Explain the validity of identifying patient problems based on the data collected but also on your “gut feeling.” Give an example of this from your practice.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Peer discussion # 1
The type of clinical judgment I use in my work is to perform a focused assessment first to make sure there are no complications from surgery. I work with a lot of spine fusion and laminectomy patients so assessing their neurological and peripheral vascular exams is the most important. Once circulation, pulse, sensation, and movement of the extremities have been established, I complete the rest of the physical assessment and auscultation of the lungs, heart, and bowels. The day after surgery, the patient will work with physical and occupational therapy on how to begin to get back to normal functional status. The nurse’s role is to continue those therapy tips throughout the rest of the shift, encourage the patient to be as independent as possible, and provide nonpharmacological pain control methods the patient can use for intermediate pain control. One of the best methods of nonpharmacological pain control is positioning (Bayoumi, et al., 2021). Ice and heat therapy is also a commonly used nonpharmacological pain control method in my unit. Propping the patient on their side with pillows, a pillow between their legs, and ice packs along their back seems to be a favorite among my patients. Even though a lot of my patients are spinal surgery patients, they cannot be treated in a “one size fits all” kind of manner. The other day I had a spinal fusion patient, he had a JP drain in his back that wasn’t putting anything out so the doctors removed it and as soon as they did, he started seeping blood from the bottoms of his incision, I changed that dressing 6 times during my shift. Finally, the doctors admitted the drain was in the wrong place (to me, not the patient) and they placed a stitch between the staples and the bleeding stopped. So every post-surgical patient is different from the next and it’s important to treat the patient as an individual.
Peer discussion #2-
During my physical assessment, I begin to identify abnormal findings, or finding that is most significant. Additionally, I distinguish relevant information from non-relevant information and ensure that I am identifying information that may need additional follow-up. Then I compare the data that I collected with my patient’s current problem or diagnosis. This helps me identify findings that would be expected– or those that coincide with my patient’s condition. Once I understand my patient’s condition, I start to identify all the potential problems that my patient may experience due to their condition. From there, I will analyze interventions for each potential problem that might arise, these interventions would then be ordered by level of priority.
I often utilize the Quick Priority Assessment (QPA) during my daily patient rounds. The QPA is condensed, focused, and prioritized assessment that focuses on highlighting the most important information from an assessment and will help you quickly flag existing problems and patient risks. The information gained from a QPA will play a part in all aspects of care, including how you move forward with your assessment (Alfaro-LeFevre, 2013).
One of the first things I would assess in a QPA is the patient’s risk for infection, injury, or violence. Safety is the most important priority when it comes to patient care and should always be considered above all else. Immediately following my quick safety assessment, I will identify risks for patient infection or the transmission of infections between my patient and myself, or vice versus, and between my patient and others or vice versus. Next, I assess my patient’s vital signs as well as barriers that would impact my patient’s ability to breathe, communicate, or be comfortable. Risks for problems in these areas need to be addressed early because any alteration in either area may indicate additional concerns or issues in other areas. Then I address my patients’ allergies, all medication that they are currently taking or treatments they are undergoing, my patient’s admission diagnosis, current and past medical problems es and current and past nursing issues; this will highlight all known problems and or risks; this will also contribute to the forming clinical judgment regarding nursing actions or interventions that I may decide to initiate.
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