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Week #3: Evaluate the effectiveness of the care given using the nursing

process and modify care for clients accordingly.


b.

Critical Thinking

How did I use problem-solving to adapt nursing care as clients health condition changes?
This clinical week in particular definitely had me involved in using the nursing process

by evaluating the effectiveness of care in order to modify and adapt to changes in care
accordingly. My patient who had cellulitis of her right leg also had a wound vac suction to this
area. She also had a significant left leg wound as well in which its dressing was ordered to be
changed daily.
On my first day working with this patient, a priority concern was her hemodynamic status
related to her low Hgb and platelet counts because she had received an RBC and platelet
transfusion the day prior. Unfortunately, these lab values showed no improvement. As the
primary nurse and I performed the dressing change to the left lower leg wound, I noticed that the
wound bed was a beefy consistency with a layer of bloody, clot-like drainage that I was able to
cleanse and remove with a few sheets of gauze and normal saline. As I pondered on this
observation, I also brought up that during her PT session moments before performing wound
care and as she sat up to dangle at the side of the bed and transferred herself into the therapy
chair was a saturated bloody dressing to that same wound.
Subsequently, critical thinking was used within the nursing process after assessment of
the wound to come to the decision that the physician should be notified of the continued low Hgb
and platelet counts. The wound nurse was also informed. She recommended that the wound vac
to the right lower leg be discontinued and to apply honey gauze and mepilex dressings until
further assessment and evaluation can take place the next clinical day. As evidenced in this

incidence, I was able to adapt to the change in nursing care as a result of interpreting the possible
reasons for the low H/H.
On the second clinical day, I was able to witness the assessment of the wounds and
participate in the dressing changes with the wound nurse. She maintained the ordered daily
dressing change from yesterday using the honey gauze and mepilex to continue promoting
wound healing. Overall, this was a good learning experience as it pushed me to think about the
big picture as it involved implementing the entire nursing process to look at the problems that are
still present when evaluating the effectiveness of current care in order to ultimately reach for a
better intervention for even better outcomes.