Question:

Module 1 – Critical Thinking, Clinical decision Making

You should pay particular attention to the use of traditional vital signs in assessing critically ill patients.

Module 2 – Collaborative and Therapeutic Practice1.

What does the term tribalism mean?2.

How does power imbalance and tribalism impact information sharing3.

What are five important dimensions to a functioning health care team?

Case Study 2

Norma Ellis (76 years old) is a widow who fell in the nursing home she’s been living in for 7+ years. She fractured her hip.

After receiving a hip repair, she is now able to return to her nursing home.

Norma has a detailed medical history which includes postural hypotension as well as rheumatoid and impaired mobility.

She moved around the nursing facility using a wheelchair.

Her son demanded that her mother be kept in the ward and treated as an inpatient. He felt the nursing home staff had been negligent.

The doctor, physiotherapist (NUM of the rehabilitation unit), social worker, and NUM the Norma’s wing in the nursing home she was previously in make up the treating group.

You are the team leader.

The doctor believes that Mrs Ellis’ rehabilitation has been enhanced and there is no reason to keep her on the ward. This view is also shared by the physical therapist.

Norma feels at home in the nursing home, and she would love to go back.

Answer the following questions1.

What are the most important issues in this dilemma2.

How would Norma’s child be handled?

Do his objections justifiable

Module 3 Care Coordination and Provision

You work the morning shift at the ward, receiving a patient in the ED.

The ED nursing nurse

Below is the handover using the ISBAR Format.

You can find more information at the

The page 7 of this module contains the ISBAR format.Handover’.

Listen to the recording, then answer the following:1.

Care to ask your nurse additional questions?2.

Make a list of any additional assessments you might perform for the patient when they arrive on the ward3.

Upload the following answers to your LEO E-Portfolio.

This is part your assessment for the unit.

Module 4 – Professional Practice: Time Management. Delegation. Scope Of The Practice

The following summaries of Benner’s stages of clinical competence are available. Please take a look at these and other related information.

Take a look at the NMBA competencies as well as decision-making tools.

Next, determine your priorities for your business.

Last semester: Consider what skills are necessary to help you make the transition.

You can transition from student nurse to registered nurse.

Answer to Question: NRSG355 Clinical Integration

Module 1

The collapse of an elderly patient after facial surgery, as per the events listed, will be my top priority.

The complications of facial and skin surgery can include excessive bleeding due to abnormalities in blood-clotting.

Over bleeding can cause complications such as lightheadedness, syncope (or fainting), shortness of breath and chest discomfort.

The cause of excessive bleeding must be determined (Www.dermnetnz.org 2017.

The AIN will assist me in this task.

If you have excessive bleeding due to medications such as anticoagulants (Kahn Amara & Halperin 2016), then it is possible to apply interventions like protamine sulfate which can reverse heparin effects, and vitamin K which can reverse warfarin effects (Kahn & Halperin 2016).

Mrs. Chew will receive our attention as the next priority event.

The EN, who specializes IV cannulation is yet to be issued her certificate.

The patient will undergo an examination for signs of embolism, which is the presence of painful, swollen and redden veins with low or no IV flow.

My job will be to remove the device from the patient and administer the IV infusion. Warm soaks will also be administered (Lms.rn.com 2017).

The event that the visitor has fallen asleep is the next priority.

Low blood pressure, low blood sugar levels and cardiac problems are all possible causes of fainting.

It is important to monitor vital signs, such as blood pressure, blood glucose levels, and any medical history concerning cardiac problems (Www.ok.gov 2017, 2017).

This monitoring can be done by the AIN.

Next, Mr. Esposito’s medication will be delivered to him.

While the EN may be used, the EN will not be able to administer the medication. I will supervise her.

I will have a discussion with the VMO regarding the medication error, then delegate responsibility to the EN for providing the correct medication.

This will take place under my supervision, as it will enable me to evaluate the competency of ENs in administering medications.

The ward Clerk and the AIN will take care of managing the overflowing in the staff toilets.

Both the ward staff clerks and AIN can perform the task as it is their duty to help the nursing staff maintain a clean hospital environment (Tech.lds.org 2017.

Module 2

Motor neuron patients need the assistance of a respiratory specialist as well an occupational therapist, speech-therapist, and physiotherapist.

The palliative support team is there to provide support and the doctor or neurologist will review the symptoms.

In order to ensure that the patient receives proper nutrition, a dietitian must be employed.

This multidisciplinary approach helps patients to get overall care (Williams Philip Ephraim, Oparah, 2014).

A team coordinator typically leads multidisciplinary teams.

A member of the team that is important to the patient’s care is the doctor or neurologist.

Case Study 2

The patient is suffering from postural hypotension. They may feel dizziness, syncope, or fainting.

The patient has impaired mobility. After her hip fracture, her condition may be worsening, which could increase her chance of falling (Ambrose Paul and Hausdorff, 2013,).

Rheumatoidarthritis can cause inflammation of her eye glands and dryness that may impact her vision.

