NURS 453 Adult Health II

Purpose of 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: I engaged with this assignment with a desire for improvement by analyzing existing patient care models and exploring avenues for innovation. My approach was to enhance patient engagement and outcomes through thoughtful, evidence-based approaches while aiming to bridge the gap between theoretical knowledge and practical application.

Reason for Inclusion of the Assignment in the Portfolio: This assignment is included in my portfolio because it reflects my commitment to improving patient outcomes and my dedication to professional growth. It demonstrates my ability to analyze complex health conditions critically, integrate comprehensive care strategies, and adapt my patient care based on current evidence-based practice. By focusing on this case, I have showcased my ability to address specific health challenges with innovative solutions, emphasizing the importance of personalized and holistic care.

Outcome 6:

Communicate effectively with individuals.

I gathered critical information and built a foundation of trust and understanding by engaging in a comprehensive dialogue with the patient regarding his symptoms and personal concerns. During this discussion, I asked the patient about his outcome goals and what concerns he had once he was released from the hospital. This allowed me to ascertain that his primary concern was his ability to socialize with his family and friends. This interaction emphasized the importance of effective communication in understanding patient needs and tailoring care plans reflecting on his unique health goals and concerns.

Outcome 7:

Demonstrates clinical reasoning.

I utilized clinical reasoning to evaluate the patient's presenting symptoms against his lab results. Analyzing his elevated troponin levels, significant bradycardia, and hypotension, I cross-referenced these findings with his medical history of non-ST elevated myocardial infarction (NSTEMI) and a third-degree atrioventricular (AV) block. This analysis directly informed the development of a targeted care plan grounded in the latest clinical guidelines and the patient's specific health needs. By integrating these lab results with the patient's health profile, my approach exemplified clinical reasoning by ensuring the interventions were tailored to address the patient's complex condition.

Outcome 8:

Applies appropriate knowledge of major health problems.

I demonstrated the application of knowledge in cardiovascular health, specifically in managing the patient's heart failure. This involved thoroughly assessing the patient's condition, including interpreting echocardiogram results and understanding the significance of his reduced ejection fraction. A thorough understanding of how heart failure leads to acute kidney injury was also explored and is necessary in managing the patient's condition to reduce kidney damage. By incorporating this specialized knowledge, I could select evidence-based interventions tailored to the patient's condition, such as optimizing fluid management and understanding the importance of ACE inhibitors as recommended by heart failure guidelines.

Outcome 9:

Implements nursing care practices as appropriate to provide holistic health care to diverse populations across the lifespan.

As demonstrated in the section titled Social Isolation, I took a holistic approach to patient care, addressing not just the physical ailments but also considering the emotional and social factors affecting the patient's health. I provided emotional support by actively listening to his concerns about his health and the impact on his lifestyle. I facilitated a family meeting to discuss his care needs and support. I provided education on how chronic heart failure can impact his lived experience and affect interactions with family and friends. I encourage problem-solving dialogue in a way that allows the patient to discover solutions to prevent social isolation and reduce emotional stress in a manner that aligns with his unique goals. This comprehensive care strategy underscores the nurse's role in catering to the wide-ranging needs of diverse patient populations.

Outcome 11:

Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques.

Due to this patient's increased fatigue, my focus on quality management and safety was integral to the therapeutic interventions. For instance, when administering medications, I double-checked medications and dosages against the patient's current health status and potential interactions while also following the six rights of medication administration. Additionally, I followed safety protocols to prevent falls and injuries for non-pharmacological interventions like patient positioning, range of motion exercises, and toileting. This included using a walker and gait belt for stability during ambulation and ensuring the bed was at a safe height during transfers.

Outcome 12:

Establishes and/or utilizes outcome measures to evaluate the effectiveness of care.

In the patient outcomes section, I established clear and measurable outcome criteria for the patient's care. Specifically, I monitored vital indicators such as the patient's heart rate, blood pressure, lung sounds, and edema to evaluate the effectiveness of the angiotensin-converting enzyme (ACE) inhibitors, vasopressors, diuretics, and fluid management strategies. Additionally, I assessed the patient's mobility and symptom reduction progress to measure the success of non-pharmacological interventions like patient positioning and range of motion exercises.

Outcome 13:

Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies.

In the Evaluation section, I detailed the nursing care provided, focusing on the critical analysis of patient data to uncover any inconsistencies. For example, when the patient's lung crackles and edema did not initially resolve with fluid restriction and the use of sequential compression devices, treatment with diuretics was incorporated. Additionally, I collaborated with physical therapy to begin a recovery plan aligned with the patient's condition.

Outcome 14:

Revises actions and goals based on patient data or responses to interventions.

The Evaluation highlights my proactive role in adjusting the care plan according to the patient's feedback and treatment responses. Upon observing unexpected variations in blood pressure, I notified the physician to modify the patient's medication regimen. Additionally, based on the patient's progress and feedback in physical therapy, I advocated for modifications to his exercise program to better meet his mobility goals and comfort levels. These actions involved direct communication with the healthcare team to ensure the patient's care plan remained responsive and tailored to his evolving needs.

Outcome 18:

Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.

Throughout my care, I conducted educational sessions with the patient and his family, focusing on key aspects of self-care for managing heart failure. This included teaching on monitoring symptoms, dietary adjustments to control fluid retention, and the importance of regular physical activity as recommended by his physician. I also guided medication management, explaining the purpose and proper administration of prescribed medications, including the newly added midodrine, to ensure they were fully informed on how to support his recovery and maintain his health. I also provided education on reducing feelings of social isolation and modifying his daily activity per his reduced cardiac output.