Application of the Nursing Process

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linked item M6A3: Application of the Nursing Process Paper
Using APA format, the information from this course, and your assigned readings write a six (6) to ten (10) page paper (excludes cover and reference page) addressing the application of the nursing process to a patient care scenario. Use these directions and the scoring rubric as you develop the paper. Outlines and abstracts are NOT required with this paper. Do not include the scenario in the paper
A minimum of three (3) current professional references must be provided excluding a nursing diagnosis book. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used. Do not use abbreviations…write out everything.
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Running Head: APPLICATION OF THE NURSING PROCESS Application of The Nursing Process Irini Sheffler NUR 104 Professor Part 1 The nursing process
is a modified scientific framework used to guide nursing practice and at the same time providing a holistic patient care. There are 5 steps constituted in the nursing process namely assessment, nursing diagnosis, planning, implementation, and evaluation.
12Nursing Process is defined as a five-part systematic decision-making method that focuses on identification and treatment responses of individuals or groups to actual or possible alterations
to well-being or health (Comer & Jaffe, 2005).
10The nursing process is an organized, cogent, method of providing nursing care so that the needs of the patient are effectively and comprehensively met. The
first step is assessment. Assessment takes into account gathering of data and its analysis when providing nursing care. Although the main focus of this stage is physiological assessment, other elements involved in this stage include socio-economic, spiritual and other lifestyle factors. After assessment the next step is diagnosis. This is the where clinicians make sound judgment based on
3client's response to potential health conditions and needs (Leahy & Kizilay, 2005). The
starting point in the nursing care plan is diagnosis after which is followed by planning. Planning is based on outcomes. Planning is involves setting goals relating towards what should be accomplished after the diagnosis has been established. The nurse then makes use of the first three phases mentioned in this paper to help them in the implementation of nursing care. Implementation results in nursing interventions which is followed by the last step of nursing process namely evaluation. During evaluation, the nurse is able to establish whether the goals set have been met or whether the process need to return to the planning stage to devise a different pathway that would ensure a more appropriate outcome has been achieved (Leahy & Kizilay, 2005). The interventions undertaken by nurses have been categorized into direct and indirect care by the Nursing Interventions Classification (NIC). Direct care involves those treatments undertaken having interactions with a patient. Indirect interventions is involving the family to encourage them to help the patient in the most effective way (Comer & Jaffe, 2005). Independent nursing interventions (nurse-initiated) are autonomous actions carried out by the nurse and are based on the diagnosis carried out by the nurse as well as the patient-centered goals. Dependent interventions which may also be referred as physician-initiated require the order of a physician. Interdependent interventions also termed as collaborative are as a result of a multi-disciplinary collaboration and consultation (Chiffi & Zanotti, 2015). The nursing process allows the nurse to individualize care to a particular patient or community. Knowing the steps of the nursing process helps a nurse to better understand and incorporate care provision thereby determining the priority of care. Nurses can become then plan that can best help facilitate their needs in providing patient care within the nursing process (Bulson & Bulson, 2010).
21Three variables that may influence the ability to achieve the desired outcomes for the patient can be
categorized as; 1. Patient Variables: The patient is key in determining how the nursing interventions will be applied. Successful nurses adjust their practice according to patient's elements such as developmental stage and psychosocial history. 2. Nurse Variables: Nurse Variables include levels of expertise, ability to apply critical thinking, creativity, willingness
23to provide nursing care, and the available time. 3. Resources: A designed plan of care cannot be successfully implemented without
resources such as medical facilities and adequate staff. Part 2 Patient scenario An old man aged 78 years is living in a helped living place. He finds himself unable
15to walk long distances and uses a wheelchair when going to the dining room area. He is able to administer his medication unassisted and
is also able to bathe himself. In the course of the most recent
1year he wants to stay in the wheelchair even when in his room. He has a medical history marked by hypertension, CHF, hyperlipidemia and lower extremist shortcoming. He finds himself able to express his present prescriptions that include incorporate metoprolol (Lopressor) 50 mg once every day by mouth, furosemide (Lasix) 20 mg by mouth once
22a day, atorvastatin (Lipitor) 20 mg by mouth once a day, Quinapril (Accupril) 20 mg by mouth once a day.
