Nursing Skill Analysis - Essay Example

? Case Study (Skill Analysis) The essay aims to address a two-fold objective to wit to demonstrate an understanding of wound management and causative factors in wound breakdown; and (2) to demonstrate an understanding of safe and effective nursing practice. Case Study (Skill Analysis) Introduction Emerging changes in today’s healthcare system has broadened the expertise and clinical responsibilities of nurses, one of which is the management of wound breakdown (Dunk & Taylor, 2009, p. 5). Understanding wound management and breakdown requires an accurate and comprehensive wound assessment as well as understanding the physiology of wound healing. Sophie Smith is a 44-year-old female who is two days post-operative, following an appendectomy. Sophie works as a real estate agent, weighs 46kgs and 168cm tall. Sophie has a story of rheumatoid arthritis and takes 10mg of prednisone daily and also has an allergy to penicillin. While changing her dressing you notice a thick yellow discharge oozing from the wound. Wound management following an appendectomy is essential for the complete recovery of Sophie. A comprehensive assessment of the present state of the wound is necessary as well as the stage of healing. Thus, it is important to obtain information from the client about factors that may affect wound healing. Consent is necessary so that nursing procedures can be carried out and prioritized according to the patient’s needs. The nurse’s role in wound management is critical not only to wound management but to maintenance of aseptic technique while doing nursing care. Identify and discuss the importance of obtaining information during a nursing admission in relation to post-operative assessment.The process of obtaining and communicating information during a nursing admission also refers to the nursing assessment and these can be obtained from the client, significant others, health team members, and client’s medical records (Funnell, Koutoukidis& Lawrence, 2009, p. 229). Obtaining information during a nursing admission is important in identifying areas needing nursing interventions. Obtained information may either be subjective or objective and includes nursing history, physical examination and observation, and laboratory and diagnostic tests. Applying Sophie’s case, obtaining information during a nursing admission requires explanation of the purpose and rationale for gathering information. Sophie must also be put in a quiet and private place for ease of patient during personal information gathering. Information such as medical diagnosis, previous admission to the hospital, client’s perception of condition, allergies, social data, activities of daily living, habits, and use of prosthesis are necessary because obtaining these information during a nursing admission will adjust the plan of care related to post-operative treatment. For instance, Sophie has a history of rheumatoid arthritis, takes 10mg of prednisone daily and has allergy to penicillin.These information has relevance to post-operative treatment as rheumatoid arthritis impairs healing, can cause deformities, and increase pressure on the soft tissues leading to increased risk of skin breakdown. Prednisone is a corticosteroid which also delayed healing by interrupting cellular division (Guo and DiPietro, 2010, p. 219). Sophie has allergy to penicillin and its significance include not giving Sophie penicillin to avoid allergic reactions and tests other antibiotics that will not produce allergic response because antibiotics are essential for wound healing and combatting infection. Identify and discuss the nurse's role in consent procedures for patients undergoing a procedure involving general anesthesia.Surgical and invasive procedures involving administration of general anesthesia requires written consent. Nurses play a major role during consent procedures. Nurses provide the needed information of the individual and make sure that it is well-understood prior to administration of general anesthesia. They are also engaged in providing information about the recovery period, potential benefits and risks, and further clarifications needed regarding what have been discussed between the doctor and the patient. Nurses must act on benefit of the client and must have confidence, knowledge, and debating skills to challenge a medical staff about informed consent when the situation requires. Identify and discuss the purpose of vital sign data in the pre and post-operative period. Vital signs are indicators of the patient’s physiological status. The purpose of taking vital signs before and after an operation is to have a baseline data whether the patient is progressing to recovery or has worsening conditions related to complications. It is essential that nurses monitor vital signs before and after a surgical procedure. Define and identify the purpose of wound assessment. Wound assessment is defined as the written record and picture of the wound utilizing different assessment techniques such as observation, data collection, and evaluation of the wound condition (Baranoski and Ayello, 2008, p. 79). Yates (2009) identified five purposes of wound assessment and these are: to determine extent and severity of the wound, and the risks posed to the patient; to determine the health and nutritional status of patient in relation to the patient’s ability to heal normally without complications; to design and justify a management and documentation plan; to classify wound for clinical, audit, and research purposes; and, to provide a complete and conscise documentation consistent with standards of care and practice (p. 507). Define and identify the purpose of aseptic technique in wound management. Aseptic technique refers to methods or measures designed to completely eradicate germs, infection, and septic matter through the use of forceps and gloves (Gillespie & Fenwick, 2009, p. 85).The main purpose of aseptic technique is to prevent acquisition and transmission of infection. Infection can impede the rate of wound healing thus, application of aseptic technique is considered as the most important and preventable method of bacterial contamination. Identify and discuss four nursing priorities undertaken in relation to aseptic technique within the context of dressing Sophie's wound and support your discussion with evidenced based rationales. There are four nursing priorities for patients like Sophie who underwent an appendectomy procedure. The first priority is the risk for infection. The presence of infection may signal impending complications such as peritonitis. Nursing interventions include placing the client in Fowler’s position to decrease the risk of any contaminated peritoneal fluid infecting the upper abdomen (McCann et al., 2006, p. 63). Dressing is also regularly checked for drainage and changes using aseptic technique. The danger of having peritonitis