Module 9 - EBP in Nursing by Erica Kent-Nakui https://padlet.com/enakui1/mr290ry3grkesehf post examples of EBP from your daily nursing practice that either aligned with or did not align with patient preferences or clinical experience en-us 2021-03-02 15:19:05 UTC 2021-11-02 23:06:48 UTC hello@padlet.com https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862415808 The patient was waiting to be discharged home after a serious of diagnostic tests had been ran. The physicians ordered a biopsy of the liver before discharge however the patient was not told this until the day of the appointment. When I mentioned this to the client at the start of my shift, the client was astonished and confused. As a student nurse, I thought I had created unnecessary fear or anxiety. I went back to review the clients chart and thi was true; I also informed the primary nurse to educate/ update the patient. However this was not done. In summary, the client refused to undergo the test. About two surgeons and the nurse came in to educate the client on the need for the test  and apologize for the miscommunication. The client expressed that she was not aware of the decision and also felt upset about this. She opted to defer the test and see her oncologist in her small town to discuss any further plans. 


]]> 2021-11-02 17:44:28 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862415808 The patient had undergone spinal surgery and was in 9/10 back pain. In order to improve his back pain, I spoke to the patient directly about his current options for additional medication administration including his choice of PRN opioids (type, route, etc) and his upcoming scheduled analgesics. After discussing his options and the benefits and risk of each medication/route, he had chosen to take hydromorphone 3mg PRN PO (ordered 1-3 mg PO PRN) and wait for 30-60 minutes to see if he gets any relief before taking hydromorphone 0.3mg IV push PRN (ordered 0.1-0.3mg IV PRN) for breakthrough pain. In this case, the patient truly collaborated with the nurse. The nurse provided appropriate knowledge to the patient for him to make an informed decision and then the choice was given to the patient. The patient became an active member in his own care. https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862417000 2021-11-02 17:44:56 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862417000 https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862418186  The patient had undergone spinal surgery and was in 9/10 back pain. In order to improve his back pain, I spoke to the patient directly about his current options for additional medication administration including his choice of PRN opioids (type, route, etc) and his upcoming scheduled analgesics. After discussing his options and the benefits and risk of each medication/route, he had chosen to take hydromorphone 3mg PRN PO (ordered 1-3 mg PO PRN) and wait for 30-60 minutes to see if he gets any relief before taking hydromorphone 0.3mg IV push PRN (ordered 0.1-0.3mg IV PRN) for breakthrough pain. In this case, the patient truly collaborated with the nurse. The nurse provided appropriate knowledge to the patient for him to make an informed decision and then the choice was given to the patient. The patient became an active member in his own care. 


]]> 2021-11-02 17:45:19 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862418186 During one of our clinical rotations, one of our pts, who was using multiple substances and experiencing homelessness, had been admitted for a hip fracture requiring surgery, but required stabilization first before undergoing the operation. Due to this pts high pain tolerance, they were on high doses of scheduled and PRN hydromorphone both PO and IV. Upon coming onto the shift, the pt was NPO but was unaware why. Despite multiple inquiries as to why they were not being served breakfast and how it was reminding them of living on the streets, they were still not being told why they were NPO. It was later determined that the patient was scheduled for diagnostic imaging as a requirement to be cleared for surgery. Based on the nature of the imaging, the pt was placed to NPO status overnight. However, he was not provided with any information or explanation, only finding out when he was withheld breakfast the next morning. In this situation, this pt was not an active (collaborator) in their own care as they were not told what was happening to them nor were they involved in the steps to their recovery. https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862421859 2021-11-02 17:46:44 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862421859 https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862908467 The patient had been having a difficult time swallowing food and often coughed when trying to eat. The nurse put in a referral for SLP to come and assess due to the risk of dysphagia and, while waiting the referral, opted to administer medications crushed in apple sauce rather than swallowed with water which appeared to be difficult for the patient]]> 2021-11-02 22:02:45 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862908467 https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862911034 The patient was experiencing constant 8/10 abdominal pain which was not relieved with hydromorphone both PRN and long-acting, receiving almost 1600 mg per day combined. This pain occurred after a G-tube insertion procedure. The nurse called a physician to come and assess due to the inability to manage the pain with medication and the unknown etiology of the pain. ]]> 2021-11-02 22:04:48 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862911034 The patient was experiencing a 6/10 that was constant to their surgical site. This was causing the patient significant discomfort and limiting their mobility. LOTARP was completed and pain education provided to the patient. Then after collaborating with the nurse PRN hydromorphone was given to the patient as per the doctors orders. Pain was then reassessed and patient was now experiencing a 2/10 pain which was tolerable. https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862985209 2021-11-02 23:06:48 UTC https://padlet.com/enakui1/mr290ry3grkesehf/wish/1862985209