CNA250 Nursing Practice

Introduction:

The clinical reasoning cycle serves as an important tool in helping the nursing professionals to design accurate interventions by enhancing their decision making ability (Levett-Jones et al., 2015). This essay would focus on the use of clinical cycle reasoning to evaluate the client in the case study and would progress with the steps to design a suitable intervention.

Collection and Assessment of fact:

Jennie Pickett who is in her first pregnancy is visiting the clinic for her third antenatal visit. She is at her 26^th week of gestation. The detailed observations from the first antenatal visit reveal that she was at her 12 weeks of gestation. The recorded height was 178 cm with corresponding weight of 64 Kg. The recorded blood pressure was normal 120/80 mm Hg. The uterine size was also normal and was felt slightly above the symphysis pubis. The fetal heart beat was recorded to be normal, beating at 120 beats per minute. The urinalysis was also recorded to be normal and no other abnormal functioning was recorded. On the third antenatal visit, a few changes were observed in the patient. The body weight was recorded to be 66 Kgs. The recorded blood pressure was considerably high at 140/92 mm Hg. Urinalysis was recorded to be normal with no signs of glycosuria or proteinuria. Uterus could be evidently felt at the level of the patient’s umbilicus. Fetal heart rate was recorded to be 140 beat per minute and mild swelling was observed in hands and feet.

Processing the fact:

The recorded observations so far revealed the healthy condition of the patient and as per the proceedings of the pregnancy it can be summarised that the pregnancy had been uneventful with no critical implications.

Identification of problems:

Three issues that can be defined with reference to the issues based on the health assessment data as collected by the nursing professional would significantly include controlling the blood pressure of the patient. This is so because it is significantly evident that during the third antenatal visit the recorded blood pressure of the patient revealed (140/92) which depicted an elevated blood pressure that needs to be immediately checked. Further, the documentation report also reveals presence of mild swelling in hands and feet which might be considered as a sign of increased retention of water in the body. Also, inflammation in hands and legs might lead to discomfort and problems with mobilisation if not immediately addressed. The patient is in her first pregnancy and according to the statistical evidences it is revealed that more than 87% of the women feel extremely anxious and nervous at the time of their first pregnancy (Alderice et al., 2013). Scientific literatures also reveal that at this point of time, counselling should be compulsorily administered to the patient so as to assist the patient efficiently with the pregnancy journey and at the same time avoid instance of an eventful pregnancy on account of manhandling of the patient due to concerns of anxiety and stress (Ambrosius et al., 2014).

Establishing goals:

The goals developed to effectively help the patient with better service delivery would be based on long term goals as well as short term goals (Dalton et al., 2015). The long term goals would essentially ensure that the risk associated with an eventful pregnancy is avoided and the short term goals would be based on providing immediate relief to pregnancy associated stress and depression (Dicenso et al., 2014). The short term goals would also involve in designing medication to normalise the elevated blood pressure and provide relief from the inflamed hands and legs (Frederiksen et al., 2015).  Administration of Thiazide diuretics can help in controlling the blood pressure of the patient (Daskalopoulou et al., 2015). This medication effective regulates the kidney to eliminate excessive sodium and water from the body (Hill et al., 2013). In addition to this, a strict diet with restricted intake of salt can help in normalising the blood pressure. In addition to this, the puffiness or the mild swelling in the hands and legs can be prevented by administering minimal exercise to the patient. This would be done under the guidance of the physiotherapist. Evidences have also revealed that administration of massage can help in improving the blood circulation that can considerably help ion reducing the puffiness of the hands and legs. Pregnancy requires the patient to be in a positive atmosphere with an optimistic surrounding. Any kind of anxiety, depression or negativity can affect the health of the mother as well as the developing baby. In order to help the patient deal with the anxiety and nervousness associated with the development of her first baby, counselling would be provided to the patient on a mandatory basis. Counselling sessions would be organised where the psychologist would essentially counsel the patient and help in maintaining positivity. 

