Overview of Clients Condition Including the Conditions Aetiology - Essay Example

Reflective clinical case study Date: Institution: Introduction Today’s swiftly changing environment of health care requires practicing nurses to be aware of the need to assess and improve their practice and also consider the structural and social issues affecting it(Bulman & Schutz, 2004). Since change is taking place everywhere around us, it is vital for nurses to be able to analyze and react to latest and variety of challenges in a proactive manner. Developing reflective and critical thinking skills assist nurses in meeting the challenges of giving care in a perspective of rapid change and to become practitioners who are critically reflective (Bulman & Schutz, 2004). Reflective practice facilitates nurses through increasing their knowledge, developing their skills, and handling situations that are emotionally challenging (Imel, 1998). Reflective practice creates a strong basis for a successful career in the field of nursing. This paper illustrates a reflective clinical case study. Overview of client’s condition including the condition’s aetiology The case study revolves around a 60 years old man diagnosed with myocardial infarction (MI). The patient was presented into the department of emergency with a severe tightness within the neck region, dizziness, chest pain 9/10, and shortness of breath, pain radiating from his left arm, and discomfort which began 30 minutes ago and was linked with diaphoresis. Additionally, the client had a history of type 2 diabetes, pitting edema, and acute renal failure. The client also had a family history of ischemic heart disease whereby both his aunt and mother had a heart attack and died. Myocardial infarction means that section of the heart muscle promptly loses its supply of blood (Bhatt, Sabatine & Network for Continuing Medical Information, 2006). Without quick treatment, this can result to damage of the affected region of the heart. This condition is sometimes referred to as coronary thrombosis or heart attack. MI is normally caused by clots of blood that prevent the flow of blood in a coronary artery. This condition calls for an emergence attention. There are various causes of MI. However, the leading cause is blood clots in the coronary artery. Other causes include coronary arteries inflammation, heart surgery complications, a wound to the heart resulting from a stub, a blood clot originating elsewhere within the body, and consuming cocaine which can make a coronary artery to result in spasm (Wilde, 2003). Various risk factors have been connected with MI. These include smoking, overweight, high blood pressure, inactivity, a high cholesterol level, diabetes, diet, ethnic group, and family history whereby members of the family suffered from heart diseases (Wilde, 2003). The risk factors identified in the patient include smoking, overweight, high level of cholesterol, family history of heart diseases, and high blood pressure. People who are most likely to be at risk of suffering MI include people who are over 50 years (MacGregor & Kaplan, 2006). Ways to prevent myocardial infarction include quitting smoking, observing a healthy diet and engagement in activities (Arnot, 2005). Regardless of the patient’s gender, physical state and culture, it is important to provide individual care to every patient (Doenges, Moorhouse & Murr, 2010). Latest modalities of MI treatment including interventions Prehospital Care Every patient transported to the hospital for pain in the chest region should be taken care of as if the pain was ischemic in origin, except when clear evidence to the contrary is ascertained. An advance life support (ALS) unit, if available, should transport clients with respiratory difficult or hemodynamic instability. Specific prehospital intervention include intravenous access, pulse oximetry, supplemental oxygen, immediate aspirin administration en route, nitroglycerin for dynamic chest pain, administered by spray or sublingually, if available, telemetry and prehospital ECG (Zafari, 2012). The patient in the case study was managed well on arrival at the hospital. For instance, he was managed for pain whereby nitroglycerin and aspirin were administered. Emergency Department Care For intentions of establishing suitable emergency treatment, viewing myocardial infarction as component of a spectrum of coronary syndromes is useful; this spectrum includes ST-segment elevation myocardial infarction (STEMI), non- ST-segment elevation myocardial infarction (NSTEMI) and Unstable angina (Zafari, 2012). The patient had STEMI and treatment is aimed at restoring the balance between the supply of oxygen and demand to avert further ischemia, relief of pain, and prevention and complications treatment. A chest radiograph is supposed to be obtained immediately after arrival of the patient, to screen for other causes of chest pain and to discover potential contraindications to thrombolysis (Zafari, 2012). In-Hospital Treatment Critical care units (CCUs) have decreased early rates of mortality from acute myocardial infarction by almost 50% by providing instant defibrillation and by facilitating the execution of beneficial interventions (Zafari, 2012). These interventions consist of administration of intravenous medications and therapy intended to limit the degree of myocardial infarction, recanalize arteries that are infarct-related, to retrieve jeopardized ischemic myocardium. The