Nursing: Patients in the Acute Care Facility

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Table of Contents

Introduction
Discussion
Conclusion

Introduction

Patients in the acute care facility, in most cases, present a challenge to nurses because the workload and the amount of attention required for each patient may be overwhelming. The most challenging issue, however, concerns making sure that the patients health condition is stable. Since I work in the Nephrology division, the cases of acute care are not frequent, as the majority of cases are detected at the early stages. However, during the first months of working in the division, I faced a case of critical nephrology care when a 50-year-old woman was admitted to the hospital with an acute kidney injury.

Discussion

When the patient was admitted, her medical record included no information on the previous history of kidney disease or any chronic health conditions, as she had not been to a medical check-up for several years until she was admitted to the facility. The woman was admitted to the ER with an AKI, but she was soon stabilized and transferred to the Nephrology division. I was assigned to the patient and found out that the woman had a history of substance abuse for several years. She was diagnosed with chronic kidney disease and hypotension.

Two years after her first attack, her blood pressure began to reduce rapidly, and she vomited several times. At the time when it happened, I was in her room and the doctor had just left, and I beeped the attending doctor immediately, but the doctor came in some minutes later. I realized that during those several minutes before the doctor comes, I needed to make sure she was stable but I was not to administer any kind of drug without the instructions from a doctor. But I made an on-the-spot decision to administer 10mg of Phenylephrine IV because the patient demonstrated the signs of dysautonomia. Just when I was about to administer the drug the doctor stepped in he was shocked but looking the patients signs he gave me a go ahead. For five minutes after the injection, her BP stayed at the rate of 55-60/40 mmHg.

Then, BP suddenly increased to 85/40 mmHg, and her skin color became less yellow since she stopped vomiting bile. I also noticed that she had not urinated for most of the day, and I realized that bladder blockage could be one of the reasons for a sudden failure, so I also installed a urine catheter. At the time, those fifteen to twenty minutes before the doctor could come seemed like an eternity because I was afraid to act without the clinicians directions. Later, the patient was prescribed medications to control blood calcium and potassium and dialysis to remove blood toxins. Currently, she continues her treatment yet is unwilling to stop drinking alcohol.

This experience has taught me to take responsibility in critical situations, as a rapid response is a key to success in acute care. I felt considerable pressure throughout the whole scenario, and nearly half of my actions were automatic. It should be admitted that the sense of fear and uncertainty adversely affected the speed of my problem-solving, and this is an aspect I should work on.

In the Nephrology division, we always have a number of patients with progressive kidney failure who require a kidney transplant. In most cases, someone from the family is eligible to become a donor, and the decision to help a fellow relative is quick, and we have no problems with securing the transplant. However, one time during my job as a nephrology nurse, I had to resolve a challenging situation concerning the unwillingness to transplant a kidney. A 12-year-old boy with kidney failure required a kidney transplant, and his 21-year-old cousin could become his donor. Since the patient could not legally make a decision for himself, I asked the childs parents to sign a formal agreement for a transplant.

Their response was negative, and their primary argument was that their religion did not accept such an unnatural intervention to a human body. They told me that the church they went to was very strict about sacrificing ones body for the sake of saving others. I told about this situation to the patients doctor, and together, we decided to talk to them about their options and tell them the worst-case scenario that could happen to their child. I realized that we could by no means convince the family to abandon their religion. The solution was found was to ask the familys permission to contact their mentor from church so they could meet with the family and talk about this complex situation. The situation was rather urgent, so we asked them to make a decision until the following day.

They wanted their pastor to come to the hospital and talk to them, their son, and us. The pastor came to the hospital the same day and had a long talk with the patients parents. During our conversation, the pastor asked about the potential outcomes in both scenarios and wondered about the risks for the potential donor. In the end, the family agreed to the transplant, and their child survived.

Conclusion

Although this story has a happy end, I sometimes wonder how I would feel if the parents eventually refused a transplant. Respecting ones religious affiliation is extremely important, but it becomes ethically challenging when the childs life is on the line. From the above, it seems clear that this religious factor impacts the treatment to a great extent because it does not align with medical principles and approaches. Despite this, during the case, I felt confident in delivering the necessity of the transplantation to the parents anyway, as the child was responding well to all the inquiries and expressed a desire to live.

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Nursing: Patients in the Acute Care Facility

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