NRSG355 Clinical Integration
Question:
Module 1 – Critical thinking, clinical decision making
Module 2 – Collaborative and Therapeutic Practice
2. How do tribalism and power inequities impact on information sharing?
3. What are the five key dimensions for a well-functioning health care team?
Case study 2
The doctor feels there is no need to have Mrs Ellis on the ward as he feels that her rehabilitation has been maximised, this is an opinion shared by the physiotherapist. Norma wants to go back to the nursing home as she has made many friends there and feels at home there.
Discuss the following questions
1. What are the key issues in this dilemma?
2. How would you deal with Norma’s son? Are his objections warranted?
Module 3 Provision and Coordination of Care
provides you with the following handover, using the ISBAR format. Further information about the
ISBAR format can be found on page 7 of this module.
1. What further questions will you need to ask the nurse?
2. List specifically what further assessments you would complete when the patient arrives onto the ward
3. Upload the above answers to your e-Portfolio on LEO. This forms part of your assessment for this unit.
Module 4 – Professional Practice: Time Management, delegation, scope of practice
with the NMBA competencies and decision making tools. Then, consider what your priorities for your
final semester are and consider what skills you need to consolidate that will assist in you making the
transition from student to registered nurse.
Answer:
Module 1
According to the events listed, the event that will get my highest priority is the collapse of the post-operative elderly patient, who had undergone facial surgery. Facial or skin surgeries can give rise to complications, like excessive bleeding resulting from abnormalities of blood clotting due, medications like heparin, aspirin, warfain can cause excessive bleeding (Hunt, 2014; Agarwal et al., 2012). Excessive bleeding can give rise to wound infections, lightheadedness, syncope or fainting, shortness of breath, chest discomfort, among others. Thus, it is necessary to determine the cause of the excessive bleeding (Www.dermnetnz.org, 2017). This activity will be carried out by me along with the help of the AIN. Moreover, if excessive bleeding is caused due to medications like anticoagulants, then necessary interventions can be applied like protamine sulfate can reverse heparin effects and vitamin K can reverse the effects of warfarin (Kahn, Amara & Halperin, 2016).
The next priority event will be attending to Mrs. Chew. The EN, who is specializing in IV cannulation has not received her certificate. The patient will be examined for signs of thrombosis, which involves painful, swollen and reddened veins along with very poor or negligible IV flow. The procedure will be carried out by me, which will involve removal of the device and carrying out the infusion in the other limb as well as application of warm soaks (Lms.rn.com, 2017).
The next priority will be the event, where the visitor has fainted. Fainting can be caused due to low blood pressure, low blood glucose levels, cardiac problems, among others. It is necessary to monitor the vital signs of the patient like blood pressure, check the blood glucose levels and determine any medical history regarding cardiac problems (Www.ok.gov, 2017). This monitoring can be carried out by the AIN.
Next, Mr. Esposito will be provided with his medication. The EN can be employed for this but she will be carrying out the administration of the medications under my supervision.
I will discuss the medication error with the VMO and then delegate the EN to provide the right medication. This will be carried out under my supervision as it will help me to determine the competency of the EN in administering medications.
Management of the overflowing of the staff toilets will be delegated to the ward clerk and the AIN. Both the ward clerks and the AIN can carry out the task, since it is their duty to assist the nursing staff in the maintenance of clean environment in the hospitals (Tech.lds.org, 2017).
Module 2
Patients affected by motor neuron disease generally require the help of a respiratory specialist, occupational therapist, speech therapist, physiotherapist, among others. The palliative team helps in providing support, while the doctor or the neurologist reviews the symptoms. A dietitian is needed in order to ensure proper nutrition being administered to the patient for effective recovery. Such multidisciplinary approach helps the patient to obtain overall care (Williams, Philip-Ephraim & Oparah, 2014).
A multidisciplinary team is usually led by a team coordinator.
The doctor or the neurologist is an important member as he will carry out the review of the symptoms and the care plan for the patient will be based on his diagnosis.
Case study 2
The patient suffers from postural hypotension and may show symptoms of syncope or fainting, dizziness and can fall when changing positions (Raj & Coffin, 2013). The patient suffers from impaired mobility and following her hip fracture, her condition may have worsened, which may further increase her chances of falling (Ambrose, Paul & Hausdorff, 2013). The complications associated with rheumatoid arthritis involves inflammation of the glands of the eye, dryness which may affect her vision. Rheumatoid arthritis also causes inflammation of the lungs and the pericardium resulting in shortness of breath, chest pain and heart attack (Www.nhs.uk, 2017).
The son should be informed about her medical conditions that have resulted in her fall and he will be informed that extra precaution will be administered in the case of his mother, so that such falls does not occur in the future.