Rheumatoid arthritis can also cause inflammation of her lungs and pericardium. This results in shortness and chest pain as well as heart attack (Www.nhs.uk 2017.

Information about her medical conditions should be given to the son. The son will also be informed of the extra precautions that will be taken for his mother in case of a fall.

Yes. Patients with impaired mobility should be under the watchful eye of an AIN. The AIN has the responsibility to aid the patient in mobility activities every day (Algoso & Peters 2012.

Module 3

Activity 1

Handovers help nurses exchange information about patients.

This is crucial when a patient shifts from one hospital to the next (Johnson, Jefferies & Nicholls,2012).

During handovers the nurse may ask about the patient’s medical history.

It is necessary to find out if the patient wants to remain nilby-mouth, if they need barrier nursing, require assistance in moving, eating, and going to the toilet.

It is vital to identify the type of surgery the patient had and the treatment plan they received.

It is also necessary to determine if any treatment plans were changed after surgery or if the patient has allergies.

Rayo and colleagues (2013) recommend that you determine the patient’s culture as well as whether or not the patient can communicate verbally.

When the patient has been transferred to another ward the nurse in charge can conduct assessments of her vital signs such as blood pressure and heart rate. They also assess mobility and pain using the visual analog scale.

Activity 2

Clinical reasoning is the ability of nurses to analyze and understand patient conditions in order to make sound decisions.

A good nursing education, exceptional procedural skills and timely judgments all make up clinical reasoning skills.

One way clinical reasoning can help is for nurses to be able to use their knowledge in the behavioral and biophysical sciences to provide holistic nursing care.

The nurse should be able identify and communicate important cues with patients to avoid adverse patient outcomes. (Levett-Jones & Hoffman 2013; Victor-Chmil 2013).

Knowing vital signs can help you plan your treatment protocol and make decisions to save lives.

The early detection of a severe medical condition can be done by monitoring vital signs. This will allow for prompt action to avoid adverse situations, even death, (Felton & Coventry; Elliott & Coventry: 2012).

The patient situation is important

* What are your current details on this subject?

* What is the most recent information you have gathered?

Jack Reed is Jack Reed.

He is a man aged 76.

He suffers from anxiety and dementia.

He lives on his own.

He is an Alzheimer patient.

He is still extremely confused and disoriented.

He also has impaired mobility.

He is highly anxious and remains isolated from others.

After he had fallen in residential care and fractured his hip, he was taken by ambulance to the emergency department.

Collect Information/Cues

* What additional information and cues would you like to have? Why?

His vital signs were recorded.

His pain assessment was done.

He was unable or unwilling to speak and was confused.

He was suffering severe pain and was crying.

Process Information

* What changes are you noticing in the cues and information?

* What are the most significant changes for this patient?

* What do YOU think these changes might indicate?

* What is the potential outcome of these changes

His vital sign were not normal due to high temperatures and high respiration rates.

The hip replacement surgery was his first.

In order to prevent the development of Alzheimer’s disease, pain relieving medication should not be the only thing that the patient is given.

Galantamine and Donepezil may be administered (Bond and colleagues, 2012).

A psychopharmacologic as well as psychological intervention can be used for anxiety disorders (Lader (2015)).

Identify Problems/issues

* Take the facts and compare them with what you think the changes could indicate/identify a possible patient problem/issue.

Because he is afraid of falling again, the patient’s anxiety disorder and dementia can worsen.

He will feel isolated and unable to be active.Establish Goals

* Describe the outcome you desire.

* Who would you like to have involved? What do you want them doing?

* In what timeframe

In addition to his current condition, he should have more confidence in his abilities.

For mobility improvements, physiotherapists are an option.

He could be sent to memory clinics which offer memory counselling.

Cognitive Behavioural Therapies (Wells 2013,) are available for him.

This will not be a quick fix. It is important to continue these therapies for at most one month.

Get active

* What types of nursing actions do you plan to perform?

* What are you nursing priorities?

Assessment of cognitive function and mobility of the patient. Memory and thinking skills assessments. Maintaining an interactive environment. Keeping the environment safe. Regular exercise.

Assess Outcomes

* What can you expect to accomplish from the actions that have been taken?

It will enhance mobility of patients, increase memory and thinking, reduce the risk for falls, prevent confusion, disorientation and improve self-confidence.

Reflection on the Process and learning new things

* What have your learnings been from this exercise

It is crucial to care for patients with mental illnesses in a compassionate manner.

Module 4The responsibilities a RN has are to conduct physical exams, evaluate the medical history and administer medication.

To evaluate patient information and make timely decisions. Supervise the care provided by nurses, ENs and other healthcare professionals.

They are also involved with research to improve nursing practices and interventions. This helps improve patient outcomes.

They work under the supervision of a RN.

They are responsible for providing nursing care and education promotion.

They help plan, implement and evaluate care.

They support patients in their daily activities, such as administering medication.

They work closely with a team made up of healthcare experts.

The AIN assists the EN and registered in providing patient care.

