nursing analysis in healthcare

I have to create a concept map and a reflection. I am currently working in a surgical hospital for my clinical. I work in Med Surg. All patients that we see are post-op patients that had spine surgery. They are typically discharged home after two or 3 days. The instructor that I am submitting this work to does not know any of my patients. She only knows I work at a Surgical clinic.

I have attached the Concept map template, Reflection sample paper and Guide to help you create the work.

COMPETENCIES7093.6.1 : Applies Care for the HEENT and Integumentary ConditionsThe learner applies the clinical judgment model to person-centered nursing care of diverse adults experiencing common alterations of the head, eyes, ears, nose, throat, and the integumentary system.7093.6.2 : Applies Care for F&E, and Respiratory ConditionsThe learner applies the clinical judgment model to person-centered nursing care of diverse adults experiencing common fluid and electrolyte and acid-base imbalances and alterations in respiratory functions.7093.6.3 : Applies Care for the GU, Reproductive, GI, and Hepatic ConditionsThe learner applies the clinical judgment model to person-centered nursing care of diverse adults experiencing common alterations in genitourinary, reproductive, gastrointestinal, and hepatic functions.7093.6.4 : Applies Care for Pain, Inflammation, Immunity, and InfectionThe learner applies the clinical judgment model to person-centered nursing care of diverse adults experiencing pain, inflammation, immunity, and infection.7093.6.5 : Recognizes Diverse Adult Patient Medical ConditionsThe learner recognizes the cues of diverse adult patients’ body systems using the clinical judgment model.7093.6.6 : Recognizes Medical Conditions for a Care PlanThe learner recognizes the cues of diverse adult patients’ conditions to prepare a plan of care using the nursing process.7093.6.7 : Explains Collaboration with Interdisciplinary TeamsThe learner explains the importance of collaborating with interdisciplinary teams to promote safety, quality, and improved patient outcomes.7093.6.8 : Explains Pharmacological Care Error PreventionThe learner explains how to provide pharmacological care to diverse adult patients using safe, person-centered practices based on principles of medication error prevention.7093.6.9 : Describes How to Promote Well-BeingThe learner describes strategies to promote health and well-being.7093.6.10 : Describes How to Support Adult PatientsThe learner describes professionalism, therapeutic communication, teaching, and learning strategies to use with diverse adult patients.INTRODUCTIONThe Clinical Judgment Measurement Model (NCJMM) provides nursing students different ways to develop care plans to reinforce clinical thinking and clinical reasoning that will prepare them to apply concepts from their didactic and lab courses in the clinical setting. In this course you will select one of the patients you cared for in your clinical intensive and complete the clinical judgement concept map for your performance assessment using the “Concept Map Template” in the Web Links section. You will need to collect information during your clinical intensive using the “NCJMMT Template” in the Web Links section. Do not include patient identifiers. During your clinical intensive, your clinical instructor will serve as a resource to guide you as you complete this assignment.REQUIREMENTSYour submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).Concept Map:Using the “Concept Map Template” in the Web Links section, complete the following (do not include patient identifiers):A. Describe the pathophysiology related to a disease process, disorder, or injury.B. Identify at least 4 critical cues that are relevant to the patient’s current condition.C. Analyze the 4 critical cues from B by making 3 supporting connections between the cues and patient conditions.1. Identify 2 cues of concern related to the patient’s overall health outcome.D. Determine 3 hypotheses critical to positive patient outcomes, listing them in order of priority.E. Develop 5 SMART goals with appropriate interventions that will positively impact patient outcome and are appropriate to the care of the patient.F. Describe how each of the 5 interventions from E will be prioritized and implemented into the patient’s plan of care.G. Describe how the 5 interventions from E were effective or ineffective in improving patient outcome or care.H. Demonstrate professional communication in the content and presentation of your submission.File RestrictionsFile name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )File size limit: 400 MBFile types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7zRUBRICA:DISEASE PROCESS/PATHOPHYSIOLOGY RISK FACTORSNOT EVIDENTThe description does not include a review of pathophysiology related to a disease