NR 536 Week 3 Developing Critical Thinking Questions
Student Name
Chamberlain University
NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice
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Date
Week 3 Assignment: Developing Critical Thinking Questions
Concept to Be Presented: Protection and Movement – Infections
This assignment focuses on the development of critical thinking questions related to protection and movement, specifically addressing infections such as ventilator-associated pneumonia (VAP). The target audience for this assignment is staff nurses working in acute healthcare settings, with three years of experience in patient protection and infection management. Developing critical thinking skills among healthcare professionals is essential for improving patient outcomes, especially in infection prevention and control.
Problem Recognition
A 65-year-old male patient was admitted with chest pain, later diagnosed as localized pleuritis. In this healthcare setting, the hospital-acquired pneumonia (HAP) rate is 3.8%, with a notable risk of VAP among patients. The primary goal is to reduce infection rates and prevent the onset of VAP during this patient’s care.
Table 1: Critical Thinking Questions for Problem Recognition
| Pathophysiology | Physical Assessment | Pharmacology |
|---|---|---|
| Question: What are the causes behind the increased VAP rate in the healthcare facility? | Question: What physical assessments are necessary to prevent bacterial secretions in the respiratory tract? | Question: Has antibiotic resistance contributed to increased VAP rates? |
| Answer: Major causes include poor hygiene, inadequate waste management (Hua et al., 2016), improper head elevation, aspiration events, and high antibiotic exposure, among others (Khan et al., 2017). | Answer: Assessments such as chest auscultation, airway monitoring, and secretion checks every 48 hours are crucial (Álvarez-Lerma et al., 2018). | Answer: Yes, antibiotic resistance, particularly in older adults, compromises defense mechanisms against pathogens, heightening VAP risk (Zampieri et al., 2015). |
Clinical Decision-Making
To address the risk of VAP, the healthcare team implemented a VAP prevention bundle, focusing on reducing VAP incidence, shortening hospital stays, and minimizing treatment costs. This evidence-based intervention aligns with best practices in infection prevention and control.
Table 2: Critical Thinking Questions for Clinical Decision-Making
| Pathophysiology | Physical Assessment | Pharmacology |
|---|---|---|
| Question: What clinical data supported the decision to adopt the VAP prevention bundle? | Question: When should physical assessments ideally be conducted? | Question: How does prolonged hospital stay impact the efficacy of bundle interventions? |
| Answer: Studies indicate that bundle interventions reduce infection rates and improve oral hygiene (Álvarez-Lerma et al., 2018; Pinho et al., 2020). | Answer: It is recommended within 24 hours to assess breathing patterns and chest congestion, as VAP risk escalates after 48 hours (Fortaleza et al., 2020). | Answer: Longer hospital stays increase antibiotic resistance; multimodal interventions with probiotics have shown efficacy in reducing VAP risk (Xie et al., 2019). |
Prioritization and Clinical Intervention
The healthcare team prioritized 24-hour patient monitoring to reduce VAP risk, emphasizing the need to alleviate potential stress and workload for nurses. Additionally, multimodal interventions, such as sedation management protocols, were considered to enhance care optimization.
Table 3: Critical Thinking Questions for Prioritization and Clinical Intervention
| Pathophysiology | Physical Assessment | Pharmacology |
|---|---|---|
| Question: What are early symptoms indicating the need for increased patient care? | Question: What is the optimal ventilator inclination to minimize infection risks? | Question: Is prioritizing chlorhexidine over regular oral hygiene effective? |
| Answer: Early signs include fever, altered breathing rate, and mucus production, requiring enhanced care and possibly isolation (Álvarez-Lerma et al., 2018). | Answer: A 30-degree head inclination is effective in preventing bacterial growth, especially when combined with oral hygiene practices (Fortaleza et al., 2020). | Answer: While 0.2% chlorhexidine may reduce bacterial secretions, concerns about its cytotoxicity remain (Prasad et al., 2019; Vieira et al., 2020). |
References
Álvarez-Lerma, F., et al. (2018). Prevention of ventilator-associated pneumonia. Critical Care Medicine, 46(2), 181-188. https://doi.org/10.1097/ccm.0000000000002736
Bardia, A., et al. (2019). Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. The Journal of Thoracic and Cardiovascular Surgery, 158(4), 1094-1100. https://doi.org/10.1016/j.jtcvs.2019.01.014
Fortaleza, C., et al. (2020). Sustained reduction of healthcare-associated infections after introducing a bundle for prevention of ventilator-associated pneumonia in medical-surgical ICUs. The Brazilian Journal of Infectious Diseases, 24(5), 373-379. https://doi.org/10.1016/j.bjid.2020.08.004
Hua, F., et al. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008367.pub3
NR 536 Week 3 Developing Critical Thinking Questions
Khan, Z., et al. (2017). Ventilator-associated pneumonia or ventilator-induced pneumonia. Multidisciplinary Respiratory Medicine, 12. https://doi.org/10.4081/mrm.2017.224
Prasad, R., et al. (2019). The impact of 0.2% chlorhexidine gel on oral health and pneumonia incidence among adults with profound complex neurodisability. Special Care in Dentistry, 39(5), 524-532. https://doi.org/10.1111/scd.12414
Vieira, P., et al. (2020). Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles? Medicina Intensiva. https://doi.org/10.1016/j.medin.2020.09.009
Xie, X., et al. (2019). Drug prevention and control of ventilator-associated pneumonia. Front Pharmacol, 10(298). https://doi.org/10.3389/fphar.2019.00298
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