Yes, because patients with impaired mobility should be kept under the monitoring of an AIN, since, it is the duty of the AIN to help the patient in mobility and other daily activities (Algoso & Peters, 2012).
Module 3
Activity 1
Handovers are a form of communication that helps in the passing of patient information between nurses. This is essential when there occurs a shift of the patient from one department of the hospital to another department (Johnson, Jefferies & Nicholls, 2012).
The questions that can be asked to the nurse during handovers include patient’s medical history. It is also necessary to ask about whether the patient is to remain nil-by-mouth or whether require barrier nursing, requires help in moving, eating or going to the toilet. It is necessary to determine the surgical procedures the patient underwent and the treatment plan that was developed for the patient. Additionally, it is necessary to determine whether there was any change of treatment plan after the surgery and presence of allergies. It is also necessary to determine the culture of the patient and whether the patient is capable of verbal communication (Rayo et al., 2013).
When the patient is shifted to another ward, the nurse of that ward can carry out the assessments regarding her vital signs like blood pressure, heart rate, respiration rate, blood sugar levels, assess the cognitive status of the patient, assessment of mobility, pain assessment using the visual analogue scale.
Activity 2
Clinical reasoning enable nurses to carry out effective decision making by reviewing and understanding the patient condition. Proper nursing education, excellent procedural skills and timely judgments are some of the important features of clinical reasoning skills. The ways in which clinical reasoning can be applied includes the ability of the nurses to use the knowledge of behavioral or biophysical sciences to provide a holistic nursing care to the patients. The nurse should have the ability to analyze the patient environment, identify the important cues, communicate the events and carry out interventions in order to prevent any adverse patient outcomes (Levett-Jones & Hoffman, 2013; Victor-Chmil, 2013).
Determination of vital signs helps in planning of treatment protocols and making decisions in order to save the lives of patients. Monitoring of vital signs helps in early diagnosis of the severity of a medical condition, thereby enabling timely actions to prevent adverse situations and even death (Felton, 2012; Elliott & Coventry, 2012)
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Consider the patient situation · What current information do you have on this pt? · What new information have you gathered?
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The patient is Jack Reed. He is a 76 year old man. He suffers from dementia and anxiety disorder. He lives alone. He is an Alzheimer’s patient and as a result used to live in a residential care. He remains highly confused and disoriented. He also suffers from impaired mobility. He remains highly anxious and isolated from others. He was brought to the emergency department after he suffered a fall in the residential care resulting in a fracture of the hip. |
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Collect Cues/Information · What further cues and information would be useful? Why?
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His vital signs were monitored. His pain assessment was carried out. He was unable to carry out verbal communication and was highly confused. He was crying due to severe pain. |
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Process Information · What changes do you notice in the cues and information provided? · Which changes are significant for this patient and why? · What do you think these changes could indicate and why? · What could be the outcome of these changes?
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His vital signs were not normal as his temperature was high along with high respiration rate. He was first subjected to hip replacement surgery. However, apart from the pain relieving medications, the patient should be given medications for the treatment of Alzheimer’s disease as it is the root cause of dementia. Drugs like Galantamine, Donepezil can be administered (Bond et al., 2012). Moreover, as he suffers from anxiety disorders, psychopharmacologic and psychological interventions can be applied (Lader, 2015) |
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Identify Problems/issues · Given the facts that you have available and comparing those to what you think the changes could indicate/identify one potential patient problem/issue.
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The patient’s problems regarding dementia and anxiety disorder can get worsened after his surgery, as he may restrict his mobility because of fear of falling again. This will prevent him to carry out an active life and create feelings of isolation. |
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Establish Goals · Describe what you want to happen. · Who do you want involved and what do you want them to do? · In what timeframe?
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Apart from his condition, his confidence on his abilities is to be increased. Physiotherapists can be employed in order to increase his mobility. He can be sent to memory clinics that provides memory counselling. He can be provided with Cognitive Behavioural Therapy (Wells, 2013). The improvement of his condition will take time and it is necessary to carry out these therapies for at least 1 month. |
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Take Action · What nursing actions will you take? · What will be your nursing priorities?
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Determination of the cognitive functioning of the patient, assessments of mobility, dehydration, infection, memory and thinking skills, maintaining an interactive environment, keeping the environment safe, ensuring regular exercise. |
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Evaluate Outcomes · What do you expect to achieve from the actions have taken?
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It will help to enhance patient mobility, enhance memory and thinking, prevent the risk of falls, prevent confusion, disorientation, enhances self-confidence. |
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Reflect on Process and new learning · What have you learnt from this exercise?
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It is necessary to treat patients with mental disorders in a sensitive manner, listening to their problems and providing solutions in an empathetic manner. |
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