Nursing Informatics
Assignment
Foundation of Knowledge: Case Study Application
Read the case study presented below. Copy and respond to the questions at the end of the scenario in a Word document. Responses should be thorough and relate to your assigned readings for this lesson.
Sadia M. is a registered nurse working on a cardiac unit in a local hospital. During morning report, she is told that one of her patients, Mr. H, had a restless night with some intermittent complaints of dyspnea for which he received IV Lasix with good response. His vital signs prior to report were stable at BP 123/75, HR 70 with 100% pacing on telemetry, RR 18, and SpO2 96% on 2LNC. A quick review of his chart revealed his admitting diagnosis was new onset CHF, that improved in ICU prior to transfer to the floor. He has a history of dilated cardiomyopathy, hypertension, chronic anemia, coronary artery disease, and prostate cancer. He has a dual chamber pacemaker. Upon completion of her review, Sadia decided to assess Mr. H. before her other patients.
Upon entering the room, she noted the patient was pale and dyspneic, with respirations of approximately 34 bpm. His breath sounds were coarse, with rales 1/2 way up bilaterally in both anterior and posterior lobes. Lips were dry with a pale grayish hue. Skin turgor was poor. Telemetry showed 100% paced rhythm. Sadia obtained a new set of vital signs, noting that they were stable except for his respiratory rate and oxygen levels were at 98% despite his presenting symptoms and appearance. When asked how he felt, Mr. H said he was tired and a bit short of breath, but denied any chest pain. Sadia identified that her patient had an ineffective breathing pattern, potential for decreased cardiac output and decreased tissue perfusion, and some impaired gas exchange. She noted he was not in immediate danger of respiratory failure or cardiac arrest, but felt that his symptoms warranted further evaluation and that another dose of Lasix might not be enough to cause significant improvement. Upon notifying his assigned hospitalist and discussing her findings, she quickly received computerized orders and was told the hospitalist would arrive soon. Per orders, Sadia pushed Lasix 40mg, notified the lab of the required stat blood work, and contacted RT to obtain arterial blood gases and provide a nebulizer treatment. When the hospitalist arrive, Sadia informed him that there was little change in the patient and he had had minimal urine output in the catheter bag. Lab indicated Mr. H’s cardiac enzymes were negative, he had a low hematocrit, high creatinine, and was retaining CO2. The hospitalist ordered a different diuretic that would “wash out” the carbon dioxide in Mr. H’s blood and also help alleviate his pulmonary congestion. Since Sadia had never administered this drug before, she accessed the hospital’s intranet drug database to review the nursing implications.
Over the last hour of the shift, Mr. H’s condition improved. His respiratory rate stabilized and his breathing pattern became non-labored. Oxygen saturation remained at 98%. He diuresed almost a liter of fluid over the first hour after administration of the new diuretic. During report, Sadia explained all that had happened to Mr. H’s oncoming nurse. He was a new graduate, so together they agreed on close monitoring and an additional set of labs to ensure that Mr. H’s potassium level didn’t drop after the large diuresis. The nurse also stated he wanted to look up the new diuretic to become familiar with it in case the patient needed an additional dose.
Essay Questions:
1.Define data and information and explain what data and information Sadia uses to deliver appropriate care to her patient?
2.Explain the difference between knowledge and wisdom and describe how Sadia uses knowledge and wisdom to direct the care of her patient?
3.In this scenario what activities did Sadia participate in to build her foundation of knowledge?
4.How did Sadia demonstrate dissemination of knowledge to other members of the healthcare team?
