To Select a Training Census and Patient

To Select a Training Census and Patient

PRACTICE SCENARIO

You are working day shift and your 27 yo ,Mary Lou was admitted to the Ortho unit around 5pm after an MRI revealed a cervical cord mass. She is experiencing weakness, is ataxic and has neck and back pain. Her pain score is a 5 with morphine on board. She is scheduled for a cervical laminectomy tomorrow. She is a single mother and concerned about her 4 and 2 year old children and how she will care for them after surgery.

  1. Select and Save Pathway ( StarPanel)

To select a training census and patient.

  1. Document Pathway Name & Phase (HED)

REMEMBER TO USE HED TRAIN

Notice that the cervical surgery pathway does not have a preop phase so pick the best fit – Day of Surgery since the pt is going for surgery tomorrow.

  1. Create 2-3 Priority Problems (HED) and Define Expected outcomes (long term goals) for each problem
  2. Enter a Nursing Summary and Plan Priorities for the next shift since it is almost shift change time.

It is the beginning of the next Shift……

  1. Review the pathway and the phase. Are any changes needed?
  2. Document expected short term goals for your shift. Be realistic. If it is night shift, you would not want to put SW consult as a goal but adding a goal for “x” of hours of uninterrupted sleep would be appropriate. Could you put in as a goal for night shift to obtain order for SW consult?

It is the end of your shift.

Mary Lou has received adequate pain control and reported pain scores of 4 or less all shift. She has not fallen. Her parents are driving in from out of town to help with her care and to take care of the children. She verbalized increased fears re: nature of the mass and required Ativan to assist with anxiety and fear in order to sleep. She is scheduled for 10 am surgery and has yet to sign her consent or have anesthesia consult.

  1. Document on the short term goal outcomes as well as a Nursing Summary and plan priorities for the next shift.

Mary Lou is 3 days post op and being discharged. The neck mass was benign and her fear problem is resolved but she is still requiring Lortab to manage her pain. The surgeons have said she should be able to transition to Motrin for pain in 7-10 days.

8. Document on her outstanding problem and discharge plans.

Your pain problems needs to be addressed but it is NOT met yet.

Other considerations:

  1. On day shift, you are very focused on helping a patient increase activity tolerance and have ambulation goals. On night shift, there is a real priority for the patient to get adequate rest and sleep so that he is able to fully participate in therapy during the day.
  2. Should day shift inactivate night shift goal that is NOT a priority for them? Does day shift have to document against a night shift-specific goal?
  3. Should night shift inactivate day-shift specific goals?
  4. Nurse Florence documented Alteration in Breathing Pattern as a priority problem for a pt. with COPD. Nurse Clara ended that problem and started a new priority problem Alteration in Gas Exchange. The next day Nurse Florence ended that problem and restarted Alteration in Breathing Pattern. What’s wrong with this picture?
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