ross_453case_study-2.pdf
Adult Health Case Study
NURS 453- Adult Health II
NURS 453- Adult Health II
- Purpose of the Assignment
- The purpose of this case study it to integrate knowledge from the humanities and sciences, including nursing research and theory, to plan, provide, and evaluate holistic care provided to a client selected during this clinical rotation.
- Student Approach to Assignment
- This patient was chosen for the case study due to the multiple reasons he was in the state he was currently in. It was interesting to understand the impact nonadherence can have on a person’s state of health.
- Reason for Inclusion of this Assignment in the Portfolio
- This case study exemplifies the my nursing practice, and as a senior in the nursing program I am more comfortable in my practice and professionalism.
- Critical Thinking
- Uses decision-making skills in making clinical or professional judgements
- Example: The prioritization of nursing diagnoses in R. J.’s care exemplifies decision making in clinical judgements. Impaired tissue perfusion to his foot was the first priority, and the second was nonadherence to diabetic lifestyle, which led to the development of the foot ulcer. The impaired tissue perfusion was considered the top priority because it caused the impaired skin integrity. The impaired skin integrity combined with the decre473ased tissue perfusion led him to an increased risk for infection. Due to this, the root causes, nonadherence and impaired tissue perfusion were the primary nursing diagnoses.
- Revises actions and goals based on evidence rather than conjecture
- The initial goal when the patient was admitted was to stabilize his blood sugar, then have him go to the operating room to have a toe amputation, which is typically how a diabetic foot ulcer is treated, but after he underwent a scan, they realized he still had a pulse, although weak, and his bone structure seemed to be intact, with no sign of infection. From this knowledge, the surgery changed from amputation to an incision and drainage operation. This also changed his nursing care plan, and likely shortened his hospitalization. We continued to lower his blood glucose level to within an acceptable range, but there was not as much coping necessary since he would still have his toe. He did not have to undergo grief of a body part, so his education could begin sooner.
- Uses decision-making skills in making clinical or professional judgements
- Nursing Practice
- Demonstrates an awareness of complementary modalities and their usefulness in promoting health
- Example: Mobility and exercise in the control of diabetes and promoting tissue perfusion is an idea often used in health care. Although it is not something always promoted in the hospital, we discussed with him the importance of going on walks, which he understood and agreed he should go on more walks regularly. Mobility helps with venous return when muscles contract, and regular exercise can lead to weight loss, which can help to manage diabetes a bit easier.
- Establishes and/or utilizes outcome measures to evaluate the effectiveness of care
- Example: I evaluated his readiness to learn, which was low toward the end of shift, since he had not been able to eat for over 24 hours, and his family was not with him yet. Once he was out of surgery, able to eat, and had family with him, he would be more receptive to a more formal education. However, during the shift we had an informal teaching with him about his diet and the changes possible to be made to decrease the sugar intake. He seemed to listen and understand, but when he called to order a meal, his choices were still high in sugar content. On the other hand, we mentioned a need for increased physical activity, and he stated he plans to take his dogs on walks more regularly, or accompany his family members when they take the dogs on walks. This statement led us to believe he understood the education, but further instruction is needed in regards to his diet.
- Demonstrates an awareness of complementary modalities and their usefulness in promoting health
- Communication
- Accesses and utilizes data and information from a wide range of sources to enhance patient and professional communication
- Example: I researched different ways to teach patients, and the best recepted mode of education. Educating a patient multiple times and having them teach back appeared to be the best way for a person to remember, so that is the type of education we tried. The information was from various journals, and helped to provide insight into education.
- Accesses and utilizes data and information from a wide range of sources to enhance patient and professional communication
- Teaching
- Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions
- Example: The patient was originally going to have a toe amputation, but after a scan, the bone structure was seen to still be intact, so the plan shifted to an incision and drainage procedure. Due to this change, we needed to get a new consent form. The physician explained the procedure to the patient, but once he left we went in to confirm he understood the procedure and get a signature for informed consent. We helped to answer his questions, including the need for him to be NPO before the procedure.
- Provides relevant and sensitive health education information and counseling to patients, and families, in a variety of situations and settings
- Example: In the hospital in-patient setting, we began an informal teaching of diabetic diet changes. The nurse and I were talking with the patient when he mentioned his current diet, so we listened, and suggested healthier changes he could include in his diet, and possible examples of increasing his physical activity, given his current state of health. We gave him many chances to ask questions, and it was more of a conversation with the three of us, which helped ease the education and helped him understand more of it.
- Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions
- Research
- Differentiates between descriptive nursing literature and published reports of nursing research
- Example: The first article reviewed in the literature review was a descriptive nursing literature article which conducted a systematic review of literature. The other two articles were nursing research. A case-controlled study examining the importance of health literacy and the correlation between low literacy and higher rates of developing neuropathy from diabetes. The other nursing research article assessed the risk factors for non-adherence regarding diabetic medication, and for this they had quantitative aspects of if the participant was adherent or not, then qualitative aspects when they asked participants why they are not adherent.
- Evaluates research that focuses on the efficacy and effectiveness of nursing interventions
- Example: In the literature review, multiple articles were examined to see if the research was effective and credible. One of the articles pertaining to educational interventions admitted to performing a systematic review of literature, but almost all of the articles reviewed had a “moderate risk of bias”, which made the article results inconclusive. The other two articles reviewed in this paper were research studies that examined the importance of health literacy in regards to teaching, and risk factors for non adherence. Both of the studies had large numbers of participants with high confidence in the research, so these articles were used more to navigate nursing practice than the first article.
- Differentiates between descriptive nursing literature and published reports of nursing research
- Professionalism
- Understands the effect of legal and regulatory processes on nursing practice and health care delivery, as well as limits to one’s own scope of practice.
- Example: The lack of health insurance led to the nonadherence to the diabetic regime. Due to this, he was unable to manage his diabetes and glycemic control, so his condition worsened until he was admitted for a diabetic foot ulcer. The scope of practice of the nurse is to provide care, but at the hospital, the management of insurance is to be done by case management, so we discussed with them to try to find a better insurance plan for the patient.
- Understands the effect of legal and regulatory processes on nursing practice and health care delivery, as well as limits to one’s own scope of practice.
- Culture
- Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age
- Example: The patient was a middle class man who is a delivery driver. Due to the lifestyle of his career, he tried to avoid going to the doctor because it would have meant he needed to take time off. During his time in the room, he continued to ask when he would be discharged so he could return to work. His job also demands long hours, so his lifestyle makes it difficult for him to maintain an active lifestyle and prepare a healthy diet.
- Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age