Make the Best Choice for the Right Situation
In evaluating the patient’s best action in this scenario, I used the five rights of clinical reasoning. This is a patient who was involved in an accident and, as a result, has had surgery done. The best method to evaluate the course of action would be to use an educational model that is clinically efficient for use for patients with high-risk factors (Levett-Jones et al., 2009). The model depends on a practitioner’s ability to collect the right cues and take action prioritizing the patient’s needs. Additionally, time and reason must be considered.
- What is the best action to perform first from the six actions identified as part of planned client care for this particular client?
The first action to perform would be to call the physician to get an order for Nicotine Patch and report decreased urinary output. The patient’s pain rate is at 8/10, and the goal is to get it to 5. The pain has triggered the patient to ask for a nicotine patch. Calling to report the two shows the nurse has dealt with the patient’s priority and has shown good communication by addressing the decreased urine output. The patient is on bed rest meaning he cannot smoke and thus asking for a patch indicates that the nurse is concerned with the patient’s care which is good practice. One of the factors that a good nurse should consider is patient care. Calling the physician is an act of patient care. That is, it shows that the nurse is empathetic with the patient and is ethical (McMillan-Coddington, 2013).
- What is the best action to perform second from the six actions identified as part of planned client care for this particular client?
The second-best action to take would be to administer 2mg Morphine IV now for breakthrough pain. The patient’s pain rate is 8/10, and the goal is 5. The patient is still in so much pain that he is triggered to ask for a cigarette to calm down the pain. Also, the patient has just come out of surgery so that he might need pain medication badly. When pain is dealt with, the patient might relax more. This will help the patient rest well as he is in bed rest. On the physician’s order, there is the discontinuation of PCA and consultation of pain management. Thus, dealing with pain promptly will help the patient heal faster.
- What is the best action to perform third from the six actions identified as part of planned client care for this particular client?
The third best action to take in this case is to input consult for pain management into the electronic order system. The patient was involved in an accident which has resulted in a surgery to repair fractures. Electronic Ordering system improves postoperative pain, especially after injuries (Urban et al., 2015). Thirdly, the patient is on bed rest, making him comfortable is vital in helping him heal. When the pain is dealt with, his urge to smoke or use a patch may decrease, making him get enough rest. The goal of this action is to help the patient recover quickly. This would be the third course of action because it will take some time. Thus, it can, therefore, be done after other operations to manage pain have been done.
- What is the best action to perform fourth from the six actions identified as part of planned client care for this particular client?
The fourth action to take would be to apply anti-embolism stockings bilaterally. The patient has only one stocking on. There is a need to put the stockings on both legs to increase circulation. This is because the patient has just come out of surgery and because the patient is a smoker. When circulation is not properly monitored in a patient who is a smoker, the risk of the patient developing blood clots increases. The patient’s heartbeat is at 92, and the oxygen saturation level is at 94% on 4L Nasal Cannula. The goal of this action is to put these vital signs as stable as possible. That is, if possible, increase the saturation level because the patient is on bed rest. Also, ABGs are being conducted after every 4 hours to check on his oxygen levels and circulation.
- What is the incorrect action?
The action that I deem inappropriate is to administer tetanus immunization and flu immunizations before discharge. Tetanus doses are given in two series, one between the age of 4-7 and another between 12-15 years. The injection is supposed to be administered only if it was issued less than five years for dirty wounds and less than ten years for clean injuries. According to the patient’s chart, the scars appear dry. The patient is also 25 years old, and when the last immunization was administered has not been reported. It would be inappropriate to administer the vaccination without first collecting the important dates on when he was last issued the vaccine.
References
Levett-Jones, T., Hoffman, K., Dempsey, J., & Jeong, Y. S. (2009). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. PubMed, 30(6), 515–520. https://doi.org/10.1016/j.nedt.2009.10.020
McMillan-Coddington, D. (2013). Reflection through journal writing to educate registered nursing students on patient care. Teaching and Learning in Nursing, 8, 63–67. https://doi.org/10.1016/j.teln.2012.09.004
Urban, M. K., Chiu, T., Wolfe, S., & Magid, S. (2015). Electronic Ordering System Improves Postoperative Pain Management After Total Knee or Hip Arthroplasty. NCBI, 6(3), 591–599. https://doi.org/10.4338/ACI-2014-12-RA-0114