NRSG140 Integrating Practice 2: Respiratory Assessment and Reflection

This report reflects on a respiratory assessment performed on a 35-year-old female patient, Amanda, with suspected hospital-acquired pneumonia. The reflection covers the initial nervousness, the positive experience of applying the clinical reasoning cycle, and the importance of sequential assessment. It evaluates the process, highlighting the effective teamwork and adherence to nursing assessment steps. The report concludes with an action plan for improving skills in managing pneumonia, including reading evidence-based articles, observing experienced nurses, and seeking consultations. The student acknowledges the importance of nutritional assessment and its placement within the assessment process, emphasizing the achievement of learning objectives and required competencies. The reflection adheres to Gibbs' reflective cycle, detailing the description, feelings, evaluation, analysis, conclusion, and action plan related to the nursing skill.

RUNNING HEAD: INTEGRATING PRACTICE 1
Integrating practice
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INTEGRATING PRACTICE 2
NRSG140 Integrating Practice 2 (Nursing)
DESCRIPTION
In this assignment, I will reflect on the respiratory assessment of a patient that I came
across. There was a case of a woman called Amanda who was 35 years old. Her medical history
included appendectomy. The vital signs that were determined from the patient included a body
temperature of 37.9 degree Celsius, PR of 94, RR OF 22 and the blood pressure was
110/64.Another important vital was the oxygen saturation of 93%.There were other assessments
that were done to Amanda and they include the physical assessment through observation,
inspection, palpation, percussion and Auscultation. During the process of auscultation, there was
a sequence of events that were adhered to such as comparing the left to the right, lateral and
finally the anterior. Different landmarks were also used to determine the position of the lungs on
both expiration and inspiration. There was also a comprehensive nutritional assessment and this
included subjective global assessment where the weigh, dietary intake and the GI symptoms
were thoroughly assessed. There was also the anthropometry and the Body Mass Index
assessment. The breath sounds were also reviewed. From the assessments, it was clear that the
patient was suffering from hospital acquired pneumonia.
FEELINGS
During the initial steps of the assessment, I was quite nervous. This is because I thought
asking about the past medical history would irritate the patient. However, the patient responded
very well to any questions asked. I was also worried at the beginning just in case the whole
process of assessment would not go on smoothly. With time, I got the courage and started
enjoying the whole exercise up to the end.

INTEGRATING PRACTICE 3
EVALUATION
During the whole process of assessment, everything was positive. Everything was going
according to plan and this is to mean that the whole experience was positive. Observation of the
patient, collection of important cues, processing of the information, identification of the problem
and the action or nursing intervention were all carried out well (Tolomeo, 2013). All the nursing
team that we were worked together contributed to the effective flow of all the clinical reasoning
cycle. The nurses who were present provided good advice on what I should do and that is why
the whole process was a success.
ANALYSIS
During the process of assessment, it is very essential for all the necessary steps to be
adhered to effectively. The steps are known as the clinical reasoning cycle. This is a framework
that guides on how nurses should conduct assessment as well as nursing intervention and am
glad I adhered to all the steps. Under the clinical reasoning cycle, the steps include first
considering the patient. This involves viewing of the patient against a background of their own
history (McGrath, Pyke, & Taenzer, 2016). After that, important cues or information are then
collected using interviews. The information is then later processed. The problem is identified and
the necessary goals are then established. After the problem has been identified, an action is then
taken. The action in this case include the nursing intervention (Douglas, Windsor, & Lewis,
2015). Finally, the outcome is then evaluated. There are a lot of important aspects that I managed
to gather during the whole case, one of the most important things is that sequential assessment
leads to accurate diagnosis and eventual intervention for better outcomes (Spitzer, 2016). It does
not make any sense as to conducting an auscultation before obtaining important information
from the patient.

INTEGRATING PRACTICE 4
CONCLUSION.
The only thing that I feel I did differently was the nutritional assessment. The nutritional
assessment should have come before any other form of assessment. What prevented me from
conducting a nutrional assessment before the other assessment was the fact that I felt it was vital
to identify the problem before any other step. However, the objective of the assessment was
achieved and I learnt that it is very important to adhere to the steps of nursing assessment. I also
learnt that am quite knowledgeable when it comes to conducting respiratory assessment. The
whole experience actually met my required competencies.
ACTION PLAN
To ensure that I develop the skills of managing pneumonia in clinical practice, there are
different strategies that I need to put in place. One of the strategies includes reading evidence
based articles that are published recently (Birks, James, Chung, Cant, & Davis, 2014). This will
enable acquisition of new and current methods in assessing patients with the same condition.
Another method is observing the experienced nurses carry out extensive assessment. Despite the
fact that I did everything perfectly, I still believe that I should observe how the senior nurses
carry out the assessment so that I can perfect on it. Another strategy is consultation (Considine &
Currey, 2014). I should always consult other nurses on anything that is not clear so that they can
explain to me well.

INTEGRATING PRACTICE 5
References
Birks, M., James, A., Chung, C., Cant, R., & Davis, J. (2014). The teaching of physical
assessment skills in pre-registration nursing programmes in Australia: Issues for
nursing education. Collegian, 21(3), 245-253. doi:10.1016/j.colegn.2013.05.001
Considine, J., & Currey, J. (2014). Ensuring a proactive, evidence-based, patient safety
approach to patient assessment. Journal of Clinical Nursing, 24(1-2), 300-307.
doi:10.1111/jocn.12641
Douglas, C., Windsor, C., & Lewis, P. (2015). Too much knowledge for a nurse? Use of
physical assessment by final-semester nursing students. Nursing & Health Sciences,
17(4), 492-499. doi:10.1111/nhs.12223
McGrath, S. P., Pyke, J., & Taenzer, A. H. (2016). Assessment of continuous acoustic
respiratory rate monitoring as an addition to a pulse oximetry-based patient
surveillance system. Journal of Clinical Monitoring and Computing, 31(3), 561-569.
doi:10.1007/s10877-016-9884-y
Spitzer, A. R. (2016). Data Collection and Assessment of Respiratory Outcomes. Manual of
Neonatal Respiratory Care, 769-775. doi:10.1007/978-3-319-39839-6_97
Tolomeo, C. (2013). Pediatric Respiratory Health History and Physical Assessment. Nursing
Care in Pediatric Respiratory Disease, 38-50. doi:10.1002/9781118785805.ch2