You are the registered nurse performing a health assessment on a newborn infant. From the functional health pattern portion of the assessment, you learn the mother is reluctant to breastfeed her baby. How do you respond? Explain the approach you will take to ensure adequate nutrition for the newborn, with or without breastfeeding. Provide rationale for your answer.

The student is to choose an incident that occurred during one of the clinical days this week. The issue can be from the patient’s pathophysiology, education needs, psychosocial needs, socioeconomic conditions, cultural/religious concerns, or a combination of these factors. It can be an incident like a cardiopulmonary arrest, a procedure like a dressing change or bladder catheterization, or an interaction (positive or negative) with a family member, staff person, or physician.

Paragraph 1: Briefly describe the scenario.

I went to the Operating Room (OR) on Monday afternoon (4 pm -8:30 pm the surgery lasted) and was able to witness and observe a surgery by a Gynecologic Oncologist who removed a mass from the pelvic area on a female patient in her 50’s. prior to meeting the surgeon the surgical team get the room prepped for sterile field, do the counts of all instruments, gauzes, pads, drapes and sutures and they write on a dry erase board. He was assisted by (2) residents. However during the course of the surgery the mass was found and removed and the attendees assumed they were done and could close the patient up. However, the surgeon new the mass he removed was not the place of origin of the cancer. He went up to her abdomen and begin inspecting the large intestine (while showing me and stating what I was looking at in hands was the transverse colon) and he went all the wat to the small intestine and there he found what was the source of her cancer that obviously metastasized to her pelvic region. Due to regulations of the hospital he asked the OR nurse to contact a trauma surgeon or the surgeon in the ER. Because of the time there were no surgeons available and the one that was on call contacted back in OR room and stated it would take him about 20 min to back to the hospital (that doesn’t include the time it would take him to scrub in). The surgeon over the phone gave my surgeon permission to go ahead and cut out the tumor in the small intestine and that we he came back tomorrow he would make an addendum to the patients chart stating he gave the surgeon I was watching permission to resection her small intestine. The residents as well as I and everyone else in the room was impressed how he knew that the cancer did not originate in her pelvic region. He let us know he’s been doing this so long that it comes with time and that the residents would get there to eventually after they have did hundreds upon hundreds of surgery’s. Since the patient was under for quite some time the anesthesiologist had to order a pint of blood to infuse into her since the surgery became much more complicated than expected. So I was able to witness them place the order in from their computer screen warm it in a warmer machine than piggy back it on her IV. Finally when the residents were told to close her up (I witnessed the internal suturing (dissolvable sutures) which would dissolve without her coming back to have them removed) and then they begin to staple her stomach on top and they were almost done until the surgical nurse and the OR nurse noticed the discrepancy on the sponge count. There was supposed to be 24 total that’s what was write on the board but the surgical nurse only counted 23 as well as the OR nurse did too! The surgeon told the residents to open the patient back up and low and behold a sponge was left inside the patient! They removed and redid all the suturing and stapling again. Finally the patient was closed up all the way now and the count for the surgical needle holders was off. So now the OR nurse had to call X-ray and I was able witness the portable x-ray team take an x-ray of the patients abdomen and pelvic area where the surgeon and resident were working to see if the needle holders were in her stomach. We than had to wait from confirmation from the cardiologist (who was on staff) to approve the x-ray that there was no instrument left in the patients abdomen. It was cleared and the needle holders somehow I think were found in the trash. Finally she was ready to come off sedation and a post op team came in to transfer to recovery. I t was a very eye opening experience for me. But it did prove to me that I absolutely love being in the operating room. I can’t wait to go back.

Paragraph 2: Explain the issue.

The issues was the surgery was more complex than expected to be; gauze (sponge) was left inside the patient’s body and possible needle holders.

Paragraph 3: Use the Critical Incident Analysis Model below, and reflect on what occurred. Address only the relevant questions.

Critical Incident Analysis Model

1 What was I trying to achieve?

2 Why did I respond like I did?

3 What strengths and /or limitations did I demonstrate in this situation?

4 What were the consequences of this for the patient, others, myself? The consequences are for the patient and staff. If they would have left the gauze pad inside the patients abdomen that would have eventually if not immediately caused the patient to get an infection (due to a foreign body left inside her) and may cause her to go septic. The consequences that would have affected the staff and surgeon. If they had not did the count and left the gauze inside her they could have been sued as well as the hospital when she began to show signs of illness.

5 How was this person (or persons) feeling? I know patient was going through divorce

6 How did I know that? When the patient was getting closed up the surgeon scrubbed out and let us know he was going out to talk with the family to inform them of how the surgery went. That’s when one of the OR nurses stated she was going through divorce and that when she came out of surgery they were to contact her sister and she would come up.

7 How did I feel in this situation? I felt very bad for the patient. I did not get to speak to her prior to the surgery nor after. However, when the nurse stated that to the surgeon I could only imagine the stress she must be going through. She just recently got diagnosed with cancer and at the same time she is going through divorce. I can only pray she has a great support system to get through everything. Even the surgeon felt bad when he was told.

8 What internal factors were influencing me including attitudes about working with patients of diverse backgrounds?

9 How did my actions match my beliefs?

10 What factors made me act in incongruent ways?

11 What knowledge did or should have informed me?

12 How does this connect with previous experiences?

13 Could I handle this better in similar situations?

14 What would be the consequence of alternative actions for the patient, others, and myself? The consequences the patient would either have gotten very ill or died. The staff and surgeon along with hospital could have been sued by either the patient or her family (if she passed away because of simple medical error.)

15 How do I feel now about the experience? As stated above I absolutely loved my experience. In a crazy way it felt like a television show.

16 Can I support myself and others better as a consequence?

17 Has this changed my way of knowing?

 
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