Acute Care Intro Page 

Acute Care Assignment

Nurs 453: Adult Health II Clinical Case Study

 

Purpose of the Assignment: 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.

 

Student Approach to Assignment: My approach to writing this paper was to bring the reader along with me so that they may see how I took the patient information I gathered, applied critical thinking, and came up with my plan action. The goal was to have the audience see my thought process along the way of my care. 

 

Reason for Including this Assignment in the Portfolio: I chose to include this assignment in my portfolio because I believe it a good reflection of what I have learned in nursing school when it comes to the disease process and critical thinking. In this paper, I was able to show how I use the patient's labs, signs and symptoms, and vital findings to direct the plan of care for my patient.

 

Domain 1,2,3: Knowledge for Nursing Practice, Person-centered Care, and Population Health

(7) Demonstrates clinical reasoning in making clinical or professional judgments

• I demonstrated clinical reasoning in my paper when my patient was showing signs of septic shock. The nurse and I tried many interventions to stabilize the patient when he was displaying symptoms of septic shock but nothing was working so rapid response was called. I demonstrated clinical reasoning by determining that his chills, tachypnea, drop in blood pressure, and fever were all signs of septic shock. 

Domain 2,3: Person-Centered and Population Health 

(8) Applies appropriate knowledge of major health problems to guide nursing practice

• After evaluating my patient’s signs and symptoms such as a high heart rate, temperature, respiratory rate, and lactic acid levels I knew that the patient was going into septic shock

(12) Establishes and/or utilizes outcome through the acquisition of data and the questioning of inconsistencies 

• With the information that I had about my patient from his progress notes, vitals, lab, and through conversation with him I was able to set realistic expected outcomes such a decrease in the  temperature by 1 degree fahrenheit and getting the pain score down from a 10 to a score of 3 by 1900

(14) Revises action and goals based on patient data or responses to interventions

• As mentioned in the paper, I had to revise my patient’s pain medication intervention because of the patient’s response to it. The patient was given dilaudid to help with his pain but when that did not work the provider recommended increasing the dosage as well as giving it as an IV push 

(18) Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management 

• The patient was educated on the purpose of his lidocaine medication. The nurse and I went into the patient's room to educate the patient, telling him that the lidocaine is used to numb the area that is causing his pain which should bring down his pain levels. I also had the chance to educate the patient on why he has an ulcer related to his diabetes and to prevent a recurrence. I let the patient know that because he has diabetes he is at a higher risk of having complications such as the infected foot ulcer he came in with. With taking his insulin as instructed by his physician and managing his diabetes daily, he lessens his chances of health complications related to his diabetes.

Domain 2,3,5: Person-Centered, Population Health, and Quality & Safety

(11) Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques

• In this case study, I demonstrated my ability to incorporate quality management and proper safety techniques by including in my paper that I administered medications such as antibiotics and pain meds to prevent further complications, assessing wound dressings for signs of infection, and monitoring the patients vital signs to ensure that the patient's quality and safety needs are met.

Domain 2,7: Person-Centered and System-Based Practice 

(19) Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions 

• In this case study, I had a patient who came in with a diabetic foot ulcer. The patient's foot ulcer was considered unstageable, so the nurse and I reexplained what the doctor said which was that the he may have to receive an irrigation and debridement procedure. After it was determined that an  irrigation and debridement was necessary, we explained to the patient how IND procedures typically go and explained the surgical technologies that will be used.

Domain 4: Scholarship for the Nursing Discipline

(27) Evaluates research that focuses on the efficacy and effectiveness of nursing interventions

• In my paper, I mentioned how I used research on non-pharmaceutical interventions for pain. I used an intervention that is supposed to help with pain by having loved ones come to visit such as friends and family. I advised the patient to give his family a call since his family could not be there in person. After re-evaluating it seemed to have helped.

Domain 7: Systems-Based Practice

(35) Describe the impact of healthcare cost and payment models on the delivery; access, and quality of care

• In my paper, I mentioned how my patient who is of hispanic descent, had his health impacted because he did not have any insurance. My patient had type 2 diabetes but did not have any insurance because he can not afford it which means he has not been able to order his insulin either. My patient got a cut on his foot but when left untreated, it turned into an ulcer. He also stated that he waited so long to go into the hospital because he did not feel like he could pay for it.