Question:

Personal Practice Improvement Episode

This assessment task asks you to prepare an episode that includes evidence and accountability for practice and capability, as well as critical reflection.

Your episode must include all elements of clinical reasoning.

For best practice discussions to be supported, the paper should be well-integrated with relevant scholarly literature.

Answer to Question: CNA408 Advancing Transitions To Nursing Practice

Mrs. Brown was injured in a fall at her house while she was absent from her carer and was admitted to the emergency department.

After Mrs. Brown had been served lunch by her carer, she heard a commotion and went back to her room to find her on the floor.

Her son and the caregiver immediately admitted her to the orthopedic unit.

She is 67 years of age and has osteoarthritis, hypertension and extreme obesity.

She lost mobility and is now restricted to a bed.

She also had pressure ulcers and was suffering from severe pain.

Her ADLs are taken by the caregiver and medications are given on time.

Because he isn’t able to take the fact that she has become dependent, he often encourages her to walk and perform tasks independently.

She is unable to complete her tasks independently, and she often falls.

Both her father and mother revealed to each other that she has become more anxious and aggressive, and cannot properly communicate with them. This makes the situation worse.

She had her hip replaced and is currently in observation.

She is currently anxious and very stressed.

Collect Cues

This step is primarily about reviewing the most current information such patients’ history, investigations results, and others.

This step also involves gathering new data and recalling information to form an association of the physiology of the patient with the pathophysiology. (Alfaro LeFevre 2015.

The patient was discovered to be obese. This is a serious condition for someone so old.

Her BMI was high and she is more likely to develop the diseases mentioned.

She also suffered several episodes from falls that did not seem to have been fatal.

In the episode’s last episode, she fell on her buttocks. She was carrying a lot of weight which had caused her to put pressure on her parts and resulted in the breaking of her bones.

In addition, she suffered bruises to her knees and arms.

An analysis revealed that her pain quotient was as high at 8/10.

Also, her blood pressure is high (145/95mmHg), which has made it a major concern in her treatment. High pressure often threatens lives.

Furthermore, her mental state is unresolved and she may have developed anxiety and stress because she isn’t in a safe place with her son and carer.

Process Information

The steps include analyzing the data in order to get a better understanding of the data.

These steps also require discrimination, where the nurse must distinguish between relevant and insignificant formations. Finally, she will relate the information with the present situation, inferring logicly and making suggestions about possible situations (Victor Chmil 2013.

This step is used to determine the root causes of different symptoms.

The prediction step follows.

The patient’s attempts to feel independent is the main reason she falls. This is evident in the case study.

Both her son and her carer failed to make a good connection with her, so the patients had different difficulties when helping her with daily tasks.

Her anxiety and stress were the main causes of poor patient education (Shnayderman Yugrakh und Levy 2016).

Even though she had fallen several times, her fall prevention strategies were not followed and she did not do risk assessments.

The BMI rate clearly shows that her diet plan wasn’t correct and that she also didn’t do any exercise that made her more tired.

Further, her pressure sores were also a sign of her frustration. Her carer didn’t recommend proper rolling of her bodies or proper mattresses. 2014).

Her osteoarthritis pain also caused her sleepless nights.

Although she claimed to have provided regular medication, the absence of any form of exercise and lack of physiotherapy did not help in the development of the condition. Emotional health was also poor since she couldn’t connect to her son or the carer (Bliddal. 2014).

Identify Problem/Issue

This step is mainly about the correct synthesis or analysis of all the information collected and analyzed during the previous step.

These nurses are responsible for the care plan and can connect them to identify the most important issue.

The nurse is usually able to make a final diagnosis of the patient and then can create a treatment plan. 2014).

The most crucial identification the nurse would make is how to care for the patient following her hip replacement surgery.

In this stage the nurse would first need to try to heal the patient from any pain caused by the surgery.

Her aggression and anxiety are also the main reasons for her hypertension (Yates, et al. 2014).

A proper care plan for the pressure ulcers is also necessary. This makes it crucial for the nurse to have a good therapeutic relationship with the patient.

An ill patient can be more responsive to medication and other treatments if they are happy and content.Establish Goal

The first goal is to identify the best ways to support her post-op condition. As she is vulnerable to many types of infections, this phase is crucial.

The second goal is to create strategies to ease her pain from the surgery and osteoarthritis. 2015).

The third goal is to properly manage the patient’s diet, and also educate her on the various mild exercises that can be done at the moment. This will help with both weight loss and osteoarthritis management.

Fourth goal: properly manage pressure sores and educate family members and caregivers on the proper way to treat such patients.

The last goal is to provide proper counseling to the patients in order to fully understand her issues and to foster a loving relationship with her that allows her to rely on her nurse and overcome all her obstacles (Patnaik und al. 2017).

These procedures would be performed in a week in order to see positive changes in patients’ condition.

Take action

Infection: When changing dressings, the nurse should use strict antiseptic and sterilizing techniques. They should also instruct the patient to stay away from any incisions.

This will help prevent any contamination.

This would reduce the risk for wound infection.

The proper maintenance of drainage devices is essential as it reduces the risk of infection by preventing blood buildup and joint space secretions. (Burland, et al. 2013).

