Pediatric Ground Rounds NURS 421 - Clinical Management of Infants and Children Purpose of Assignment To provide the student

an opportunity to integrate knowledge from the sciences, developmental theory and physical assessment data to the care of a pediatric client and family in the acute care setting. The student will utilize critical thinking and independent judgments in presenting a holistic plan of care in a formal oral presentation.. Student Approach to Assignment This presentation was created to describe a case study of a patient I cared for during my time in the pediatric clinical rotation. I analyzed the patient’s background, history, assessment findings, progress, and research applicable to his care. I then presented this information as an oral lecture to my peers, and discussed with them various aspects of his care. Reason for Inclusion of this Assignment in the Portfolio This required portfolio assignment shows my growth understanding the depth and breadth of nursing practice as I develop the framework that will guide my career. The following program objectives are highlighted:  Critical Thinking  Engages in creative problem solving.  In this presentation, I talked about an instance where creative problem solving yielded success. The problem in need of solving was getting the patient to void. I had been 8 hours since his Foley catheter had been removed, and he was now due to void or be re-catheterized. Since the patient as still unable to void, I had him ambulate to the bathroom to try to void standing. This still yielded no results, so he laid back in bed to rest (this was one of his first times ambulating). While in bed, I placed warm compresses on his lower abdomen. Approximately 15 minutes later, he ambulated again to the bathroom to try and void. This time, I turned on the sink to flowing water and instructed him to lean against the wall and relax. The combination of these techniques worked, and he was able to void. This showed creative problem solving by turning on the water, applying the warm compress, and getting the patient to ambulate.  Nursing Practice  Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques based upon assessment findings  In this presentation, I discussed several interventions involving the patient’s safety. Particularly, the ambulation of this patient was a safety-filled operation. Gettingt he patient to walk the hallway was a balance between allowing him to go his own pace,

which he enjoyed greatly, and keeping him limited to avoid accident. The patient had a tendency to lean on the IV pole, almost like a cane. Combined with his altered gait was a recipe for disaster. There were several times I had to stop the patient to stop him from bearing weight on the pole, since if he slipped that pole would not stay put. He also had a tendency to speed up as he walked, usually to a speed his gait was not ready to accommodate. To allow him to enjoy his walks at the slower pace I was making him walk, I got him up more frequently. This balanced the need for walking safely with his desire to walk more and more.  Communication  Expresses oneself and communicates effectively with diverse groups and disciplines using a variety of media in a variety of contexts.  This presentation was delivered to my peers and instructor. I used the PowerPoint as a guide, and the bulk of the information was delivered orally during my presentation. At the end, many students had questions regarding the patient and the interventions I performed during the clinical. Their interest, relevancy of questions, and attentiveness was evidence that I expressed myself effectively and clearly using my own voice, the PowerPoint, pictures, and graphs.  Teaching  Evaluates the efficacy of health promotion and education modalities for use in a variety of settings with diverse populations.  During this presentation, I spoke about a specific example where I evaluated the efficacy of teaching that was done to this patient. In the immediate post-op period, the patient was taught how to use and Incentive Spirometer and how it will help him with his breathing. Since this patient has a pectus repair completed, his respiratory function was very important to monitor. Since he was taught immediately post-op, he could not recall at all the teaching that had been done. Therefore, I repeated the teaching to the patient and concluded that the previous session was unsuccessful. This seems obvious in hindsight, as the patient was likely still very confused and groggy and not at all ready to receive teaching.  Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions  With the patient I talked about in this presentation, I spoke about the extensive teaching required. In particular, the patient needed much teaching about ambulation and the incentive spirometer. In the presentation, I spoke about how I initially thought he was non-compliant with his ambulation restrictions (arms, log-rolling) but later found he simply had not been adequately taught. In the PowerPoint, the evidence of this is on slide 13, where particular emphasis was put in the activity restrictions – this is where I spoke about the teaching. The incentive spirometer needed teaching

because the patient was not taking a full breath because it made him cough – which hurt. Therefore, I had to teach the patient how the incentive spirometer is used to cough up the fluid/anesthesia from surgery out of the lungs. I also taught him how to brace his chest with his pillow.  Research  Shares research findings with colleagues.  In this presentation, I spoke about a research study which showed the effectiveness of giving patients a respiratory bundle. The bundle was focused around deep breathing and ambulating to restore respiratory function. This applied to my patient because of his altered use of the incentive spirometer referenced above. However, the purpose of the research was to evaluate using the bundle on all patients – therefore my by presenting the article in my presentation (with the audience being my colleges) I shared research findings that applied to all patients in the future.  Professionalism  Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care.  During the presentation, there was a great deal of time spent discussion fluid balances and the input/output of the patient. This was the protocol for the unit, where every patient had very strict I/O measurements and daily evaluation of them. This is an example of an institutional standard of practice, but is also specialty-specific. The reason the institution set forth these policies was due to the acute way pediatric patients respond to hydration status – little changes can present as large deficiencies. The specialty-specific standard is to maintain acute control of pediatric patient’s hydration status, whereas the institutional standard is more specific – a daily analysis of the input/output measurements for each patient.