Using APA format, the information from this course, and your assigned readings write a six (6) to ten (10) page paper (excludes cover and reference page) addressing the application of the nursing process to a patient care scenario. Use these directions and the scoring rubric as you develop the paper. Outlines and abstracts are NOT required with this paper. Do not include the scenario in the paper

A minimum of three (3) current professional references must be provided excluding a nursing diagnosis book. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.

The paper consists of three (3) parts:

The meaning and use of the nursing process in making good nursing judgments that effect patient care

The development of a plan of care using the nursing process for a specific patient situation

The preparation stage for a teaching plan to prevent a recurrence of a similar situation

The following sheet will assist you when composing the plan of care for the paper: Overview of the Nursing Process.

Part 1

Review the required readings about the nursing process. In your own words, define each step of the process and provide an example for each step.

In the implementation step, what is meant by direct and indirect care as described by the Nursing Intervention Classification (NIC) project?

Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and interdependent) that applies to the patient care situation. Provide an example of each (refer to your textbook).

Explain how the nursing process provides the basis for the registered nurse to make a nursing judgment that results in safe patient care with good outcomes.

Discuss how the registered nurse evaluates the overall use of the nursing process. Identify three (3) variables that may influence the ability to achieve the desired outcomes for the patient.

How is the plan of care modified when the outcomes are not met?

How does the RN use the nursing process to make decisions about the priority of care?

Part 2

Patient scenario

A 78-year-old man is living in an assisted living facility. He is able to walk very short distances and uses a wheelchair to transport himself to the communal dining room. He administers his own medications independently and bathes himself. Over the last year he prefers to remain in the wheelchair even when in his room. He has a history of CHF, hypertension, hyperlipidemia and lower extremity weakness. He is able to state his current medications include metoprolol (Lopressor) 50 mg once daily by mouth, furosemide (Lasix) 20 mg once daily by mouth, Quinapril (Acupril) 20 mg once daily by mouth, atorvastatin (Lipitor) 20 mg once daily by mouth.

During a routine examination, his physician noted a pressure ulcer over the ischium on the right buttocks. The wound is oval about 10mm x 8 mm, with red and yellow areas in the middle and black areas on some surrounding tissue. It has a foul odor. The patient had been padding the area so "it doesn't get my pants wet". The physician arranged for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated.

After being admitted to the hospital his medications are: metoprolol (Lopressor )50 mg orally every 12 hours, furosemide (Lasix ) 40mg once daily by mouth, quinapril HCl (Accupril) 40 mg once daily by mouth, cefazolin (Ancef)1.5 Grams in 50 mL 0.9 % Normal Saline intravenously three times a day. The result of the wound culture identified Methicilin-resistant staphylococcus aureus. After a surgical debridement of the black tissue a SilvaSorb® (antimicrobial gel) dressing was ordered daily.

Develop a Plan of Nursing Care for this patient that includes all steps of the nursing process:

One (1) actual NANDA-I nursing diagnosis addressing the priority problem the patient is experiencing. Provide a rationale, with evidence, why this nursing diagnosis is the priority for this patient.

What is the assessment data that supports the use of this nursing diagnosis?

One (1) expected outcome that addresses the diagnosis and meets the criteria for an expected patient outcome. Discuss whether the outcome is a cognitive, psychomotor, affective or physiologic outcome. Discuss why the time frame selected for the evaluative criteria was selected. Use evidence as the basis for the time frame and criteria.

Four (4) nursing interventions that includes at least one (1) nurse-initiated, one (1) dependent, one (1) interdependent intervention. Label your interventions as above. Provide a rationale for each intervention that is evidence-based.

Part 3

To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Consider the information the RN would need prior to development of the plan. Respond to the following and be able to support your answers. You will not be developing a teaching-learning plan but demonstrating using the teaching-learning process to prepare for an individualized plan.

How does the RN decide the format of the teaching plan, i.e., written, verbal, or other?

How does the RN know which information needs to be included?

When does the RN determine how and when to evaluate the teaching-learning process?