diagnosis and treatment of alternative conditions is helpful as well. Alternatives for recanalization of coronary encompass the intravenous administration of agents that are thrombolytic and approaches that are catheter-based. Measures commonly include the utilization of stool softeners to prevent straining, subsequent circulatory derangements, and constipation (Zafari, 2012). MI is an event that is very stressful for the patient. Studies show that patients who are in the critical care unit have a higher risk of having gastrointestinal ulcers because of stress. During the patient’s CCU stay, prophylaxis for ulcers related to stress was given through administration of oral sucralfate, or an H2-antagonist like cimetidine, ranitidine or famotidine, administered intravenously or orally, is appropriate for patients at greater risk, including the ones with hypotension, sepsis, or bleeding diathesis. Antipyretic like acetaminophen should be implemented to suppress or prevent the fever that is typically observed within the first 24-48 hours and its consequential tachycardia (Zafari, 2012). Use of anxiolytic, sedative, and hypnotic drugs at night may be useful (Zafari, 2012). Giving the patient both ACE inhibitors and beta-adrenergic blockers may enhance the balance involving myocardial oxygen demand and supply, and it may limit the size of the infarct (Zafari, 2012). Suitable treatment of status of fluid to optimize left ventricular filling pressures, control heart rate by averting stimulation of reflex sympathoadrenal and maintain saturation of oxygen is also useful. Thrombolytic therapy Thrombolytic treatment may be useful in a number of patients, specifically the ones with stuttering infarcts (Zafari, 2012). It has not been established to be effective in patients with unstable angina or non-Q-wave myocardial infarction. Antithrombotic Agents Currently, IV unfractionated heparin (UFH) is normally administered, together with aspirin which is administered orally (Zafari, 2012). Options include low-molecular-weight heparin or enoxaparin, other coagulation inhibitors like fondaparinux, hirudin or bivalirudin, and antagonists of fibrinogen binding to the surface of platelet like glycoprotein iib/iiia (Zafari, 2012). Thienopyridines like clopidogrel and ticlopidine equally inhibit platelet aggregation by binding to receptors of platelet adenosine diphosphate, which block iib/iiia pathway activation. Aspirin and Antiplatelet Therapy Aspirin, which relieves pain and is also an antipyretic (Lehne, 2007), is supposed to be administered instantaneously if the patient has not taken it at home. In case of allergy to aspirin, clopidogrel should be administered. Aspirin in low dosage has shown considerable benefit for primary prevention of stroke and myocardial infarction, although its usage needs to be weighed against the risk for gastrointestinal bleeding and hemorrhagic stroke (Zafari, 2012). Ensuring the safety and comfort of the patient during his or her stay in the hospital is very essential toward the positive outcome of the patient’s situation (Pender, Murdaugh & Parsons, 2011). Assessment and ongoing management of the patient In the initial assessment, it was established that the patient has past medical history of high cholestrerol, he was a heavy smoker since twenty years, and hypertension. On examination the pulse beat of the patient was 106 per minute and she had a blood pressure of 170/110 mmHg confirming he had hypertension. There was no past history of any use of drug, the ECG showed 3-mm ST-segment elevation in leads ii,iii, and a ventricular fibrillation (VF). The patient had shortness of breath, was anxious, obese, presented with excessive sweating and was afraid he might die since he believed that his mother and aunt died of heart diseases. For relief of chest pain, 300mg oral aspirin, morphine and sublingual nitroglycerin were administered to the patient. The client is monitored for daily weight and fluid restriction of 1.5 m/l. As a care provider, I had to reassure the patient that through proper management which he will get from the hospital, he will recover. Critical reflection upon caring for and managing this patient using relevant evidence Upon reflecting this occurrence during my placement period at the cardiology department, I was performing IDC which is an important procedure for patients who are in critical care on Mr. X together with my buddy RN and my fellow students. I prepared the trolley and equipments were ready for work. I had collected all that I needed apart from water. Water s used to put in the catheter balloon in order to put the catheter in place. After the assembly of all equipments, I went to the bedside of my patient and introduced myself. After the introduction, I explained the procedure to the patient then I inserted the catheter using the policy of the hospital of aseptic technique. After I inserted the catheter, I started looking for water to insert in the catheter balloon then my friend discovered that we did not carry water and she had to get one. In the time being, I hold Mr. X’s penis to ensure that the catheter did not come out. I did not recognize that the patient’s penis can react to my touch. It was then that the patient told me that I was playing with his penis and I got shocked because that was not my intention. I told the patient I was not playing with his penis and my buddy RN advocated for me stating that I was just doing my duty. My fellow