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Application of the nursing process to a patient scenario

Application of the nursing process to a patient scenario

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This paper looks at the nursing process and the ways that a nurse can be able to make proper judgments in order to offer the best patient care. It also shows how to use a plan of care and teaching plan which are also essential nursing tools.


The application of the nursing process to a patient scenario

According to (Pottery & Perry, 2005) the nursing process is a system that can be used to organize and deliver the nursing care. The process contains five steps which include; assessment, diagnosis, planning, implementation and evaluation. The overview of these steps is shown below.

i.Assessment

Assessment involves the systematic collection of information. It is the first step in the nursing process where the nurse is also supposed to write a care plan. The assessment stage is helpful to the nurse because it helps him/her to know more about the condition of the patient. The day before the clinical the nurse is also supposed to draft a care plan based on the information gathered from the patient’s records. This draft is supposed to show more information about the patient including his/her history, any current medications, the purpose of coming to the hospital and the current health condition. This is an important step because it gives the nurse all the necessary information about the patient such that he/she can still proceed with the care plan even if the patient is away.

ii. Diagnosis

The nursing diagnosis is involves clinical judgment about the actual problem that the patient is facing. The nurse can thereafter use their own assessment to know the most appropriate care that the patient is supposed to be given. All nurses need to follow the rules set by The North American Nursing Diagnoses Association(NANDA). Any diagnoses found on the nurse’s care plan need to be approved by NANDA because it is the organization that provides a common language that all nurses across the globe can get to understand. A nurse is supposed to start learning the diagnostic procedures set by NANDA right after joining their first year in college. For instance in the first year the nurse get to learn five diagnoses. In the second year the nurse will get to learn 15 more. In the diagnosis step the writing process is also very useful because it enables the nurse to rank the patient’s problems and deal on them according to their priorities.

iii. Planning

This is the phase where the nurse decides on the appropriate care that the patient needs to be given. The nurse also looks for the best measures that needs to be undertaken during the treatment process. It also involves making interventions on each of the listed diagnosis and trying to decide whether they will be carried out with patient. One of the best example in the planning process reads: “if the patients is obese then probably you need to position in reverse Trendelenberg’s position exactly at 45 degrees that is for the short periods”(Ackley & Ladwig, 2006, p.439). From this example, if the patient the nurse is working on is not obese then such intervention should not be indicated in the plan of care. It is always very important for a nurse to learn early enough on how to make the interventions that are specific to their patients. Every interventions has got a scientific explanation for why the measure that is carried out is important.

iv. Implementation

This is the step that involves carrying out the identified interventions that were necessary for the patient’s care. According to (Carpenito, L.J, 2012) the preparations carried out ensures that the patient gets safe, efficient and effective nursing care. As part of preparation the nurse is also required to have a well written and completed care plan before arriving in the clinic. This is mandatory for the nurse because after arriving in the clinic it is only through well planned nursing interventions that he/she will asses the patient and determine whether the plan is still necessary for the patient.

Nursing intervention can be defined as any treatment given based on any clinical judgment that can be performed by a nurse to enhance the outcomes of the patient. The nursing intervention classification also differentiates between two words that are direct and indirect intervention. Direct nursing intervention is defined as any type of treatment that is done through interaction with the patient. On the other hand indirect nursing intervention is defined as any action that is performed by the nurse away from the patient but on the latter’s behalf .As part of the implementation, there are a number of steps carried out some of them including counseling, teaching and direct care. In this through a well planned care plan that the nurse will be able to perform these steps effectively.

There are also three types of nursing interventions; nurse initiated, dependent and interdependent. Independent nursing interventions are the autonomous actions taken by the nurse which are also based on patients centered goals and the diagnoses carried out by the nurse. Dependent interventions on the other hand are carried out through the directions of the physician. Interdependent interventions can be as a result of consultation.

The nursing process also gives a chance for a registered nurse to make proper decisions. For instance the nurse is able to use cognitive and interpersonal skills. The nurse can be able to make good decisions, think critically and use the acquired skills to manipulate the equipment for example by giving injections, re-positioning and bandaging his/her patients. The assessing step also assists the nurse to collect, analyze, validate and document data . It enables the nurse to establish the overall goals of his/ her client. Current researches that are being carried will be able to assist in the proper understanding of how the RN makes decisions. This can be seen from the cognitive and invisible work of nursing and also the actual situations that is the quality of care and the health environmental work.

When the goals are not met during the nursing process, two things can be done. In the first one the nurse will be required to revise the care plan. Secondly the patient needs to be given more time in order to achieve the desired goals. The nursing process therefore is very important because it also helps the nurse to:

  • Develop clinical judgments which are required for safe nursing practice.
  • Enables the nurse to assess and evaluate the requirements of his/her client.
  • Enables the nurse to seek alternative action in life threatening cases.
  • Planning, organizing and giving the required patient care.
  • Enables the nurse to operate and think critically under any given situation.
  • Have enough flexibility by reordering tasks during shift hours.
  • Working on matters that need urgency for examples a patient with a major effect like a life threatening case needs to be given the first priority.

Evaluation

Evaluation is the final step in the nursing process. This step allows the nurse to determine whether the application of the nursing process was effective. It also helps the nurse to know whether the condition of the patient will improve because every nursing diagnostic has got its desired results (Fischbach, F, 2004). Through evaluation the nurse can therefore know whether the expected results have been achieved. In the care plan the nurse is also required to document whether he/she believes whether the diagnoses,assessment, planning and the implementation were correct. In addition to support his/her position the nurse will also have to include rationales.

Plan of nursing care

Detailed background information of the patient.

Clients gender: male age 78 admitting diagnoses: history of CHF, hyperlipidemia and extremely lower weakness.

