NR 341 Complex Adult Health Interdisciplinary Care
Student Name
Chamberlain University
NR-341 Complex Adult Health
Prof. Name
Date
Background Information
Mrs. Watson, a 62-year-old African American woman, was admitted to the emergency department on March 10, 2018, in a critical condition and categorized as a full code. Upon arrival, she exhibited symptoms of respiratory distress and was suspected of experiencing an opioid overdose. Her lifestyle choices have been a contributing factor, including the daily consumption of an entire pack of cigarettes, the intake of four to five glasses of wine per day, and the combined use of heroin and prescription painkillers.
Her medical history is extensive and includes chronic conditions such as asthma, hypertension, type II diabetes mellitus, and recurrent urinary tract infections (UTIs). She also experiences urinary incontinence and has previously undergone surgical interventions, including a right knee replacement and excision of a benign breast cyst.
The diagnosis at admission included bilateral pulmonary infiltrates, potentially aggravated by substance abuse. These infiltrates indicated a respiratory complication possibly stemming from infection or chemical-induced inflammation.
Vital Signs and Physical Assessment
On the day of her admission, a comprehensive assessment was conducted, revealing the following:
| Vital Sign | Measured Value | Interpretation |
|---|---|---|
| Blood Pressure | 98/58 mm Hg | Hypotension, possibly due to overdose |
| Oral Temperature | 98.9°F | Within normal limits |
| Respiratory Rate | 8 breaths/min | Severe respiratory depression |
| Radial Pulse | 40 beats/min | Bradycardia, indicating cardiovascular impact |
| Oxygen Saturation (SpO2) | 88% on room air | Hypoxia, necessitating supplemental oxygen |
| Weight | 146 pounds | Within average range for her age |
Additional findings from her physical exam included a strong odor of alcohol and smoke, slurred speech, erratic behavior, inflamed nasal passages, gingival ulcers, and multiple bruises and lacerations located on her abdomen, arms, and legs. Despite her critical state, she remained alert and oriented but showed signs of respiratory compromise—labored breathing, wheezing, and shallow respiratory patterns.
NR 341 Complex Adult Health Interdisciplinary Care
What was the nursing diagnosis?
The nursing diagnosis for Mrs. Watson centered around her impaired respiratory function and substance abuse history. The primary diagnosis was:
- Ineffective airway clearance related to opioid-induced respiratory depression and chronic respiratory issues (i.e., asthma), as evidenced by wheezing, shallow breathing, and low SpO2.
- Impaired health maintenance due to ongoing substance use, noncompliance, and lack of health-promoting behavior.
- Risk for self-harm or suicide, considering the pattern of polysubstance abuse and neglect.
What were the nursing goals and interventions?
The overarching goals were to:
- Restore and maintain a clear airway.
- Promote healthier lifestyle choices and self-care behaviors.
- Ensure patient safety during acute care.
Interventions included:
- Continuous monitoring of arterial blood gases and oxygen saturation.
- Administering naloxone, an opioid antagonist, to reverse respiratory depression.
- Using mechanical ventilation and positioning (high Fowler’s) to facilitate lung expansion.
- Offering emotional support, focusing on the psychosocial aspects of care.
- Encouraging detoxification and education on substance abuse.
Interdisciplinary Care Team and Collaborative Management
Who was involved in the interdisciplinary team?
An integrated team worked together to provide patient-centered care. The team included:
| Healthcare Role | Responsibilities |
|---|---|
| Emergency Physicians | Assessed patient condition, ordered diagnostic tests, initiated treatment protocols. |
| Nurses | Delivered medications, performed frequent assessments, provided bedside care. |
| Respiratory Therapists | Administered nebulizers, managed ventilators, monitored respiratory status. |
| ECG Technicians | Monitored cardiac activity using electrocardiograms. |
| Lab Technicians | Collected and processed blood, urine, and other specimens for diagnostic analysis. |
| Support Personnel | Assisted with hygiene, positioning, and basic care tasks under nurse supervision. |
Each professional collaborated to optimize outcomes by contributing their specific expertise. The nurses played a central role in coordinating this care, serving as the communication bridge between disciplines.
NR 341 Complex Adult Health Interdisciplinary Care
Therapeutic Communication and Psychosocial Interventions
Effective communication and psychosocial support were vital in managing Mrs. Watson’s care. Nurses used therapeutic techniques such as active listening, nonjudgmental presence, and empathetic responses to build trust with the patient. These efforts helped the patient feel secure, valued, and motivated to engage in health-promoting behaviors.
Mrs. Watson’s condition necessitated constant reassurance, especially given her substance use history. The nursing staff emphasized dignity, autonomy, and compassion, fostering an environment conducive to both physical and emotional recovery.
What was the student nurse’s role?
As a nursing student present during Mrs. Watson’s emergency admission, I was actively engaged in both observational and hands-on care. I participated in:
- Monitoring vital signs and recognizing abnormal trends.
- Applying ECG electrodes under supervision.
- Observing how the interdisciplinary team communicated and functioned cohesively during high-stress moments.
This experience highlighted the importance of calm, systematic interventions during crises. I admired the nurse I shadowed, who demonstrated resilience, professionalism, and attention to detail. This encounter further solidified my aspiration to become a compassionate and competent nurse.
Conclusion
The interdisciplinary and evidence-based approach used in caring for Mrs. Watson exemplifies the critical role of collaboration in acute healthcare settings. Through precise coordination, therapeutic communication, and holistic nursing care, the healthcare team effectively managed her complex needs. This experience underscores the importance of individualized patient care, particularly for individuals dealing with comorbidities and substance abuse. It also illustrates the value of interprofessional teamwork in improving patient outcomes.
References
Carpenito, L. J. (2017). Nursing diagnosis: Application to clinical practice. Philadelphia, PA: Wolters Kluwer.
For All Your Nursing Needs. (n.d.). Retrieved March 30, 2018, from https://nurseslabs.com/
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems (9th ed.). St. Louis, MO: Elsevier Mosby.
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2017). Pharmacology and the nursing process (8th ed.). St. Louis, MO: Elsevier.
NR 341 Complex Adult Health Interdisciplinary Care
Vallerand, A. H. (2015). Davis’s drug guide for nurses (14th ed.). Philadelphia, PA: F.A. Davis Company.