Administering And Monitoring Therapeutic Interventions And Regimens Essay

Exemplars

Exemplar 1

In this exemplar, I used the following Benner’s domains:

• Helping role.
• Teaching-coaching function.
• Diagnostic and patient-monitoring function.
• Effective management of rapidly changing situations.
• Administering and monitoring therapeutic interventions and regimens.
• Monitoring and ensuring the quality of health care practices.
• Organizational and work-role competencies. Administering And Monitoring Therapeutic Interventions And Regimens Essay
  

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Working as a labor and delivery nurse is a high intensity position that requires much diligence and adaptation. While every patient expects a safe delivery, the work that goes into ensuring a safety delivery may significantly differ for individual patients based on the combination of prevailing factors. In fact, diligence is required in understanding and meeting the nursing needs of each patient. One incident that standards out involve Mrs. P., a 32 years old woman who was pregnant for the first time and had not yet delivered. She came in towards the middle of my shift at work. While she did not have any complications, had been through a safe pregnancy having attended all prenatal clinic appointments with her medical records kept up to date. However, she was full of anxiety and fear, as she had been experiencing cramps. Her anxiety was over the fact that this was her first pregnancy, she was in the 38 week of pregnancy, and had been informed that she should expect to give birth between the thirtieth and fortieth week of her pregnancy. Her fear was that she was having a complication and that the baby was in some danger. I understood her fears, and calmed her down by assuring her that the hospital had knowledgeable personnel and equipment to handle her situation and ensure a safe delivery. Administering And Monitoring Therapeutic Interventions And Regimens Essay

After calming Mrs. P. down, I reviewed her medical records and noted that while she had a fairly safe pregnancy, her obstetrician had notable concerns about her blood pressure. She had been anxious during the course of her pregnancy. This stemmed from the fact that she was overweight and this was her first pregnancy after trying to get pregnant for five years. She was fearful of losing the pregnancy and any chance at having a baby. The obstetrician diagnosed her as having gestational hypertension.

Once Mrs. P. was calm, I contacted her obstetrician even as I ordered tests of her vitals as well as an ultrasound test to assess the status of the fetus. The ultrasound assessed the placenta, determined the position of the fetus, checked the biophysical profile, checked the amount of amniotic fluid, and monitored fetal growth. The results of the ultrasound test revealed that the baby was in an unusual position. Ideally at 38 weeks of pregnancy and this close to delivery, the baby should be in cephalic presentation with the head facing down, chin tucked to the chest, and back of the head ready to enter the pelvis. However, the ultrasound results indicated that the baby was in occiput or cephalic posterior position with the head facing down, but instead of the facing the mother’s back the baby faced the mother’s abdomen. This implied that as the mother was on her back, the baby was facing the ceiling. Administering And Monitoring Therapeutic Interventions And Regimens Essay

Even as the tests were conducted, it was clear that Mrs. P. was going into labor. She was having painful contractions and fluid leakage from her vagina. The vitals signs indicated that she had normal temperature, slightly elevated heart rate, oxygen saturation, respiratory rate, and blood pressure. I placed her on continuous cardiotocographic monitoring to ensure fetal wellbeing even as her obstetrician reviewed the results and noted the unusual position of the baby. She ordered for an emergency cesarean section. I informed Mrs. P. about her test results and the need for an emergency cesarean section, talked about the risks and complications involved, and assuring her that the procedure was necessary to ensure a safe delivery. She had been aware of the possibility of the cesarean section being conducted as she had struggled with her weight and blood pressure during the course of the pregnancy. Her husband signed the consent form for the procedure, agreeing to have the procedure proceed.

I prepared Mrs. P. for the procedure and had her wheeled into surgery. She asked that I be part of the surgical team, a request to which her obstetrician consented. She was given a general anesthetic with the procedure proceeding as planned.  There were no complications during the delivery. I was part of the care team that continued to provide nursing care to Mrs. P. after the procedure. Over the next two weeks, I was a presence at her side, helping her manage the pain and constipation following the surgery, as well as caring for the baby. She was discharged home two weeks after the cesarean section with a healthy baby in tow. Administering And Monitoring Therapeutic Interventions And Regimens Essay

Although my efforts were nothing beyond the routine nursing duties expected in my professional role, Mrs. P. was very grateful for the care and attention I had offered. She commended me for calming and assuring her, not ignoring her fears, and providing competent care that enabled her to have a safe delivery. She was particularly grateful that I had been constant stabilizing presence at her side, helping her understand her medical situation and that of the baby, providing help with her care and that of the baby, educating her on her medical situation, and providing emotional support. Her obstetrician similarly commended me for taking charge of the situation and ensuring that she received the appropriate care.

The experience had me applying Benner’s domains as explained. First, I undertook a helping role that involved establishing a healing relationship with the patient, providing comfort measures, and inviting her active participation and control in the care. Second, I undertook a teaching-coaching function by reading the patient to make an informed decision on whether or not to proceed with the cesarean procedure. Third, I undertook a diagnostic and patient-monitoring function by ordering tests, conducting ongoing assessments, and anticipating outcomes. Fourth, I ensured effective management of rapidly changing situation by contingently matching demands with resources while assessing and managing care during the crisis. Fifth, I administered and monitored therapeutic interventions and regiments by preventing complications during the treatment and hospitalization. Sixth, I monitored and ensured the quality of health care practices by consulting and collaborating with other medical personnel, such as the obstetrician, to ensure that Mrs. P. received the best possible care for the best care outcomes. Finally, I applied organizational and work-role competencies in setting care priorities, coordinating care, and providing for continuity of care. In essence, the experience in providing care to Mrs. P. presented an opportunity to apply the seven competencies presented in Benner’s domain. Administering And Monitoring Therapeutic Interventions And Regimens Essay

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I am a labor and delivery nurse and would like to get my staff nurse III Certification. I need examplar written based on an event which makes me stand out in my nursing. Should be written in first person narrative. Just talking about my experience with a patient and how I handled the situation and what makes me stand out then the rest of the nurses.
I had a patient 32 year old G1P0. Did not have any complication in her pregnancy but came in with full of anxiety and fear.
I managed to calm her down and because we were busy unit that day..by the time the midwife or ob md came in , I was able to deliver the baby. She was very grateful that I was her nurse. Administering And Monitoring Therapeutic Interventions And Regimens Essay