- Leslie Bruchey
- Elements of the Professional Medical Role
Nursing good care is provided in all hospitals, in several expresses, different countries with different techniques. But with that being said, the nursing process using NANDA -I Taxonomy of Nursing diagnoses, the Nursing Effects Classification (NOC) and Nursing Intervention Classification (NIC) can provide some criteria in treatment where it is received. Throughout this newspaper, we will discuss a professional medical case that uses these tools in providing care and looking at the individual results and discuss the systems that were set up.
Clinical Encounter
This patient was accepted to a medical surgical unit with the diagnosis of pulmonary fibrosis, shortness of breathing and pain with enthusiasm, atrial fibrillation and MRSA in the urine. Patient's other record included long-term kidney disease, oxygen centered at home and a minimal ejection fraction. With this being said, this patient had several things going on, but had been cured with antibiotics and Cardizem to regulate A-Fib. In the middle of the night, the patient was an instant response for hypotension and moved to the intense care. Due to a past echo that uncovered the patient's EF was only 12%, large substance boluses weren't really an option to treat hypotension. The hypotension was the effect of a few different reasons, the nurse in med surg got with all this patient multiple blood pressure medications, and the critical attention doctor noticed that she was becoming septic due to her demonstration. Also, the critical good care doctor made the decision that the patient needed a stat VQ scan to eliminate the possibility of any pulmonary embolism. The individual results figured there was a high probability of a pulmonary embolism which warranted the individual to be placed on IV heparin, have a venous ultrasound of her legs and an echo. These tests examined no clots in her legs or center.
With heparin, a PT/INR was drawn for baseline and then a hep xa was drawn every 6 hours until the heparin was restorative. A BNP and CBC were attracted to monitor blood cell matters and a central collection was positioned and the patient was positioned on Levophed to avoid hypotension for a few hours. After a couple of hours, the patient could keep blood circulation pressure controlled without medications. Antibiotics were extended as patients WBC's were 14000 and the patient was continuously supervised in the ICU for a few days. CVP's were measured at 5 and urine outcome was monitored tightly.
Nursing Diagnosis
This patient had multiple medical diagnoses' that fit her condition. Among the diagnoses that fit this patient is lowered cardiac end result. With the patient being in A-fib and with an EF of only 12% this patient doesn't have optimal cardiac end result. The individual also prevents with hypotension which is thought to might have been triggered by medications that result preload and afterload which will also reduce the cardiac output of the patient. This examination is an integral part of NANDA- I Taxonomy of Medical Diagnoses and comes under domain name 4 Activity and Recovery and school 4 which discusses Cardiovascular/ Pulmonary Reactions (NANDA, 2012).
Nursing Interventions Classification Interventions
The pursuing are nursing interventions which were used on this patient using the NIC (Medical Interventions Classification).
Hemodynamic Rules (4150)
Definition: "Optimization of heart rate, preload, afterload and contractility" (Bulechek, Butcher, Dochterman, 2008)
Ways to intervene:
- Patient was put over a presser, i. e Levophed to cause vasoconstriction and promote an increase in blood pressure
- A small 250ml liquid bolus was given prior to approaching to the rigorous care unit
- The patient was positioned on hemodynamic monitoring to check central venous stresses and allowed us to screen fluid status
- Medication guidelines were set up for medications that would impact HR, preload, afterload
Oxygen Therapy (3320):
Definition: "Administration of air and monitoring of its efficiency" (Bulechek, Butcher, Dochterman, 2008)
Ways to intervene:
- Oxygen provided by nasal cannula was titrated by air saturation, patient was on 3L.
- Continuous oxygen saturation monitoring by way of a pulse ox on the finger.
- Respirations and patient comfort were also watched, i. e. no shortness of breath or trouble respiration.
Urinary Catheterization (0580):
Definition: "Insertion of an catheter into the bladder for non permanent or long term drainage of urine" (Bulechek, Butcher, Dochterman, 2008).
Ways to intervene:
- Foley was placed to screen urine result.
- Output was supervised to check fluid balance because of patient's history of CKD, the MRSA an infection and having a low ejection portion.
- The catheter was short-term and was used for strict input and outcome.
Family Presence Facilitation (7170):
Definition: "Facilitation of the family's existence to get an individual undergoing resuscitation and or intrusive types of procedures" (Bulechek, Butcher, Dochterman, 2008).
