Question

A nursing student is providing a hand-off report to a registered nurse (RN) who is assuming her patient's care at the end of the clinical day. The student states, "The patient had a good day. His intravenous (IV) fluid is infusing at \(124 \mathrm{~mL} / \mathrm{hr}\) with \(\mathrm{D}_{5} 1 / 2 \mathrm{NS}\) infusing in left forearm. The IV site is intact, and no complaints of tenderness. I ambulated him twice during the shift; he tolerated walking to the visitors lounge and back with no shortness of breath, respirations 14 , heart rate 88 after exercise. He uses his walker without difficulty, gait normal. The patient ate \(3 / 4\) of his dinner with no gastrointestinal complaints. For the goal of improving the patient's activity tolerance, which expected outcomes were shared in the hand-off? (Select all that apply.) a. IV site not tender b. Uses walker to walk c. Walked to visitors lounge d. No shortness of breath e. Tolerated dinner meal

Short answer

The expected outcomes shared in the hand-off that pertain to improving the patient's activity tolerance are: b. Uses walker to walk, c. Walked to visitors lounge, and d. No shortness of breath after exercise.

Step-by-step solution

Identify Expected Outcomes Related to Activity Tolerance

Review the hand-off report to identify the outcomes that demonstrate an improvement in the patient's activity tolerance. Expected outcomes related to activity tolerance would typically include signs that the patient can perform physical activities without distress or difficulty.

Analyze Report for Relevant Outcomes

From the given report, find the outcomes that are relevant to the goal of improving the patient's activity tolerance. This involves noting any mention of physical activity and the patient's response to it as shared by the nursing student.

Select Correct Outcomes

Compare the identified outcomes in the report with the options given (a to e), and select the ones that are directly related to the patient's activity tolerance. The outcomes of 'IV site not tender' and 'Tolerated dinner meal' do not directly demonstrate activity tolerance, whereas the other responses do.

Key concepts

Patient Care Hand-Off Report

Navigating through a patient care hand-off report requires precision and attention to detail. This report plays a crucial role in maintaining continuity of care as one healthcare provider shifts responsibilities to another.

In our scenario, the nursing student provides vital information regarding the patient's condition, activities during the shift, and response to treatments. An effective hand-off must cover several elements, typically including the patient's current status, recent changes, and treatments or interventions provided, such as the IV fluid management and the extent of physical activity.

As highlighted in the exercise, specific details about the patient's tolerance to activity and ability to use a walker, heart rate and respiration after exercise, and gait stability reflect the quality and safety of care during the transition. Proper training in delivering concise and accurate reports is fundamental in nursing education, and the student's report serves as a tangible example of this essential skill in ensuring seamless patient care transitions.

Physical Activity Outcomes in Nursing

Monitoring physical activity outcomes is an integral aspect of nursing care. It helps to assess a patient's recuperation and the effectiveness of interventions aimed at improving their overall health status.

Physical activity is an indicator of a patient's tolerance and resilience. In the given exercise, indications of the patient's ability to walk to the visitors' lounge and back, usage of a walker, and maintenance of normal gait and vital signs post-exercise are clear manifestations of meaningful activity outcomes. These factors are a testament to the patient's activity tolerance.

A refined objective like ‘no shortness of breath’ can significantly inform about the patient's cardiopulmonary function under exertion. Improved activity tolerance can ultimately lead to expedited recovery times, reduced hospital stays, and better quality of life for patients. Analyzing and documenting these measures are therefore crucial in tailoring patient care to encourage independence and mobility.

Intravenous Fluid Management

Effective intravenous (IV) fluid management is a cornerstone of stable nursing care, critical for sustaining patient health during hospital stays. It encompasses selection of the appropriate fluid composition, determining the correct infusion rate, and monitoring the patient for signs of fluid imbalance.

In our exercise, the rate of the IV fluid (\(124 \text{ mL/hr}\)) and the specific type of fluid (\(D_5 1/2 NS\)) are detailed, which are fundamental aspects of fluid management. Observation for adverse effects, such as tenderness at the IV site, is also a key part of this process. While absence of IV site tenderness is important, it does not directly reflect the patient’s activity tolerance.

The recorded fluid infusion rate and the type of fluid used can directly influence a patient’s physiological response to physical exertion and thus must be monitored and adjusted in tandem with changing physical activity levels. It's vital for nursing students and registered nurses to be adept in managing IV fluids, as it's essential to patient stabilization and recovery.