students also advocated for me. Since this was a gender issue, the patient had the right to tell me that although he acknowledged that I was a student and I was learning. Although I felt a little bit uncomfortable regarding Mr. X’s reaction when I hold his penis, I felt so confident when he was able to appreciate that I was a student and that I was learning. I also felt confident since my buddy and fellow students professionally explained to the patient about the whole thing regarding the duty of a nurse. This is when he appreciated that I was learning. Using Gibb’s framework of reflection which illustrates the description of the incidence, feelings felt, evaluation of the experience, analysis and conclusion of the incidence (Gibbs, 1998), I am glad that the occurrence that happened was handled in a professional manner since my friend RN and fellow students made effective clarifications to the patient. When there is proper checking and confirmation of every working requirement, some of the nursing errors can be avoided and hence enhance the practice of nursing (Gulanick & Myers, 2011). For instance, forgetting the water made the patient to think that he was not being attended to instead his penis was being played with. Nursing practice entails different challenges (Oermann & Heinrich, 2007). The role of a registered nurse in caring for and managing patients using relevant ANMC Registered nurses should demonstrate legislation knowledge and general law pertinent to the practice of nursing (Australian Nursing & Midwifery Council, 2005). This means that the nurse is able to identify acts, legislation and policies in which the nurse who is enrolled is named either by exclusion or inclusion. The nurse is able to illustrate the general requirements of law of the practice of enrolled nurse. The nurse should identify the lawful implications of nursing interventions. Also identify and clarify the effects of legislation in the health area. In accordance with the guidelines of ANMC (2005), I was able to fulfill the responsibility of care whereby I carried out nursing interventions according to the recognized guidelines of practice. I explained the responsibility for features of care with the health care team, acknowledged the responsibility for harm prevention, carried out nursing interventions using comprehensive and precise assessments to the patient. The nurse is supposed to recognize and react correctly to unprofessional or unsafe practice by recognizing interventions which hinder care being compromised, recognize correct action to be taken in particular situations, identify and clarify other strategies for the intervention and their possible results, spot action that is detrimental to attaining the care that is optimal and doing follow up occurrences of practices that are unsafe to prevent the reoccurrence of such scenario (Australian Nursing & Midwifery Council, 2005). This was achieved when my buddy and fellow students advocated for me in the reflection incidence. A registered nurse is supposed to practice in a nursing framework that is professional and ethical (Australian Nursing & Midwifery Council, 2005). I managed to practice according to the professional codes of conduct and ethics of nursing whereby I appreciated the patients regardless of his culture, race, religion, gender and age. According the ANMC guidelines, I was able to carry out evaluations that are sensitive to the people’s needs, and appreciate other people’s rights. Regarding the reflection incidence, I appreciated that Mr. X had the right to know why I was playing with his penis. Nurses should practice in a manner that appreciates the culture, dignity, beliefs, rights and values of people by portraying respect for people (Australian Nursing & Midwifery Council, 2005). For Mr. X, I respected his views and my colleagues responded to the matter in a professional way. Registered nurses should practice in a framework that is evidence-based through identifying the importance of research to enhancing the health outcomes of people (Australian Nursing & Midwifery Council, 2005). This is done through problem identification in nursing practice whereby investigation can be done through relevant research (Australian Nursing & Midwifery Council, 2005). Since Mr. X’s diagnosis was MI, effective intervention was required. This included interventions like IDC since he was on bed rest. Registered nurses are supposed to carry out a nursing assessment that is comprehensive and systematic by using a relevant framework that is evidence-based to gather information regarding the person’s socio-cultural, mental and physical health. In accordance to Australian Nursing & Midwifery Council (2005), I demonstrated skills that are analytical in accessing and examining health information and evidence of research by demonstrating knowledge of the role of the registered nurse in contributing to research nursing. Registered nurses should plan care of nursing in consultation with groups, the interdisciplinary team of health care and significant others (Australian Nursing & Midwifery Council, 2005). This was illustrated when I worked together with my friend and fellow students. In the patient’s case, priorities to determine his health needs were determined by managing his pain among other complains. The nurse will successfully handle the nursing care of people by using resources efficiently and effectively in giving care (Australian Nursing & Midwifery Council, 