N390 Integration seminar I

Darah Daskalakis

Professor B.

NUR 390-100

15 September 2020

Asynchronous Activity- Case Study 1

The pertinent assessment finding that the SN would identify based on this data is the pinkish-red area on the patient’s lower back. The SN notes that this is “not normal” to find on a patient, so taking this finding into consideration when assessing the patient’s body is very important. This pinkish-red area is important to note during an assessment due to the fact that the SN does not want the patient to have any more complications, he is having enough issues having 2 broken legs.

The lab values that the SN should be concerned about for this case would have to be the patient’s complete blood cell (CBC) as well as the patient’s erythrocyte sedimentation rate (ESR). I believe both of these lab values would be important for the SN to look at for the patient because if the SN noticed a discoloration of the skin on the patient’s lower back, it could be a rash or some kind of infection forming from the patient being confined to bed and not moving around a lot. Looking at these lab values will tell the SN if there is an infection and can tell the level of inflammation based on the amount of red blood cells (if they’re low) as well as the amount of white blood cells (if they’re abnormally high).

The evidence based practice guidelines that the nurse may consider applying to this aspect of patient care would be amongst knowledge and skill. The nurse needs to have the knowledge to know upon assessment that finding this kind of discoloration on the patient’s lower back is not normal, so the nurse needs to think about what may have caused this. In my personal opinion, I believe that this discoloration on the lower back is the result of the patient not being moved often enough in their bed at the hospital, so this is a bed sore forming. The nurse can note the size and complexity of this discoloration, trying to get an idea of when it may have started to form and think about what the nurse may do to properly address and fix this situation for the patient. This is where the skills component of evidence based practice comes in, where the nurse will have to properly address, clean, and bandage up the area of redness on the patient to prevent the area from worsening. Based on the nurse’s research of bed sores and how they occur, the nurse will know to now check on the patient more frequently to change his positioning in bed in order to prevent the reddish-pink area from getting worse.

Based on nursing priorities and patient safety, a plan of care that the nurse can carry out would have to prioritize the patient. First, the nurse should get a translator so that communication between the nurse and the patient will be clear. Next would be to check on the patient more often to ask if they are experiencing any discomfort/pain. Along with this, the nurse should change the bandages covering this area frequently to check on the size and intensity of the discoloration on the lower back, making sure that the reddish-pink area is clean and not being aggravated. Lastly, the nurse should comfortably change the position of the patient frequently to a way that it will not put pressure on the lower back or hinder the healing of his broken legs/cause him any pain.

Some ideas I have that would actively involve the patient in his own care would be to let the patient wash as much as he is comfortable with on his own when it is time for a bed bath. I would also have the patient take care of other hygiene related activities on his own (if he is able to) such as brushing his teeth and combing his hair in order to make the patient feel included in his own healing process.

Part II:

The QSEN competency that I am choosing to talk about related to this case study is patient centered care. In this case with the Hispanic male, it is important that the nurse does all that he/she can in order to do what’s best for this patient to keep him comfortable and out of pain in an already painful situation. Having been emitted into the hospital for 2 broken legs after being in a car accident, it’s safe to say that this patient has been through not only physical pain, but emotional pain as well. By the nurse providing a translator in order to have better communication with the patient, it is already putting the client at ease knowing that he is able to voice his feelings/ able to communicate with the nurse during his healing process. When the nurse notices the discoloration on the patient’s back, the nurse will assess and carry out a process/plan (checking on the inflicted area and moving the patient comfortably and frequently) that will benefit the patient, putting his needs first and making sure he is comfortable throughout the process. Doing things like the SN has already done (assisting the client with bed baths) is exhibiting patient centered care in itself because the nurse does not want the client to be uncomfortable (not having good hygiene), so the nurse helps with this process. In the nursing field, the patient and their feelings/overall health should always be the number one priority, this case study proves exactly that.