Nr 341 Week 1 Edapt Notes

Sample 1

Thrombolytic Therapy and Patient Placement: A Comprehensive Review

Thrombolytic medications are critical in reopening arteries that are clogged by clots, a therapy primarily administered in an intensive care unit (ICU) setting. This paper aims to provide a comprehensive review of thrombolytic therapy and patient placement, with a focus on older adults in traction and middle-aged adults post-colon resection. The ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework will be utilized to structure the discussion, and scholarly references will support the analysis.

Introduction

Thrombolytic therapy is a medical treatment used to dissolve clots in the blood vessels, improving blood flow and preventing damage to tissues and organs. This treatment is especially crucial in conditions like myocardial infarction, stroke, and pulmonary embolism. The administration of thrombolytic therapy requires a controlled environment, typically an ICU, due to the potential for severe complications such as bleeding. This paper will discuss the application of thrombolytic therapy, the appropriate patient care settings for different medical conditions, and the use of the ISBAR framework in healthcare communication.

Thrombolytic Therapy

Indications and Administration

Thrombolytic medications, such as alteplase and streptokinase, are used to lyse thrombi in acute medical emergencies. The ICU setting is ideal for administering these drugs due to the need for continuous monitoring of vital signs, potential for rapid intervention in case of adverse reactions, and the requirement for advanced supportive care.

Complications and Monitoring

Potential complications of thrombolytic therapy include intracranial hemorrhage, systemic bleeding, and reperfusion arrhythmias. Therefore, continuous cardiac monitoring, frequent neurological assessments, and regular blood tests are necessary. According to Powers et al. (2018), the timely administration and meticulous monitoring of thrombolytic therapy can significantly improve patient outcomes in cases of acute ischemic stroke.

Patient Placement: Older Adults in Traction and Post-Colon Resection Care

Older Adults in Traction

Older adults in traction for orthopedic conditions, such as hip fractures, require specialized care but are generally stable enough to be managed in an orthopedic unit. These units are equipped to handle the unique needs of orthopedic patients, including pain management, mobility assistance, and prevention of complications like deep vein thrombosis (DVT) and pressure ulcers.

Middle-Aged Adults Post-Colon Resection

Middle-aged adults who have undergone colon resection surgery can typically be managed in a medical-surgical unit once they are medically stable. The care in these units focuses on postoperative recovery, including pain control, wound care, and monitoring for complications such as infection or anastomotic leakage.

ISBAR Framework in Healthcare Communication

The ISBAR framework is a standardized communication tool used to ensure clear and effective exchange of patient information among healthcare providers. It is applicable in various scenarios, including hand-off reports, shift changes, and patient transfers.

Situation

In the context of patient care, the situation involves describing the current status of the patient. For example, “Mr. Smith is a 70-year-old male currently receiving thrombolytic therapy for an acute ischemic stroke.”

Background

The background provides relevant medical history and context. “He has a history of hypertension and atrial fibrillation, which are risk factors for stroke.”

Assessment

The assessment includes current findings and clinical judgments. “Mr. Smith’s neurological status has improved since the administration of alteplase, with a decrease in the NIH Stroke Scale score from 15 to 8.”

Recommendation

The recommendation involves the suggested course of action. “Continue to monitor Mr. Smith’s neurological status hourly and maintain ICU care for 24 more hours before considering transfer to the stroke unit.”

Documentation and Scheduling Tests

Charting by Exception and SOAP

Documentation of patient care is often completed using charting by exception, which focuses on recording deviations from the norm. The SOAP (Subjective, Objective, Assessment, Plan) format is also widely used in medical documentation. This method ensures that all aspects of patient care are thoroughly documented, facilitating continuity of care.

Scheduling Radiological Tests

Radiological tests, such as CT scans or MRIs, are frequently scheduled using computerized systems. These systems enhance efficiency and accuracy, ensuring that necessary imaging studies are performed in a timely manner.

Conclusion

Thrombolytic therapy is a life-saving intervention that requires careful administration and monitoring in an ICU setting. The placement of older adults in traction and middle-aged adults post-colon resection in appropriate units is crucial for optimal care. The ISBAR framework serves as an essential tool for effective communication among healthcare providers, ensuring that patient information is accurately and efficiently conveyed. Proper documentation and test scheduling further support the delivery of high-quality care.

References

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., … & Summers, D. V. (2018). Guidelines for the early management of patients with acute ischemic stroke: 2018 guidelines update from the American Heart Association/American Stroke Association. Stroke, 49(3), e46-e110. https://doi.org/10.1161/STR.0000000000000158

Sample 2

NR 341 Week 1 Edapt Notes: Comprehensive Review

Complex Adult Health (Chamberlain University)

Unit 1: Nursing Care in Complex Health Situations

Aspects of the Critical Care Environment

Environmental Stress and Anxiety:The critical care environment often contributes to increased stress and anxiety for both patients and their loved ones. Factors such as the loss of privacy and separation from family exacerbate these feelings.

Physical Environment:The ICU’s constant artificial lighting can disrupt natural circadian rhythms, causing disorientation and agitation in patients. Solutions include orienting patients and families to the equipment used, keeping wires and tubing organized, increasing natural lighting, allowing patients to see outside, and turning off unnecessary artificial lights.

