Practice Profile Assessment Task 2

This project is a practice profile assessment that analyzes the student's professional development in anaesthesia nursing through reflective journal entries and Situation, Action, Outcome (SAO) statements. The student examines various case studies, including breast cancer, osteoarthritis, and coronary artery disease, to demonstrate their understanding of patient care, critical thinking, and clinical decision-making in perioperative settings.

Assessment Task 2 Practice
Profile

Table of Contents
INTRODUCTION...........................................................................................................................1
Situation, Action, Outcome statements (SAO).......................................................................1
PART: 2 Reflection summary paper:.....................................................................................3
CONCLUSION................................................................................................................................6
REFERENCES ...............................................................................................................................7
Appendix 1.......................................................................................................................................8
PART 1: Reflective journal-...................................................................................................8
Case 1: Breast cancer..............................................................................................................8
Case 2: Osteoarthritis............................................................................................................8
Case 3: Coronary artery disease.............................................................................................8
Appendix 2.......................................................................................................................................9
PART 3- Situation, Action, Outcome (SAO).........................................................................9
Appendix 3 ....................................................................................................................................11
PART 4- Self assessment and reflective journal entries......................................................11

INTRODUCTION
Practice profile is an essential role possess by an individual as basic practices of nurse
care such as supporting patient to recover, monitory situation of patient, screening and other
health related preventions. It works collaboratively with common specialist to deliver
assessment, education and care to every all kind of patient, ranging from kids to ageing people.
The aim of this practise profile is to show an individual professional growth, development and
knowledge in anaesthesia nursing practices, whereas CNA772 Anaesthetic and recovery nursing.
As a good capable perianesthesia nurse working as nurse educator, I have decided to attain brief
goals and henceforth, undertaking an informal self- assessment of all my experience, learning
and skills at the initial stage of the semester. Therefore, there are below mentioned practice
profile discussed in three sections (Perner and et. al., 2012).
The first one related with the self-assessment examine to benchmark the present level of
practice during the commencing of this project. There is a perfect evidence of reflective thinking
in the journal recorded over the learning phases that consists of certain entries. The other section
is associated with the two SAO episodes those are based on my goals and provide specific
knowledge and attitude during the period of research. The third and last element is based on the
reflective summary paper that assist in reviewing professional clinical practices development are
linked under this report.
Situation, Action, Outcome statements (SAO)
Case 1
A 34 years old man, Adam Johnson who is suffering from severe pain below ribs in the
side and back and that radiates to lower abdomen & groin. He has admitted in the emergency
unit and provide primary relieving treatment to control pain so that diagnosing process can be
takes place in an appropriate manner. Moreover, several other signs are observe such as pain in
urination, abnormal colour of urine (pink, red brown), nausea, vomiting, white blood cells or pus
in urine, persistent need to urinate, burning sensation during urination and many more (Jones and
et. al., 2013). At the other hand, several tests are carried out to ensure about actual issue of stones
which occurred in kidney due to which critical pain takes place. Additionally, this patient also
have an issue of Chronic obstructive pulmonary disease (COPD) whose medication is still going
on.
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Pathophysiology of kidney stone – In case of Adam Johnson, his kidney stone size is
evaluated as 7mm which is analysed through conducting different tests. It include abdominal X-
rays, intravenous pyelogram (IVP), retrograde pyelogram, MRI Scan, Abdominal CT Scan etc.
The formation of stone in kidney starts with synthesis of crystals in supersaturated urine which
further adhere urothelium which leads to growth of stone. It include that calcium oxalate stones
develop on Randall's plaques which are made of calcium phosphate crystals (Dougherty and
Lister, 2015). However, these grows to erode the urothelium and prepare nucleus of calcium
oxalate deposition. At the other hand, crystal formation is required to be evaluated to prevent
synthesis of stone.
Treatment – The kidney stone has different types of sizes and nature according to which
more effective as well as efficient medication is selected. In context of Adam, ureteroscopy is
takes place by utilising technique of general anaesthesia. It include several medicines which are
sufficient to dissolve minor stones but if not work then surgical procedure is needed to be carried
out. Meanwhile, medication involves medicines such as allopurinol (Zyloprim) for uric acid
stones, diuretics, sodium bicarbonate or sodium citrate, phosphorus solutions, ibuprofen (Advil),
acetaminophen (Tylenol), naproxen sodium (Aleve). Additionally, Extracorporeal Shock Wave
Lithotripsy (ESWL), percutaneous nephrolithotomy and ureteroscopy.