is imminent most especially if aseptic techniques were not employed. Patients are observed for sign of peritonitis such as fever, wound drainage, and other signs of infection. The second priority is acute pain related to surgical incision and infectious process. Nursing interventions depend upon the related factors. Pain related to infectious process is geared toward prevention and elimination of infection. However, pain related to surgical incision differs in nursing management. Medication such as analgesics was given in order to alleviate pain, discomfort, and anxiety (McCann et al., 2006, p. 63). Surgical incision pain must decrease within a 24-hour period because continuous presence of pain may signal impending peritonitis. The third nursing priority is deficient fluid volume. This can be attributed to the temporary cessation of oral fluid intake related to appendectomy. Nursing interventions are geared toward monitoring vital signs and urine output of 30mL per hour, and making sure that no signs of dehydration are present because good hydration status are necessary to speed up the rate of wound healing (McCann et al., 2006, p. 63). The fourth nursing priority is knowledge deficit. Sophie needs recovery and home care instructions following an appendectomy. Undergoing a surgical procedure is a traumatic experience for the patient. Giving information will help alleviate their worries and correct misconception. Nursing interventions include instructing the patient to watch for signs of infection after discharge to prevent further complications, teaching the patient wound care to enable independent care, instructing the patient to resume normal activities after 8-10 days to ease anxiety related to inability to perform activities of daily living, and encouraging the patient for a follow-up visit to monitor healing and detect complications (McCann et al., 2006, p. 64). Describe two causative factors of wound breakdown in relation to the case study.Impaired tissue integrity and wound breakdown occurs due to the presence of intrinsic, extrinsic, and iatrogenic factors. Intrinsic factors are related to medical status and include age, presence of chronic disease, perfusion and oxygenation, immunosuppression, and neurologically-impaired skin. Extrinsic factors are related to the environment and include medications, nutrition, irradiation and chemotherapy, psycho-physiologic stress, and wound bio-burden and infection. The iatrogenic factors are related to wound management and include local ischemia, inappropriate wound care, trauma, and wound extent and duration (Sussman, 2007, p. 43). In Sophie’s case, two of the causes of skin breakdown are immunosupression and medications. Sophie has rheumatoid arthritis and persons with rheumatoid arthritis are immunosupressed. The likelihood of increased wound breakdown is relatively high because immunosupression impedes and prevent any inflammatory response and affects all phases of wound healing and recovery ( (Sussman, 2007, p. 44). The other causative factor is medications. Nursing assessment revealed that Sophie is taking 10mg of Prednisone daily. Prednisone is a steroid used to treat inflammatory disorders such as rheumatoid arthritis. Steroids delay all phases of wound repair by inhibiting macrophage levels, reducing immunocompetent lymphocytes, decreasing antibody production, and diminishing antigen processing (Sussman, 2007, p. 45). Thus, prednisone has made Sophie’s post-operative wound at risk for tissue or wound breakdown. Conclusion Nurses are primarily responsible for wound management and prevention of wound breakdown. A comprehensive assessment of the patient and the wound condition is necessary in understanding the process of wound healing. The case focused on Sophie Smith who had an appendectomy. General information was taken in order to determine factors that may affect healing and adjust nursing care according to patient’s condition. In line with nursing assessment is the nurse’s role in consent procedure, particularly when a patient underwent a surgical procedure under general anesthesia. The main rule is that nurses act as patient advocates and provide the needed information by the patient. Nursing assessment also includes getting vital signs before and after a surgical procedure in order to have a baseline data of the physiological status of the patient. Nurses also perform wound assessment to determine extent and severity of the wound, and the risks posed to the patient, to determine the health and nutritional status of patient in relation to the patient’s ability to heal normally without complications, to design and justify a management and documentation plan, to classify wound for clinical, audit, and research purposes and, to provide a complete and concise documentation consistent with standards of care and practice. Implementation of care during wound management involves aseptic technique to prevent bacterial contamination and prevention of infection. Nurses are responsible for ensuring that aseptic techniques are employed at all times in order to promote wound healing. Nursing priorities for patient who underwent appendectomy includes prevention of infection, decreasing pain, ensuring enough fluid volume, and giving health education. Nursing interventions are geared towards these priorities in order to prevent further complications and promote wound healing. However, factors such as intrinsic, extrinsic, and iatrogenic factors may contribute to wound breakdown and nurses play an important role in managing these factors to aid in wound healing and patient’s wellness. References: Baranoski, S. and Ayello, E.A. (2008). Wound Assessment. Wound Care Essentials: Practice Principles (2nd ed.) (p. 77-92). Philadelphia: Lippincott Williams & Wilkins. Dunk, A.M. & Taylor, J. (2009 February). A survey of clinicians’ perceptions of, and product choices for, the infected wound. Wound Practice and Research, 17 (1): 5-11. Funnell, R., Koutoukidis, G. & Lawrence, K. (2009). Components of the Nursing Process. Tabbner's Nursing Care: Theory and Practice (5th ed.) (p. 228-236). New South Wales: Elsevier Australia. Gillespie, B.M. & Fenwick, C. (2009 May). Comparison of the two leading approaches to attending wound care dressings.Wound Practice and Research, 17 (2): 84-89. Guo, S. & DiPietro, L.A. (2010 March). Factors Affecting Wound Healing, Journal of Dental Research, 89 (3): 219-229. McCann, J.A. et al. (2006). Appendectomy. Handbook of Medical-surgical Nursing (4th ed.) (p. 62-64).Philadelphia: Lippincott Williams & Wilkins. Sussman, C. (2007). Wound Healing Physiology: Acute and Chronic. Wound Care: A Collaborative Practice Manual for Health Professionals (3rd ed.) (p. 21-51). Philadelphia: Lippincott Williams & Wilkins. Yates, B. (2009). Assessment of the at Risk Foot. Merriman's Assessment of the Lower Limb (3rd ed.) (p. 499-528). Philadelphia: Elsevier Limited. Read More