Amid a standard examination, his doctor noticed a weight
1ulcer over the ischium on the right backside. The injury is oval around 10mm x 8 mm, with yellow and red zones in the center and dark zones on some encompassing tissue. It has a foul scent. The patient had been cushioning the region so that it would not get his pants wet. The doctor organized for him to be admitted
so that an intravenous anti-toxin treatment would be undertaken on him. In the wake of being admitted to the healing facility the medication requirements of the patient is as follows: metoprolol (Lopressor) 50 mg administered orally at regular intervals of 12 hours, furosemide
14(Lasix) 40mg by mouth once a day, Accupril (quinapril HCl) 40 mg by mouth once daily, 1.5 Grams cefazolin (Ancef) in 50 mL 0.9
%, Normal Saline intravenously 3*1. The injury's aftereffect distinguished Methicilin-safe staphylococcus aureus. Dressing was requested day by day after a surgical debridement of the dark tissue. Assessment Using a systematic and dynamic way to collect patient's data, the physiological and psychological data for the old man aged 78 years
1living in an assisted living facility are; he is able to walk y short distances without assistance, uses a wheelchair to carry himself,
administers his own medicines independently and is able to bathe himself and ability to state his current medications as well as request for medication. Diagnosis The nursing diagnosis reflects a number of issues. First it shows that the patient has a history of hypertension, CHF, hyperlipidemia and low extremity weakness. In addition the patient developed a pressure ulcer on the right buttocks. This condition is capable of causing more severe complications such as respiratory infection. This can be a potential hazard to the patient. Planning
19Based on the assessment and diagnosis, the physician and nurses did set measurable and achievable short and long-range goals
for this patient that include arranging
1for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated.
3Assessment data, diagnosis, and goals were written in the patient's care plan so that nurses as well as other health professionals caring for the patient may have access to it. Implementation Nursing care was implemented according to the care plan to ensure continuity of care for the patient during hospitalization and
after a surgical debridement of the black tissue. This was
3in preparation for discharge needs assurance to the patient. Care was documented in the patient's medical record. Evaluation Both the patient's status and the effectiveness of the nursing care has been continuously evaluated, and no modification to the care plan
has been deemed necessary at the moment. Evaluation is
4the last phase of the nursing process. It follows implementation of the plan of care. It's the judgment of the effectiveness of nursing care to meet patient goals based on the patient's behavioral responses. Evaluating is a planned, ongoing, purposeful activity in which patients and health care professionals determine the patient's progress toward achievement of goals/outcomes and the effectiveness of the nursing care plan
(Bulson & Bulson, 2010). Actual NANDA-I
5nursing diagnosis statement Impaired Skin Integrity related to pressure ulcers as evidence by disruption of epidermal and dermal tissues. Assessment Data
13Subjective Data: Able to walk very short distances unassisted, uses a wheelchair to transport himself, administers his own medications independently and bathes himself,
able to state his current medications and request for medication. Objective Data: Metoprolol 50 mg orally after
11every 12 hours, furosemide 40mg by mouth once a day, Accupril (quinapril HCl) 40 mg by mouth once a day, cefazolin 1.5 Grams in 50 mL 0.9 % administered intravenously three times (3*1) a day.
Methicilin-resistant (staphylococcus aureus) identified. Expected Outcome Patient may start to verbalize and use energy-conservation techniques.
7No limitations on physical activity: ordinary physical activity does not cause undue fatigue, dyspnea or palpitation. Initial revisit in 2 weeks. Follow-up at 2 months (if tests normal), then after 6 months if patient stable
(Comer & Jaffe, 2005). Ongoing Assessment - Nurse will determine the
6patient's perception on the causes of fatigue or activity intolerance. These may
guide progressive treatment of the patient. - The nurse will assess the level of mobility for the patient whether they be any improvement. This will aid in defining the patient's capabilities
6which is necessary for setting realistic goals.- The nutritional status
will be assessed by the nurse. Adequate energy reserve is
6required for body activity. - Assess potential for physical injury due to activity. Injury may be related to falls or overexertion.
Intervention Nursing interventions are the actual treatments performed to the patient with an aim of achieving the goals set for them. The nurse uses critical thinking skills as well as their own knowledge to decide the most effective interventions to be carried out to maximally help the patient. The three categories of interventions have been discussed in this paper which are Independent, Dependent and Interdependent interventions (Chiffi & Zanotti, 2015). Four (4) Nursing Interventions ? Monitor V/S especially
8respiratory status for rate, regularity, depth, ease of effort at rest or with exertion.
8Rationale: Changes in respiratory pattern or patency of airway may result in gas exchange imbalances (Comer
& Jaffe, 2005). ? Turn the patient
5every two hours as evidence by nursing documentation. The patient's wound will be changed daily as per wound care orders. Proper hand hygiene will also be performed before and after dressing changes.