The nurse should know that drainage form infusions show a developing skin tract that causes infection.

The nurse should assess the skin color and temperature along with the presence of erythema, inflammation, or other conditions.

All of these signs can provide information about how the healing process is progressing.

Care for pain management: Properly reporting the pain of the incisions as well as any changing characteristics of it should be done. Pain that is depp or dull, but also aching around the operative sites, is something to be aware of.

These signs indicate joint infection.

To understand the effectiveness and efficiency of interventions, the nurse will need to report pain intensity (scale 0-10), duration, and place.

To reduce muscle spasm, tensions on prosthesis, and in other tissues around the operation site (Weiss und Tapen 2014), it is necessary to keep the extremity in a proper position.

Comfort should include back rubs and frequent repositioning.

It is important to include stress management techniques such as progressive relaxation, visualizations, meditation, and also guided imagery.

This will reduce muscle tension as well as reduce attention.

This will improve your sense of control and your ability to cope.

The use of exercises, therapy, ambulation and exercise can also reduce stiffness in joints and ease muscle spasm.

Her diet and exercise management would be integrated. A qualified dietician will evaluate her BMI and then create a diet guide that will encourage her to reduce food calories while not affecting her hypertension.

Air filled mattresses will help relieve pressure sores.

You can also reduce the chances of pressure sores by [roper rolling her position every four hour].

Counseling is vital as the patient must openly talk about her self insecurity and ego with professionals (Depuree, et al. 2014).

This would allow the professional to determine the reason for aggression and to counsel the patient to overcome her anxiety.

Family members should also be educated. They must understand the patient and adjust their behavior accordingly.

Analyze the Results

The whole planning process would be reviewed after the introduction of each strategy. It would then take one week for the nurses to review and record the responses of each patient to each of these goals.

Nurses should adjust their care plans according to the patient’s results.

Reflect on practice:

While creating the care plans, I discovered that using the clinical reasoning process has allowed me to correctly note the symptoms of each patient and helped me to identify the main reasons for their occurrence.

This allowed me to link the emotional and the physical state of the patient and helped me understand her better.

I only recommended the intervention after establishing a network that connected the various diseases of the patient. This allowed me to develop a care plan that was patient-centered.

I was able to prevent myself from becoming confused or disillusioned with the patient’s co morbidity. This allowed me the opportunity to plan the care and solve any problems or flaws.References:Alfaro-LeFevre, R., 2015.

Critical Thinking and Clinical Reasoning: A Practical Approach. Elsevier Health Sciences.Bliddal, H., Leeds, A.R. and Christensen, R., 2014.

Osteoarthritis. Obesity and weight loss: Evidence, hypotheses & Horizons-a scoping overview.

The 15th edition of the obesity review, pp.578-586.

Brand, C.A. Harrison C. Tropea J. Tropea J. Hinman R.S. Britt H. Bennell K.

The management of osteoarthritis in general practitioner in Australia.

Arthritis care and research, 66(4).

Burland E. Martens P. Brownell M. Doupe M. & Fuchs D.

The evaluation of a fall prevention program in a nursing-home population.

The Gerontologist. 53(5). pp.828-838.

DuPree. Erin, Amy Fritz Campiz, Donise Musheno.

“A new way to prevent falls with injuries.”

Journal of nursing services quality 29.2 2014: 99–102.Losina, E., Paltiel, A.D., Weinstein, A.M., Yelin, E., Hunter, D.J., Chen, S.P., Klara, K., Suter, L.G., Solomon, D.H., Burbine, S.A. and Walensky, R.P., 2015.

Lifetime medical costs associated with knee osteoarthritis management. The United States. Impact of expanding indications for total-knee arthroplasty.

Arthritis care and research, 67(2). pp.203-215.Nelson, A.E., Allen, K.D., Golightly, Y.M., Goode, A.P.

Jordan, J.M. (June 2014).

A systematic review and evaluation of guidelines and recommendations regarding the management of osteoarthritis.

Seminars in arthritis (Vol. 43, No. 6, pp. 701-712).

WB Saunders.Patnaik, S., Swain, N., Behera, C.K., Jain, M.K.

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Assessment of knowledge, perceptions, attitudes and practices regarding pain management in children among pediatric nurses working in a tertiary healthcare hospital.

Indian Journal of Child Health. 4(1). pp.75-78.Shnayderman, M., Yugrakh, M.D.

Levy O.A. (2016)

Clinical Reasoning. Middle-aged man with gait irregularities and a newly discovered gene mutation.

Clinical Reasoning In Neurology: A Case Based Method, p.142.Victor-Chmil, J., 2013.

Critical thinking versus medical reasoning versus judgment: Differential diagnosis. Nurse Educator, 38(1), pp.34-36.

Tappen R.M. and Weiss S.A.

Essentials for nursing leadership and managing.

FA Davis.

Yates Jr. A.J. (McGrory B.J.), Starz T.W. Vincent K.R., McCardel B., and Golightly Y.M.

AAOS suitable use criteria: optimizing non-arthroplasty management osteoarthritis of knee.

Journal of the American Academy of Orthopaedic Surgeons. 22(4). pp.261-267.