Posted: October 29th, 2022

Module 11 Discussion – Reflection MDC4

Module 11 Discussion – Reflection MDC4

Initial Post
Describe how you achieved each course competency including at least one example of new knowledge gained related to that competency.

Describe how you achieved the transferable skill, Critical Thinking, including at least one example of new knowledge gained related to the transferable skill

Describe how this new knowledge will impact your nursing practice.

Course Competencies
• Apply strategies for safe, effective multidimensional nursing practice when providing care for clients with neurological disorders.
• Outline appropriate nursing strategies for providing care to perioperative clients.
• Compare nursing interventions for clients with complex disorders.
• Identify strategies for safe nursing practice of the client with multi-system organ failure.
• Prioritize nursing interventions for clients with medical emergencies.
• Summarize the nurse’s role and care strategies for clients during disasters.

Transferable Skills
• Critical Thinking (Application)

Responses
You are required to give a minimum of two responses and follow the criteria listed below:
• Review how your classmates achieved each course competency and transferable skill.
• Identify new knowledge others gained you had not considered.
• Describe how this new knowledge could impact your nursing practice.

Courtney Spina
3/4/22, 11:29 AM
Apply strategies for safe, effective multidimensional nursing practice when providing care for clients with neurological disorders.

The first couple of modules focused on the central nervous and peripheral nervous systems. The course competency was completed by creating a presentation on dementia and a discussion post about central nervous system disorders. I made a presentation on Alzheimer’s Disease. I learned about Alzheimer’s that the etiology of the disease is unknown, and the most significant risk factors are age, gender, and genetics. One skill that I will use in my nursing practice is to assess the patient’s functional status. This includes changes in memory, performing ADLs, and current work status to evaluate the functional status (Ignatavicius et al., 2021).

Outline appropriate nursing strategies for providing care to perioperative clients.

In Module 4, we discussed preoperative measures. A live classroom code completed the course competency. I answered with obtaining consent. Appropriate nursing strategies for providing care to the perioperative client are monitoring and managing care, including cough and deep breath every 2 hours, providing oral hygiene, using a bladder scanner to assess for urine retention, and ambulating early. One thing that I learned is not to place pillows under the knees because it decreases venous return. We are taught to keep the patient comfortable, and sometimes that includes positioning as the least invasive measure. I will use this in my practice to consider the client’s psychosocial, cultural, and spiritual assessments. Surgery is a stressor for everyone. I will encourage and praise the client’s most minor achievements (even if it’s passing gas) (Ignatavicius et al., 2021).

Compare nursing interventions for clients with complex disorders.

In Module 5, we discussed complex respiratory disorders. There was no specific course competency on this subject; however, the remediation for ATI was due, and exam 1 was in this week. Before this module, I understood that the hallmark sign for ARDS was refractory hypoxemia. However, I learned that the other key features include dyspnea, non-cardiac-related bilateral pulmonary edema, and dense pulmonary infiltrates. I will add to my practice is proving the patient and using PEEP. I will also monitor for signs of pneumothorax because that is an adverse effect of PEEP (Ignatavicius et al., 2021).

Identify strategies for safe nursing practice of the client with multi-system organ failure.

In Module 8, the topic of discussion was sepsis, septic shock, and multi-organ failure. A live classroom code completed this course competency. The instructor asked us to respond with the interventions implemented within the first hour with a patient who exhibits septic shock. My response was to obtain a blood culture before administering antibiotics. One thing that I learned is how to recognize MODS. The signs and symptoms include altered level of consciousness, nonpalpable pules, dusky and cold extremities, and shallow respirations. One thing I will use in my practice is to focus on the cause of MODS. I will ensure the patient has an adequate airway, measure vital signs every 15 minutes, minimize bleeding, and fluid replacement measures (Ignatavicius et al., 2021).

Prioritize nursing interventions for clients with medical emergencies.

In module 9, we discussed the subject of medical emergencies. There was no specific course competency on this subject; however, remediation for Med Surg ATI and exam 2 were in this week. The common environmental emergencies include heat exhaustion, heatstroke, lightning, hypothermia, and frostbite. As nursing students, we are blessed to exhibit these common environmental emergencies while living in Minnesota. I learned that whether it is fresh or saltwater removes the surfactant from our lungs, which increases airway resistance. In both cases, it can lead to pulmonary edema. Drowning is a risk factor for ARDS. I will use it in my practice to educate parents about drowning safeguards. I will teach parents never to let kids swim alone, never leave children unattended in the bathtub, and have appropriate water equipment available (Ignatavicius et al., 2021).

Summarize the nurse’s role and care strategies for clients during disasters.

In Module 10, disaster preparedness is the topic of interest this week. Disaster preparedness includes planning for natural disasters such as hurricanes and earthquakes. In some natural disasters, there is time to prepare; however, for others, there isn’t. The course competency is a live classroom code. I learned about the nurse’s role during a disaster that they may be the triage or part of the response team. The nurse is trained on reacting, treating, and protecting the client. I will use it in my practice to identify the community’s immediate needs, such as water, food, shelter, and medical care. I will perform in annual disaster drills and be confident and comfortable with the required skills (Ignatavicius et al., 2021).