An AIN has the following duties: monitor vital signs, feed patients properly, help them brush their teeth, dress, determine skin integrity, care for their skin, aid in mobility, transfer patients, apply anti-embolic stocksings, notify RNs of abnormalities in patients’ urine, and communicate with patients and RNs.

They are responsible for patient monitoring and ensuring a safe environment.

In this case, the shared-care model will be used. Shared care is when a group of healthcare workers participate in providing quality care for patients (Primdahl (2013)).

This is also useful for monitoring and exchanging information about patient condition.

The doctor will also have to be present during patient surgeries.

ENs can help the RNs with their surgeries by monitoring vital signs, administering the medications and providing support.

The ENs are able to prepare a care package for patients following the surgery.

The AINs may assist with the transfer of patients to the wards. The AINs can also provide intravenous access and antibiotics to the patients under the guidance of the RN.Reference:Agarwal, B., Wright, G., Gatt, A., Riddell, A., Vemala, V., Mallett, S., … & Burroughs, A. (2012).

Evaluation of coagulation abnormalities following acute liver failure.

Journal of hepatology 57(4) 780-786. Algoso M. & Peters K. (2012).

Undergraduate Assistants in Nursing (AIN): Their experiences. Nurse Education Today, 32(3), 197-202.Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013).

An analysis of the literature on risk factors for falling among older adults. Maturitas, 75(1), 51-61.Bond, M., Rogers, G., Peters, J., Anderson, R., Hoyle, M., Miners, A., … & Jeffreys, M. (2012).

The effectiveness and economic cost-effectiveness donepezil (galantamine), rivastigmine and mmantine in the treatment of Alzheimer’s Disease (review Technology Appraisal No.

111): A systematic analysis and economic model.M. Elliott & A. Coventry (2012).

Critical care: The eight vital indicators of patient monitoring. Br J Nurs, 21(10), 621-625.Felton, M. (2012).

Michelle Felton provides a case study on a patient suffering from suspected gastrointestinal bleeding. She explains how to recognize signs and symptoms that indicate patient deterioration.

Emergency Nurse, 20(8). pp. 23-27. Hunt. (2014).

Bleeding in critical care.

New England Journal of Medicine. Vol. 370 (9), 847-859.Johnson M. Jefferies D. & Nicholls D. (2012).

Exploring the structure, organization, and use of information in nursing handovers.

International journal nursing practice, 18(5) 462-470. Kahn M. R., Amara R. S., and Halperin J. L. (2016).

The cardiology perspective.

The American Journal of Gastroenterology Supplements. 3(1). pp. 22-28. Lader. M. (2015).

Generalized anxiety disorder.

In Encyclopedia of Psychopharmacology. 699-702). Springer Berlin Heidelberg.Levett-Jones, T., & Hoffman, K. (2013).

Clinical reasoning–What it’s and why it’s important.

Clinical reasoning: Learning to think like an nurse, 1st Edn Pearson Australia Frenchs Forest NSW.Lms.rn.com (2017).

Cite a Site – Cite It For Me. Lms.rn.com. Retrieved 19 December 2017, from https://lms.rn.com/getpdf.php/640.pdfPrimdahl, J., Sorensen, J., Horn, H. C., Petersen, R., & Horslev-Petersen, K. (2013).

Nursing consultations and shared care as an alternative to rheumatologist monitoring of rheumatoid activity outpatients. Results from a randomised controlled 2-year trial. Annals of the Rheumatic Diseases, annrheumdis-2012.Raj, S. R., & Coffin, S. T. (2013).

Treatment of orthostatic hypotension, vasovagal syncope, and other conditions using medical therapy.

Progress in Cardiovascular Diseases, 55(4), 425-433. Rayo (M. F.), Mount-Campbell (A. F.), O’brien (J. M.), White, S. E. White, Butz A. Evans K., & Patterson E. S. (2013).

Interactive questioning in critical-care during handovers. A transcript analysis and analysis of communication behaviours from physicians, nurses, and nurse practitioner. BMJ Qual Saf, bmjqs-2013.Tech.lds.org. (2017).

Responsibilities of Ward Clerk – LDSTech. Tech.lds.org. Retrieved 19 December 2017, from https://tech.lds.org/forum/viewtopic.php?t=19019Victor-Chmil, J. (2013).

The difference between clinical reasoning and critical thinking: A differential diagnosis. Nurse Educator, 38(1), 34-36.Wells, A. (2013).

Cognitive therapy for anxiety disorders: A conceptual guide and practice manual.

John Wiley & Sons.Williams U. E. Philip Ephraim E. E. & Oparah S. K. (2014).

Multidisciplinary Interventions In Motor Neuron Disease. Journal of neurodegenerative diseases, 2014.Www.dermnetnz.org. (2017).

DermNet New Zealand – Risks and complications in skin surgery

Cite a Site – Cite It For Me Ok.gov. Retrieved 19 December 2017, from https://www.ok.gov/health2/documents/Syncope%20(fainting%20).pdf