Rationale: Frequent turning and positioning does not cause skin to break down (Comer & Jaffe, 2005) ? Immediate treatment would be required to terminate occurrence of stage 3 pressure ulcer Rationale: To avoid high risk for impaired skin integrity related to redness - Allow rest periods between activities. Rationale: This promotes healing pattern (Chiffi & Zanotti, 2015). ? Verbalize and demonstrate to the patient's family the four
5(4) ways on how to prevent pressure ulcers.
Rationale: Lower pressure formation and increase the peristaltic to relieve discomfort due to pressure accumulation (Bulson & Bulson, 2010). Part 3
2The Teaching Plan To help the patient in avoiding a recurrence of the incidence once he comes back to the healing facility, the RN needs to build up a teaching plan. The nursing procedure should
be utilized to consider the data the RN would require preceding improvement of the teaching process. The RN should be able to respond to the questions listed below and have the capacity to support their answers. Registered Nurses won't be building up a teaching plan but doing a demonstration using the educating learning procedure to get ready for an individualized arrangement. (Chiffi & Zanotti, 2015) How the RN decides the format to be followed for the teaching plan; either written, verbal et al.
9To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Teaching
plans are where the objectives are based on the desired outcome. In order to teach, the nurse need to have an understanding of the nursing process. From the nursing process, the nurse must be able to identify the problems and needs of the patient and his/her family. The nurse is therefore able to decide the format of the teaching plan based on the patient's knowledge needs (Rankin, 2001). Deciding what will be taught is a decision made by both the nurse and the patient together, but the format of the teaching plan is a decision made by the nurse after the contents of the teaching plan has been identified. The goal of the teaching plan
20is to make the patient as competent as possible so as to manage their own health care needs. The collected data from the
nurse's assessment about the patient's preferred learning style helps the nurse to select the method that they will use. For example a global learner may like to first to understand the big picture before working down the details later. A linear learner on the other hand may first want to know the details and expect the bigger picture to emerge from understanding the details. By examining the assessment, the nurse is able to select the teaching materials to use. For example if the patient had indicated in the assessment that they are visual learners, the nurse may want to choose
18teaching materials that encompass reading, writing, and watching visual media such as slides and videotapes. Auditory learners will need to
learn by listening to audiocassettes or by hearing the information being read out aloud. In the hospital setup, it is important for the nurses to begin patient teaching immediately after the patient has been admitted. Documentation of the teaching is equally important for the purposes of evaluation and reimbursement (Chiffi & Zanotti, 2015). - How the RN knows which information to be included in the teaching plan The RN knows which information needs to be included because they have first been able to identify their patient's learning needs. This means that they have been able to answer questions such as; what does the patient already know? From what they know, what is still unclear? What relevant information has not yet been conveyed that needs to be presented? By taking time to identify what the patient already knows, the nurse is assessing the patient's information needs that need to be included in their teaching plan. By this, the nurse is able to identify
16It is important to prioritize his needs to focus on what is most essential to improving his physical health status
(Chiffi & Zanotti, 2015). - When RN determine when and how to evaluate the teaching-learning process Evaluating teaching-learning process usually happens after assessing the learning needs of the patient, developing learning objectives and after planning & implementing the patient teaching. Like in the nursing process steps, evaluation is the last phase of the teaching process which refers to a continuous appraisal of the learning progress of the patient during and after teaching. The goal of evaluation is to determine whether the patient has learned and understood what you taught them. Evaluation should include considerations such as the timing, the teaching strategies, the environment, amount of information and whether the objectives were achieved. This information gathered from evaluation may serve as a valuable input for future nursing teaching activities (Chiffi & Zanotti, 2015). The nurse can use the feedback from the evaluation to modify the ongoing teaching activity to ensure that a more appropriate teaching outcome has been achieved. References Bulson, J., & Bulson, T. (2010). Nursing Process and Critical Thinking Linked to Disaster Preparedness. Journal of Emergency Nursing, 37(5), 477-483. Chiffi, D., & Zanotti, R. (2015). Medical and nursing diagnoses: a critical comparison. Journal of Evaluation in Clinical Practice, 21, 1, 1-6. Comer, S., & Jaffe, M. S. (2005). Delmar's geriatric nursing care plans. Australia: Delmar Learning. Leahy,J. & Kizilay, P. (2005): Foundations of Nursing Practice: Nursing Process Approach, New York, W. B. Saunders.