Ways to intervene:
- Family approached because patient was moved to intensive good care and needed a emergent central range placement.
- Patient was extremely stressed and requested that people contact her family to come set for needed support.
- Family came in and informed on what occurred and any information that was needed at that time.
Nursing Effects Classification Outcomes
Now that we have described a nursing analysis and provided some interventions that patient needed, it is time to discuss the individual results. These interventions help the individual achieve multiple goals so that as a nurse, our interventions help us improve patient final results. This patient has multiple medical diagnoses, but because decreased cardiac result was addressed, the outcome will be as follows:
Cardiac Pump Performance (0400)
Definition: "Adequacy of blood level ejected from the still left ventricle to support systemic perfusion pressure" (Moorhead, Johnson, Maas, Swanson, 2008).
- The patient will be able to maintain blood pressure without pressers.
- Patient will have a follow up echo that exhibited her ejection small fraction was 45%.
- Patient will have sufficient urine end result.
- CVP measurements will be within normal restrictions.
- Patient will have activity tolerance when getting out of bed and ambulating around room.
- Patient will continue outpatient treatment to rebuild durability as time passes.
Advantages and Disadvantages
The nursing process allows for a standard of good care to be provided everywhere that a nurse cares for a patient. With being able to identify what the patients problems are through the nursing diagnosis, we are able to next concentrate on the interventions that best fit and will provide the best patient results. When looking at a patient, most of us have our very own outcomes that we want to achiever to better the individual. In the individual above, there a wide range of problems that could ends in a long set of nursing diagnoses. With being able to focus on one at a time, a nurse can think about the needed steps to achieve the positive outcome that people all check out. With using the NIC, NOC and NANDA-I, nurses everywhere are able to identify an issue, the steps to increase the problems and the ideally outcome because of this concern. While these tools help standardize care that nurses provide and give attention to and to ensure that the needed interventions to enhance the end result are being performed and are being noted. It's important that the nurse can give attention to the needs of the patient and also to take credit for all the considerations we do during our time with an individual. I also think the medical process is great for other disciplines to watch out what nursing is concentrating on and also can help guide all of those other attention that is provided. With this documenting process and simply using in the clinical setting, newer medical can put it to use to help concentrate the caution their patients may need. These tools are a great source of information for nurses nevertheless they do have some disadvantages.
In day to day health care in the medical world, these tools are a great learning resource, but in actuality are hard to find time to gain access to and continually record on them. I've seen these kind of programs being found in the clinical setting up and because nurses are occupied, some just duplicate and paste a similar thing again and again daily. This does not show how exactly we are intervening to meet the results. If used right, it is a great tool, but there are a great number of nurses that consider it as just another ridiculous hoop to hop through during patient care and just another thing to document. Some nurses do not take the time to think about what interventions would help our patients. Also, I feel that the various lists are good; however, sometimes it is difficult to find the exact name of the involvement that people want to make use of. It takes time and energy to look through the list to find the exact treatment or outcome that best fits out patient needs. Also, it might be hard to get all nurses on board to file with this kind of system because some are resilient to change and others just are already overwhelmed with the amount of documentation that's needed is throughout the day.
Conclusion
The NIC, NOC and NANDA-I Taxonomy of Medical Diagnoses are a great guide for standard nursing care. Anyone can use these documents to help focus the care and attention their patients need. I really believe documenting to nursing process throughout this system will allow for better patient outcomes to constantly reevaluate the actual patients' needs are and the proceedings with a patient. Other disciplinary team members would be able to check out what the issues nursing are concentrating on to see where they can help support that patients worry. Overall, the standardized health care would support patient results and invite for nurses to focus on what they can do, increasing the patients service by discovering problems, inventions and effects.
References
Bulechek, G. M. , Butcher, H. K. , & Dochterman, J. C. (Eds. ). (2008). Nursing Interventions
Classification (NIC) (5th ed. ). St. Louis, MO: Mosby Elsevier.
Moorhead, S. , Johnson, M. , Maas, M. , & Swanson, E. (Eds. ) (2008). Nursing Outcomes
Classification (NOC) (4th ed. ). St. Louis: Mosby/Elsevier.
NANDA International. (2012). NANDA international nursing diagnoses: Definitions &
classification 2012-2014. T. H. Herdman, (ED. ). Kaukauna, WI: Writer.
