Assignment: NSGCB 416 Competency 1

Assignment: NSGCB 416 Competency 1

Assignment: NSGCB 416 Competency 1

NSGCB 416 competency 1 instructions

Assessment Details

Read the following case study:

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old American Indian man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered several setbacks. Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.

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In 1 or 2 sentences, describe the measurable nursing outcome desired related to the improvement of the patient’s condition. Example: Patient will have a respiratory rate of less than 30 breaths per minute….

Identify a nursing theory to align with a plan of care to improve this patient’s outcome.

Define the nursing theory concepts and align to nursing practice, critical thinking, and clinical decision-making processes and how this can improve the nursing care plan.

Write a 700-word nursing plan of care. Integrate the nursing theory in the plan of care as a concept map using visual presentation software from the Technology Resources Library.

Submit your assignment.

Assignment: NSGCB 416 Competency 1 Sample

Patients with different conditions need appropriate care and treatment approaches to help lower the illness impact and do away with the symptoms. Therefore, healthcare professionals such as nurses need to use effective strategies that can be used to enhance the treatment, management, and healing process. One of the most important aspects is formulating a care plan. A care plan plays a major role in acting like a guide or a map of what will be done or accomplished to help the patient recover as appropriate (Doenges et al., 2019). A care plan also contains various aspects, such as the goals to be achieved and proposed activities to achieve such aims. The patient in the case study is a seventy-five-year-old patient who recently underwent coronary artery bypass graft surgery and also has a history of chronic obstructive pulmonary disease. The patient has suffered numerous setbacks, and the staff members have so far been unable to wean him off the ventilator since surgery. Therefore, the purpose of this assignment is to formulate a care plan for the patient and discuss a nursing theory that aligns with the care plan.

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The Patient Care Plan

The Measurable Outcome   

            It is important to note that the patient turned red and began coughing when the nurse started the process of suctioning the patient, which is an indication that the patient was in distress. Therefore, as part of the targeted outcomes, the patient should show reduced amounts of secretions, a respiratory rate below 25, no coughing, and no signs of respiratory distress such as a red face.

The Proposed Nursing Theory

            The proposed nursing theory is Orlando’s theory of deliberative nursing which asserts that “patients have their own meanings and interpretations of the situation and therefore, nurses must validate their inferences and analysis with patients before concluding (Fahmi et al., 2022). Every patient’s behavior can be an indication of an individual in need of health. The behavior can be non-verbal or verbal, so it is the responsibility of the nurse to correctly interpret the behavior and determine the patient’s need. As such, the nurses use their feelings and perceptions from their thoughts to make meaning of the patient’s distress.

            The theory’s concepts align with the care plan and the targeted outcomes since the nurse finds out and meets the patient’s immediate need, which in this case is the need to do away with distress. In addition, nurses have to respond to individuals who face suffering and anticipate a sense of helplessness and cure, diminish, relive, and avoid a patient’s sense of helplessness.

Integration of the Nursing Theory as a Concept Map in the Plan of Care

            The patient’s care plan will be based on five phases, as shown in the concept map. As part of the care plan, there is a need to complete the general assessment of the patient’s needs, which is best achieved by not considering the reason for the encounter. Both the object and subjective data should be collected in this phase (Montief et al., 2018). These steps help in finding the patient’s immediate need for help to cause an automatic response to help the patient. The patient was seen to be distressed, a situation which the patient could not resolve hence a sense of helplessness.

The assessment makes the nurse to clinical judgment and arrives at a diagnosis and specific risk factors in the patient’s assessment. The patient is expected to have an internal response to create a nurse-patient relationship which then triggers the nursing process. The nurse is able at this stage to recognize other needs apart from the immediate needs. As part of the plan, it is important to address every problem identified at diagnosis as part of the implementation. As earlier indicated, the patient had thick secretions, coughing, a red face, and signs of distress; hence a goal was formulated to address all the problems.

The concept map

It is important to use nursing interventions for every problem. The patient looked to be in distress; as such, the possible nursing interventions include giving accurate information about the current status and what is expected, encouraging coping methods for relaxation, and providing reassurance to the patient. Other nursing interventions to be used include monitoring pulse oximetry, monitoring ABGs, keeping the patient comfortable by elevating the head of the bed, monitoring secretions, and observing symptoms and signs of infection (He et al., 2018). The other interventions include assessment and monitoring of breath sounds and respiration rates, performing chest physiotherapy, and administering bronchodilators and suction secretions as needed. Following these, nursing interventions are likely to improve the care plan and patient outcomes.

            As part of the care plan, the nursing process should be used as appropriate, and any observation of the patient should promptly be used to determine the resulting needs and meet them. It is also important to explore how the patient is impacted by the nursing actions or process and make decisions in collaboration with the patient for further actions. Such actions should also be evaluated after performing them as part of the plan. At this stage, if there is a change in the behavior of the patient regarding the identified problems, such as an improvement, then it can be concluded that the nursing process is complete and successful (Gosling et al.,2019). On the other hand, if there is no change or the problems become worse, then there could be a need to restart the process while integrating new efforts into the plan using appropriate nursing actions.

            The nurse actions will not be evaluated; however, the nurse action results will be evaluated with the focus of determining if the actions were key in helping the patient communicate their needs and if the needs were resolved. As part of the evaluation stage, the nurse examines the patient’s progress against the goals set, and necessary adjustments are made in the plan depending on the outcomes.

Conclusion

            The patient requires immediate nursing interventions as outlined in the plan of care. The patient is likely to have better outcomes if the care plan is followed. As such, the patient will have reduced distress, reduced or no coughing, and a respiratory rate of less than 25.

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span. FA Davis.

Fahmi, I., Nurachmah, E., Dyaningtyas, H. E., Kamal, M., & Ganefianty, A. (2022). Application of Breathing Exercises Using Ida Jean Orlando’s Dynamic Nurse-Patient Relationship Model in Overcoming Postoperative Hypoxia (POH) after Coronary Artery Bypass Grafting: A Case-Series. Nurse Media Journal of Nursing, 12(2), 249-257. https://doi.org/10.14710/nmjn.v12i2.45394

Gosling, R. C., Morris, P. D., Silva Soto, D. A., Lawford, P. V., Hose, D. R., & Gunn, J. P. (2019). Virtual coronary intervention: a treatment planning tool based upon the angiogram. JACC: Cardiovascular Imaging, 12(5), 865-872. Doi: 10.1016/j.jcmg.2018.01.019

He, S., Wu, F., Wu, X., Xin, M., Ding, S., Wang, J., … & Zhang, J. (2018). Ventilator-associated events after cardiac surgery: evidence from 1,709 patients. Journal of Thoracic Disease, 10(2), 776. https://doi.org/10.21037%2Fjtd.2018.01.49

Montrief, T., Koyfman, A., & Long, B. (2018). Coronary artery bypass graft surgery complications: A review for emergency clinicians. The American Journal of Emergency Medicine, 36(12), 2289-2297. https://doi.org/10.1016/j.ajem.2018.09.014