Nursing Essay

Why is it important to identify practice guidelines? Some of you may be questioning the relevance of exploring this topic. Simply put, clinical practice guidelines are evidence-based practice. Practices that are derived from research findings are more likely to result in desired (i.e. positive) patient outcomes across a variety of settings and geographical locations. This is the beginning of quality improvement in practice. For instance, the treatment of a patient with SVT, Heart Failure, and COPD should be the same whether we work in California, New York, or in southwest Louisiana! The care that is provided should be based on evidence for best practice.

Practice Guidelines can be a template for the care we provide. For instance, The Joint Commission (TJC) has practice guidelines for Heart Failure. These practice guidelines often become “standing orders” in cardiac care units and emergency departments. If you have worked in these areas, I am sure you have seen them. Implementation of these guidelines with every patient produces positive patient outcomes, which in turn result in decreased hospital stays, admissions, and re-admissions. Patient welfare is always a top priority for health care providers, but we also have a fiscal responsibility to the organizations we work for. Great patient outcomes mean reimbursement in sufficient amounts for the organization to operate! Its as simple as that.

Identify clinical practice guidelines or research that support the medical and nursing plan of care for the patient in the case study. In Module 2, you made a conclusion about actual and potential problems in the case based on the data clusters you created. Now you need to ensure the priority problems are being addressed in the medical plan of care. For example, you could review the American Heart Association (AHA) guidelines for the treatment of cardiac arrest or SVT, as well as the Joint Commission Core Measures for the treatment of CHF.

Evaluate medical therapy by providing a rationale for the medical orders
Identify medical orders you would question as incorrect and give a rationale
Identify missing orders for which you would need to follow up with the health care provider, and give your rationale as to why

Your paper should be 500 words (excluding the title page and reference page), double-spaced, in 12-point size Arial or Times New Roman font.
Be sure to address all components of the assignment.
Organize your paper utilizing the assignment components as headings and subheadings.
The assignment must contain a title and reference page.
Analysis of all cases and assignments should be based on evidence-based practice. Students are expected to use the course textbook and/or additional resources (books or web-based). Blogs and Wikis are not considered reliable sources of evidence.
Resources must be current (published within the last 5 years).
Include citations using APA format.

Case Study Info:
An elderly male is transported to the emergency department after his wife calls 911 because of his increasing shortness of breath. He was evaluated in the emergency department and admitted to a medical telemetry unit.
ER Report This is a 65-year old man who was brought in by ambulance after having increasing SOB over the last 2 days. He remains a 2ppd smoker and has COPD as well as heart failure and is a type 2 diabetic as well. He is admitted with the diagnosis of supraventricular tachycardia. We gave him 20 mg Cardizem IVP and started a 1:1 infusion at 5 mg/hr. We drew electrolytes, BUN, creatinine, CBC, PT/PTT, troponin level, BNP, theophyllin level. We did a CXR and 12-Lead EKG. We put a 20- gauge angiocath in his right hand and that is where the Cardizem is running. He also had a breathing treatment with Albuterol and Atrovent. Right now he is on a 50% venti-mask with O2 Sats of 94% and he says his breathing is better. His respiratory rate is 26 and his blood pressure is 160/92. Hes now in sinus tachycardia at a rate of 100. He has crackles and wheezes throughout his lungs. He voided 400 cc yellow urine.
Diagnostics Results
o Electrolytes Na 136; K 3.0; Glu 130; Cl
100 mEq/L; CO2 25 mEq/L o BUN66
o Creatinine 1.7
o CBC WBC 10,000; Hgb 14 g/dl Hct
44% Plts 200,000

Admission Orders
o AdmitmedicaltelemetrySVTr/o
pneumonia, r/o heart failure o NKDA
o Bed rest with HOB
o Turn, cough, and deep breath q2 hr
o VS q 4 hrs
o 1800KcalADA
o Nasal Cannula 2L/min
o Record O2 sats each shift
o Breathing treatments with albuteral and
ipratropium q4 hrs.
o Cardizem 125 mg in 100 cc D5W to run
at 5 mg/hr.
o Medications
Lantus Insulin
10 units SC
QHS
Lasix 20 mg
po q am
K dur 20 mEq
po q am
ASA81mg
po qd
Zocor 20mg
Volmax 4 mg po BID
Proventil MDI 2 puffs QID Vanceril MDI 2 puffs QID Colace50mg po qam Alprazolam 3
qHS mg po BID
Prevacid 60 mg po qd
Temazepan 7.5 mg po hs PRN
o Accu check ac and hs with sliding scale
Accucheck <200 no coverage
201 300 3 units Regular
Insulin SC
301 400 5 units Regular
Insulin SC
401 500 7 units Regular
Insulin SC
> 500 Notify physician