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Interdisciplinary Care
REQUIREMENTS: THE FOLLOWING ELEMENTS MUST BE INCLUDED IN THE PAPER
Background Information Summary:
Demographics
History of present illness
Relevant past medical and surgical history
Admitting diagnosis (diagnoses)
Course of current hospitalization to date
Significant assessment findings during day(s) of care. Include vital signs, focused assessment, and data from monitoring devices. (This information can be presented in a table).
Laboratory and Diagnostic Tests
Identify and list a summary of relevant and significant lab values and diagnostic tests/procedures performed. Include the rationales for performing the tests and for any abnormal results. Provide an analysis of the relationships between/among the diagnostic tests and lab results with the critically‐ill individual’s current condition(s).
Chamberlain College of Nursing NR340 Critical Care Nursing
NR340 RUA Interdisciplinary Care.docx Revised
Medications
Identify and list a summary of relevant and significant medications. Indicate the trade name and generic name, the medication classification, the therapeutic use, major adverse effects, timing, dosage, route of administration, and the nursing implications. Also include the rationale(s) as to why the medication is prescribed for treatment. For example, document the rationale for how the treatment corrects the critically‐ill individual’s condition or a side effect of another drug that is prescribed for treatment. *This information can be presented in a table.
Nursing Diagnoses
In order of priority, identify three (3) nursing diagnoses for the individualized plan of care for this patient. Two of the nursing diagnoses must address actual problems, and one of the nursing diagnoses must be a “Risk for” or “Potential Complication” (PC). For each nursing diagnosis, include three (3) nursing outcomes, three (3) nursing interventions, and three (3) collaborative interventions. *This section can be presented as a table or concept map.
Interventions ‐ ROUTINE NURSING MANAGEMENT
Describe independent nursing care you provided in the care of the critically‐ill individual.
Examples include, but are not limited to: activity level, position, ongoing monitoring, and nutrition (prescribed diet, tube feedings/TPN, formula, rate, and calculation of basal energy expenditure (BEE), patient education, wound care etc.). The rationale must be included for each intervention.
Interdisciplinary (ID) Care
Collaborative Management
Identify the members of the interdisciplinary team caring for the critically‐ill individual. Provide a brief description of their roles and responsibilities. Interdisciplinary team members include, but are not limited to: physician, pharmacist, lab/diagnostic tests personnel, respiratory therapy, physical therapy, occupational therapy, speech therapy, social work/case management, pastoral care, ethicist, etc.
Therapeutic Modalities
Describe the various therapeutic modalities used in the management of care for the critically‐ill individual. Discuss the extent of the nurse’s responsibilities and skills required to manage the therapeutic modality in comparison to the responsibilities of the members of the interdisciplinary team. Therapeutic modalities include but are not limited to: oxygen therapy (mode, FiO2,), dialysis/CRRT (settings), ventilator therapy (mode of ventilation, settings, FiO2).
The rationale must be included for each modality.
Nursing Role Reflection
Provide a brief summary of how your role interacted with the members of the interdisciplinary team. Include in your summary
Analysis of communication style preferences among interdisciplinary team members and with the critically‐ill individual and family members. What is the impact of your own communication style on others?
System barriers and facilitators. Did the organizational framework for interdisciplinary management of care facilitate or hindered the quality of care/outcomes for the critically‐ill individual? What recommendations can you make to the organizational system for enhancing
Chamberlain College of Nursing NR340 Critical Care Nursing
NR340 RUA Interdisciplinary Care.docx Revised interdisciplinary collaboration? Provide at minimum two (2) evidence‐based literature sources to support your recommendations.
Professional Development. Based on your experience(s), write ideas for your own professional self‐development plan to enhance your potential for becoming an effective member in an interdisciplinary team.
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Interdisciplinary Care
Background Information Summary
The patient is a male who is 43 years old. He has a medical history of medical noncompliance, severe hypertension, heart failure, and hemorrhagic stroke. The stroke manifests itself with memory loss. The patient’s past medical history was presented to the Carolinas Medical Center Emergency Department through the emergency medical services. The past medical history of the patient can be a leading cause of the patient’s present illness. The patient also complained about several things. The first was he had a mild headache that worsened with time. He also vomited a lot. Subsequently, the patient was found unconscious in the bathroom of his home. After he was tested for blood sugar, it was discovered that it was normal and he had marked hypertension. The patient also had obstructive hydrocephalus and he was emergently incubated for persistent GCS 3 on arrival. EVD was also placed on the patient.
