PMH of: Right total knee replacement

Critical aortic stenosis on 9/15/16, in which he developed

BSMCON NUR 3111P severe post op hypoxemia. Everyday Flash pulmonary edema/
1
Not related to smoker (70 pack years). Recent COPD
Furosemide 40 mg IV. respiratory failure, but diagnosis of CAD and HF. Type II COPD patients that
diabetes undergo surgery
Loop diuretic. Increases the pt has CAD and
renal excretion of water, aortic stenosis appears can develop
sodium, chloride, as a marker for respiratory failure -Fluticasone 1 puff daily
magnesium, potassium cardiovascular events b/c of airflow (inhalation). Corticosteroid. Anti-
and calcium. Diuresis and such as CAD limitations inflammatory and immune modifier
(J.O., 74 y.o.
subsequent mobilization male) -Tiotropium. 18 mcg. 1 cap
of excess fluid. Acute on (inhalation) daily. Anticholinergic
(Kluwer,2016) chronic acting, reversibly inhibits
respiratory muscarinic receptors in smooth
failure muscle of airways
-Oxygen 5L nasal cannula
-Methylprednisolone 30 mg daily.
Pertinent physical exam: O2 saturation= 89% on 5L of -For this condition there is not
Immunosuppressant. Suppresses
O2 by nasal cannula and 50% ventimask. Dyspenic with many medications to treat it; inflammation and the normal
exertion. Upper lobes breath sounds are diminished. however, early ambulation is immune response
Lower lobes have crackles. Large dark purple bruise beneficial in the treatment. (Kluwer, 2016)
noted all along patients bottom and right thigh. Cough is -It is best to treat the
Results when either underlying cause which in this
productive with clear blood tinged sputum. Aortic
murmur noted. Incision on R knee, no signs of oxygen exchange or case is COPD. The patients
inflammation or infection. Dressing is clean, dry, and carbon dioxide COPD needs to be managed Pt needs more information on how
intact. Abdomen is distended and soft. Foley is draining exchange are inadequate to help the respiratory failure. to manage his COPD. Pt spoke
and patent. about how he does not want to quit
(Lewis, p.1654) smoking so he needs some
encouragement and knowledge
about this being since he will be on
Priority Nursing Diagnosis (3 parts) O2 at home. The pt needs a lot of
Deficient knowledge r/t recent COPD diagnosis as evidenced by misconceptions
reinforcement with activities of
about health status
Measurable outcome w/ timeframe: daily living. He expressed concerns
The patient will verbalize understanding of disease process and treatment by about how he cannot even enjoy
9/27/16 food because of his oxygenation.
Nursing interventions, you used with rationales:
1)Assess the pts knowledge base of COPD
Rationale: Pts need to understand that COPD is a progressive disease that requires -Glucose: 255- high due to being a
self-management to reduce episodes of exacerbations
2)Allow the pt to identify what is most important to him diabetic/stress from hospitalization
Rationale: This clarifies learner expectations and helps the nurse identify patient
Pt was given teaching about the importance of -BUN 32 high due to HF
needs. Adult learning is problem oriented -BNP 2222 high due to HF and aortic
3)Refer the patient to smoking cessation support groups stopping smoking with his new COPD diagnosis. The
Rationale: Smoking is the leading cause to COPD. These groups provide patient was taught how to conserve energy and to do stenosis
emotional support activities with higher priority first. The patient was -Chest x-ray showing pulmonary
Evaluation: Goal partially met, pt was able to verbalize understanding about new given teaching on how to manage his disease and how edema and infiltrates representing
COPD diagnosis, but still does not understand the importance of smoking blood
he can still live a good life.
cessation (Gulanick & Meyers, 2014)
(provide citation)
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Guide for Reflection

Guide for Reflection Using Tanners (2006) Clinical Judgment Model

Program Thread: Servant Leadership and Global Health

I think that the critical care unit is a great place to utilize servant leadership. During this practicum experience I felt that

I served my patient well. A servant leader is someone that holds situations together well and I feel that I did this week. I

encouraged my patient to understand his new diagnosis and I didnt just talk to him about it. I felt that I encouraged

him to want to know more about his condition, because I feel he truly cared about and loves his life. At one point he

didnt want to go for a walk with the physical therapist team, but I talked to him about how beneficial it would be for

him to get up and move around to make him get better. He was inclined to take the walk after we talked about it for a

little while. Ultimately I was thinking about his future with his condition and even though he is very sick right now, the

more you encourage him, the better off he will be. I talked in terms that my patient would understand. I did not use any

medical terminology with him because he would not listen to me if I did, Im sure. He really appreciated the time I was

taking with him to talk about his condition. What I did this practicum experience was put aside all the medical aspects

for a few minutes and actually maintain a therapeutic relationship with my patient. This was very important for this
BSMCON NUR 3111P 3

patient because he just got diagnosed with COPD and does not know how to manage this condition. He just needed

someone to advocate for him, and that someone was me.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.

List two goals for the next practicum experience:

1. I want to feel more comfortable doing paternal routes of medications
2. I want to be able to document the hourly vitals and I&Os with better timing
BSMCON NUR 3111P 4