulcer is successfully treated on the outpatient basis if strict adherence to the current recommendations is followed. Control fibroscopy is planned on an elective basis after the completion of the cycle. The patient’s arterial hypertension needs additional evaluation. On examination, his blood pressure is elevated, but no tachycardia is present. Should blood pressure with low pulse persist, a additional angiotensin-converting enzyme inhibitor or angiotensin II blocker could be considered. It is not known what his lipid profile is; therefore, this patient should make a lipidogram in order to evaluate the efficacy of Zocor. A low-density lipoprotein level is of utmost importance since it is the key risk factor for atherosclerosis and subsequent coronary or carotid lesions. The patient’s gout is to be re-evaluated aiming at reducing the symptoms without further administration of Indocin. Probably, his diet should contain less meat; moreover, is a non-NSAID drug that could be applied, and angiotensin II blockers are new agents that show effectiveness in the gout treatment (Rothschild, 2015). Thus, interdisciplinary cooperation on gastroenterology/fibroscopy, cardiology, and gout is essential for the effective management of this case.

From the case scenario, the body-mass index of a patient cannot be calculated, but the case description mentions that he moves not enough. Thus, one may assume his physical activity is insufficient; this fact that worsens the blood pressure profile, alters body mass index, and worsens the lipid profile. Until now, the low physical activity might have been attributed to gout symptoms, although with the new interdisciplinary approach this condition is to be improved. Thus, the patient needs to be taught about the importance of sufficient physical actions to supporting his cardiovascular system and ways of avoiding heart attack by altering the lifestyle. In this case, the patient has a very positive feature: he is not willing to ignore social activities, and he does teaching on the side. This pattern should be encouraged in order to manage the man’s depression: as soon as pains resolve, his further activities will likely be safe to continue and with time he can ensure the medical aid. However, he is not very compliant with the current drug regimen, so the health care provider must convince him that a strict drug regimen cannot be violated. His son and daughter is engaged in the rehabilitation program; they can explain to the man that the current deterioration is potentially curable, and their communication will not be burdened.

As soon as the peptic ulcer is an outpatient disease treated with tablets, the key obstacle is the patient himself. Therefore, strong compliance needs to be achieved as soon as possible; otherwise, the evidence-based treatment protocol may fail. In order to reduce wine consumption, the patient should put the bar at eliminating alcohol from his diet at least for the treatment period. His wife who suffers from joint troubles is another barrier to be effectively managed. She needs further medical assessment; maybe her example can improve her husband’s interest in terms of the depression management.

Care Plan Synthesis

Treatment of peptic ulcer invariably includes endoscopy and careful history analysis (Anand, 2015). All patients with new-onset dyspepsia after the age of 50 should undergo fibroscopy, as well as all individuals with postive tests, or high-resk patients taking NSAIDs (Anand, 2015; Banerjee et al., 2010).

Endoscopy aims at visualization of the ulcer, identification of its location and complications statement. If peptic ulcer is complicated by bleeding, perforation or obstruction, an abdominal surgeon is usually engaged and intensive care treatment is planned. Bleeding is usually followed by hypotension and anemia, thus intensive volume resuscitation is required to replace the lost blood. Packed red blood cells are needed if hemoglobin and hematocrit level falls below safe levels. Bleeding ulcers is coagulated during endoscopy through the use of special coagulation electrodes. Perforation usually requires laparotomy to evacuate the gastric contents from the abdominal cavity and to place securing sutures on the perforated locus. Obstruction is also a surgical complication requiring creation of bypass shunts for the nutritive mass to proceed downwards without resistance.

Medical approach to uncomplicated peptic ulcers depends on etiology. Positive test is a clear indication for antisecretory agents and antibiotics, as may be detailed later (Bashinskaya, Nahed, Redjal, Kahle, & Walcott., 2011). Acid suppressive agents can be given both orally and intarvenously. Oral administartion is simple and effective and thus is recommended for uncomplicated cases that receive treatmnet on an out-patient basis. Intravenous route of admnistration is best for critical patients, for example psenting with bleeding in an emergency department. NSAIDs anamnesis determines the need for cessation of these drugs and proton pump inibitors prolongation whether or not concomittant eradication is successful (Sondashi, K.J., Odimba, B.F.K., & Kelly, P., 2011).

Dietary limitations, although helpful, are not specially indictaed after the end of medication scheme (Anand, 2015). It is a commonsense to avoid beverages, alcohol and foods that provoke pains or dyspepsia in clients. If eradication is not achieved (for example, form resistance to antibiotics), in complicated ulcers, or in rccurent ulcers, a proton pump inhibitor is indicated to continue for more one year. Moreover, continuation of NSAIDs even after successful eradication places the patient at risk for reccurent peptic hemorrhage, so an one year prolongation of proton pump inhibitor is indicated (Anand, 2015).

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Middle-income earners and regular alcohol drinkers suffer from the peptic ulcer oftener, especially if the previous history of the disease is present. These assumptions were proved in the recent research (Sondashi et al., 2011). As for this patient, the man is a retired schoolteacher willing to continue social activities; he has a wife working at the local grocery store. After the peptic ulcer treatment course, the health care provider is advised to concentrate on the patient’s gout symptoms. The man has access to a primary care provider so his economical status must allow him to continue the treatment.