21 APPLICATION OF THE NURSING PROCESS 2 APPLICATION OF THE NURSING PROCESS 3 APPLICATION OF THE NURSING PROCESS 4 APPLICATION OF THE NURSING PROCESS 5 APPLICATION OF THE NURSING PROCESS 6 APPLICATION OF THE NURSING PROCESS 7 APPLICATION OF THE NURSING PROCESS 8 APPLICATION OF THE NURSING PROCESS 9 APPLICATION OF THE NURSING PROCESS 10 APPLICATION OF THE NURSING PROCESS 11 APPLICATION OF THE NURSING PROCESS 12
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The paper consists of three (3) parts:
The meaning and use of the nursing process in making good nursing judgments that effect patient care
The development of a plan of care using the nursing process for a specific patient situation
The preparation stage for a teaching plan to prevent a recurrence of a similar situation
The following sheet will assist you when composing the plan of care for the paper: Overview of the Nursing Process.
Part 1 (3-4 pages)
Review the required readings about the nursing process. In your own words, define each step of the process and provide an example for each step.
In the implementation step, what is meant by direct and indirect care as described by the Nursing Intervention Classification (NIC) project?
Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and interdependent) that applies to the patient care situation. Provide an example of each (refer to your textbook).
Explain how the nursing process provides the basis for the registered nurse to make a nursing judgment that results in safe patient care with good outcomes.
Discuss how the registered nurse evaluates the overall use of the nursing process. Identify three (3) variables that may influence the ability to achieve the desired outcomes for the patient.
How is the plan of care modified when the outcomes are not met?
How does the RN use the nursing process to make decisions about the priority of care?
Part 2 (3 pages)
Patient scenario
A 78-year-old man is living in an assisted living facility. He is able to walk very short distances and uses a wheelchair to transport himself to the communal dining room. He administers his own medications independently and bathes himself. Over the last year he prefers to remain in the wheelchair even when in his room. He has a history of CHF, hypertension, hyperlipidemia and lower extremity weakness. He is able to state his current medications include metoprolol (Lopressor) 50 mg once daily by mouth, furosemide (Lasix) 20 mg once daily by mouth, Quinapril (Acupril) 20 mg once daily by mouth, atorvastatin (Lipitor) 20 mg once daily by mouth. During a routine examination, his physician noted a pressure ulcer over the ischium on the right buttocks. The wound is oval about 10mm x 8 mm, with red and yellow areas in the middle and black areas on some surrounding tissue. It has a foul odor. The patient had been padding the area so “it doesn't get my pants wet”. The physician arranged for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated. After being admitted to the hospital his medications are: metoprolol (Lopressor )50 mg orally every 12 hours, furosemide (Lasix ) 40mg once daily by mouth, quinapril HCl (Accupril) 40 mg once daily by mouth, cefazolin (Ancef)1.5 Grams in 50 mL 0.9 % Normal Saline intravenously three times a day. The result of the wound culture identified Methicilin-resistant staphylococcus aureus. After a surgical debridement of the black tissue a SilvaSorb® (antimicrobial gel) dressing was ordered daily.
Develop a Plan of Nursing Care for this patient that includes all steps of the nursing process:
One (1) actual NANDA-I nursing diagnosis statement addressing the priority problem the patient is experiencing. You need to provide the entire nursing diagnosis statement. For example: Acute pain, related to tissue trauma, as evidenced by patient rating pain at 7 on the 0-10 verbal pain scale. Provide a rationale, with evidence, why this nursing diagnosis is the priority for this patient.
What is the assessment data that supports the use of this nursing diagnosis? These are the assessments you will collect to determine if the patient has this nursing diagnosis. For example: Will assess the patient's pain using the 0-10 verbal pain scale.
One (1) expected outcome (realistic, measureable and contains a time frame). that addresses the diagnosis and meets the criteria for an expected patient outcome. Discuss whether the outcome is a cognitive, psychomotor, affective or physiologic outcome. Discuss why the time frame selected for the evaluative criteria was selected. Use evidence as the basis for the time frame and criteria. You need to be specific to this particular patient. For example: Patient will rate pain at 3 on the 0-10 verbal pain scale. Of course, you would also need to answer the rest of the items in this section.
Four (4) nursing interventions that includes at least one (1) nurse-initiated, one (1) dependent, one (1) interdependent intervention. Label your interventions as above. Provide a rationale for each intervention that is evidence-based. Lastly, your interventions must be able to move the patient toward the achievement of the outcome. Select interventions, you as the RN can perform, that could reduce the pain and provide the rationale as to why; be sure they are evidence-based. For example: Teach patient guided imagery to distract attention and reduce tension.
Part 3 (1-2 pages)
To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Use the nursing process to consider the information the RN would need prior to development of the plan. Respond to the following and be able to support your answers. You will not be developing a teaching-learning plan but demonstrating using the teaching-learning process to prepare for an individualized plan.
How does the RN decide the format of the teaching plan, i.e., written, verbal, or other?
How does the RN know which information needs to be included?
When does the RN determine how and when to evaluate the teaching-learning process?