Clinical Reasoning

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

This review is to discuss an overview of this case study with a clinical reasoning model and all contributing factors of this event. Then, the critical analysis of three articles relating to the factors with the reasons for the selection and their evaluation will be presented.

According to the Wound, Ostomy, and Continence Nurses Society, (WOCN), before focusing on the ostomy care, the nurse should establish a relationship with the patient and their family. A comprehensive assessment should be performed that focuses on all aspects of the patient’s wellness; physical, psychosocial, cultural and spiritual. The nurse informs the patient about dietary needs, bathing/showering, and returning to work (Cronin, 2005). In doing so, the nurse gains the patient’s trust and confidence helping ease them throughout the intervention process. The assessment allows the nurse to fully recognize the patient not as another client needing a procedure but as a person who is going to have questions, concerns, and needs (WOCN, 2010).

Mrs. Pink, aged 75 was admitted to the orthopaedic ward after suffering a fall at home, resulting in an intracapsular fracture of the hip at the femoral neck. Mrs. Pink has a history of cancer and cardiac diseases and has severe rheumatoid arthritis. Due to ageing patients putting a great deal of strain on the health care system, the incidences of hip fractures in the elderly are a major concern and requires careful consideration regarding treatment. Known as a major cause of disability in the elderly, hip fractures and their subsequent need for surgery result in chronic pain and an altered quality of life (Strike, Sieber, Gottschalk & Mears, 2013). Although important to improve a patient’s quality of life and physical independence, pain related to a total hip replacement (THR), also known as hip arthroplasty (HA) can lead to delays in ambulation, longer hospital stays, poor functional outcomes and quality of life. The purpose of this essay is to identify the rationale behind nursing interventions provided to post-operative THR patients as well as the pathology of a femoral neck hip fracture and their procedure for assessment and diagnosis.

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

Immediately following the procedure, what will the nurse’s responsibility be to minimize bleeding at the femoral puncture site, and what will be Robert Wilson’s prescribed activity level? How will

Many patients admitted to the stroke and orthopedic rehabilitation unit have impaired physical mobility. The length of time in rehabilitation is ten to fourteen days. Many times nurses, patients and family members form bonds that last long after the discharge. I recently had the opportunity to take care of a patient I will never forget. Mrs. C was admitted to the rehabilitation unit following recent hip surgery. She is eighty years old and had fallen raking leaves in her front yard. Mrs. C has a history of hypertension, arthritis and gout. Medications include aspirin, metoprolol and allopurinol as needed. Prior to admission Mrs. C lived independently and has two children who checked on her routinely. No cognitive or mental deficits are noted. Key parts of this paper include the introduction, NANDA, NIC and NOC elements, data, information, knowledge and wisdom and the conclusion.

elderly, and approximately one third of patients undergoing hip arthroplasty surgery will die within the first year (Gregersen et al., 2012). The specialised nature of the orthopaedic ward is a complex environment for not only nurses, but for all health care professionals. It is the role of the registered nurse within the orthopaedic ward to provide holistic assessment and comprehensive post-operative planning to facilitate client centred care for an elderly patient undergoing a total hip arthroplasty (Walker, 2012). The purpose of this essay is to identify and prioritise appropriate nursing assessments and care provided for an elderly man (Mr. Simons) transferred to the Orthopaedic ward from the Emergency Department via operating theatres. The discussion will initially consider the environment of the orthopaedic ward and the role that the nurse must assume to provide high quality care. Focusing briefly on the ageing population and the impact that hospitalisation has on the elderly, the essay will then rationalise and prioritise current nursing assessments considering the primary and secondary assessment strategy and consideration of major body systems. Moreover, the discussion will detail and rationalise the appropriate management of patient safety, comfort and communication with substantiated planning of care by the registered nurse in the first eight hours of stay.

On April 11, 2014, I had the privilege of direct observation of a patient’s orthopedic surgery, from the pre-operative to post-operative setting. The patient with the initials N.R, which we will call Mrs. R, arrived to the hospital just prior to 6:30a.m. As the name implies, Mrs. R was a female patient, 76 years old with an admitting diagnosis of right hip osteoarthritis. Due to arthritis in her hip, Mrs. R’s ability to perform daily activities and participate in hobbies such as dancing has been extremely compromised over the last 2 years. The overall goal of Mrs. R’s surgery

The objective of this reflection is to explore and reflect upon a situation from a clinical placement on an orthopedic unit. The incident showed that I did not provide safe, timely and competent care for my patient when the oxygen saturation was low. Furthermore, this reflection will include a description of the incident, and I will conclude with explaining what I have learned from the experience and how it will change my future actions.

In my area of work, which is nursing it is important to draw clinical inferences. A clinical inference is part of the clinical decision-making process and precedes a conclusion or judgment and action. Correct clinical inferencing is an integrated response to patient cues and other evidence and a necessary skill for nurses to posses. During the assessment process nurses gather objective and subjective data. This data of patterns of health and illness and serve as inferences and is used to make a care plan for the patient. Such as if, a client has a urine output 20 ml/hour, and a blood pressure of 80/52 it is probable that they might be in shock. Nurses are expected to make these types of inferences every day and are part of the vital ability

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

Mrs Smith, 5 days prior to visiting hospital tripped and fell, her injury’s prevented her from standing up. At hospital she was diagnosed with a left fractured neck of the femur (L NOF) and required an immediate left total hip replacement surgery. Mrs Smith is 85 years old, lives with her husband at home, has no children however has a strong social support network through her church. She is involved in her community and continues to teach piano. Mrs Smith only known medicine issue is urinary incontinence. 10 days’ post-surgery Mrs Smith developed a urinary tract infection increasing her length of stay in the hospital. This led to the diagnosis of delirium, worsening of her continence issues impacting negatively on her mental health. This has resulted in slow progress in mobility and delay of her rehabilitation plan. Mrs Smith’s anxiety levels are heightened as she is fearful of falling again and is concerned whether she will be able to return home as her mother passed away shortly after she broke her hip. This case study will examine if Mrs Smith will be able to return home with an effective management & discharge plan based on a multidisciplinary team using a person centred approach. The treatment plan will endeavour to assist Mrs Smith to return home. A full health, coordination and function analysis is scheduled to assess to identify any underlying medical condition and possible risk factors for further falls.