process, disorder, or injury.APPROACHING COMPETENCEThe description includes an incomplete or inaccurate review of the pathophysiology related to a disease process, disorder, or injury. Or it is missing key disease components.COMPETENTThe description includes a complete and accurate review of the pathophysiology related to the disease process, disorder, or injury including key disease components.B:RECOGNIZING CUESNOT EVIDENTThe concept map is missing all 4 critical cues.APPROACHING COMPETENCEThe concept map is missing 1 or more critical cues that are relevant to the patient’s current condition.COMPETENTThe concept map identifies at least 4 critical cues that are relevant to the patient’s current condition.C:ANALYZING CUESNOT EVIDENTThe analysis does not make any supporting connections between cues and patient conditions.APPROACHING COMPETENCEThe analysis is missing 1 or more supporting connections between cues and patient conditions. Or one or more of the connections is inaccurate or not related to the patient’s conditions.COMPETENTThe analysis makes 3 accurate supporting connections between the cues and patient conditions that are related to the patient’s conditions.C1:PATIENT OUTCOMES CUESNOT EVIDENTThe concept map does not identify any cues of concern.APPROACHING COMPETENCEThe concept map is missing identification of 1 or more cues of concern related to patient outcome. Or one or more of the cues identified is inaccurate or not related to the patient’s conditions.COMPETENTThe concept map accurately identifies 2 cues of concern related to patient’s conditions and outcome.D:PRIORITIZING HYPOTHESESNOT EVIDENTThe concept map does not include hypotheses critical to positive patient outcomes.APPROACHING COMPETENCEOne or more hypotheses critical to positive patient outcomes are missing. Or one or more of the hypotheses is inaccurate. Or the hypotheses are not prioritized correctly.COMPETENTThe concept map includes 3 accurate hypotheses critical to positive patient outcomes that are prioritized correctly.E:GENERATING SOLUTIONSNOT EVIDENTThe concept map does not include 5 SMART goals.APPROACHING COMPETENCEOne or more SMART goals does not have appropriate interventions that will positively impact patient outcome or is not appropriate to the care of the patient.COMPETENTThe concept map includes 5 SMART goals with appropriate interventions that will positively impact patient outcome and they are appropriate to the care of the patient.F:TAKE ACTIONSNOT EVIDENTA description of how each of the 5 interventions will be prioritized and implemented into the patient’s plan of care is not included.APPROACHING COMPETENCEThe description of how 5 interventions will be prioritized and implemented into the patient’s plan of care is incomplete or inaccurate.COMPETENTThe description of how each of the 5 interventions will be prioritized and implemented into the patient’s plan of care is accurate and complete.G:EVALUATING OUTCOMESNOT EVIDENTThe concept map does not include a description of how the 5 interventions were effective or ineffective in improving patient outcome or care.APPROACHING COMPETENCEThe concept map includes a description of how the 5 interventions were effective or ineffective in improving patient outcome or care, but the description for 1 or more interventions does not accurately explain how that intervention was effective or ineffective in improving patient outcome or care.COMPETENTThe concept map includes an accurate and detailed description of how each of the 5 interventions were effective or ineffective in improving patient outcome or care.H:PROFESSIONAL COMMUNICATIONNOT EVIDENTContent is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.APPROACHING COMPETENCEContent is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.COMPETENTContent reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding. WGU Nursing Concept Map
Recognizing Cues
Disease Process/Pathophysiology/Risk Factors
Analyzing Cues/Concerns
Prioritizing Hypotheses
Supporting
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Concerning
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Outcomes Interventions SMART Planning
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2.
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5.
Evaluations Outcomes
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5.
Take Actions
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Adult Health II Clinical
A nursing situation that I encountered during this clinical rotation was that one of my
patients was getting hypertensive, having difficulty breathing, and getting diaphoretic. After
getting report and taking the time to read the patients history this is a patient who has a past
medical history of COPD, CAD with a systolic heart failure with an ejection fraction of 10%,
pacemaker, AKI, Seizures, tracheostomy, and stage 4 lung cancer.
