Patients Management Plan within the Intensive Care Field of Practice - Essay Example

Principle of Critical Care Principle of Critical Care Patient’s Management Plan within the Intensive Care Field of Practice According to the consensus guidelines for the use of Potassium replacement in clinical practices strategies to restore the low serum potassium concentration (Aronson, 2009). However, proper reactive care must be taken before the replacement therapy is executed (Aronson, 2009). The baseline potassium values must be determined as well as the existence of underlying medical conditions such as CHF. In addition, the presence of other medications altering the levels of Potassium in the serum such as non-potassium-sparing diuretics as well as those resulting in arrhythmias in case of hyperkalaemia such as cardiac glycosides. Besides, the clinicians must ascertain the patient’s variables such as salt and diet intakes alongside the ability to adhere to the therapeutic regimen (Aronson, 2009). It is critical to maintaining optimal potassium levels of at least 4.0 mmol/L for this particular patient besides a routine potassium monitoring. There is also need for the joint administration of Magnesium to enhance the cellular uptake of potassium (Urden, Stacy & Lough, 2014)). The Intravenous piggyback infusions of electrolyte require that the administration be executed based on free-flow protected devices such as an infusion pump. Patients must meet certain conditions before the initiation of the Potassium (SCr 40Kg). The electrolyte replacement protocols such as potassium Phosphate or Chloride may be ordered individually or jointly (Kee, Paulanka & Polek, 2010). Initiating intravenous Potassium therapy is hazardous and should meet certain strict requirements. The intravenous treatment of hypokalemia has to be instigated only when the enteral route cannot be availed or confirmed not to achieve the standard elevation of serum Potassium based a clinically set timeframe (Kee, Paulanka & Polek, 2010). The guidelines for initiation of replacing Potassium must be determined by the urgency of Potassium replacement and should only be performed in case of cardiac arrhythmia, low serum Potassium (4.0 still lies within the normal range and thus need to be replaced and hence a one percent loss of total body Potassium content leads to an adverse disturbance of the delicate balance between intracellular and extracellular Potassium resulting from profound physiologic changes (Urden, Stacy & Lough, 2014). Potassium is essential actions and should always not be depleted in the body (Peacock, 2012). When serum shows a level between3.5 and 4.0 as indicated by the patient’s serum analysis, there is a need to replace and increase the intake of Potassium. 2) Biopsychosocial Needs of the Patient The application of the biopsychosocial approach in medicine traces back to cardiologist Engel (1977) that applied in the understanding of heart disease. According to Engel, heart disease is the ultimate result of the range of cultural, psychological and social factors that impinge on the cardiovascular system (Kiesler, 1999). Such factors are genetic vulnerabilities, poverty and diet, smoking and exercise as well as coping with stress (Greenberg & Cheung, 2005). Despite the pathophysiology of heart failures being real enough, many have limited understanding of it as well as grossly limited mechanism to prevent it due to limited understanding of psychosocial interaction with the cardiovascular system (Brown, & Shah, 2012). Therefore, Kiesler (1999) has greatly contributed to the understanding of the biopsychosocial approach both in terms of its development and the current application in medical disorders focusing on the biomedical approaches (Aronson, 2009). Biopsychosocial is thus the interaction of domains illuminating significant process based on the physiological effects of social interaction and the benefits of individual differences (Aronson, 2009). The quality of our social relationships shapes a host of philological systems ranging from hormonal, immune to cardiovascular (Ackley, 2008). Based on the impression such as Encephalitis, Meningitis and Hypovolemia as well as the past medical history (Focal epilepsy, hypothyroidism) and the examination of the present conditions of the patient that has shown a maintained GCS between 8 and 9 and airway breathing alongside stable haemodynamic with required standards of sepsis markers, output urea & creatinine and abdomen soft, the biopsychosocial needs of the patient can be examined (Porth & Porth, 2011). The proposed plan aids in the examination of these needs (Engel, 1977). The biological component focuses on the analysis of whether the patient was an ectopic and thus need for replacement of Potassium alongside the examination of Magnesium and Phosphate levels (Mahan, Escott-Stump, Raymond & Krause, 2012). According to the past medical history of the patient, replacing Potassium need to be done as the patient has showed cardiac problem resulting from the chest pains (Mahan, Escott-Stump, Raymond & Krause, 2012). On the other hand, the social component focuses on the need by physicians to inform the family of the patient about the conditions of their relative. It is essential to inform