PNURS 210
October 18th, 2014
Clinical Reasoning

Reflection #5
Description:
During one of my clinical days at Harrison Medical Center, as I was working with my nurse, a rapid response code was activated in the room of one of my patients. The rapid response was for my patient’s roommate who was admitted earlier with chest pain. The rapid response was activated because the patient was experiencing chest pains that were not resolved with multiple unsuccessful treatments of sublingual nitroglycerin tablets. Every available member of the unit and the charge nurse showed up at the patient’s room. A doctor that was on the floor at the time, respiratory therapy, pharmacy, nurses available, charge nurse, case worker, and the CNA. The charge nurse was very organized in delegating tasks to everyone. As I was sitting against the wall, I was able to see that the patient was in so much pain that his eyes were bulging out. His body was stiff and he was holding his hands as a fist. The respiratory therapist was monitoring the patient’s oxygen levels and had the patient on 5L of oxygen via nasal cannula. The doctor ordered Morphine and Nitroglycerin in an IV format. The pharmacist immediately went to get the medications. The charge nurse made the decision to get IV access started and delegated to the CNA to get an EKG on the patient to assimilate information and analyze data to make clinical judgment on the care and needs of the patient. At that moment the patient’s doctor came in and consulted with the first doctor on the scene and began reading the EKG results. The patient’s doctor said that he wanted the patient to be moved to the PCU unit as soon as possible. During the move to the PCU unit, the wife of the patient came to visit. Once she saw what was going on, she became very emotional and worried as to what was going to happen with her husband. Immediately the social worker took the wife aside in the waiting area and spoke to her.
Reflection:
During the rapid response I felt really overwhelmed by the rapid response. At one point I was thinking what would happen if this young patient dies. I was amazed how prepared they were. The way the case manager and the rest of the team were communicating and the clinical reasoning in all the decisions they were making was absolute at very high level of skills. I felt really helpless because I could not do anything to help the patient. I hope to one day achieve the same level of clinical reasoning that the charge nurse showed by staying focused on the priorities and making appropriate clinical reasoning under high level of stress.
Influencing Factor:
When a rapid response in activated, and the patient is being monitored very closely this would fall under course out comes of demonstrating appropriate clinical reasoning because you would need to make judgments as to what the treatment is needed and if vital signs have changed outside the patient’s baseline. Also demonstrating clinical reasoning in evaluation of client status, diagnostic tests like EKG and clinical reasoning in establishing plan of care used during and after rapid response to insure patient safety and effectiveness.
I was not familiar with rapid response and I was very excited to see and learn from the whole team and who it involved and what their responsibilities were. I was glad that I was there during the rapid response to take what I saw and discuss it with my nurse and gain more knowledge on facility policy during rapid responses. This better helps me understand what my role as an LPN will be.
Alternate Strategies:
An alternate strategy is what would have happened if the nurses would have not called rapid response and in her clinical reasoning she would have decided to wait till the doctor did rounds. I believe that the patient’s outcome could have easily turned into and emergency and the patient could have gone into cardiac arrest with the possibility of death occurring.
Learning:
I learned that before any treatment is done, it is very important to be aware of what the patient’s wishes in regards to living will. Also I learned that it is very important to know the patient’s baseline for vital signs, oxygen saturation. Also how important it is to monitor throughout the whole treatment. Nurses need to be prepared to show appropriate clinical reasoning in case any complications happen. They need to be ready to act fast, in a calm matter and know priorities before it happens. I learned that the nurses are constantly assessing and analyzing what they observe during the treatment and having good clinical reasoning is very important.