Table of Contents
A patient should always be initially stabilised for further diagnosis and treatment and the task to clinically stabilise a patient is the accountability of a nurse. In the PEP, the heading of a hypovolemic patient has provided such experience to the nursing students. The study is all about reflective analysis of the entire event and evaluation of the importance of the experience for future career.
As per the introductory section, this study is focused over the analysis and evaluation of the experiences that have been acquired from the PEP. This reflective analysis should be done with the support of Driscoll’s reflective cycle. As per the viewpoint of Snowdon (2018), John Discroll has developed a three stepped model which includes the sections like what, so what and now what helps in systematic analysis of a personal experience. The process of logical thinking in the course of analysis of an experience is also guided by Driscoll’s model.
In this section, the detailed description of the event is needed to be mentioned. A 78 years’ old female patient has arrived with pain in her abdomen. It has been identified that the patient has no strength to walk and has been assisted by her husband to get into the ward. As per the report of her husband, the patient has fallen in the morning and has been found unconscious. Ithas been examined by the registered nurse that there was no thrashing or injury in the head of the patient. The patient has not taken any food or liquids since this morning and is showing disorientation in her speech. With further communication with the husband of the patient, it has been identified that the patient has clinical complications of hypothyroidism for the last 5 years and she has to take Thyronorm 75mg regularly and the patient is obese. In the last month she was diagnosed with high blood sugar, and the endocrinologist of the patient has prescribed furosemide and last 1 week the patient is regularly taking the medicine. Additionally metformin has also been prescribed for regular administration in the long term. The initial check up has been done which indicates that the patient has low blood pressure. The value of the BP of the patient is about 90/50 and has poor capillary refill as well. The cardiac rate of the patient is about 120 bpm. The respiratory rate of the patient is 24 RR and shallow as well. After analysing the signs and symptoms and the medical history of the patient, the registered nurse has mentone that thepstit has hypovolemic shock which needs to be treated with fluid resuscitation.
This is the second stage, that is, the statue of analysis of the entire experience that has been gathered in the PEP. As per the idea of Standl et al. (2018), hypovolemic shock is the condition when the quantity of body fluid suddenly drops and drives the patient towards deterioration. The medical literature regarding hypovolemic shock has mentioned it as one of the most dangerous critical conditions which demands initial stabilisation of the patient. The same thing has been noticed for the mentioned patient. The patient has been identified with shallow and frequent breadth and high cardiac rate which is a highly dangerous clinical condition. The capillary refill has also been identified for the patient. As per the viewpoint of Goucher et al. (2019), poor capillary refill indicates poor peripheral perfusion and the shock of dehydration. Hence, the skill of analysis of sigh and symptoms of a patient is crucially important in order to manage the critical condition of the same.
The skill of critical thinking is highly important for the course nursing. As per the idea of Pitt et al. (2015) in the case of both enrolled and registered nurses, the application of critical thinking skill. The implementation of critical thinking skill helps in the process of diagnosis and in the identification of the root cause and ways out of the clinical issue of patients. In this case, it has been noted that the patient has to take furosemide as per the instruction of her doctor. Oh and Han (2015) has research and mentioned that furosemide is a diuretic drug and used in the first line therapy and is identified as loop diuretic. The patient is obese which has been noted by the doctor and this is the main reason for the administration of diuretic drugs along with the medicine for hyperglycaemia. As per the research of ter Maaten et al. (2017), diuretic drugs trigger renal clearance of excess fluid from the body .On the contrary, Sharma et al. (2017) has further stated that prolonged and repeated administration of diuretic molecules drives the patient towards hypovolemic shock with the real loss. The loss of fluid and salt takes place for osmotic diuresis therapy and this triggers the loss of sodium and volume through renal output. This idea has been analysed with the application of critical thinking and the decision of fluid resuscitation has been taken on the basis of this critical thinking.
On the other hand, the skill of communication is needed to be developed, in order to be efficient in the process of caregiving. As per the idea of Joo et al. (2015), communication with patients, doctors, peer nurses and the patient associates is the principal task of the caregiver.in this case also, the caregivers have to communicate with the husband of the patient regarding the medical history and regular medication of the patient. Hence, from this angle, it can be mentioned that the communication skill of the caregiver promotes the process of diagnosis of the clinical issue of the patient and the root cause tagged with the same. The clinical intervention is always taken on the basis of that investigation.
After the experience of the management of such a patient with acute hypovolemic shock, it can be mentioned that this experience will certainly help the nursing students in their future career. It has been identified that the critical thinking skill and communication skill have direct implementation in the process of caregiving. Identification of hypovolemic shock and the cause behind such condition (administration of diuretic drug) is the result of the communication skill and critical thinking ability of the registered nurse. NMBA (Nursing and Midwifery Board of Australia) has also prioritised the role of critical thinking in the career of registered and enrolled nurses. As per the NMBA standard-1.1, it has been instructed to access the best available evidence and analyse the same critically to enhance the quality of nursing (Nursing and Midwifery Board Aphra, 2017). In the process of access to the best evidence and information communication has a dominant role. The aspect of communication has further been emphasised with the help of Standard-5. NMBA Standard 1.2 has helped in the promotion and implementation of reflective thinking and knowledge into action. With this PEP experience, the importance of reflective thinking has also been conceptualised by the participants.
Patient management demands the application of interdisciplinary skill and this is the first fact that has been conceptualised with the experience of hypovolemic patient management during PEP. The application of critical thinking skill and decision making ability that has been identified through reflective practice will help the participants in their future nursing career.
Goucher, T.K., Hartzell, A.M., Seales, T.S., Anmuth, A.S., Zanghi, B.M. and Otto, C.M., 2019. Evaluation of skin turgor and capillary refill time as predictors of dehydration in exercising dogs. American journal of veterinary research, 80(2), pp.123-128.
Joo, G.E., Sohng, K.Y. and Kim, H.J., 2015. Effects of a standardized patient simulation program for nursing students on nursing competence, communication skill, self-efficacy and critical thinking ability for blood transfusion. Journal of Korean Academy of Fundamentals of Nursing, 22(1), pp.49-58.
Nursing and Midwifery Board Aphra, 2017, Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Oh, S.W. and Han, S.Y., 2015. Loop diuretics in clinical practice. Electrolytes & Blood Pressure, 13(1), pp.17-21.
Pitt, V., Powis, D., Levett-Jones, T. and Hunter, S., 2015. The influence of critical thinking skills on performance and progression in a pre-registration nursing program. Nurse education today, 35(1), pp.125-131.
Sharma, S., Patel, S. and Mina, B., 2017. Canagliflozin Use Leading To Hypovolemic Shock. In B56. CRITICAL CARE CASE REPORTS: ICU TOXICOLOGY (pp. A3781-A3781). American Thoracic Society.
Snowdon, K., 2018. Humour in reflective practice. Journal of Paramedic Practice, 10(4), pp.144-146.
Standl, T., Annecke, T., Cascorbi, I., Heller, A.R., Sabashnikov, A. and Teske, W., 2018. The nomenclature, definition and distinction of types of shock. Deutsches Ärzteblatt International, 115(45), p.757.
ter Maaten, J.M., Rao, V.S., Hanberg, J.S., Perry Wilson, F., Bellumkonda, L., Assefa, M., Sam Broughton, J., D'Ambrosi, J., Wilson Tang, W.H., Damman, K. and Voors, A.A., 2017. Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure. European journal of heart failure, 19(8), pp.1014-1022.
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