the family in case there is a need for intubating (In Metheny, 2012). Therefore, social component help manages the family and informing the family about the significance of replacing potassium, as well as other electrolytes, during such times the patient’s condition is critical. The patients thus according to the plan needs to be guided based on the application of the biopsychosocial approach as it is noted that our interaction based on physiological and mental are closely embedded on the social interactions (Ronco, Bellomo & Kellum, 2009). Therefore, the patient needs to be talked and guided not to feel stressed up and persuaded that she is just like any other people who are not sick and convinced to take the drugs as prescribed (Greenberg & Cheung, 2005). The family as well should be brought close to the patient to help in dealing with the patients biopsychosocial needs making the patient to feel protected and cared for without stigmatization and this will help the patient’s mind not to focus on the illness making her to heal. 3) Evidence for Safe and Effective Management of the Patient’s Condition According to the plan, there is evidence that the patient‘s management is safe and effective. Based on the past medical history and current status comparison, it is noted that most of the challenges are restored (Mahan, Escott-Stump, Raymond & Krause, 2012). For example, the patient is hemodynamically, soft abdomen, airway breathing is maintained, stable GCS between 8 and 9. In addition, sepsis markers and urea and creatinine are as per required standards. Such levels demonstrate that management of the patient condition is under control since most of the adverse problems show required standards. The patient experience is thus enhanced and maintained based on the plan and as per the required guideline (Mahan, Escott-Stump, Raymond & Krause, 2012). Despite the fact that there is an academic gap between the practice and the JNC guidelines, the plan as provided has helped manage the patient’s condition effectively. Most of the disorders are under control indicating the effectiveness of the plan as outlined. The existing gap between the practice and evidence based on the national guidelines is that some physician dissent in replacing the potassium while others advocate the replacing (Barash, 2009). The national guidelines outline the fundamental requirements to guide the replacement, but some clinicians still would want to do it in their own ways hence posing challenges to the patient’s care. The gap is justifiable based on the proposed plan that has deviations from the required guidelines (Croskerry, 2009). The aggressive requirement rejects the need to replace Potassium greater than 4.0 but as per the plan, it is required that the Potassium be replaced and hence massive gap existing between the practice and the evidence or the national guidelines. Therefore, the doctors’ traditional customs are justifiable based on this fact (Croskerry, 2009). The plan illustrates an elaborate and proactive mechanism to care safely for the patient. Despite the evidence of effectiveness of biopsychosocial approaches, there is a massive gap as clinicians pay lip service to it but only few actualize its application in their research or practice making it difficult to understand the biopsychosocial needs of the patients and hence derailing the enhancement of patient’s care (Croskerry, 2009). The reason attached to this is that clinicians fail to understand the biopsychosocial approach hence calling for radical shifts in research, practice and practice (Mahan, Escott-Stump, Raymond & Krause, 2012). Despite the National guideline requirement of frequent monitoring and augmenting Potassium stores on a routine basis, only few attempt to undertake this provision making hence a greater academic gap between the evidence and the practice (Schrier, 2010). The gap arises from the inconvenience of accurately ascertaining the levels of total body Potassium encompassing a 24-hour urinary accumulation rather than rapidly measuring the laboratory serum (Schrier, 2010). The practical difficulty of achieving and maintaining the required standard levels of Potassium also lead to clinicians failing to remedy subnormal Potassium levels while validating replacing Potassium only under high-risk patient’s conditions. The depletion of Potassium in the body leads to hypokalemia (Potassium levels of < 3.5 mmoI/L) 4) How Leadership, Teamwork, Communication and the Decision Making Process Enhance the Patient’s Experience Leadership is essential in team building. The presence of a figure leader is a motivational source to the employees. Consultation amongst within the healthcare environment is an inevitability (Robertson, Paige, & Bok, 2012). Frequently, clinicians are faced with situations that require consultation ranging from prescription of medication, administering the medications, cases of emergency such as Adverse Drug Reactions, Event Reactions as well as allergies (Lerma & Rosner, 2013). An effective leadership framework will outline an efficient communication chain or channel that aids in consultation in order to make quick and rational decisions regarding the particular needs of patients and the clinicians, doctors, nurses and other