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Order Essay with this Title Evidence-based approach to peptic ulcer treatment started in the 1980th when proton pump inhibitors alone were shown to eradicate in approxiamtely 10% of patients. Later, addition of bismuth derivatives and/or an antibiotic improved the percentage of effective elimination up to 60%. Combination of a couple of antibiotics with proton pump inhibitors is able to achieve positive result in almost 95% of infected individuals. Evidence-based results of triple therapy as suggested in the previous chapter of this paper is a proven strategy that has strongly demonstarted its effectiveness (Bashinskaya, Nahed, Redjal, Kahle, & Walcott., 2011). However, if this patient would show allergy or ineffectiveness of one scheme, the World Health Organozation has approved at least three recipes for peptic ulcer management: esomeprasole or omeprasole or rabeprasole in combination with various doses of amoxicillin and clarithromicin and metronidasole, but one of these antibiotics can be omitted if doses of the other two is doubled (Ghana Ministry of Health, 2010). Thus, health care providers have strong evidence-based instruments to cure this patient.

Conclusion

Peptic ulcer is a nice example of how modern medicine achieves high effectiveness due to scientific advances. It was discovered that plays the central role in shifting the tiny balance between acidity and natural cytoprotection mechanisms in the stomach. By administrating antibiotics, the causative agent is eliminated and patients who were condemned to suffer from visceral abdominal pains, dyspesia and life-threatening complications, today achieve optimistic prognosis. Evidence-based recommendations are today applied all over the world and thus safe many millions of lives in both adults and children. Nevertheless, a broad understading of peptic ulcer from positions of medical history, social and economical aspects, physical and psycological demands, the need for education in can not be rejected. The World Health Organization defines health because the state of both physical, social and mental well-being (WHO, 2015), so a comprehesive approach to treatmnet is able to deliver best health care to all patients with peptic ulcer.

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In addition, life- threatening conditions include patients at risk to themselves and others; and also the patients, whose vital signs and degree of consciousness, indicate potential for respiratory or circulation failure( Kelly 428). In this case, a patient with such condition is the highest priority and should be monitored until transfer or stabilization. These conditions cannot be anticipated and that can occur at any time during the shift; therefore, the nurse should use the quick ABC guide to implement the assessment. a stands for Airway, and this is the highest priority to check if the airway is open. B stands for Breathing, and is used to check whether there is a breathing distress (Kelly 428). Lastly, C stands for Circulation, and is used to check any compromise in the circulation system.

The bigger picture

Further, the wider picture must be examined, and there should be no nurse works in isolation. All nurses should know what is expected from their co-workers, what is happening on the other shifts and beyond the unit. If nurses know what is expected from their coworkers, they can assist them during emergencies. In return, they will also receive assistance if their shifts are characterized by the crisis. (Kelly 428).Secondly, if areas outside the unit are overwhelming, a nurse should be ready to assist in that unit. When nurses consider the situation globally, they are less likely to be frustrated when asked to offer assistance. They can also involve chance of given and received assistance into their time management plan (Kelly 430).

After defining corresponding priorities, the nurses know the most significant activities which must be accomplished first.  Time management strategies can be used in all areas of care delivery. These strategies are necessary to maximize the nurse’s time and minimize lost time and efforts. Nurses should estimate the time each activity will require and plan accordingly (Kelly 430). The previous discussed activity may help to estimate the time many activities will require. For example, a patient may need more time for medication administration that the others. In this case, it will likely be wise for the nurse to take care of this patient after dealing with others. In addition, by estimating the time of activities, the nurses can schedule the best time to perform their activities. The nurses may notice, when passing 6pm medications, that water pitchers are empty and juice cups dry. Scheduling the assistant nurse to refill them prior to administering medication will be a prudent response to an observation( Kelly 430).Further, it is important that the nurses create an environment supporting time management and patient care. In the frenzy of giving care, the nurses often forget the obvious information such as where they have placed the linens and medical supplies. Summarily, time management principles aim at creating more enjoyable time and not filling every moment with chores (Kelly 440).

The role of leadership

In order to help nurses overcome the challenges they face in their practice, leadership skills play a important role. The leader-manager’s subtle reactions to others are vital.   There are negative outcomes whenever leaders negate the viewpoints of other nurses, criticizing their behaviors and work using non-verbal reactions to show disapproval (Baker 154). If a particular nursing practitioner is deemed to be out of favor, he will have difficulty in securing the cooperation and thrust of others. Consequently, it will affect the performance of team work that is much required in order to improve patient care. On the other hand, being sensitive to one’s own message about other nurses and sending positive reviews is a best practice to build the trust within the group (Baker 154).Further, successful transformational leaders rarely use punishment and disapproval as techniques of control. They should be sparingly and thoughtfully applied.  Mistakes are inevitable in just about any field, including nursing (Baker 154). However, if a nurse makes mistake, the leader should search what he right and compliment them. Showing the nurses how to avoid mistakes as time goes on is a practice aiming at building trust and self-esteem of the other person.

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