Module 4 RLE Activity:
Sample Nursing Clinical Pathway
NURSING SERVICE DEPARTMENT
NURSING INTERVENTION CHECKLIST (NIC) AND ALGORITHM FOR PNEUMONIA
(Adjunct to the Clinical Pathway Guidelines for Pneumonia)
Name of Patient: Date: January 30, 2020 (Day 13)
Attending Physician: N/A Room Number: N/A
Staff Nurse in-charge: Angela P. Neri, RN
PRIORITY NURSING DIAGNOSIS: Impaired Spontaneous Ventilation related to hypermetabolic state infection manifested by dyspnea
and decrease in oxygen saturation (SpO2), detection of Influenza B viral RNA &
Streptococcus pneumoniae DNA.
PERTINENT DATA SPECIFIC IMPLEMENTATION REMARKS AND SPECIAL
Patient- Nurse-centered INTERVENTIONS Performed Not performed ENDORSEMENTS
centered (Objective) (EVALUATION)
(Subjective)
Assisted patient in
N/A Breathing exercises are
DAY 13 deep breathing commonly used to help lung
- Febrile (38.5– exercises conditions like pneumonia.
40.0 °C) with However, with lack of evident
bibasal crackles based practice of this
- Increased technique, it does not fully know
crepitations in whether these exercises would
both lung fields apply to alleviating symptoms of
- Polymerase coronavirus. It is also possible
Chain Reaction that the involvement of deep
(PCR) detection inspiration is dangerous for the
test result: throat or nasopharynx through
SARSCoV-2 colonization of novel
viral RNA coronavirus. Due to the
movement of virus upon deep
DAY 15 inspiration from upper to lower
- Stable Vital respiratory tract because of the
Signs: significant pressure difference
BP= 110/70, between them. Thus, the
HR= 95, infection may spread to lower
RR= 30, respiratory tract system.
SpO2= 99% Reference: Shetti, A.N. (2020)
with FiO2= 80% Are you doing Deep Breathing
- Adequate urine Exercise Preventing from
output COVID?–Well you are Not Truly
- Laboured Safe!! Maharashtra, India:
breathing Medwin Publishers. (5)(3)
followed by [Link]
Cardiac Arrest 16000180
- Formation of
Positioned patient It is a known fact that head
thick sputum properly by bed elevations at a designated
and blood clots elevating the head angle (30-45 degrees) can play
in the ET tube of the bed a positive impact in prevent the
infection of their lungs.
Furthermore, in the patient’s
case, head bed elevation has
physiologic effect when
intubated endotracheally
because it decreases
compressive atelectasis in the
posterior lung zone and
improve diaphragm function
which are potentially at risk of
complication during emergent
intubation. However, several
limitations constraints the
performance of intubation such
as the unqualified training level
of intubation by the health care
staff, subjective to recall,
uncertain degree of patient’s
benefit to the procedure and its
risk of complication.
Apparently, there is also lack of
evident based research and low
quality of existing evidence
about the effectiveness of head
bed elevation in terms of
alleviating the symptoms of
pneumonia and especially,
COVID-19 cases.
Reference: Khandelwal, N.,
Khorsand, S., Mitchell, S. H., &
Joffe, A. M. (2016). Head-
Elevated Patient Positioning
Decreases Complications of
Emergent Tracheal Intubation
in the Ward and Intensive Care
Unit. Anesthesia and analgesia,
122(4), 1101–1107.
[Link]
00000000001184
Wang L, Li X, Yang Z, Tang X,
Yuan Q, Deng L, Sun X. (2016)
Semi-recumbent position
versus supine position for the
prevention of ventilator-
associated pneumonia in adults
requiring mechanical
ventilation. Cochrane Database
of Systematic Reviews. DOI:
10.1002/14651858.CD009946.
pub2
Suctioned
secretions as
necessary
- Oral
- Nasal
- ET tube
- ET Tube was
used for
suctioning
secretions.
Administered
medications as
ordered
(please
specify):
- Ceftriaxone 2g
intravenously (IV)
once daily (OD)
- Azithromycin 500
mg once daily
(OD)
- Oseltamivir 75 mg
Twice a day (BID)
- Midazolam drip
- Meropenem 2g
intravenously (IV)
three times a day
(TDS)
- Vancomycin 30
mg/kg loading
dose followed by
25 mg/kg twice
daily (BD)
- 8 L/min of oxygen
via a face mask
- 2–3 L/min of
oxygen
Administered and
maintained
oxygen support as
ordered
- Funnel
- Nasal cannula
- Face mask - Administered
- Mechanical oxygen support
ventilator via Face mask.
Referred the On an ethical observation, a
patient to the Medical referral undergoes a
attending process of procedures which
physician as necessitates proper
necessary consultation. It is possible that
in the patient’s case that an
appropriate consent wasn’t
obtained from the patient’s
family as a requirement. During
the process, it may also arise
conflict of interests between
one physician to another
because of fee-splitting for
financial gains to for a referral is
unethical. Resulting to several
anti-referral laws existence to
prevents abuse by health
workers. At the state of the
medical institution in the
pandemic, it is plausible that
the attending physician
have/has a preexisting duty to
care for which allows them to
withdraw from the referral case,
considering the amount of
knowledge and responsibility
that needs to be accounted to
legally refer the patient.
Reference:
Anyanwu E.B., Abedi H. O.,
Onohwakpor E.A (2015). The
Practice of Medical Referral:
Ethical Concerns. American
Journal of Public Health
Research: Science and
Education Publishing 3 (1), pp
[Link]: 10.12691/ajphr-3-1-
5
Other
interventions
relevant to the
nursing diagnosis
(please indicate
and use another
sheet if
necessary):
(VARIANCES)
- Collected
NPS/OPS
specimens
- Polymerase
Chain Reaction
(PCR) detection
test on NPS/OPS
samples
- Chest
Radiograph
- Endotracheal
Tube (ET)
intubation
- Endotracheal
aspirate (ETA)
- Complete Blood
Count (CBC)
Test
- Blood culture
Test
- HIV (human
immunodeficiency
virus) test
- Monitor Output
- Vital Signs
Assessment (BP,
HR, RR, SpO2)
- Cardiopulmonary
resuscitation
(CPR)
EVALUATE
INTERVENE
ASSESS - Execute applicable nursing
- Gauge if the nursing
procedures performed are
effective. If not, repeat
- Document sets of data that procedures to address the assessment for further
are relevant to the nursing nursing diagnosis. management. Collaborate with
diagnosis. Cluster important other members of the team.
cues.
Note: Kindly corroborate your Nursing Intervention Checklist (NIC) with the Clinical Pathway Guidelines for Pneumonia.
Accomplished by: Noted by:
Angela P. Neri, SN
Staff Nurse in-charge/ Student Nurse-in charge Nurse Supervisor-on-duty/ Faculty
-EBN F&E ()
-Webinar reflection
-Research activity #6 (Sat)
-NI NCP (Friday)
health threat:
Smoking
drinking
polluted water supply
improper garbage proposal = 4.665
inadequate physical activity = 3.17
health deficits:
parasitism of children = 3.67
