Acute Care Assignment
Acute Care Intro
NURS 453: Clinical Management: Adult Health II
Assignment Purpose: The purpose of this case study is 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. This case study is an extension of your daily concept map and should be based on standards of care and clinical pathways.
Approach to Assignment: I approached this assignment as an opportunity to integrate my knowledge of hemodynamics, evidence-based critical care practices, social determinants of health, and interdisciplinary communication into a clinical application of competent, compassionate nursing care. Additionally, I was able to consciously incorporate real-world application of the American Association of Colleges of Nursing domains (AACN, n.d.) into my practice throughout my care for this patient.
Reason for Inclusion:
· Domain 1: Knowledge for Nursing Practice. Demonstrates clinical reasoning in making clinical or professional judgements.
I used nursing judgement to determine that incentive spirometry use would be an appropriate tool for improving health outcomes for the patient with pneumonia.
Upon assessing the patient’s readiness for discharge by interpreting his laboratory values and vital signs and evaluating his psychosocial support, I determined no additional or alternative plans (such as additional interdisciplinary support from Respiratory Therapy) were necessary and recommended discharge to the patient’s provider.
· Domain 1: Knowledge for Nursing Practice. Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age.
This patient was a father, husband, and pastor of a local church. The holidays were approaching, and he was eager to get home to decorate, cook, and spend time with his family. I understood that patient’s underlying social systems were a key motivator in his adherence with the plan of care (utilizing the incentive spirometer regularly throughout the day, ambulating in the walkways, and taking his medication as prescribed).
· Domain 1: Integrate Nursing Knowledge. Integrate foundational and advanced specialty knowledge into clinical reasoning.
I actively engaged with and used information produced by multiple disciplines to guide my nursing priorities, monitoring, and advocacy, such as incorporating the findings from his cardiology reports (coronary angiogram results, EF of 40%, aortic stenosis) into my assessment of impaired cardiac output and continued telemetry monitoring, thus showing collaboration with the patient’s cardiology team.
I incorporated renal considerations (ESRD, peritoneal dialysis, and lab values) into my evaluation of anemia, tissue perfusion, and assessment of the patient’s risk for delirium.
· Domain 2: Person-Centered Care. Communicate effectively with individuals.
I understood the nonmedical needs of my patient and analyzed cues regarding his motivations and tailored my patient education and plan of care with the patient’s underlying goals. Specifically, through rapport-building conversation with my patient, I learned that he was a pastor and ARMY chaplain who was hospitalized for cardiopulmonary disease processes. I recognized his knowledge deficit regarding incentive spirometry use and benefits, so I tailored my patient education to teaching him how to use an incentive spirometer to assist with improving lung function and his return to public speaking. I confirmed patient understanding via teach back.
· Domain 2: Person-Centered Care. Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.
I structured teaching related to illness management to the patient’s comorbidities (impaired cardiac output and impaired gas exchange), his baseline self-care behaviors (independence with activities of daily living completion) along with his social roles within his communities instead of relying on generalized care instruction.
I realized that the patient had end-stage renal disease on peritoneal dialysis, which indicated a pattern of self-management and health literacy. I factored this into my care planning by reminding him of the importance of fluid balance, medication adherence, and symptom monitoring as they relate to his renal disease and heart failure.
I taught the patient to recognize the symptoms of worsening cardiac output (i.e., dyspnea, dizziness, and chest pain) and stressed the importance of promptly reporting to the Emergency Department to prevent worsening of his conditions.
· Domain 8: Informatics and Healthcare Technologies. Uses informatics to enhance one’s own knowledge base to provide patient centered care and support teaching.
I used the EPIC electronic medical record (EMR) data to trend lab values (WBCs, hemoglobin, hematocrit, BUN, phosphorus) and connect these values to the clinical manifestations of my patient (impaired gas exchange, poor tissue perfusion, anemia, and risk for perfusion).
I interpreted telemetry monitoring data to assess the patient’s cardiac rhythm stability, confirm sinus rhythm, and evaluate the effectiveness of the patient’s cardiac pharmacological interventions.
References
American Association of Colleges of Nursing (AACN). (n.d.). Domains & Concepts. The essentials. https://www.aacnnursing.org/essentials/tool-kit/domains-concept