A head nurse oversees nursing activities in a range of health care settings, such as clinics, hospitals and nursing homes.

To qualify for head nurse roles, a candidate must become a registered nurse (RN) by completing an undergraduate degree from an accredited university or nursing school and passing a licensing exam. In addition to nursing education, a head nurse typically requires leadership skills and a compassionate nature. The salary of a head nurse as of July 2010 ranges from $58,837 to $85,415, according to Pay Scale, a career and education website.

Nursing Duties A head nurse is expected to undertake normal nursing duties when staff resources are lacking. Typical duties in this role include monitoring patients' vital signs, administering medication and changing wound dressings.

Administration Role A head nurse initiates and maintains work schedules for the nursing staff in her department. In addition to assigning duties and organizing shift patterns, she ensures medical records are securely stored and accurately maintained.

Maintaining Standards Head nurses assess general hospital ward areas and patients' rooms to ensure they are kept in a hygienic and comfortable state. They accompany doctors on their rounds of patient visits and take notes of any special instructions with regard to treatment or care changes. Head nurses also ensure all care and treatment activity is carried out in strict accordance with state regulations.

Hospital Inventories Head nurses are responsible for ordering drugs, medical solutions and equipment needed for patient care. They also must keep accurate records of the amounts and types of medication administered to individual patients so they can assess recovery times and speak to physicians about treatment changes when necessary.

Staff Supervision A head nurse oversees nurses administering medication to ensure all regimens are in strict accordance with the physician's instructions, as stated on the Career

Planner website. Head nurses are ultimately responsible for the quality of the work performed by nursing staff. They evaluate work activities such as the maintenance of patient records, end-of-shift reports and prescribed treatment records. Head nurses also identify and resolve any conflicts among nursing staff members to ensure a positive work environment is maintained.

Staff Development Head nurses ensure nurses are fully trained and capable of performing the duties assigned to them. They also assist in preparing training materials and techniques for nurses failing to perform their duties correctly and for those recently hired.

Patient Complaints Head nurses field complaints from patients or their relatives regarding issues with nursing care or the efficacy of treatment regimens. If a head nurse cannot deal with the complaint herself, she might refer it to the director of nursing or the facility administrator.

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Glasgow Coma Score Eye Opening (E) 4=Spontaneous 3=To voice 2=To pain 1=None Verbal Response (V)

5=Normal conversation 4=Disoriented conversation 3=Words, but not coherent 2=No words......only sounds 1=None Motor Response (M) 6=Normal 5=Localizes to pain 4=Withdraws to pain 3=Decorticate posture 2=Decerebrate 1=None Total = E+V+M The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury. It is used primarily because it is simple, has a relatively high degree of interobserver reliability and because it correlates well with outcome following severe brain injury.

It is easy to use, particularly if a form is used with a table similar to the one above. One determines the best eye opening response, the best verbal response, and the best motor response. The score represents the sum of the numeric scores of each of the categories. There are limitations to its use. If the patient has an endotracheal tube in place, they cannot talk. For this reason, many prefer to document the score by its individual components; so a patient with a Glasgow Coma Score of 15 would be documented as follows: E4 V5 M6. An intubated patient would be scored as E4 Vintubated M6. Of these individual factors, the best motor response is probably the most significant.

Other factors which alter the patients level of consciousness interfere with the scale's ability to acurately reflect the severity of a traumatic brain injury. So, shock, hypoxemia, drug use, alcohol intoxication, metabolic disturbances may alter the GCS independently of the brain injury. Obviously, a patient with a spinal cord injury

will make the motor scale invalid, and severe orbital trauma may make eye opening impossible to assess. The GCS also has limited utility in children, particularly those less than 36 months. In spite of these limitations, it is quite useful and is far and away the most widely used scoring system used today to assess patients with traumatic brain injury.

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Ventricular tachycardia is a rapid, regular heart rhythm that originates in the lower chambers of the heart. Ventricular fibrillation is an abnormal heart rhythm that is disorganized and irregular.

Ventricular fibrillation (V fib, VF) is a fatal dysrhythmia that occurs as a result of multiple weak ectopic foci in the ventricles. In other words, there is NO coordinated atrial or ventricular contraction and NO palpable pulse. Ventricular tachycardia (VT or V tach) have three or more PVCs with a rate of >100

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Ventricular fibrillation is a life-threatening electrical abnormality of the heart. There is no coordinated heartbeat. It is rapidly fatal. Ventricular tachycardia is usually fatal, but the heart beats, although not normal, are more coordinated and may be able to maintain a blood pressure compatible with life. One of these two rhythms is usually responsible for cases of sudden cardiac death, in which a person suddenly dies without much warning.

Cardiomyopathy is a dysfunction of cardiac muscle that can be associated with coronary artery disease, hypertension, cardiotoxic agents, valvular disorders, and vascular or pulmonary diseases. Cardiomyopathies are classified into three groups by etiology and the abnormal physiology of the left ventricle. Dilated or congestive cardiomyopathy (DC) is characterized by ventricular dilation and impaired systolic contractile fuction. Emboli may occur because of blood stasis in the dilated ventricles. This is the most common type cardiomyopathy. Hypertrophic cardiomyopathy (HC) is characterized by inappropriate myocardial hypertrophy without ventricular dilation. Obstruction to left ventricular outflow may or may not be present. Restrictive cardiomyopathy (RC) is characterized by abnormally rigid ventricles with decreases diastolic compliance. The ventricular cavity is decreased, and clinical manifestations are similar to constrictive pericarditis. Signs and Symptoms Dyspnea Fatigue Dysrhythmias or conduction disturbances Onset may be insidious or exhibited by sudden death. Physical Examination Vital signs HR: increased, irregular rhythm BP: increased or decreased, depending on underlying disease or degree of heart failure RR: may be increased Cardiovascular Murmurs S3 and/ or S4 Ectopy Jugular vein distention Pulmonary

Crackles Dry cough Acute Patient Care Management Nursing Diagnosis: Decreased cardiac output related to left ventricular dysfunction and dysrhythmias. Outcome Criteria Patient alert and oriented Skin warm and dry Pulses strong and equal bilaterally Capillary refill < 3 sec BP 90 to 120 mm Hg Pulse pressure 30 to 40 mm Hg HR 60 to 100 beats/min Absence of life-threatening dysrythmias Urine output 30 ml/hr CVP 2 to 6 mm Hg Patient Monitoring Obtain Bp hourly or more frequently if the patients condition is unstable. Monitor hourly urine output to evaluate effects of decreased cardiac output or pharmacologic intervention. Analyze ECG rhythm strip at least every 4 hours and note rate. Continuously monitor oxygen status with pulse oximetry. Monitor patient activities and nursing interventions that may adversely affect oxygenation. Patient Assessment Obtain vital signs every 15 minutes during acute phase. Assess the patient for changes in neurological function hourly and as clinically indicated.

Assess for skin warmth, color, and capillary refill time. Assess for chest discomfort because myocardial ischemia may result from poor perfusion. Assess heart and lung sounds to evaluate the degree in heart failure. Diagnostic Assessment Review ECG Echocardiography Cardiac catheterization Patient Management Provide oxygen at 2 to 4 L/min to maintain or improve oxygenation. Minimize oxygen demand by maintaining the patient at bed rest. Provide liquid diet on acute phase, Administer diuretic as prescribed to reduce preload and afterload. Monitor serum potassium before and after administration of loop diuretics. Prophylactic heparin may be ordered to prevent thromboembolus formation secondary to venous poisoning. Institute pressure ulcer prevention strategies secondary to hypoperfusion or vasoconstriction agents.