Action Plan:

The nursing care that could be followed in order to administer proper care of the patient has been enlisted in the table given below with the expected time frame requirement. An efficient nursing plan is regarded as the hallmark of a successful midwifery intervention program (Hunter & Arthur, 2016). As per my perspective, the nursing care plan would involve the following aspects,

The time frame considered for the successful implementation of the nursing plan would stretch over the entire gestation period and detailed observation would be recorded every week so as to clearly identify the ongoing complications if any and effectively maintain the vital signs of the patient so that any complication can be avoided (Ricci, 2013).

Evaluation:

The degree of effectiveness of the designed care plan would be dependent on the feedback of the patient. In addition to this, the effectiveness would considerably rely on the time frame allotted for the completion of each objective mentioned in the care plan. In case certain objectives of the care plan are not seen to deliver effective results, attempts would be taken to closely identify the reason behind the failure of the plan and effectively another new plan would be designed in order to enhance the effectiveness (Levett-Jones et al., 2015). Also several evaluative factors would be considered in order to analyse the effectiveness of the interventions used. For instance, frequent blood pressure check-up to access the feasibility of the drugs used in order to lower the blood pressure. Further, the use of pain score could help in closely monitoring whether or not the patient has developed any possibility of trauma or infestation of pain (Mather et al., 2015). The mood and the behaviour of the patient can help in determining the patient’s ability to cope up with the progress of pregnancy and being able to adapt with the continuous physiological changes in the body (Nishikawa & Sakakibara, 2013).

Reflection:

On thoroughly complying with the designed action plan for the patient, it can be expected that the patient would yield positive results. It can further be stated that the patient on receive sessions with the psychologist would efficiently be able to relieve herself of the anxiety, worry and mood swings based on her first experience of pregnancy. Also, it should be noted that the patient would feel more comfortable and would be able to conveniently undertake the course of interventions designed. Also, the proper administration of increased fluid intake and proportional diet would help the patient in following a healthy regime in the course of her journey of pregnancy. In addition to this, the elevation in the mood would help in keeping her happy with a mind free from stress and worries that would eventually lead to the development of a healthy and a happy baby.

Conclusion:

  Hence, it can be concluded that the devised intervention would successfully help in providing a happy pregnancy to the patient and at the same time would also reduce the risks involved with the possibility of an eventful pregnancy.

References:

Alderdice, F., McNeill, J., & Lynn, F. (2013). A systematic review of systematic reviews of interventions to improve maternal mental health and well-being. Midwifery, 29(4), 389-399.

Ambrosius, W. T., Sink, K. M., Foy, C. G., Berlowitz, D. R., Cheung, A. K., Cushman, W. C., … & Lewis, C. E. (2014). The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clinical Trials, 11(5), 532-546.

Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to’flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29.

Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., … & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31(5), 549-568.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Frederiksen, Y., Farver-Vestergaard, I., Skovgård, N. G., Ingerslev, H. J., & Zachariae, R. (2015). Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ open, 5(1), e006592.

Hill, B., Skouteris, H., & Fuller?Tyszkiewicz, M. (2013). Interventions designed to limit gestational weight gain: a systematic review of theory and meta?analysis of intervention components. Obesity Reviews, 14(6), 435-450.

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse education in practice, 18, 73-79.

Levett-Jones, T., Andersen, P., Reid-Searl, K., Guinea, S., McAllister, M., Lapkin, S., … & Niddrie, M. (2015). Tag team simulation: An innovative approach for promoting active engagement of participants and observers during group simulations. Nurse Education in Practice, 15(5), 345-352.

Mather, C. A., McKay, A., & Allen, P. (2015). Clinical supervisors’ perspectives on delivering work integrated learning: A survey study. Nurse education today, 35(4), 625-631.

Nishikawa, M., & Sakakibara, H. (2013). Effect of nursing intervention program using abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment. Reproductive health, 10(1), 12.

Ricci, S. S. (2013). Essentials of maternity, newborn, & women’s health nursing. Wolters Kluwer Health| Lippincott Williams & Wilkins, pp 70-78