Applying Critical Thinking and the Nursing Process

Class 2: Applying Critical Thinking and the Nursing Process Class activity guide: Read the following cases and try to identify the components of the nursing process as well as the thinking and doing of the student nurse. See the guide below to address questions. Case #1: A student nurse (SN), is assigned to care for a male hispanic speaking client . The client is confined to bed with no weight-bearing on his legs. Both legs were broken when he was hit by a car 1 week ago. While the SN is helping with his bed bath the SN observes a pinkish-red area on his lower back. The SN thinks, “ This is not normal. The skin over the lower back should be the same color as the rest of the patient’s skin.” The student nurse next thinks : Part I: (Apply the nursing process to plan individualized care for the client addressing each question ): 1. What pertinent assessment findings would the SN identify based on the data? The SN can do a skin assessment on the pinkish-red area. The SN should observe to see what stage the skin breakdown is, possibly stage 1 sacral pressure ulcer based on their findings. If there is a language barrier, the SN should also have a translator for the assessment because the client is hispanic speaking. 2. What lab values should the student nurse be concerned about? ● WBC counts ● CBC counts ● Blood cultures if sepsis or bacteremia are suspected ● glucose/ iron level ● Elevated Blood Pressure ● Platelet count ● If there is skin breakdown (culture test (gram +/-) for bacteria etc.) ● urine input/output 3. What evidenced based practice guidelines might the nurse consider applying to this aspect of patient care? The student Nurse should acknowledge their own knowledge and limitations in regard to the skin condition. After acknowledging these limitations, they then should determine the best place to deviate evidence based practices from. The Student Nurse can conduct research on this condition through journals, and locate appropriate data collections, as well as other providers who have more clinical experience/expertise in the area to help deliver the best care. 4. Develop a plan of Care based on nursing priorities and patient safety. The client should be repositioned at least every 2 hours to prevent the development of a pressure ulcer.. The skin should be inspected with each resposition, and the joints should be supported. The area should be cleaned and proper dressings should be applied. Dressing should be changed daily and the area should be kept dry. A dietician referral may be beneficial as the patient needs adequate nutrition and hydration for healing. The nurse should instruct the patient on proper methods to control the pain and edema. Monitor closely for any signs and symptoms of other complications. 5. Think about what the nurse did that specifically involved the patient as an active participant in his care. Write your ideas down. The nurse gave the patient a bed bath and realized the patient could not do it himself. The nurse assessed the patient's skin and realized there was abnormal findings on the patients, the nurse then asks what she can do after to make the patient's skin better. Part II: Apply QSEN competencies to the case study and discuss: What did the student learn from the case study related to: 1. Safety It is also necessary to have a call bell nearby, have clutter removed, and make sure that everything is in reach for the patient. It is also important to have a cushion placed near the rails to avoid any injury, and to have any equipment near the wall. 2. Patient centered care The patient has two broken extremities, therefore, it is important to know if the patient is positioned correctly on their bed or if they have any cushions to prevent any pressure ulcers. It is important to do skin assessments every shift to check on the skin integrity as this patient isn’t able to ambulate on their own. Also, the patient’s position should be shifted regularly to prevent worsening the stage of the pressure ulcer. 3. Teamwork and collaboration Shared- decision making to assist with quality patient care. Communicated with integrity and respect for differing views as a team on strategies and what lab values we should focus on. We initiated requests for help when needed to clarify any confusions and make sure what is being done is the best for the patient. We respect the unique attributes that members bring for effective team functioning. 4. Evidenced based practice (EBP) The student nurse should establish their own limitations, strengths and acknowledge their value as a team member. As a team member if her limitations outweigh her strengths then she should develop a plan to either conduct research, or integrate other professionals into care contributions to achieve health goals. 5. Quality improvement (QI) Use charts to measure and understand how well the patient is improving. Value measurement because it has a good role in patient care. Incorporate other’s contribution to the outcome of care, and seek information about quality improvement. 6. Informatics Always document and plan patient care in an electronic health record. Look up patient history and document patient's vitals and any care that was given. Document lab values and vitals for evaluation which can also help with new implementation of care/treatment. Use information management to consistently monitor the patient's outcome of care.