Anaesthesia and Post anaesthesia – The patient has problem of COPD then it is required
to be remain much careful while using general anaesthesias in order conduct surgical process in
an appropriate way. However, it is kind of progressive inflammatory situation which may results
into expiratory airflow limitation. Additionally, it is required that treatment include smoking
cessation, inhaled therapy, pulmonary rehabilitation with diagnosing exacerbations accurately at
correct time. It is necessary to give anaesthesia very carefully because it may generates
perioperative and post operative complications (Johns and et. al, 2012).
Case 2
A 45 years old woman, Mile Wilson who is suffering from problem of vaginal bleeding,
abnormal, watery or blood-tinged discharge and pelvic pain. Last night, she is not able to tolerate
that pain and get admitted to ICU where primary medication was provided to make her feel
relieved. Moreover, by observing signs and reports of pathological tests, specialists decided to
conduct Total hysterectomy to remove that infection from uterus. Additionally, hospital
management stops her meal and said that operation will be carried out in the next morning but
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due to overload of surgical cases her surgery get delayed. Meanwhile, she was already weak and
postponed surgery will results into more critical condition of Mile Wilson due to which
complications takes place during surgical procedure and she will stay for several days in the
hospital itself for further recovery after operation.
Pathophysiology of uterine cancer – From conducting several desired tests such as
pelvic exam, Pap test, ultrasound and biopsy but it should be ensured by carried out CT Scan
MRI (Schultz and et. al., 2013). Uterine cancer has several stages which can be diagnosed by
biopsy, chest X- ray CT or MRI Scan. It is analysed that Mile Wilson is suffering from initial
stage of uterine cancer that is confined to uterus which may leads to become severe infectious
condition.
Treatment – The treatment of initial stage of uterine cancer involves to conduct surgery
to remove infectious cells or tumours from that organ of body. It include radiation therapy which
doctors prescribed after operation or either prefer vaginal brachytherapy (VB), pelvic radiation,
or both for patient. In case of Mile Wilson, surgeon carried out hysterectomy by utilising general
anaesthesia in an accurate manner and select radiation therapy after the procedure.
Anaesthesia and Post anaesthesia – The anaesthesia should be provided ion form of
drugs or gases which is most suitable for patient to make them unconscious. It is an essential task
so that person will not feel sever pain and other complications (Bagnall and et. al., 2014).
Moreover, response of immune system of patient during surgery should evaluate thoroughly as it
is responsible for complexities many times. In case of Mile Wilson, several complications are
observed because she is physically weak so that she will stayed in post anaesthetic unit to
manage her situation and recovery.
PART: 2 Reflection summary paper:
In order to analyse any of the action, it is essential for me to collect all the necessary facts
and figure those are found while analysing any of critical situation. As it has been seen that
reflection on any action is the procedure that used to take place after the accomplishment of
events that has been comes in front of me and associated with careful thought on an individual
strength and weakness. It will assist to develop various effective route of practising in upcoming
time. Reflection is a course of action that occurs as the activity is getting finished with the proper
observation and overall assessment to check what is vital in any critical situations. It has been
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seen that the concept of reflection practice in nursing is very common and has been globally
accepted so as to enhance learning of an individual.
I have analysed that case of kindney stone patientt is complicated becaue these tumours
are responsible for creation of severe infection in body which may results into major problem in
organ system. Moreover, Adam Johnson has also facing issue of COPD due to which anaesthesia
should be provided carefully because it may leads to death. Additionally, after conducting
overall surgery, he get shifted to post anaesthetic unit for further recovery by approprite
managemnt of his care facilities. At the other hand, Mile Wilson having uterine cancer undergoes
to an operation known as total hysterectomy for removing infection in uterus by removing the
same. However, due to having postponed surgery and weak physical health several complexities
takes place and she will further stayed in post anasethetic ward to remain under observation till
her recovery.
Over the course of analysis, there has been professional development shown through
overall evaluation of case that has help in growing competence in modern evidence those are
based on perianesthesia practice. Lot of chances were identified that are associated with the
literature and standard to modified the overall capacity of critical thinking and issues resolving to
individualise patient care. Airway administration problems would continue to be the most
common cause of injury and humanity at the time of perioperative stage of patient care. The
assessment was performed through the nurses at every phases of patient analysis. The main
objective is to examine patients at risk or those are likely to experience a high degree of trouble
with oxygenation, ventilation and intubation. In order to make a well organised analysis, it is
vital to make proper examination of the skills and experience of anaesthetic nurse and to
understand that this is a significant role in patient advocacy. There are certain examples of
conducting cancer disease and documented through the anaesthetist and visually performed by
the professional nurses.
