A night in the life of an rn

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A Night in the Life of an RN; Exhibiting the ANA Scope and Standards of Practice

1. Read the following scenario. Identify the passages that illustrate each Standard of Practice, by highlighting them in the corresponding colors.

Standard 3. Outcomes Identification

Standard 4. Planning

• Standard 5A. Coordination of Care
• Standard 5B. Health Teaching and Health Promotion

Unit=Adult Critical Care

John is a registered nurse (RN). He earned his ASN 15 years ago and went back to school and graduated with his BSN 5 years ago. John, a nurse, has worked on this Adult Critical Care (ACC) unit for the last 5 years. He has begun to explore the possibility of going to graduate school to pursue a career as Clinical Nurse Specialist (CNS) on the same ACC unit. He is an active member on the clinical practice committee both for his unit, and as representative for his unit on the hospital wide clinical practice committee. These committees focus on developing Clinical Practice Guidelines that reflect the latest Evidence-Based Practice and lead to improved quality as evidenced by improved outcomes and patient safety.

Report:

I

Mike Boylan, 77-year-old male, Date of Birth : 9/6/1938, Room# ACC4. Together they compare the information to his identification band.

A

Before entering the room, the nurse relays Mr. Boylan was admitted yesterday evening. He was in a motor vehicle accident (MVA). He was brought into the ER with 4 broken ribs on the right and 2 on the left. His right lung was collapsed. He appeared slightly confused, repeating the same questions verbatim. He did recognize his three step children when they entered the trauma room. Prior to having the chest tube inserted, he could be heard saying, “Please let me die, just let me die.” One of the stepdaughters explained that he had had chest tubes before and knew how uncomfortable they are. He is a full code. He has no known allergies (NKA). His condition is guarded considering his co-morbidities and we are watching his heart rate and blood pressure closely. His heart rate has been elevated and the rhythm has been mostly A Fib. He has been taking Fentanyl intravenously for pain and the last dose was 45 minutes ago, but each time he receives Fentanyl his B/P decreases to a systolic less than 100.

S

Family History: Brother and Sister died of Cancer (Colon and Brain, respectively).

A

Timing

Monitor closely. Our goal is to prevent the need for assisted ventilation.

Next

Give new medications ordered.

He enters Mr. Boylan’s room at 8:15pm. He proceeds to collect more data from him, initiating a conversation to learn more about how he is feeling, symptoms he might be experiencing and anything that might feel different. He is sure to use good therapeutic communication techniques to achieve effective communication and gather all the necessary, pertinent data needed to provide safe, quality care for Mr. Boylan. He verifies information about his background and asks questions about his family and his support system. He uncovers that Mr. Boylan has many health problems and hospitalizations in the last 10-15 years.

He has also been acting as the primary care giver for his wife, who struggles with chronic pain and mobility issues, as well as depression. His wife is currently in a rehab facility after just being transferred from the hospital the night of his MVA. She had been hospitalized with Noro virus and had a Heart attack and stroke while hospitalized for 2 weeks. She had been in ICU herself on a ventilator and was just now recovered enough to go to the rehabilitation center. He is very worried about her and feels very bad about the accident. He shares that he attempted to make a left turn into a busy street, an act that his wife had repeatedly warned him against the many times they come upon it in the past. He has three step children that he is very close too and that are taking care of both him and their mother. He is concerned about his and his wife’s future as he and the children had already begun to discuss he and his wife moving to an assisted care living situation because of his recent Parkinson’s diagnosis. He says he is reluctant to take this step, but realizes it is the smart thing to do.

1. Maximize his airway clearance and cardiac output during his shift.
2. Decrease in his anxiety level by the end of John’s shift.

1. Give prescribed pain medications: Rationale: Decrease rib pain, so that he can take deeper breaths.
2. Frequently change positions to promote the movement of secretions. Place him a semi or high fowler’s position with legs down. Rationale: Elevating the head of the bed and legs down may decrease the work of breathing and decrease the work of the heart.
3. Coordinate respiratory treatments and physical therapy treatments with peak pain control. Rationale: Patient is able to more effectively complete tasks that will promote airway clearance.
4. Provide frequent sips. Rationale: Thins secretions.

To treat irregular rhythm and increased work of heart:

1. Give new cardiac medication to help treat Afib Rationale: promote a more effective rhythm.
2. Monitor for symptoms of CHF and decreased cardiac output: Rationale: Make physician’s aware of any change in status so treatment plan may be altered.
3. Give new pain medication regimen: Rationale: By mouth Vicodin will not decrease the blood pressure as much as IV Fentanyl.
4. Provide a restful environment. Rationale: Rest helps lower atrial blood pressure and reduce the workload of the heart.

To treat uncertainties that his current health and future for he and his wife and relieve the worry of separation:

1. Use empathy to encourage Mr. Boylan to interpret the anxiety symptoms as normal. Rationale: Providing psychological support can reduce the symptoms and problems of anxiety.
2. Collaborate with Social Work to provide coordination of services for Mr. Boylan and his wife. Rationale: Addresses his legitimate concerns.
3. Set up a phone call or facetime between Mr. Boylan and his wife. Rationale: He can see her needs are being taken care of.
4. Educate him on all activities, procedures in a way he can easily understand. Rationale: Promotes a therapeutic relationship between nurse and client, by developing trust and alleviating the fear of the unknown.

Provide examples from the scenario that illustrate competency in:

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