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heart and kidney transplant

Instruction:  Write a paragraph response to peer 1 and 2 each, using APA 7 formatting guidelines for in-line citation and references, citing a minimum of 1 source.

peer 1  decision  : The first example of effective communication occurred at work. I had a patient that recently was listed for a heart and kidney transplant. Unfortunately, the patient suffered a stroke that caused him to be removed from the list. This was devasting news because the stroke left his treatment options few to none for the time being. The effective communication occurred when the doctor notified the patient that he was no longer a transplant candidate. She muted the TV, made great eye contact, soften here tone, and even ignored a phone call that came through. All these nonverbal gestures showed the patient that the doctor was present and sincere (Friderg & Creasia, 2016).

Another example of effective communication was when an older nurse was listening to her patient talk, she precisely used minimal cues such as “uh huh” and “go on” to show active listening and she even complimented it with some humor. Humor in the right amount and setting can act as a healing aid. Her effective communication led to the patient smiling.

Two examples I saw of ineffective communication were two people arguing and a couple in a movie having a disagreement. The two people arguing were a bad example of communication because nobody was taking the time to actively listen. You cannot give an appropriate response if you do not actively listen. This results in further damage to the relationship. The couple that was having a disagreement in the movie were slightly different. One spouse was pouring out their heart while the other spouse ignored them. The spouse that was ignoring had their arms crossed and their eyes were focused in the opposition direction which all indicated that she was not listening. According to Friderg and Creasia (2016), it is appropriate to make eye contact if it is within the culture norm and it is better to have a relax body stature verse a rigid one (Friderg & Creasia, 2016, p. 165-166).

            The three characteristics that a critical thinker possesses that a colleague may say I practice are inquisitiveness, open-mindedness, and maturity. I harbor the characteristic of inquisitiveness because I am constantly asking either doctors or other nurses to explain treatment plans or disease processes. I also like to do research online to better equip myself in my practice. I show open-mindedness and maturity by approaching every problem and patient individually. I realize that what worked in the last situation may not work in the present situation and that there are multiple factors to consider to have successful outcomes. With that being said, finding answers can be difficult but not impossible (Friderg & Creasia, 2016).

peer 2 decision : Effective communication is important in daily interactions. Effective interpersonal communication is particularly vital to the teamwork aspect of nursing care in both acute and critical care settings. From personal experience, effective communication in the nursing setting allows for a relatively even exchange of information between parties in order to achieve the outcome of improved patient status (Friberg, 2020).

An example of effective communication that I participated in was during a medical emergency; the physician asked for medications to relax the patient after intubation to prevent biting on the endotracheal tube but refused a sedative, etomidate, that four different nurses suggested. The physician asked for pain medication, fentanyl, which was ineffective, and then asked for the initially suggested etomidate, which was effective. In this example, the physician missed the nonverbal cue when one nurse stated that she was going to retrieve the etomidate. He also missed other cues when 4 different nurses suggested etomidate instead of fentanyl. We as the nurses did not communicate our disagreements effectively with the physician and failed to include our reasoning for requesting etomidate immediately instead of fentanyl.

Another example of ineffective communication was one that I committed last night. My patient decompensated and was hypotensive. I initially asked a newer nurse to pull epinephrine for me in order to spike a new bag. What I didn’t realize was that I meant to tell her to pull norepinephrine. I realized that I knew what drug I meant for her to pull but didn’t communicate it to her exactly which drug I wanted, which could have resulted in a medication error.

An example of effective communication, also occurring last night, is when the nurse next to me was having a busy time with her patients. Her first patient was on the verge of being emergently intubated, but her other surgical patient had a neurological change requiring an emergent scan. The nurse communicated to me, the respiratory therapist, and the charge nurse what was happening. We all in turn were able to find another therapist to go to the CT scanner with me, while she was able to assist with intubating her patient. The initial nurse was able to effectively communicate that she couldn’t complete both tasks simultaneously and requested help.

A second example of effective communication that is utilized often is closed loop communication, restatement, and clarification. In that same code, we each stated what actions were performed or needed to be done at the specified time so that everyone knew what the next steps were.

In regards to critical thinking, I would identify open-mindedness, analyticity, and inquisitiveness as characteristics that I use within my nursing practice. I have learned to become more open-minded to other viewpoints when reasoning out solutions. I have realized that my scope of a problem can be very limited and have become more open to suggestions based on not only my experience but others’ as well. Inquisitiveness is a trait that come together with analyticity when attempting to help solve a problem; these have come together in my own practice when helping another nurse solve a problem or when confirming solutions before implementation

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What is the pathophysiological basis of hypertension in a patient with chronic kidney disease?

SBI241
Assessment 2:
A 49-year-old male farmer presents to the emergency department with intractable nausea and vomiting, dyspnoea on exertion, and dizziness. The nausea began about two weeks prior to admission. There is no history of medication or toxin exposure. He has lost some weight recently and his current body weight is 52 kg. His past medical history is positive for hypertension diagnosed 4 years ago with no follow-up. He has smoked 1 packet per day for 20 years.
The attending nurse in the emergency department reports his blood pressure to be 160/120
mmHg, temperature 36.7°C, pulse 93/min. His skin is pale with numerous areas of
spontaneous bruising. Chest x-ray shows increased pulmonary vascular markings and hazy obliteration of the lower lung bases. Abdominal ultrasound examination shows a right kidney size of 7 cm and a left kidney size of 6.8 cm (normal kidney size approx. 10 cm).
Laboratory evaluation reveals:
Urinalysis
Protein 1+
Blood 1+
Glucose Neg
Casts Neg
Bacteria
Blood report Reference range
WBC 10.7 x 109/L 4.5-11 x 109/L
Platelets 245 x 109/L 150-400 x 109/L
Haematocrit 0.31 0.40-0.54 (adult male)
Creatinine 540 umol/L 60-110 umol/L (adult male)
Urea 35.2 mmol/L 3.0-8.0 mmol/L (adult)
Calcium 1.75 mmol/L 2.10-2.60 mmol/L
Uric Acid 0.68 mmol/L 0.20-0.45 mmol/L (male)
He’s admitted to the nephrology ward for further evaluation and management of his condition.
Please answer the following TWO questions:
QI. What is the pathophysiological basis of hypertension in a patient with chronic kidney disease?
(350-400 words)
Q2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage?
(100-150 words)
Support your answers with appropriate evidence (references). This assignment tests your ability to search scientific literature and present your answer in a scientific language. CDU library has heaps of resources to support you. Please make full use of these helpful resources:
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.. The word limit for this assignment is 450 to 550 words, this does not include references. Please stick to word limit, failing to do so will result in losing marks.
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