stakeholders (Robertson, Paige, & Bok, 2012). A leader will help drive the organization as employees feel represented based on their ability to report any cases to the leader who then gives the directive (Porth & Porth, 2011). Leadership is also essential as it motivate the workers culminating into increased moral hence higher-quality and productive services. Communication channels are key to the information conveyance within an organization. In case there is no leadership, each person will make parallel decision that are adverse to the policies and objectives of the organization and hence making the brand image to be at stake (Robertson, Paige, & Bok, 2012). Leadership thus provides a framework followed by workers in order to deliver their information and grievances (Porth & Porth, 2011). Where this is such set and known chains of communication, there is a harmonious teamwork as individual will know how to communicate both horizontally and vertically as outlined by each department. The patients experience within an organization will thus be much effective based on teamwork since employees will find it much easier to stand-in for others who might be engaged in other activities at the same time the patient may need additional or urgent attentions (In Karahan, In Kerkhoffs, In Randelli, In Tuijthof, & European Society of Sports Traumatology, Knee Surgery and Arthroscopy, 2015). The decision making process revolving around the patients effective care should never be a unilateral but an inclusive one since the clinicians and nurse are always in touch with the patients and thus may have essential information than the top management and hence teamwork decision making will be rational in enhancing the customers’ experience (Lerma & Rosner, 2013). However, junior employees will only be willing to share their data and knowledge about the patient’s experience if they are made to feel part of the organization based on the appreciation and recognition of their input within the organization (Robertson, Paige, & Bok, 2012). Subsequently, this is only possible based on effective communication and teamwork driven by efficient and collaborative organizational culture design resulting from an effective leadership of a particular organization (Robertson, Paige, & Bok, 2012). Before decisions regarding the patients are affected, there is a need for an elaborate consultation that further incorporate even the patients’ family members (Schwartz, 2002). Such a consultation is crucial as the stakeholders in conjunction with the family members will reveal the medication history and reactions to such medication with respect to a particular patient (In Alexander, In Brooker, & In Nicol, 2012). Where there is no leadership, teamwork is curtailed, and hence communication is impaired making clinicians hoard crucial information about the patients that would have otherwise enhanced the patients’ experience. Patient’s experiences are strongly embedded on the leadership within a hospital or a healthcare facility (Porth & Porth, 2011). Therefore, it is key by the top management to embrace a collaborative organizational culture design and ensure a higher levels of teamwork (Robertson, Paige, & Bok, 2012). The leadership must ensure an effective communication and in time so that all the stakeholders made to understand the policies and the guidelines to be followed during times of need (Endocrine Emergencies: Recognition and Treatment, 2014). In addition, motivating and rewarding the employees alongside frequent vocational trainings should be executed by the leadership to ensure that nurses and clinicians are knowledgeable enough to respond to contemporary issues arising from the administration of medicines such as event reaction, adverse drug reaction as well as allergies (Nelson & Quick, 2012). In addition, such trainings will also be beneficial to ensure that clinicians and nurses understand the biopsychosocial requirement of patients as well as making them persuade patients that may reject the administration of drugs prescribed. In so doing, patients experience will greatly increase since drug acceptance will improve amongst the patients accompanied with increased knowledge of self-care amongst the patients (Mahan, Escott-Stump, Raymond & Krause, 2012). Therefore, the hospital top management must appreciate the need to ensure teamwork besides good communication channel both for patients and clinicians in order to promote consultations as well as provision of efficient care to the patients both within and outside the hospital facilities (Nelson & Quick, 2012). Leadership is key in driving teamwork and communication that culminates into rational decisions making regarding the policies, strategies and actions to be undertaken with respect to enhancing patients’ experience (Nelson & Quick, 2012). Reference Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. St. Louis, Mo: Mosby/Elsevier. Aronson, J. K. (2009). Meylers side effects of cardiovascular drugs. Amsterdam: Elsevier. Barash, P. G. (2009). Clinical anesthesia. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Brown, T. A., & Shah, S. J. (2012). Evidence-based clinical reasoning in medicine. Shelton, CT: Peoples Medical Pub. 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