References
Ignatavicius, D.D., Workman, L.M., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.

Madison Starr
3/4/22, 11:47 AM
• Apply strategies for safe, effective multidimensional nursing practice when providing care for clients with neurological disorders.
In this course I really got familiar with the Glasgow Coma Scale. It’s designed to quickly assess three client responses: best eye response, best verbal response, and best motor response. As the saying goes, “8= intubate”. The scale classifications are: GCS 8 or less, severe. GCS 9-12, moderate. GCS 13-15, mild. The GCS is the most commonly used scoring system for the neuro-truama patient, so working in an ER or ICU or even a TCU (where falls could happen and you need to assess), the information about how to assess them will come in handy.
• Outline appropriate nursing strategies for providing care to perioperative clients.
Perioperative is pre, intra, and post op. A lot can happen in between so knowing some strategies on how to care for patients is important. In the preoperative stage, informed consent needs to happen if the patient is able to do so. They need to name the surgery, who will be doing it, all available options including benefits and risks, risks associated with the procedure and potential outcomes, risk associated with anesthesia, and risks, benefits, and alternatives of the use of blood or blood products during the procedure. It is the nurses role to clarify facts that have been presented by the surgeon and the nurse will sign the consent as a witness to the signature, not to the fact that the client is informed. If I’m a nurse working in the preoperative setting and am working preop that day, I need to make sure that all patient’s have had informed consent and that I have witnessed the signature. The surgery cannot go on if it hasn’t happened and if the patient is confused on what is going on. They can not be under the influence of pain meds when signing for informed consent. The patient also has the right to cancel the surgery if they no longer want to go through with it.
• Compare nursing interventions for clients with complex disorders.
Nursing interventions for client’s with complex disorders always start with following your ABC’s. If someone doesn’t have a patent airway, they are going to get intubated. Recognizing the need for intubation is critical for the client’s survival. The RN needs to know where the equipment for intubation is and how to retrieve it. The RN should position the client in the chin tilt position and provide oxygen by the bag-mask-valve device until the intubation is done and medications are on board. The RN should make sure there is suctioning by the bed and the RN should also listen to the lung sounds after the intubation is completed. A common guideline implemented after intubation is to secure the hands at the client’s side to prevent accidental dislodgment of the ETT. A tension pneumothorax is when air continues to enter the pleural space, but can’t escape. The pressure building until the lung completely collapses and compression of the great vessels occurs. This is also a medical emergency and they need to have needle decompression thoracotomy ASAP and then followed by a chest tube. Both interventions are to help the patient breathe but both are vastly different. It is important for the nurse to know the signs and symptoms of both complex disorders so I can quickly intervene if needed.

• Identify strategies for safe nursing practice of the client with multi-system organ failure.
Septic shock is the stage of sepsis when multiple organ dysfunction syndrome with organ failure is evident and poor clotting with uncontrolled bleeding can occur. Safe strategies for safe nursing practice include sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA). To calculate the SOFA score, the following lab values are needed: bilirubin, creatinine, coagulation studies, and arterial blood gases. These lab values are total up and scored from 0 (normal function) to 4 (organ failure). The higher the cumulative score, the greater the patient’s risk. A score 2 or higher in any system indicates an increased risk for organ failure. The qSOFA can quickly alert the need for further assessment for organ dysfunction. Abnormal parameters include: systolic bp equal or less than 100, respiratory rate equal or more than 22 breaths/ min, and any change in mental status (Ignatavicius, 2021). Early detection is a key component of saving lives and nursing assessment plays a critical role in the detection of subtle changes that can occur.

• Prioritize nursing interventions for clients with medical emergencies.
ABC’s is the priority framework but acute can kill faster than chronic. An instructor once said to treat the patient, not the number and to never assume. In triage, there’s a three-tiered system that helps prioritize the client complaints by performing a rapid assessment and determining the acuity of every patient. Emergent- respiratory distress, chest pain, stroke, unstable vital signs. Urgent: severe abdominal pain, Renal colic, displaced fractures, pneumonia in older adults. Non-urgent: skin rashes, Syrians, colds. The triage nurse may begin interventions in the triage area by performing EKGs, drawing blood samples, and sending them to the lab. As everything is going on though, an urgent case can turn into an emergent case so you always need to be checking up on the patient.

• Summarize the nurse’s role and care strategies for clients during disasters.
As nurses, we are primary first responders when it comes to disasters. The role can be from helping triage patients or to work in a facility that has a disaster plan in place. It’s important to know what your specific role is, depending on the facility that you work for. Your nurse manager should give you the details on what is to be done and where you are to show up in the case of an actual emergency. In disasters not only does the nurse treat clients but you need to remember to take care of yourself as well. You can’t help other’s if you, yourself, are hurt. If you’re a nurse who is triaging out in the field of a natural disaster, you need to know what each color represents of the tags and to treat everyone with dignity and respect.

References:
Ignatavicius, D.D., Workman, L.M., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.

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