Some of the critical example demonstrated in the reflection paper which consists of, pre-
anaesthetic and cancer patient analysis as well as axilla breast cancer of the critical patient is
done accordingly. In this particular analysis, airways management can be more vital to make sure
that best results for patient care is essential for the patient in order to make them improve from
the critical problems. During the initial phase for recognition of airways trouble in the post
anaesthetic care unit is found which was associated with the rapid assessment of ventilation and
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oxygenation position of the patient is been check accordingly. There are certain non-technical
skills of crisis administration and safe surgery which consists of effective decision making,
clinical evaluation and proper communication with the team members which have been carried
out appropriately. Under the case examples, there are various specific situation and their
recommended solution is providing accordingly. Overall experience and skills were more
significant however that to analyse the various evident that control, communication and
situational awareness and making critical decision were at the forefront to responding to the
critical aspects those are found during the time of analysing the condition of the patient.
There is case of Coronary artery disease is a kind a narrowing or blockage of the
coronary arteries (it consists of blood vessels that used to carry blood as well as oxygen to the
heart). It is basically causes because of atherosclerosis which develop up of fatty material and
plaque present inside the coronary arteries. It can cause chest pain, shortness of breath at the time
of exercise and heart attack. After making proper analysis of the patient condition correct
documentation has been made on them. It will assist in knowing all the vital implication those
are associated with these kind of issues. The patient leads to serious issues that consists of
coronary artery disease and peripheral arterial disease (Coronary Artery Disease. 2017). Apart
from this, the team method to managing the crisis that enable the anaesthetist and overall group
to apply time-vital in coming future assessment. It has been noticed that in case all the evidence
related with various incident of the patient is being lead to positive outcomes for patient as well
as entire organisation to maintain their positive aspects in the industry. These principles and non-
technical skills can be applied in day to day practices in nursing areas. Although, a well-
intentioned the claim of anaesthetist principles are in clinical practise, human factors evaluation
can still be able to provide errors after making analysis of the patient condition.
There are certain other general issues which is associated with the Osteoarthritis. Under
this a patient would have to face critical issues in the hands, neck, lower back or neck. It is
essential take suggested dosage of acetaminophen so that liver damages can be avoided. NSAIDs
consists of Motrin IB and Advil as well as naproxen sodium as recommended doses can easily
assist in releasing osteoarthritis issues. This assessment was undertaken by the post anaesthetic
care nurse on the admission to PACU which can examine overall supervision of care and impacts
definitely on the overall patient outcomes. Documented patient data vital signs and ensure that
wound care, analysis and impact of osteoarthritis on the patient. At the time of care of this kind
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of disease mentioned under the paper, early recognition and intervention is being modified in
order to attain more specific outcome for the patient. The disease was examining during the time
of clinical handover and quick process were taken to ascertain overall condition of the patient. At
the of learning OA is a growth situation which is having 5 stages from 0 to 4. The 0 represent
sing of normal joint pain. 4 indicate severe osteoarthritis. Patient those are suffering from
extensive loss of cartilage in one of more joints can need to take to the hospital for the providing
quick treatment for that particular issues. A well organise report is being made which will show
increase in swelling and inflammation of the synovial fluid within the joint. This case situation
provided further investigation into the incidence of osteoarthritis and subsequent trail of pre-
operative issue of the patient. The another one is related with the axilla breast cancer under
which the cancer spreads to the axillary lymph nodes. There are major symptoms which are
found in the female regarding the swelling in or around breast and skin thickening or redness. I
have analysis all these symptoms in the patient and recorded all the properly in order to analyse
the results for my further studies that will help in nursing career.
CONCLUSION
Reflection journalising provides assistance to the student to gain valuable insight into
individual nursing practice and how this has been contributing to the overall professional growth
and development over the period of time. This feedback provided by all the specific as well as
experience clinicians throughout the duration of this particular units. It has been assisted
professional development of practice judgement and learning skills that can be passed on through
role occupied during that particular time. presently, it has been believed that better connection
among evidence and clinical practice will be able to deliver to the patient accordingly. This will
assist me to increase by learning and prepare for future opportunities in this particular profession.