In addition to that, either a hemorrhagic stroke can be a brain aneurysm or it can be a leak on the weakened blood vessel. If the blood spills in or around the brain, a swelling is created, the pressure is exerted, and the tissue and cells in the brain are damaged. There are two types of hemorrhagic stroke, subarachnoid and intracerebral. The patient’s hemorrhagic stroke is intracerebral. Moreover, some of the ICU diagnosis that was discovered in the patient includes the use of ETOH (Ethyl alcohol) which is mainly found in alcoholic beverages, acute hypertension, acute encephalopathy, hypoactive Delirium, Fever, Acute Kidney Injury (AKI), Right Thalamic ICH with an IVH in the large volume. Within the first 24 hours, the Tmax was 99.9. Tmax is used to refer to the time after a drug has been administered when there is a maximum plasma concentration that has been reached when the absorption rate is equal to the elimination rate. The EVD was 260ml and it was raised to more than 10cm of water.
Laboratory and Diagnostic Tests
Several laboratory and diagnostic tests were done on the patient. The first tests were based on physical examination. The general tests involved the patient opening his eyes to verbal stimuli to test for hypersomnolence. The patient was also to interact appropriately and answer all the questions that the medical practitioners asked. He was also to ensure that he had no acute distress and he was to stay awake. His eyes were tested and it was discovered that he had PER, a conjugate gaze, his conjuctiva was clear and he had a poor convergence. His Hent was also tested and it was discovered that he had head normocephalic, he had a positive and active EVD draining and his mucous membrane was moist. Moreover, his cardiac was also tested and his heart had a regular rate and rhythm and it was normal S1 and S2. It also had a normal peripheral perfusion and there was no low extremity edema.
Additionally, his respiration rate was tested. There was no accessory muscle usage. The abdomen was also tested and it was discovered that it was nontender, soft, nondistended and its bowel sounds were active. The physical examination also entailed testing of genitourinary which was not performing and the neuro-mental status was tested to show that he was hypersomnolent to show that the verbal stimuli had been awakened and he was oriented to one place and person only. The naming unimpaired was also tested and the memory had delayed with recall. His cranial nerves were also tested and it showed that they had II-XII gross intact on the visual inspections. However, it was discovered that the motor examination was limited to the patient’s mentation and it was discovered that the left side was weaker than the right side. This was mainly noted through the abduction of the shoulder and hip flexion. The sensory was also tested and it was grossly intact to light touch.
Medications
The patient was given some medication when he was admitted to the hospital and he was given pothers to take while at home while admitted, he was given 0- Potassium, and Magnesium Replacement Protocol. He was also given Miscellaneo, which he was to take daily, Acetaminophen Tablet 650mg that only has 2 tablets. Moreover, he was given Amlodipine 10mg and he was to take 1 tablet daily, carvedilol 25 mg and he was to take 2 tablets orally two times a day, Dextrose which was 50% injection and he was to take 12.5gm, 25ml, IV PUSH PRN. As an inpatient, he was also given PRN Flomax 0.4mg where he was to take 1 capsule daily orally after breakfast, Hydralazine 100mg and he was to take 2 tablets Orally three times a day and Hydralazine 10mg. The patient was also given an Influenza Virus Vaccine, which was 0.5ml, and the vaccine was intramuscular, Labetalol 10mg with 2L and Ondanstron 4mg, 2ml.
Additionally, when the patient was to go home, he was prescribed some medications. He was given Amlodipine oral tablets 10mg and he was to take one tablet daily three times. He was also given Atrovastatine oral drugs 20mg which he was to take 3 times a day, Carvedilol 25mg oral tablet 3 times a day and Fluticasone 50mcg/inh nasal spray 4 tablets daily and Hydralazine 100 mg oral tablet. He was also given Losartan 100mg oral tablet to help lower his blood pressure and he was to take the drug once daily. The patient was also prescribed with Olopatadine 0.1% ophthalmic solution and Tradamol oral tablets, which were 50mg, which he would take one tablet a day.
Nursing Diagnoses
The nurse discovered that the 45- year- old male with a large volume right basal ganglia hemorrhage with intraventricular extension. His status post had EVD placement that had intrathecal TPA administration. It was also discovered that the patient had a significant functional deficit. The deficit would warrant the ongoing rehabilitation but it still remained to be medically unstable. Moreover, the pending appropriate administrative process was of great benefit to the patient from being an inpatient to an outpatient. This was done once the patient was cleared by the main team. It was also discovered that the patient needed an ongoing assessment in a bid to determine the appropriateness of the inpatient rehabilitation as his medical and function courses progress.
The nursing diagnoses also included neurostimulation. If the patient remained to be hypoarousable during the therapies the patient underwent during the day when EVD was discontinued, it was evident that the patient was eligible to become a candidate for the neuroticism agents. The patient was also in a lot of distress, which had been caused by his unresponsiveness. There was also a return of blood gas, which was not significant in explaining the patient’s medical history. In a bid to ensure that I made good decisions on the case of my patient, I had to consult in neurosurgery and critical care and it was found out that the patient had EVD, which had been placed at the bedside of the neurosurgery. When there was an extensive discussion with the family and the medical practitioners, there was a need to admit the patient in the Intensive Care Unit (ICU). This was to help in the continued evaluation of his neurology and any intervention in the pending patient’s change in his intervention in the future. Due to this reason, the patient’s systolic blood pressure transferred and it was between 150s- 160s during the period of transfer.
