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Student will utilize principles of nursing informatics to document a patient experience.
Student will utilize reliable informatics to develop a plan of care for a patient with chronic kidney disease and hemodialysis.
Student will provide safe medication administration.
Student will discuss the nurse’s role in end of life decisions.
Harold Shoemaker is a 91-year old male who is on a medical floor for treatment of anemia secondary to chronic kidney failure. Currently he has been managed at the nursing home. During dialysis today, he was noted to have a hemoglobin of 7.0 and hematocrit of 20% and was admitted for a blood transfusion.
DocuCare Activity/Assignment Prep:Review the Clinical Decision Support Tool (Green Lippincott Advisor links) provided throughout your patient’s chart:
Renal failure, chronic
Hemodialysis, arteriovenous access
Blood and blood product transfusion
Ferrous sulfate
Epoetin alfa
Hinkle, J. & Cheever, K., Management of patients with kidney disorders. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia, PA.: Wolters Kluwer.
Review Harold Shoemaker's chart including Patient Information, Notes, Vital Signs, and Orders
Activities/Assignments:
Part One: Clinical Judgment Activity EST TIME: 60 MIN
Assignment 1.1:
Review Mr. Shoemaker’s chart and answer the following questions in the Notes section>Nursing Note-Progress Note.
What concerns you? (Recognize Cues/Assessing)
Which assessment findings are consistent with Mr. Shoemaker having the following disease and condition? (Analyze Cues/Diagnosing)
Anemia:
chronic renal failure:
Which issue is most concerning at this time? (Prioritize Hypotheses/Planning)
Assignment 1.2:
Review the chart and determine if it is safe to administer the blood transfusion. If it is safe, document the steps you would take to administer the blood transfusion safely in Notes>Nursing Notes>Other
If it is not safe, document the rationale for your decision in Notes. Add yourself as a new provider, choose Nursing-event.
Part Two: Clinical Judgment Activity EST TIME: 60 min
Review Mr. Shoemaker’s orders and medication administration record.
Assignment 2.1:
Determine which medications are appropriate to administer and document administration using the MAR. Include rationale in the “Administration Notes” area OR If you do not choose to administer the medication, document non-administration and provide rationale in the “Administration Notes” area of the MAR.
Part Three: Clinical Judgment Activity EST TIME: 30 MIN
Mr. Shoemaker, asks you to sit down and talk to him.
Harold: “I’m tired of having hemodialysis. This is too hard. I feel awful before I go in and awful when it’s done. I only have one or two days a week that I feel okay. My wife is already gone and I don’t want to be alone anymore. What can we do?”
Nurse: “I’m listening, Mr. Shoemaker. Have you talked about this with anyone else?”
Harold: “No, I tried asking the doctor if there was any other choice, but he said all there is, is hemodialysis. I’m 91 years old. I’ve had a good life. I’ve finished what I needed to do.”
Nurse: “I understand Mr. Shoemaker. I want you to have all the information you need to make the best decisions. I am going to call the team and let them know what you told me, if that’s okay with you?”
Harold: “Yes, please”
You report your conversation to Dr. Myers, Mr. Shoemaker’s healthcare provider. Dr. Myers orders a hospice consult and a team meeting with Mr. Shoemaker.
Assignment 3.1:
Add End-of-life care, long-term care Orders>Add New Non-Medication Order for reference. Develop a care plan to meet Mr. Shoemaker’s wishes. Include the following:
Priority nursing diagnosis/patient problem
Patient centered and measurable expected outcome
Include rationale and how you would evaluate the interventions
How did you feel while completing this assignment?
What were your management priorities while caring for Mr. Shoemaker?
Do you feel hospice care is appropriate? Why or why not?
How would teamwork improve care for Mr. Shoemaker?
How will this experience affect your nursing care in the future?
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