00:01
Welcome to the application
of the ADPIE
otherwise known as
the nursing process.
00:06
So, if you guys recall,
there's a five-step nursing process
that we use called ADPIE.
00:13
This means to assess, diagnose,
plan, implement, and evaluate
our patient's plan of care.
00:20
So just to recall a few pointers
on each one of those
pieces of the pie.
00:25
So when we're
talking about assessment,
this is where we gather
that patient's information.
00:30
And then
we take a diagnosis,
which is within
our scope of practice,
called a NANDA
nursing diagnosis
to identify a potential
or an actual patient problem.
00:41
Then we create a plan.
00:42
And this is going to involve
our interventions,
or expected goals, and outcomes
for our patients.
00:48
And then we have the I piece,
which is the action phase,
where we implement
that plan,
and those interventions
for our patients
to help improve conditions.
00:57
Then, of course,
we've got to evaluate here
to see if our plan of care
was effective.
01:04
Now, we're going to apply
this ADPIE piece today.
01:07
And we're going to use
a little scenario for you.
01:09
So here we've got Mrs. Dorothy Meyer
as our patient. She's 63 years old.
01:14
So the situation today
is she fell at home,
broke her right hip,
and after having surgery
to repair the hip,
she is now being admitted
to our surgical unit.
01:25
So with this scenario here,
we're going to walk through
that ADPIE process.
01:30
So we're talking about
the assessment piece of that pie.
01:33
We use different
assessment approaches.
01:36
So we may use
our health history.
01:38
This is a really key piece
because we're going to
gather information
to help understand
a little bit better
our patient's
current and past health history.
01:48
Then, of course,
we need to put our skills in play
with the head to toe
physical assessment.
01:53
Now this is really key,
as you know in nursing,
that we're going to get
a great baseline idea
of what our patient's
condition is.
02:00
We're also going to know
any abnormalities
we may need to address.
02:05
And lastly, we also use
our focused assessment,
looking closely at a
particular area of concern
with our patient situation.
02:14
Now, when we're talking about
our health history.
02:16
It's really helpful because this
gives us a better understanding,
again, of the
client's current problems,
and some of their
past medical history.
02:24
Because sometimes
those past medical histories,
those are going to come into play
with the treatment of your patient
when you see them in the hospital.
02:33
So Mrs. Meyer here. She's got a
medical history of high cholesterol,
otherwise known as
hyperlipidemia.
02:40
Also COPD, which is Chronic
Obstructive Pulmonary Disease.
02:44
So, she has a lung disease
that's chronic.
02:47
Luckily, she does not have
to wear oxygen at night currently.
02:51
And also she does live
and have some psychosocial support,
where she lives at home
with her husband
in a one story home.
02:58
So we talked about
that health history.
03:00
Now, we're going to move to
that other assessment approach
called that head to toe assessment,
as you all may know.
03:06
So, if you remember,
when we're talking about assessment,
we use our
inspection, palpation, percussion.
03:12
We use our ears
for auscultation,
and we perform a thorough
head to toe assessment,
and gather data.
03:19
Now, during that assessment,
we're going to pick out
some other key pieces
such as our vital signs
we're going to take
to include more
diagnostic information.
03:28
And right now,
Mrs. Meyers oxygen level
is at 94% on two liters.
So not bad, right?
However, when we did
our head to toe assessment,
many times we're going
to communicate with our patient
their chief complaint.
03:41
We're also, again,
assess our pain score.
03:44
So if you recall,
Mrs. Meyers had that hip surgery,
So she's reporting her pain
at a 7 out of 10 in her right hip.
03:53
Now, just a little refresher.
03:55
If you guys remember,
when we're talking about
a numeric pain scale,
we go from zero
being no pain at all,
to 10 being the absolute
worst pain ever.
04:04
So you can see here, Mrs. Meyers
kind of high up on that scale
with a 7 out of 10.
04:10
Now physically, we've assessed her
and we know she had hip surgery.
04:14
So we see here, that she has
a surgical incision with staples
on that right upper hip.
Again where she had surgery.
04:22
Now, we're going to also bring
in that focus assessment piece
to continue
to gather information.
04:28
With what we know about
our health history,
we're going to listen
and auscultate her lungs.
04:34
So when we listen
to Mrs. Meyers,
we heard that she had
clear lung sounds
with a little bit of
diminished sounds and her basis.
04:42
Also focus is
her surgical incision of course.
04:45
We want to make sure it's free
of signs and symptoms of infection.
04:50
So when we assess her
we see she has no discharge.
04:53
She has normal swelling or edema
that we would note post surgery.
04:57
And some normal redness
or otherwise known as erythema
that we would again,
we would expect
all these things post surgery.