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REFERENCES
Books and journal:
Bagnall, N. M. and et. al., 2014. A systematic review of enhanced recovery care after colorectal
surgery in elderly patients. Colorectal Disease. 16(12). pp.947-956.
Dougherty, L. and Lister, S. eds., 2015. The Royal Marsden manual of clinical nursing
procedures. John Wiley & Sons.
Elliott, M.J. and et. al., 2012. Stem-cell-based, tissue engineered tracheal replacement in a child:
a 2-year follow-up study. The Lancet. 380(9846). pp.994-1000.
Johns, N. and et. al, 2012. Clinical effectiveness of transversus abdominis plane (TAP) block in
abdominal surgery: a systematic review and meta‐analysis. Colorectal Disease. 14(10).
pp. e635-e642.
Jones, N. L. and et. al., 2013. A review of enhanced recovery for thoracic anaesthesia and
surgery. Anaesthesia. 68(2). pp.179-189.
Perner, A. and et. al., 2012. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe
sepsis. New England Journal of Medicine. 367(2). pp.124-134.
Schultz, N.A. and et. al., 2013. Evaluation of a fast‐track programme for patients undergoing
liver resection. British journal of surgery. 100(1). pp.138-143.
Online
Breast cancer. 2018.[Online]. Available through: http://www.cancernetwork.com/case-studies>.
Coronary Artery Disease. 2017.[Online]. Available through:
<https://my.clevelandclinic.org/health/treatments/16819-medical-management-of-
coronary-artery-disease >.
Osteoarthritis. 2017.[Online]. Available through:
<https://www.healio.com/orthopedics/arthritis/news/online/%7Bbe3761ec-45df-4e3b-
832d-3178cb7b1e02%7D/osteoarthritis-case-study>.
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Appendix 1
PART 1: Reflective journal-
Case 1: Breast cancer
A 66-year-old female who has complaints of thickening of skin, nipple discharge and
discomfort came to clinic for check-up. She complaint about blood discharge from her nipples
and lumps in her breast. After ultrasound of her breast, it was diagnosed that she was suffering
from breast cancer. Due to no symptoms at early stage, this cancer reached at level 2 and she was
advised for immediate medical attention. After analysing the “Mammogram” (which is an X-ray
of breast) of this patient, her family was consulted about treatments of this disease and its causes.
Immediate treatment of tele therapy and radiation therapy started in order to expand her tissues
(Breast cancer, 2018).
Case 2: Osteoarthritis
Mrs jones, 55 years old came to a musculoskeletal specialist that is seeking advice for a 3
year of continuous worsening pain in both the knees. It has been noticed that her knees were
remained stiff for around 20 minutes when she arose in the morning and sometime getting up
from the chair. The major symptoms were exacerbated by kneeling or descending stairs. During
the examination of Mrs Jones hands revealed enlargement of few of the proximal joint. The feet
show similar deformities with enlargement and reduction in dorsiflexion of the initial
metatarsophalangeal joints. The specialist discussed with Mrs Jones various pharmacologic
treatment option and lifestyle modification that can results in better control for her osteoarthritis
pain and enhancement in her ability to functions.
Case 3: Coronary artery disease
A 56-year old female patient was suffering from institution for atypical chest pain and
tremors. After making proper examination her overall situation was analyse effectively in
accordance to resolve the condition that is affecting the overall health of the patient. The ECG
resting is done and analysis of coronary fistula was percutaneously end by using amplatzer
vascular plug. Moreover, I have been analyse that angiogram in assessing the coronary fistula
number and morphology at the same point of time. The patient deprived of a history of arterial
hypertensions and diabetes mellitus. The overall physical examination was not effective as the
doctor has recommended to make patient under proper surveillance.
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Appendix 2
PART 3- Situation, Action, Outcome (SAO)
Situation: Case 1
A 66-year old women was taken to the hospital because of breast cancer. It was found
that the patient was found unstable until four days back, when blood discharge from nipples was
found with passage of clots. She came to the hospital, where a blood specimen was detected for
culture. X ray or Mammogram was taken for the further assistance. The discomfort and clots
stick at and degraded two days before her admission. The patient recorded increase in fluid
intake, but the very next morning she had found voiding and came to emergency department. I
visually assessed the airways which included discomfort, blood discharge, hesitancy frequent
bleeding and fever. I discussed this frequent issues with her and found that from two years she
was having minor symptoms of breast cancer. She had lost almost 3.2kg in weight in the
previous two months. The another issue I found was related with the menstrual period which had
occurred 31 days earlier. Maximum number of laboratory examine, performed six months before
the admission into the hospital .