Brief history of the patient.

The patient survives in an assisted living facility though he can still be able to walk by himself for short distances. The patient uses a wheelchair to transport himself to the communal dining room. He is also able to administer his own medication and can bath by himself

Medication Rationale Action Dose Appropriate

Metroprol( Lopressor) 50 mg It treats high blood pressure and also prevents chest pain.it works by relaxing blood vessels and slows heart rate which in turn improves the flow of blood to lower blood pressure in return

Affects the blood circulation through the veins and the heart 25 mg once a day. Continue for two weeks.

Furosemide( Lasix) 20 mg Furosemide prevents the body from absorbing excess salt. This in turn allows the salt to be passed out with urine. Furosemide treats edema in heart failure patients, liver disease or kidney disorder. It is also used in patients with high blood pressure

It inhibits the re-absorption of sodium and chloride in the loop of henle, distal tubules and proximal

PO 40 mg twice a day

Atorvastatin( Lipitor) 20 mg Atorvastatin is used to treat patients with high cholesterol. It should not be used in pregnant and breastfeeding patients. It reduces levels of ‘bad cholesterol and triglycerides in the blood. It also increases the levels of ‘good cholesterol

10-40 mg orally twice a day.

Adjustments of the dose to be done at 2-4 weeks interval Cefazolin (Ancef) 1.5 Grams It treats bacteria that occur after certain surgeries. It is a cephalosporin which works by killing all sensitive bacteria 250mg to 500mg every 8 hours Quinapril HCL(Accupril) 40 mg It is used to treat high blood pressure. It is function by relaxing the body blood vessels 20 mg after 24 hours.

Interactions and other special considerations.

Metroprol, Furosemide and Atorvastatin can lead to some side effects. Metroprol for instance can lead to chest pains, blurred vision, shortness of breath, sweating among others. The following symptoms can also appear in case of overdose:

  • Stopping of heart
  • Unconsciousness
  • Feeling drowsy
  • Bluish color in fingernails, ski and palms.

Furosemide can also lead to weight loss, chest pain, severe skin reaction,hearing loss among others. If these happens the patient needs to seek immediate emergency care and stop using the drug. Atorvastatin can also lead to some signs related to allergy for example difficulty in breathing, swelling of the face and throat. If these happens too the patient needs to seek immediate health attention.

Priority diagnoses Nursing interventions Rationales Pressure ulcer over the ischium of the right buttock Assess

  • Site of the wound each day for any sign of the overgrowth of the tumor.
  • The nutrition status.
  • Patients continence status.Prevent
  • Widening of the ulcer to other adjacent areas.
  • Apply SilvaSorb®( antimicrobial gel) on the wound daily.
  • Do not massage the area around the wound site

Evaluate

The patient will have to regain the integrity of the surface of his skin

  • Proper inspection of the site of the ulcer can lead to discover of any impending problems.
  • Proper nutrition is required for quick wound recovery.
  • Moist skin due to incontinence can contributes to ulcer developments.
  • If the tumors can grow to the adjacent areas they can spread the infection.
  • To promote quick healing of the wound.
  • Doing this can result in deep damage to the tissues.

Priority diagnoses Nursing interventions Rationales

Infection risk for open wounds

Subjective/objective information: high temperature, redness of the wound, odor, drainage Assess

  • For high temperature, odor, drainage and redness of the wound.
  • Moist skin.
  • Moist skin due to incontinence can contributes to ulcer developments.
  • If the tumors can grow to the adjacent areas they can spread the infection.
  • To promote quick healing of the wound.
  • Doing this can result in deep damage to the tissues.

Prevent

  • Thoroughly wash the skin but avoid rubbing. Take enough care when dealing with skin folds.
  • Encourage the patient to take more fluids.
  • They indicate an infection.
  • If the tumors can grow to the adjacent areas they can spread the infection.
  • Moist skin can lead to attack by micro-organisms.
  • Thorough wash of the skin keeps it intact.
  • High fluid intake helps the body to recover the lost fluid during bleeding

How does the RN decide on the teaching plan format?

Before making a teaching plan the nurse is required to asses what is critically required to both looking at the the health of his patients and managing their care. Patients normally expect a nurse to give directions(Rankin, Stalling, &London, 2005). A good example is of a patient who had recently survived from a urinary diversion. In such a case, the nurse needs to prioritize the teaching based on what both the patient and his family will have to change at home to avoid the recurrence of such a case again. A health nurse will have to assist the family of the patient by teaching them and ensuring that they receive the information as required.

How does the RN know which information needs to be included?

The teaching plan is mostly individualized and this is based on the prioritized learning requirements of the patient. Therefore by understanding the problem of the patient the RN needs to look for information that is specific to the requirements of his/her patient.

When does the RN determine how and when to evaluate the teaching plan?

Although it is very hard for a nurse to know the patient’s learning style for example auditory or visually, it is best for him/ her to ask the patient. Equally the nurse can ask the patient for his/her hobby and this can evaluate his learning method. Different patients require different methods of learning and the only way that the RN can evaluate his/her teaching plan is by knowing each of the best way that works for all his/her clients.

REFERENCES.

Ackley, B.J., & Ladwig, G.B (2006). Nursing diagnosisi handbook. A guide to planning care. St. Louis: Mosby-Elsevier. Carpenito, L.J 2012.

Nursing diagnosis : Application to clinical practice. Philadelphia: Lippincott, Williams & Wilkins. Fischbach, F (2004).

A manual of labaratory and diagnostic tests. Philadelphia: Lippincott, Williams & Wilkins Potter, P. A, & Perry, A.G. (2005). Fundamentals of nursing 96 th ed). St. Louis Mosby-Elsevier.


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