My relationship with the patient at the time that I noticed the situation was that we did
not have one. I never took care of the patient before that day, but the nurses and other staff do
talk. So, I did hear about the patient and the family, but I personally did not have a relationship
with them. Other experiences that I have had so far as a nursing student is to know that a
patient being hypertensive, we need to treat it. My beliefs about my role as a student nurse is
that the patient’s family member is very on top of it and needs to be assured that we are taking
care of their family member. The family often needs to be reminded that we as nurses need to
assess the full situation not just the numbers that we see on the monitor. My emotion about
this situation is that it is sad given the patient’s medical history and prognosis. However, at the
same time according to the family this is what the patient wanted.
What I noticed about the situation initially is that the patient looked uncomfortable,
diaphoretic, tachypnea and was having some labored breathing. I noticed that the oxygen
saturation was sating 87-89%. I noticed that he was alone in the room (the patient’s family did
not arrive yet). As I spent more time with the patient and their family, you can tell that the
family is very involved in the patients care. The family has some understanding of the patient’s
condition. They know all the lab values; they take pictures of the chest x-rays and wounds to
compare. So, the family is very hands on, and have no issue with speaking up regarding their
family member.
Initially what I thought about the situation is that maybe the patient needs to be
repositioned and suctioned, because as stated before the patient looked very uncomfortable. So
that’s where we started, we assessed, repositioned, suctioned and cleaned the patient up. After
doing all of that we reassessed the patient and took all vitals again with not much improvement
in vitals, however, presentation wise the patient appeared comfortable. At this time, we also
consulted the respiratory therapist because in report the off going nurse stated that the
patient’s ventilator was weaned. So, my next thought was that the patient is not tolerating the
weaning that was done. The wean from the ventilator consisted of decreasing the PEEP and the
FiO2. I also noticed that the patient would be fine for a few hours after getting medication and
then the cycle would start over again.
Similar situations that I encountered before we would reassess, making sure that the
patient was repositioned, the cuff is the right size and it is on the patient correctly, making sure
the patient is suctioned and we have a patent airway. One difference I did notice was that even
though the previous settings on the ventilator were working for the patient the respiratory
therapist did not want to go back on the previous settings. And insisted that it was a nursing
issue that needed to be fixed. So, fix the blood pressure and the patient’s respiratory status
would improve was their thought.
The other information that I decided I needed as I considered the situation was the
patients past medical history what was stated above. The medication that the patient was on for
blood pressure issues. These medications included Bumex and Milrinone. Bumex was ordered
as an injection, and it is used to increase urinary output to remove excess fluid and decrease
edema in the heart and kidneys for this patient. The Milrinone was ordered as an infusion and
this is indicated for use in patients with acute heart failure, chronic heart failure and pulmonary
hypertension. It is used to dilate the arteries of the heart and increase the strength of the heart.
I review the patient’s chest x-rays because of this desaturation event going on the provider also
ordered chest x-rays which showed that the patient had edema and effusions. At this point an
extra dose of Bumex was ordered and administered. I reviewed the patients’ labs. The labs that I
was interested in was the albumin to check the kidney function. Patients’ albumin levels were
2.6g/dL; 2.8 g/dL. Creatinine levels because the patient is on the Bumex, and we want to closely
monitor the electrolytes especially calcium because Bumex can cause an increase in calcium
excretion and cause hypocalcemia. Patients creatinine levels were 1.54 mg/dL ; 1.60 mg/dL. I
am watching the potassium levels to monitor the patient’s kidney disease and heart function.
Patients’ potassium level was 3.8 mEq/L; 3.2 mEq/L. As well as BUN levels which reflect kidney
function. Patient BUN levels were 94mg/dL; 109mg/dL.
For most of this information I went through the patient’s chart. I wanted to look at
trends and see how the patient’s renal function was. The help that I received from my preceptor
with problem solving was that we talked things through. As to the blood pressure, the
medication and the patient’s respiratory status. It helped me understand why we are giving
Bumex instead of Lasix in which I learned that Bumex is forty times more potent than Lasix.