Interventions
As a nurse, I integrated both specialized expertise and knowledge as I used dynamic surveillance in a bid to try to identify problems that trigger the nursing actions. This is mainly done to manage the signs and symptoms of a patient. The first intervention is cooperate care. This is described as a form of apprenticeship and a guided participation. Using this intervention, the nurses guide, support and challenge the lay individuals for the purpose of participating in the skilled activities until there is a transfer of responsibilities to these individuals (Kusi, Dahlke & Stahlke, 2018). I also used independent nursing interventions. These are the interventions that are sanctioned by the Professional Nurse Practice Act. Such interventions do not need any direction or order from another health care professional. In the same way, I also intervened through performing skilled nursing procedures. I did the nursing procedures using my knowledge and skills in a way that will benefit the patient’s health at the long last.
I also did ongoing monitoring to the patients. I always put my patients first before anything else. Due to this reason, I constantly went to see my patients ensure that they were doing well. The main aim of this was to make sure that their health was not deteriorating in my absences and it was also a way to help me know where I was in my career, what I had done, what I expected and what would later happen. As a way of monitoring the patients, I administered both advanced and general nursing care (Kusi, Dahlke & Stahlke, 2018). This helped me to care for the patients effectively and it also helped me to gain more knowledge about how patients with different critical illnesses were to be treated. I also learned to prescribe a diet to the patients in a bid to help them get better.
Interdisciplinary Care
Several members make up the interdisciplinary team. Their main function is to care for the people who are critically ill. The first individual is a clinical nurse specialist who is registered and has additional training as a nurse at either the masters or doctoral level. The main aim of the specialist is for them to provide direct care to the patients and improve the patient’s outcomes through training, research and showing improvements in healthcare delivery (Reiter-Palmon, Kennel, Allen & Jones, 2018). Other members of the team include registered dietitian who will help educate the patients on good nutrition and an audiologist who is registered and plays the role of providing hearing health to the patients and evaluate both the hearing and balance problems using vestibular assessments as well as a specialized auditory. The team also includes a physician assistant. This individual works alongside a physician to help him in the treatment and diagnoses of an illness.
Several therapeutic modalities could be used in the management of critically- ill patients. The first modality is Iontophoresis. It is described as a form of E- Stim that is used in the administration of medication. There are electric currents that help push topical drugs via the skim into the bloodstream. This helps in reducing inflammation and even muscle spasms through the act of breaking up the mineral deposits. The other modality is Transcutaneous Electrical Nerve Stimulation, which helps in the management of both acute and chronic pain. A nurses responsibilities work to the extent that he manages the therapeutic modality and he works together with other medical practitioners in a bid to ensure that the patients recover well. The nurses also have the responsibility of putting the lives of the patients before their own lives (Yellowitz, 2016). Due to this reason, the nurses should always show care and support to the patients and they should also treat them properly.
Nursing Role Reflection
My role as a nurse helped me to interact with the members of the interdisciplinary team effectively. The interdisciplinary team prefers a direct and clear communication style. They prefer the nurse to always give a clear explanation of the patient to their family members and what decisions the family has to make. In the same context, the communication styles of the nurse should also be open since I did not hide any information about the patient from their relatives. This clearly showed them the patient’s situation and from them, they had to make decisions on the way forward in ensuring that the patient is treated effectively. The impact of my own communication style to others was that there was no situation where the patient’s family did not know the patient’s health condition. The style was also critical since it helped the family and loved ones to know the patient’s condition clearly and I also gave them the options we had as medical practitioners for the patient to become healthy and they had to consent.
In addition to that, it is factual that the organizational framework of the interdisciplinary management did not hinder the quality of care or outcomes for an individual who is critically- ill. At times, there were system barriers and the facilitators did not carry out their roles effectively within the hospital. However, when such a situation arose, the interdisciplinary team came up with a way of ensuring that the hospital’s normal programs were up and running. I think that the organization can hire more facilitators to ensure that the patients are well taken care of and they can give hire more healthcare practitioners to take care of the patients. In a bid for me to develop professionally, I will ensure that I communicate with my patients in a clear manner and I will always be caring to the patient and ensure that I offer them the best services.
References
Kusi, A. E., Dahlke, S., & Stahlke, S. (2018). Nursing care providers’ perceptions on their role contributions in patient care: An integrative review. Journal of Clinical Nursing, 27(21/22), 3830–3845. https://doi.org/10.1111/jocn.14534
Reiter-Palmon, R., Kennel, V., Allen, J., & Jones, K. J. (2018). Good Catch! Using Interdisciplinary Teams and Team Reflexivity to Improve Patient Safety. Group & Organization Management, 43(3), 414–439. https://doi.org/10.1177/1059601118768163
Yellowitz, J. A. (2016). Building the Ideal Interdisciplinary Team to Address Oral Health. Generations, 40(3), 60–65. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=119134603&site=ehost-live
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