Effectives Of Nursing Intervention

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Effectives Of Nursing Intervention

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Question:
Evaluate the effectives of nursing intervention whether patient’s condition has improved.

Answer:

Introduction
Clinical reasoning cycle in the healthcare setting is of importance as it facilitates provision of quality and safe care. The reasoning cycle is helpful in making decisions in the clinical areas as it facilitates positive outcomes. It has eight steps, that aims at guiding and facilitating the both the student nurse and nurses in formulating the most appropriate and positive decision in the clinical area. This essay will identify the steps of CRC and the clinical decision made in regards to the patient’s/client’s hypovolemia, dehydration and hypotension condition.
Consider the Patient
The first step in the reasoning cycle, is assessing the patient holistically so as to come up with the most beneficial outcome. Mrs. X a 67 years old female client was admitted to medical-surgical ward on day one post operatively following partial colectomy. Her condition was stable during the surgery, vital signs were normal but after transfers to medical ward she experienced light headache, dry mouth and her condition deteriorated.
Collect clues/information
The second stage of CRC is collecting the most relevant information about the patient’s condition. The information that is currently available; handover report, clinical documentation, patient’s medical and social history are reviewed. The nurse then identifies the additional information through assessing the vital signs and other health assessment. Mrs. X have a history of hypertension and she is on medication, beta blocker. The handover sheets indicated that her blood pressure (BP) was 140/80mmHg an hour ago before my shift.
On assessment her temperature is 37.8c, heart rate (HR) 118, respiratory rate (RR) 20, BP 112/58mmHg and specific gravity 1.022. Currently, he is on Beta blockers and has an intravenous (IV) running at a rate of 86ml/hr. She has an indwelling catheter with a urine output rate of 20-25ml/hr. Her oxygen saturation (O2 sat) and blood sugar level (BSL) are in normal range.
During surgery she had epidural anaesthesia during surgery as she has a history of hypertension. Her recent hypotension could be related to the epidural anaesthesia as it lowers the HR which impacts on the BP. In addition to this, the hypotension can be as a result of the patient being nil per oral and also blood loss during the surgery. Despite this her oxygen saturation is normal and blood sugar level is normal.
Process data
In this stage of CRC, the nurse interprets the clues collected and identify significant aberration from normal. At this stage nurse call upon their wide repertoire of previous clinical experience matching the features of the patient’s presentation with similar situation. Firstly, as it has been mentioned previously both her oxygen saturation and the blood sugars are within normal ranges. Secondly, she is afebrile as her temperatures indicates low grade fevers. Thirdly, she has oliguria (20-25mls/hr of urine) and her oral mucosa are dry. The normal urine output is 50ml/hr to 60ml/hr (Hinkle & Cheever, 2013). Lastly, she has tachycardia (118 beats/minute) as the normal heart rate is 60-100 beats/minute. This indicates that she may be experiencing hypovolemia (fluid volume insufficiency) and the circulatory and the renal system are compensating (Guyton,2015). In addition to this, she could further develop more complications such as hypovolemic shock and acute kidney injury (McMahon 2016).
Identify problems/issues
The fourth stage of CRC is synthesizing all the important information that has been collected and processed so as to identify the most appropriate nursing diagnose. Mrs. X manifestations (tachycardia, hypotension. oliguria and dry oral mucosa) clearly indicates reduced fluid volume. The causes behind these manifestations are; limited oral intake evidenced by the dry mouth and thirst, inadequate fluid intake and surgical losses (Millers & Nicholas 2013).

Establish goal
At this stage, nurse prioritizes and clarifies the goals set based on their urgencies. These goal must be specific, measurable, achievable, realistic and timely (SMART) and designed to address the nursing diagnosis. The major nursing diagnosis for Mrs. X is fluid volume insufficiency related to blood loss and reduced intake. Therefore, the therapeutic goal aims at managing the hypovolemia (Odelle et al. 2014) to avoid her condition deteriorating to hypovolemic shock which is fatal. Is managed through infusion of volume expanders. Her condition is expected to normalize in the next four hours after starting her on fluid therapy.
Take action
This is the fifth stage in which the nurse selects the most suitable course of action so as to achieve the goals set to address the specific nursing diagnosis mentioned above. In addition to this, clinical knowledge, clinical skills, and effective communication skills are required so as to achieve positive outcomes. As stated above, the patient has hypovolemia as a result of reduced fluid intake and surgery blood loss (Vincent &Ferreira, 2016). Therefore, the treatment aims at reverting this, so as to normalize the patient by restoring the fluid volume, electrolytes balance and normalizing urine output (Kreimeier, 2016). The following are the actions I took; firstly, I informed the doctor about her condition. He prescribed intravenous fluids for her which I and my friend administered at the rate of 125ml/her after checking her IV line for blockages. I also continued to monitor her vitals.
Evaluate
At this stage, the nurse re-examines both the subjective and objective data so as to evaluate the effectives of nursing intervention. This is assessed through the patient’s condition. After monitoring her closely, we noticed that her condition had improved, her vital signs normalized and also her urine output improved as well. This shows that the nursing interventions were effective (Copstead & Banasik 2013).
Conclusion
In conclusion, it is clear that the clinical reasoning cycle is imperative in the nursing practice. It is used as a guide for the nurses in formulating clinical decision that are clear and has rationales. In the clinical scenario above it has facilitates the formulation of a clinical decision and also in the breakdown of the process which has enabled the learner in coming up with the most effective solutions. Furthermore, it is also clear that the CRC is an effective tool for the healthcare providers in providing quality and safe patient care.

References
Copstead, L. C., & Banasik, J. L (2013). Pathophysiology (5th ed.). St Louis, Missouri: Saunders Elsevier.
Guyton, A. C. (2015). Textbook of Medical Physiology. (13th ed.). Philadelphia: W. B. Saunders, 4(2), 78-90
Hinkle, J.L, Cheever, K.H. (2013). Brunner and Saddarth’s Textbook of Medical and Surgical Nursing, (13th ed) Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kreimeier, U. (2016). Pathophysiology of fluid imbalance. Critical Care, 4(2): S3–S7.
McMahon, R., (2016). ‘Therapeutic Nursing: Theory Issues and Practice’, in R. McMahon and A. Pearson (eds) Nursing as Therapy. Cheltenham: Nelson Thornes.
Millers W., Nicholas S., (2013). Linear communication models. Journal of clinical nursing. 13, 707-713.
Odelle M., et al. (2014). Nurses’ role in detecting deterioration in ward patients: a systematic literature review. Journal of advanced nursing. 65(10), 1992-2006.
Vincent, L., Ferreira, L., (2016). Evaluation of organ failure: We are making progress. Intensive Care Medicine, 26(6), 1023– 102

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