NR 536 Week 3 Developing Critical Thinking Questions

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Week 3 Assignment: Developing Critical Thinking Questions

Concept to be Presented: Protection and Movement – Infections

This assignment focuses on creating critical thinking questions related to protection and movement, specifically addressing infections like ventilator-associated pneumonia (VAP). The learner targeted in this case is a staff nurse working in an acute healthcare hospital with three years of experience in patient protection and infection management. Developing critical thinking skills in such healthcare professionals is crucial to improve patient outcomes, particularly in infection prevention and control.

Problem Recognition

A 65-year-old male patient has been admitted with chest pain, later diagnosed as localized pleuritis. In this healthcare setting, the hospital-acquired pneumonia (HAP) rate is reported at 3.8%, with a high possibility of VAP among patients. Reducing these infection rates and preventing VAP are the primary goals in managing 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? 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).	Question: What physical assessments are necessary to prevent bacterial secretions in the respiratory tract? Answer: Assessments such as chest auscultation, airway monitoring, and secretion checks every 48 hours are crucial (Álvarez-Lerma et al., 2018).	Question: Has antibiotic resilience contributed to increased VAP rates? Answer: Yes, antibiotic resistance, particularly in older adults, compromises the defense against pathogens, heightening VAP risk (Zampieri et al., 2015).

Clinical Decision Making

To address the VAP risk, the healthcare team implemented a VAP prevention bundle, aimed at reducing VAP incidence, hospital stay duration, and treatment costs. This approach aligns with evidence-based practices in infection 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? Answer: Studies indicate that bundle interventions reduce infection rates and improve oral hygiene (Álvarez-Lerma et al., 2018; Pinho et al., 2020).	Question: When should physical assessments ideally be conducted? 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).	Question: How does prolonged hospital stay impact bundle intervention efficacy? Answer: Longer stays increase antibiotic resistance; multimodal interventions with probiotics have proven effective in mitigating VAP risk (Xie et al., 2019).

Prioritization and Clinical Intervention

The healthcare team prioritized 24-hour patient monitoring to lower VAP risk, aiming to minimize potential stress and workload implications for nurses. The use of multimodal interventions, including sedation management protocols, was also considered for optimizing care.

Table 3: Critical Thinking Questions for Prioritization and Clinical Intervention

Pathophysiology	Physical Assessment	Pharmacology
Question: What are early symptoms that indicate the need for increased patient care? Answer: Signs include fever, altered breathing rate, and mucus production, among others, requiring enhanced care and possibly isolation (Álvarez-Lerma et al., 2018).	Question: What is the optimal ventilator inclination to minimize infection risks? Answer: A 30-degree head inclination is effective in preventing bacterial growth, especially when combined with oral hygiene practices (Fortaleza et al., 2020).	Question: Is prioritizing chlorhexidine over regular oral hygiene effective? Answer: Studies indicate that 0.2% chlorhexidine may reduce bacterial secretions, but concerns about 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 the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units. The Brazilian Journal of Infectious Diseases, 24(5), 373-379. https://doi.org/10.1016/j.bjid.2020.08.004

Hellyer, T., et al. (2016). The intensive care society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 17(3), 238-243. https://doi.org/10.1177/1751143716644461

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

Olanipekun, T., & Snyder, R. (2019). Mortality risk in ventilator-acquired bacterial pneumonia and nonventilator ICU-acquired bacterial pneumonia. Critical Care Medicine, 47(10), e851-e852. https://doi.org/10.1097/ccm.0000000000003662

Pinho, R., et al. (2020). Impact of each component of a ventilator bundle on preventing ventilator-associated pneumonia and lower respiratory infection. Infection Control & Hospital Epidemiology, 41(S1), s259-s260. https://doi.org/10.1017/ice.2020.824

Prasad, R., et al. (2019). The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. Special Care in Dentistry, 39(5), 524-532. https://doi.org/10.1111/scd.12414

NR 536 Week 3 Developing Critical Thinking Questions

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

Zampieri, F., et al. (2015). Nebulized antibiotics for ventilator-associated pneumonia: A systematic review and meta-analysis. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-0868-y

Zhao, J., et al. (2020). Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis. ERJ Open Research, 00302-2020. https://doi.org/10.1183/23120541.00302-2020