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Working in an ambulatory infusion center I use the nursing process for every patient encounter. I perform an assessment on all patients. For example, I may have a new antibiotic patient who is to get four to six weeks of antibiotics at our center. I will evaluate how they are doing physically, mentally. Whether they have the resources they need to care for themselves at home and help to do so if needed. Evaluate if they have the proper support services ordered and follow up care and even transportation. We will discuss what they need to know from an education standpoint evaluating what they know about treatment and self-management and what I need to teach them. Talking over and assessing every aspect of the patient's individual care. An antibiotic patient may have a risk for infection related to a PICC line, they may have the inability to cope with the changes in their health related to their infection, they may have impaired mobility depending on the type of infection. They may have a knowledge deficient about their diagnosis or even fatigue related to the antibiotic treatment. By assessing the patients, the nurse can determine what the problems are and set goals in order to solve these problems. A priority for the first encounter may be to reduce the risk of infection through education of self-management of the patients picc line. A goal related to the picc line may be to have the patient verbalize to me the restrictions they have with the picc line in order to prevent a complication with the line. To identify complications at the picc site and to describe or demonstrate how to prepare the site to shower. The nurse would educate the patient on these topics verbally or through written or visual aids. The nurse would then make sure through verbal teach back the patient understands and then document this education in the chart. Since the patient comes in everyday it would be easy to evaluate their knowledge the very next day. Since the nursing infusion team is working together to care for this patient it would be easy for anyone to evaluate or reinforce teaching done on the first day. The biggest challenges I think we face is time, we have very little time and many patients to carry out all these nursing functions. Many times, a new patient comes, and we have just as much time as with an existing patient. No one patient is alike or has the same issues so time can be an issue depending on the care that is needed.
As an ambulatory care nurse in an infusion setting I assess my patients on a daily basis to make sure they are fit for their infusion and if there is any deviation from their previous baseline. In my experience I have had to do some quick critical thinking during an assessment and make sure my patient is in stable condition. Some patients that I have seen have needed emergency help and required going to the emergency room for further evaluation. Ambulatory care nursing is definitely a different environment than working in a hospital with patients that are inpatient versus outpatient. There can be a lot of challenges that arise during assessments and making sure the patient has all of their current and future needs being met. I took care of an elderly patient who would come in frequently for blood transfusions, I seen him on a daily basis and was able to identify any slight deviation from his baseline. One particular visit I noticed he had some bruising around his face, and eye, and some swelling underneath his eye area. Upon assessment he mentioned to me that he recently had a fall. This particular patient was always accompanied by a family member and usually it was always the same family member. I inquired about the patient's fall and met some resistance and frustration with the family member. I feel this type of outpatient environment can be a little tricky and difficult to navigate especially with making sure family members are following up with specific providers and case managers.
For the patient population primarily served in your setting, what important aspects does the RN contribute in the assessment, diagnosis, goal setting, planning, implementation and evaluation? What challenges do nurses experience in executing these functions? I work in an MRI diagnostic center. Here I am in charge of assessing the patient's co-morbidities for those patient's that require contrast. As we all know certain co-morbidities can affect your kidney function. Since we are administering contrast to those patient's, it is important we make this assessment. I also assess for complications such as infiltration and extravasations as well as contrast reaction. Some of the challenges I face is difficult veins or possibly a patient can be a poor historian.