2005). For instance, the hospital’s policy in my placement practice calls for aseptic technique when inserting the catheter. Registered nurse should be able to evaluate the progress towards the expected health outcomes of people in consultation with significant others, groups and interdisciplinary team of health care (Australian Nursing & Midwifery Council, 2005). Through this, the nurse will establish the progress of groups toward intended results. Registered nurses need to establish, uphold and correctly conclude therapeutic relations by demonstrating trust, empathy, and respect for the potential and dignity of the group and also relate with people in a manner that is supportive. Registered nurses should also work together as a team of health care to give comprehensive care of nursing (Australian Nursing & Midwifery Council, 2005). This can be achieved when the nurse distinguishes the impact and function of population, models of partnership and primary health care. Nurses also need to communicate the assessments and decisions of nursing to the interdisciplinary team of health care and the other significant service providers (Australian Nursing & Midwifery Council, 2005). For instance, the patient should know and understand the procedure and any medication that is to be administered to him. Failure to do so, the patient may think that his gender is being violated. Their role is to facilitate management of care to attain agreed health results by adopting and implementing a team work approach to nursing practice and taking part in activities of health care. The nurse will also work together with the team of health care to inform guideline and policy development through standard consults guidelines and policies (Australian Nursing & Midwifery Council, 2005). The Australian Nursing and Midwifery Council recognizes that the approaches and procedures in competencies assessment will be developed further, and that the review of the content (Australian Nursing & Midwifery Council, 2005). Analysis and discussion of negative and positive aspect of care in relation to reflective framework Negative aspects of care My negative aspect of care is that my team and I forget to carry water for the catheter balloon which was required during the insertion of the catheter. Critical reflection enables a nurse to think about what happened, what actions are taken and what could have been done and what future action plans may be implemented. The mistake that happened was that the patient thought that I was playing with his penis in the time when RN had gone to collect the water. The experienced was not good because that was not my intention as a nurse. The role that my friend played was very significant because she and other fellow students advocated for me explaining to the patient that I was doing my work and that nursing performing an IDCI procedure entails involvement of the penis. Nursing errors can be avoided when proper intervention and collaborative workforce help in the nursing care of the patient (Garber, Gross & Slonim, 2010). Positive aspects of care The positive aspect of my care is that I involved my friend in managing the patient. This was proper because nurses work as a team with other members of healthcare personnel in creating and implementing a care plan that is founded from the best practice that is evidence based (Youngblut & Brooten, 2001). The other positive aspect in the care is that the patient was able to understand that I was performing my duty as a student nurse. In future, I would want to explain clearly to the patient of what the procedure entails and what feelings may be felt so that mistaken indications could not arise. Nursing care also calls for shared information with colleagues. This is achieved through team work in the practice of nursing which I had with my great team. I would also encourage proper planning before nursing care so that nursing errors like forgetting water for the catheter balloon can be avoided. Nurses develop proficiency through a procedure of critical reflection on experience; they assess their work and the contribution that their nursing and nursing normally makes socially (Bowden, 2003). Afterward, in turn, they also reflect on the consequence that social powers have upon their work and themselves including mistakes learned (Evans, 1999). Critical reflection has helped me learn from my mistakes and also acknowledge the importance of total team work. Conclusion Reflective practice aims at improving the practice of nursing. In the preceding case, the patient is diagnosed with myocardial infarction, and this is accompanied by other health conditions like hypertension. This case seems to reveal that reflective practice can be utilized efficiently in the clinical environment. Through critical reflection, the nurse is able to take a demonstration look at the conduct and consequences of practice settings similar to the preceding clinical case and is in a position to question the wisdom behind traditional and habituated ideas and practices. By implementing the principles of practice that is evidence-based, the nurse engages in the procedure of seeking the best evidence to justify interventions and anticipate better outcomes. Additional study, however, is required on the use of and dynamics involving reflective practice and proof-based practice in several aspects of clinical practice and the care of patient. 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