Competency In Nursing

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Standardized terminology in nursing provides a way to organize and structure communication by creating a common language which translates nursing diagnoses, interventions and outcomes across various electronic health records (EHR’s). Benefits of using standardized nursing terminologies include: (a) better communication among nurse and other healthcare providers, (b) increased visibility of nursing interventions, (c) improved patient care, (d) enhanced data collection to evaluate nursing care outcomes, (e) greater adherence to standards of care, and (f) facilitation of assessment of nursing competency (Schwiran & Thede, 2011). I will present a scenario of an intraoperative patient who experiences malignant hyperthermia during a surgical procedure. Using this scenario I will apply the related NANDA, NIC and NOC elements and the data, information, knowledge and wisdom that guided my decisions.
NANDA, NIC and NOC for Malignant Hyperthermia
As a surgical nurse we review annually how to react to malignant hyperthermia in surgery. Although MH crisis is rare, we are responsible for recognizing signs and symptoms that can trigger staff to begin treatment right away. MH is a hypermetabolic disorder of skeletal muscle and is commonly triggered by the administration of general anesthetics in susceptible individuals (Martin, 2009). Upon review of the patient’s preoperative record I notice that after a previous surgical procedure the patient had come down with a fever of unknown origin. The patient was admitted and treated for being febrile and discharged to home with no other complications. There is no family history for malignant hyperthermia. Using NANDA (previously North American Nursing Diagnosis Association) I can choose an appropriate...

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...sweating profusely, they have tachycardia, tachypnea, arrhythmias, and unstable blood pressure. This data I recognize as irregular. Using information I have on MH crisis, the elevated vital signs and previous fever after surgery in this patient, I determine that they are going into malignant hyperthermia crisis. Through in-services and education on MH crisis in surgery I determine what interventions I need to begin. I communicate with anesthesia to call for assistance, shut off anesthesia gases and administer dantrolene. After this experience I have gained wisdom in MH crisis and I am able to apply this experience towards preventing MH crisis in the future by recognizing predisposing factors, asking appropriate questions prior to surgery, preparing the OR by communicating with anesthesia to not use certain anesthetic gases and have MH crisis crash cart available.
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