Also, we decided to titrate down on the patients Milrinone versus increase. And the nurse was
able to explain to me over night the nurse had to increase the dose but from what she seen
with working with the patient that the patient does better on the lower dose. So, we titrated
the dose down and the patient did start improving.
My observation and data interpretation lead me to believe that the patient condition is
getting worse. With an ejection fraction of 10% the heart is overworked and is requiring more
help to keep contracting. I believe that although the patient improves some with the medication
the patient’s oxygen demand is also increasing but I don’t think that the respiratory therapist
wanted to agree to that. That although some changes aren’t very significant to a patient that is
compromised small changes and make a difference. It’s important to have enough oxygen to
reach the heart and lungs to be oxygenated to be able to function at is full capacity. Also, the
patient is holding onto and or accumulating fluid which leads me to believe that the kidneys are
not functioning as well as they should. And the Bumex is literally forcing the kidneys to produce
urine. My nurse preceptor agreed with what I was saying and did inquire about maybe giving
the patient a little more oxygen or going up on support to the previous settings.
Our goal for the patient and family was to keep the patient comfortable. To monitor the
blood pressure which we set to cycle every thirty minutes. The left lung looked whited out on
the chest x-ray, so we wanted to make sure the patient had the right side up for a little to help
with oxygenation. We made sure to be on time with patients’ medications. It seemed like when
the medication was due the patients’ blood pressure would jump up the highest blood pressure
seen on our shift was 157/86. For the family we wanted to make sure that they knew we were
watching the blood pressure and that when the blood pressure jumps up, we cannot just adjust
the medications we have to reassess and make sure that it is an accurate blood pressure, and
not a pressure to reflect stress from repositioning or suctioning for example. We showed the
family the chest x-ray so that they can see another reason for the vitals being all over the place.
The family was under the impression that the patient’s chest x-ray was better until they were
shown the picture and was able to see for themselves that the chest x-ray has in fact gotten
worse. We went over labs, the extra dose of Bumex that was administered and labs that was
ordered for the next morning.
The stresses that I experienced as I responded to the patient was that other members of
the clinical team wanted to be right and wanted to leave the patient where they were and tell
us what we need to fix instead of looking at the whole picture. Or even considering trying
something different. The family was initially getting furious and giving push back because others
was saying what we need to do and then it would be a ripple effect but working in health care
often somethings are independent and need to be treated individually initially until the patient
is more stable and then we can see if one is or is not impacting the other. With patients that are
complex patients such as this one, sometimes multiple things can have a great effect.
Ultimately the patient was able to remain comfortable with repositioning every two
hours, staying on top of the patient’s medication, suctioning and having their family there to
talk to them and keep them calm. The family member relaxed and came around and was very
receptive to what we were saying after we showed the chest x-ray went over labs explained
what we did and why we did it. Furthermore, having an instance where we can show them once
the patient calms down the blood pressure often goes down too and if we would have adjusted
the medication, we could have bottomed out the patients’ blood pressure. So that why we wait
for the patient to calm down, we reassess and then determine if the medication is still
indicated. The other members on the team said see all you had to do was fix the blood pressure
but that the patient was still having waves of desaturation although not sustained there were
frequent waves.
Three ways my nurse care skills expanded during this experience is I was able to piece
together the complete picture for this patient. I was able to know this patients’ signs that that
they were having some fluid overload going on and we needed to prepare to give the
medication. I was more comfortable with assessing the IV site administering meds through the
IV site and changing the rate on the pumps. Three things I might do differently if I encountered
this situation again is I would write the last time the medication was given or when it was due
so that I can cluster care the patient. I would monitor I & O’s better and more frequently. I
would also hyperoxygenation the patient before big movement. Because when the body don’t
have enough oxygen that will also have a great effect on the heart and the blood pressure, I
don’t think that there was any additional knowledge, information, or skill that I will need when
encountering this kind of situation in the future. I think I had all the information that I needed to
be able to treat this patient. Or it was available to me in the patient’s chart. I personally don’t
have any changes in my values or feelings because of this experience.