Collaborative Nursing Practice
In order to improve the quality of patient care and ensure that the goals of care are being achieved, many settings are using the collaborative care delivery model. The collaborative “approach involves teams of health professionals working together to provide more coordinated and comprehensive care to clients,” (Kearney 2008). An interprofessional team can consist of nurses, physicians, care technologists nutritionists, counselors, physical therapists, educators, care givers and the patient. These members work together for the common purpose of enhancing the wellness of a particular patient.
Case Study Subject
The subject patient is a 53 year old obese female presenting with a stage IV pressure ulcer on the sacrum. The ulcer exhibits severe tunneling and purulent foul smelling drainage. History includes left total knee replacement approximately four weeks ago, hypertension, gout, chronic kidney disease, depression, obesity, and coagulopathy secondary to post-operative warfarin therapy. Patient stated she was unable to participate regularly in post-operative physical therapy due to a painful flare-up of gout. She also states she has not eaten in two days due to nausea and diarrhea from antibiotics.
The Nursing Process and Collaborative Care
Based on nursing assessment the salient nursing diagnoses for this patient are:
1. “Impaired tissue integrity related to mechanical destruction of tissue secondary to pressure” (Carpenito, 2009, p. 326) as evidenced by deep sacral wound.
2. “Impaired physical mobility related to restrictions” (Carpenito, 2009, p. 326) secondary to pain.
3. “High risk for infection related to exposure of ulcer base to fecal/urinary drainage” (Carpenito, 2009, p. 326).
According to NANDA (1990), “a nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.” The focus of care for the nursing diagnosis is activities that a nurse can identify and perform independently of other providers.
Collaborative problems encompass a scope beyond the nurse practice to include other practitioners. According to (Carpenito, 2009, p. 4-5), “collaborative problems are certain physiologic complications that nurses monitor to detect onset or changes of status. Nurses manage collaborative problems using physician-prescribed and nursing- prescribed interventions to minimize the complications.” In this case study the collaborative problem is the potential complication of sepsis. The nurse is responsible for monitoring the signs and symptoms of sepsis and to “collaboratively intervene to stabilize the client” (Carpenito, 2009, p. 5). The following signs and symptoms are monitored; vital signs, urine output, blood cultures, white blood cell count, and mental orientation. The nurse also carries out and coordinates physician-prescribed interventions such as; tissue and blood cultures, intravenous antibiotics, wound care, pressure relief systems, debridement, and surgical interventions.
Managing the nursing diagnoses and collaborative problem for this patient, involved the following personnel; professional nurses, advanced practice wound care nurses, physical therapists, a nutritionist, and many physician specialists (hospitalist, renal, plastic surgery, and psychiatry. Even thought this patient is obese, a weighted feeding tube was placed to increase protein intake, and the protein dosages were recommended and monitored by a dietician. Electrolytes were monitored for kidney issues, and complex wound care was provided. The primary nurse monitored the wound every two hours to ensure the wound vacuum system was in place and working properly and drainage was...
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