Acute Care Case
NURS 453 - Adult Health II
Purpose of Assignment
The purpose of this case study it to integrate knowledge from the humanities and sciences, including nursing research and theory, to plan, provide, and evaluate holistic care provided to a client selected during this clinical rotation.
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Student Approach to Assignment
In collaboration with others in my nursing cohort, we formulated a comprehensive care plan for the chosen patient. We explored her background and demographics to understand her situation and resources available to her. Based off of her pertinent diagnosis and resulting symptoms, a care plan was created outlining her plan of care. After deciding and carrying out recommended interventions, evaluation occurred to determine successes and areas of revision. Upon completion, we be came more comfortable with the nursing process and looking at a patient's holistic needs.
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Reason for Inclusion of Assignment in this Portfolio
Critical Thinking
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Uses decision-making skills in making clinical or professional judgements
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Example: In the case study, it describes specific interventions applied to the patient. Using her symptoms as a basis, the nurse and I made clinical decisions which focused improving her breathing pattern and cardiac output. For example, after a short trip to the bathroom, the patient was increasingly dyspneic and complained of fatigue. Upon assessment of her oxygen saturation indicating a decrease into the mid-80s, we quickly applied supplemental oxygen via nasal cannula and instructed the patient to rest and breathe deeply. After a few minutes, her oxygen saturation began trending upward and eventually reached baseline.
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Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies
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Example:
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Nursing Practice
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Applies appropriate knowledge of major health problems to guide nursing practice
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Example: The chosen patient was diagnosed with pneumonia, a type of respiratory infection. Understanding the pathophysiology of pneumonia allowed for a better anticipation of needs during care. Due to the effect on gas exchange and breathing pattern with obvious symptoms arising throughout the day, we increased our respiratory assessments and ensured the patient had more time to ambulate, had frequent breaks between care, obtained supplemental oxygen as needed, and received appropriate medications. Anticipation of this disease's symptoms guided most of her care.
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Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques
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Example: Quality of care and safety was safeguarded in following Sentara's Protocols in regard to titration of cardiac drips and mobility. For the cardiac drips, quality and safety were ensured through a double nurse sign off at the beginning and end of the shift, any time the rate was changed, and replacing an empty bag with a new one. Mobility protocols require the patient use of a walker for safe ambulation.
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Nursing Practice (continued)
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Establishes and/or utilizes outcome measures to evaluate the effectiveness of care
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Example: In the expected outcomes and evaluation section of the case study, patient goals related to the diagnoses and respective interventions achieved we detailed. A diagnosis of ineffective breathing pattern prompted goals including patient breaths per minute falling within normal limits, sufficient oxygen saturation, and proper use of an incentive spirometer. After the clinical day ended, her goals were revisited and evaluated. The patient met most of her goals, except for sufficient oxygen saturation levels. It did not return to a normal limit of 95% or above, but instead remained at 91% at the highest. Further interventions for the future are required to achieve the oxygen saturation goal.
Communication
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Uses therapeutic communication within the nurse-patient relationship
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Example: In caring for the patient, her admission was a difficult one. Prior to hospitalization, her sister had found the patient and her home in an unkempt state. Already suffering from general anxiety disorder and major depressive disorder, recent unemployment pushed her into that state. In talking with the patient, offering support and encouragement to care for herself was a key intervention in building a positive rapport with the patient. Taking the time to answer the call bell in person and listen to her concerns laid a foundation for productive collaboration.​
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Professionalism
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Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care
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Example:​ In the intervention section of the case study, Sentara Protocols were utilized to ensure patient safety and guide nursing care. Sentara Mobility Protocols require are based off of an assigned fall risk level based on the Braden Fall Risk Assessment. For this patient, the use of a walker and assistive person was required for ambulation. A critical drip was maintained on the unit requiring constant vigilance requiring admission to at least a step down unit level of care. Other general standards of practice include a bag valve mask and supplemental oxygen to be available at all times. The supplemental oxygen was eventually used when the patient's oxygen saturation began to decrease.