Action:
After accomplishing the pre-operative checklist, it was decided that there is not any other
clinical impact for follow up, I continued to execute an airway assessment. I asked the patient
whether she was having any kind of pain in her breast. The other thing I saw that how she was
facing difficulty in rapid breathing due to severe chest pain due to frequent blood discharge from
her nipples. I thought it was due to blood lumps or stones. I have decided to introduce
Lumpectomy to prevent this sort of issues. She will also need to haemodynamic monitoring with
continuous observation of blood pressure, pluses, oxygen saturation and the main bone heath
output depending on their condition. I read through all anaesthetic notes and surgical prescription
to complete my assessment. I quickly discussed the assessment to determine with the anaesthetist
who was aware about the history but had not performed any kind of airway assessment. In my
analysis, I reported her age and critical signs as well as every clinical facts and images. I
continued to explain the airway assessment as: symptoms of blood clots or red, pink and orange,
blood check-ups for examine the issues related with breast diseases and blood clots to check for
any tumour and bladder stone . The head of the department had listened to my assessments
which consists of patient history. After performing the assessment which consists of all the detail
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analysis of the women who was suffering from the breast cancer problem. The in-charge did not
feel any kind of difficulty intubation and decided to operate the affect part. I decided to gather all
sorts of available resources such as Video-assisted-laryngoscope and other medication details.
Outcome:
After making all the essential analysis of the patient which was successful intubated with
Mammogram and anaesthetic was maintained during surgical correction of scoliosis associated
with metallic fixation of vertebral bodies at the time of extensive blood losses. The anaesthetist
prescribed that she felt better able to manage the condition because I had made all sorts of
assessment after making the case evaluation properly. She felt I was able to help him and that
would have made him less anxious to go through all tough times whilst attempting to evaluate
the patient details.
Situation: CASE 2
A 56-years old women with no any historical presented for a Coronary artery disease.
She come for the issues of breathing since 2-3 months. The doctors decided to do ECG which is
used for the purpose of frequent supraventricular untimely beats. She is having pain after the
intubation of 10 minutes and analysis of injecting an article line, the vein was unintentionally
punctured at that particular time. It was found unrelated issues which is led to a wide range of
anaesthetic and surgical issues to the patient. The major point to be taken into account is that
there was no any consultant available with anaesthetic at that time (Elliott and et. al., 2012).
Actions:
During the time of analysing the case of patient I found that there are certain critical
aspects I would like to mention about the artery disease which she is facing from last 3 months.
Some of the critical points are, firstly types of patient need quick responses. One of the highly
experience nurse was working with a young talented surgeon which was little different. For a
wide moment, I recall being confusing matter even disbeliefs. Henceforth, I spoke to the
anaesthetic nurse that was working together with me requesting the call for further assistance. I
asked him to take an NIBP but at the same time anaesthetist said not to be anxious because of
their will be no arterial line showing at the monitor. Secondly, the condition suggested to called
up for leadership. I felt that if I keep back and maintain an effective leadership role with the
experience anaesthetist, I could be analysing things in more accurate ways. I also sometime
though quite disappointed as I cannot know the MTP .
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Outcome:
After analysing the patient properly, I found that the method of treatment is entirely
based on the certain factors that can examine certain facts such as, physical examination, RR,
heart rate (HR), hypertension and many more. The patient recovery time relies on the types of
surgery done by the doctors. At the beginning of the surgery, the patient blood loss was recorded
2.5l in total of 15 minutes. After examining the damage control surgery was analysed, this will
reduce considerably and become more concern about the renovation of cellular physiology with
noradrenaline distillation and fluid volume liberation. I noticed regular checks of ABCs and kept
people on their regular activities. I would remember feeling quite disappointed in myself because
of inappropriate knowledge about the MTP and how to deal with this in any kind of critical
issues .
Appendix 3
PART 4- Self assessment and reflective journal entries
The all above analysis which is done regarding the as anaesthetic practices on various
case situation that would be effectively helpful for my future career. All the cases are evaluated
properly and a well effective report is prepared which will be further useful in the medical
examination of various facts and figures. Under this, my basic role and learning experience is
concluded in accordance of my perioperative workplace. Moreover, it consists of basic three
specific aims in order to work toward during the learning phase. This particular reflective journal
entry was submitted throughout the study by using (MYLO) which is my learning online option
from the university of Tasmania. This document is also consisting of major journal entries in a
reflective case layout.
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