Nursing Care Plans Reflection
Reflection using John’s Reflective Model
Reflecting on the plans of care of the two patients, I feel I did not offer my best while developing the plans. For example, I did not consider that I had only 8 hours to deliver essential care to the patients. In addition, the plans were not adequately personalized to account for the patients’ lifestyles as well as issues related to their families. The plans also do not address the influence the diseases have on the lives of the patient’s families and the importance of understanding the condition. The development of the plans of care was based on training skills and formal research, bearing in mind that I am still a student, and I have not had clinical and past medical experiences. The formal research helped me in knowing the care and the type of medication that was required for the patients.
The immediate aim in developing the plans of care was to address the life-threatening symptoms exhibited by the two patients. This was helpful since it would restore patients to the conditions in which they could be prepared for other treatments in the next shifts. Nicholas showed loss of sensation as well as movements in the right arm and slurred speech. As such, assessing the extent of dysfunction was essential to help in determining the degree of brain involvement and difficulty the patient has while speaking. The plan of care for Nicholas was mainly based on the symptoms and the data provided by his wife. Respiratory failure might have occurred because of inadequate exchange of gas in the lungs. This might have caused speech challenges for the patient, and that is why I recommended for assessment and monitoring respirations and breaths sounds of the patient. This would help me to assess the patient’s verbal capabilities and sensory-motor and cognitive function that might be the cause of difficulty in moving the right arm. COPD should have also been the key consideration for Nicholas as suggested in the feedback consideration and (Gresham, 2015). I had not considered this in my plan of care for Nicholas.
The baseline vital signs of Nicholas were recorded, and his RR was 24~26 bpm, and the oxygen saturation was SpO2: 89-91 % RA. The increase in the RR was large because of metabolic demand for oxygen delivery. Additionally, Nicholas’s SPO2 increased, showing that enough oxygen was circulating into the blood. Therefore the patient would not be recommended for oxygen since his saturation was within the acceptable range for the COPD as presented by (Pilcher & Beasley, 2015). The productive cough containing crackle sound showed that the patient would require suctioning, shifting and potential fluid restriction. The plan of care for the patient considered his needs since possible TIA on the background of cardiac history, ineffective airway clearance, and the impaired gas exchange was performed, and interventions were made to provide quality care. However, in the considerations, I failed to consider the frequency of the important signs and neurological assessments of the patient.
The immediate response for Thi Minh Tran was to correct hypotension to avoid life-threatening conditions such as cardiac arrest. Hypotension condition impairs patients’ brain due to inadequate blood flow into the heart and insufficient blood into the body. Therefore enabling blood transfusion was an important immediate response as this would help in stabilizing blood flow (Opdyke & Foreman, 2017). The care plan for Thi Minh Tran addresses various critical issues based on the clinical assessment results and clinical symptoms. On clinical assessment, the patient showed high temperatures of 38.6 C and the RR was 28 and had no breathing problem. The hypotensive of the patient was 90/50mmHg and showed weak as well as thread pulse. There was a sign of confusion and agitation that could be as a result of an underlying condition. The Glasgow Coma Scale was 13/15, E3V4m6 PEARL and the size of 4mm. The Glasgow Coma Scale of 13/15 indicates that the patient could have had a minor injury. Administering antibiotics to the patient was an important immediate response, and this would help her from falling into severe conditions such as a comma. The strong smell of urine and delayed urine emptying by the patient were signs of dehydration. Therefore, the patient was supposed to be rehydrated. I recommended for IV fluid as the most suitable intervention. I did not consider the effects of IV fluids on the patient with hypotension condition. However, the majority of the plan of care considered her needs since the risk for UTI infection, shock risk, the risk for the impaired gas exchange, and risk for the deficient fluid volumes, hyperthermia and malnutrition tests were recommended as the appropriate interventions and rationales given why they should be performed. I failed to consider the risk of sepsis condition, which was due to acute deterioration exhibited by the patient. As presented by (NSW Government, 2017), monitoring the patient frequently due to sepsis should have been a priority since this puts the patients at a high risk of deterioration even after IV fluids and antibiotics.
It is important to note that the plan of care for the patient should always be according to vital signs displayed to ensure suitable quality care (Waxman, 2018). My plans of care did not consider did not concentrate mainly on the patients’ vital signs since they were influenced by the clinical assessment results and clinical symptoms. This affected my decisions regarding the type of medication and care needed. The time was also a limiting factor, and perhaps that is why I ended up developing the plans of care than addressed the patients entire treatments instead of the ones which will address the most life-threatening conditions within an 8-hour shift. Being also a student rather an experienced health practitioner affected by decisions since they were based on skills acquired from class as well as little experience from the placement. That is why I primarily relied on research to develop the plans of care.
Utilization of evidence-based practice and strictly following the clinical procedures would have been key in developing plans of care that would have a positive impact on the outcomes of the patients. The use of evidence-based practise improves the health results of the patients since it influences patient-centred care (Schneider et al., 2016). With evidence-based procedures, I would have used the available resources, including 8-hour shift to develop plans of care that would lead to improved health outcomes for the patients.
Through the development of plans of care, I have learned that they should always be based on the vital signs displayed to ensure quality care is provided to the patient as discussed by (Woolf, 2016). For example, I failed to consider speech condition for Nicholas and risk of sepsis for Thi. These omissions might have led to the worst conditions. As such, I have learned that the assessment data, as well as data on admission, forms the foundation of the vital signs that are essential in correcting the conditions that might lead to the death of the patient. This is because the assessment data helps in recommending suitable medication that stabilizes patients before being placed on further treatment.
Gresham, S. L. (2015). Clinical assessment and management of swallowing difficulties after stroke. Medical Journal of Australia, 153(7), 397-399.
NSW Government. (2017). Sepsis Management Plan. New South Wales: NSW Health Facility.
Opdyke, D. F., & Foreman, R. C. (2017). A study of coronary flow under conditions of haemorrhagic hypotension and shock. American Journal of Physiology-Legacy Content, 148(3), 726-739.
Pilcher, J., & Beasley, R. (2015). Acute use of oxygen therapy. Australian Prescriber, 38(3), 98-100. doi:10.18773/austprescr.2015.033
Schneider, Z., Whitehead, D., LoBiondo-Wood, G., Faan, P. R., Haber, J., & Faan, P. R. (2016). Nursing and midwifery research: Methods and appraisal for evidence-based practice. Elsevier.
Waxman, K. T. (2018). The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35.
Woolf, S. H. (2016). Practice guidelines: a new reality in medicine: III. Impact on patient care. Archives of internal medicine, 153(23), 2646-2655.