Noise:The ICU is a noisy and chaotic environment, which can increase stress and risk for auditory damage. Tailoring device alarms to individual patient needs, closing doors to reduce external noise, and establishing quiet times by blocking calls and minimizing overhead paging can help mitigate these issues.

Sensory Deprivation:Patients often experience stress and anxiety due to separation from loved ones, use of pain medications, and lack of normal routine and sense of time. Allowing visitors, encouraging family interaction, and using visual aids like clocks and calendars can help reduce sensory deprivation.

Family Dynamics and Access to Loved Ones

EPICS Family Bundle:An evidence-based approach to involving family in the care of critically ill patients can improve coping mechanisms for family members. EPICS stands for Evaluate, Plan, Involve, Communicate, and Support.

1. Evaluate:
   • Assess family background, relationships, stressors, coping skills, needs, and desired level of involvement.
2. Plan:
   • Meet family needs, determine extent of participation, establish communication points, and encourage touch.
3. Involve:
   • Include family in care, invite suggestions, meet with them as needed, and allow participation in simple care tasks.
4. Communicate:
   • Provide honest information, encourage conversation, and facilitate communication with the healthcare team.
5. Support:
   • Advocate for the family, offer assistance, provide resources, and mediate concerns with the healthcare team.

Responding to Alarms

Steps for Responding to Alarms:

1. Assess the patient’s level of consciousness and activity.
2. Check the endotracheal tube.
3. Observe chest rise and fall during ventilation.
4. Feel for a carotid pulse.
5. Check the ventilator and telemetry alarms.
6. Assess the intravenous (IV) site and infusion pump alarms.

Communication With the Health Care Team

TeamSTEPPS:Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) aims to optimize team performance in healthcare settings. The ISBAR framework is crucial for effective communication.

ISBAR:

• Introduction: Identify yourself and your role.
• Situation: Explain the current status or issue.
• Background: Provide relevant patient history.
• Assessment: Share current findings and clinical judgments.
• Recommendation: Suggest the next steps or actions.

Pain Management: The ABCDEF Bundle

ABCDEF Bundle:A protocol for assessing and managing pain in complex health situations. It includes:

• Assess, prevent, and manage pain: Using tools like the Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT).
• Both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT): Conducted when the patient is not sedated.
• Choice of analgesia and sedation: Treat pain first to control anxiety and reduce delirium onset.
• Delirium assessment and management: Using tools like the Confusion Assessment Method (CAM).
• Early mobility and exercise: Collaborate with physical and occupational therapists to promote mobility.
• Family engagement and empowerment: Encourage family interaction and support.

Instruments for Pain Assessment in Complex Adult Health

Pain Assessment Tools:The CPOT, BPS for intubated patients, and BPS-NI for non-intubated patients are used for assessing pain in nonverbal patients. These tools are easy to use and evidence-based.

Stress and Complex Care of the Adult

Stressors in ICU Patients:Common stressors include thirst, tubes in the mouth or nose, lack of control, inability to sleep, pain, and limited time with family and friends. Addressing these stressors through nursing interventions can help decrease patient stress.

Ethical & Legal Aspects in Complex Health Situations

Advance Directives and Do-Not-Resuscitate Orders (DNR):Patients with complex health needs have the right to autonomy and self-determination. Nurses play a crucial role in ensuring that advance directives and DNR orders are followed and that patients receive palliative and supportive care.

Rapid Response Teams (RRTs):RRTs are essential for preventing in-hospital cardiac arrests (IHCA) by providing rapid care to unstable patients. The success of RRTs relies on early identification of patient deterioration and prompt intervention.

End of Life in a Complex Health Situation

Palliative Care:The focus of care shifts from cure to comfort for ICU patients at the end of their life. Palliative care aims to alleviate symptoms, support holistic care, and provide emotional and practical support to patients and their families.

Communication at the End of Life:Open and honest communication with patients, families, and the healthcare team is crucial. Key skills include empathy, reflection, silence, and honesty.

Withdrawing Treatment:Decisions to withdraw or withhold treatment should involve the patient, their loved ones, and the interdisciplinary team. Nurses should provide support and keep the family informed throughout the process.

Nursing Care of the Organ Donor

Organ Donation:When a patient is identified as a potential organ donor, nurses must maintain the patient’s physiological stability to preserve organ viability. This includes managing blood pressure, oxygenation, and fluid balance.

Health Disparities and Access to Quality Health Care

Health Inequities:Factors contributing to health disparities include income, education, gender, race, sexual orientation, disabilities, geographic location, and immigration status. Nurses should strive to provide equitable care and address these disparities.

Health Equity and Social Justice:Health equity is a cornerstone of social justice in healthcare. Nurses should deliver individualized care with respectful consideration of each patient’s unique circumstances and needs.

References

Centers for Disease Control and Prevention. (2017). Health disparities. Retrieved from CDC Website

Dukes, J. L., Kilpatrick, A. M., & Weissman, D. E. (2019). Interdisciplinary team communication in the ICU: A review of the literature. Journal of Intensive Care Medicine, 34(8), 620-626. https://doi.org/10.1177/0885066618756825

Institute for Healthcare Improvement. (n.d.). Rapid response teams. Retrieved from IHI Website

Jackson, J. C. (2017). Preventing ICU Delirium. New England Journal of Medicine, 376(15), 1457-1467. https://doi.org/10.1056/NEJMra1607319

World Health Organization. (2020). Palliative care. Retrieved from WHO Website