Read the following case study.
You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks. Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.
Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress.
You asked the nurse why she was instilling saline into his endotracheal tube. She replied that this was being done to loosen the secretions. You told her this was no longer an acceptable practice. She stated that she many years of critical care experience and she didn’t care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch.
Determine a plan of care for the patient using the nursing process.
Define each step of the nursing process and align each step to critical thinking and clinical decision-making processes.
Format your care plan as a concept map using visual presentation software, such as bubbl.us from the College of Education Technology Resource Library
- Click Web Tools.
- Click Collaboration & Productivity.
Format your alignment of the nursing process with the critical thinking process and clinical decision-making process in a document, table, or other visual representation approved by your instructor.
Click the Assignment Files tab to submit your assignment.
Assignment adapted from Leading and Managing in Nursing (Ch. 21), by Patricia S. Yoder-Wise, 2015, St Louis, MI: Elsevier. Copyright 2015 by Elsevier. Adapted with permission
Expert Solution Preview
Introduction:
This case study involves a 75-year-old male patient who underwent coronary artery bypass graft surgery four days ago and has a history of chronic obstructive pulmonary disease. The patient has been unable to be weaned off the ventilator since the surgery and is being evaluated for the development of ventilator-associated pneumonia. During the nurse’s absence, another experienced nurse instilled saline into the patient’s endotracheal tube, causing distress to the patient. The task is to determine a plan of care using the nursing process and define each step of the process along with the critical thinking and clinical decision-making processes.
1. Determine a plan of care for the patient using the nursing process:
The nursing process is a framework used by nurses to provide patient-centered care. The five steps involved in the nursing process are assessment, diagnosis, planning, implementation, and evaluation. The plan of care for the patient can be determined as follows:
Assessment: Assess the patient’s current condition and gather information about their medical history and current medication regimen. Identify potential complications that may arise, such as ventilator-associated pneumonia and decreased lung function.
Diagnosis: Identify the patient’s problems, which include a difficult postoperative course, difficulty being weaned off the ventilator, and recent distress caused by the instillation of saline into the endotracheal tube.
Planning: Establish goals and outcomes, such as successful weaning from the ventilator, optimum lung function, and the prevention of complications such as ventilator-associated pneumonia.
Implementation: Use the nursing interventions to achieve the patient’s goals. The interventions could include airway clearance techniques, administering respiratory medications, and positioning the patient for comfort and to enhance lung function.
Evaluation: Assess the patient’s response to interventions and make necessary adjustments to the plan of care based on the patient’s condition.
2. Define each step of the nursing process and align each step to critical thinking and clinical decision-making processes:
Assessment: The first step of the nursing process, which involves collecting patient data through observation, interviews, and physical examination. Critical thinking and clinical decision-making are essential in this step because nurses must identify and interpret relevant data to make accurate diagnoses and treatment plans.
Diagnosis: The second step of the nursing process that involves identifying and categorizing the patient’s health problems using critical thinking and clinical decision-making skills. Nurses use their assessment data to formulate accurate diagnoses and plan interventions.
Planning: In this step, nurses develop a plan of care for the patient using critical thinking and clinical decision-making. The plan must identify clear and specific patient goals and outcomes and describe how interventions will be used to achieve the results.
Implementation: The implementation step involves carrying out the nursing interventions described in the plan of care based on critical thinking and clinical decision-making. Nurses must prioritize interventions, monitor the patient’s response, and modify the plan of care as needed.
Evaluation: The final step of the nursing process involves assessing the patient’s response to interventions, which requires critical thinking and clinical decision-making. Nurses must compare the patient’s progress to the initial goals and modify the plan of care as required to achieve optimal patient outcomes.
3. Format your alignment of the nursing process with the critical thinking process and clinical decision-making process in a document, table, or other visual representation approved by your instructor.
(The format will depend on the instructor’s requirements and preferences.)
