Take a look at the following case study.
Please read the bold instructions twice.
You are a staff nurse in an intensive care unit and have been assigned to care for a 75-year-old man who underwent coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease, which has been aggravated by heavy smoking. His postoperative recovery has been difficult, with a number of setbacks. Despite their best efforts, staff members have been unable to wean him off the ventilator since the surgery. Throughout the shift, he required frequent suctioning, and he is being monitored for the development of ventilator-associated pneumonia. When you returned from lunch today, you noticed an experienced nurse suctioning your patient. His secretions were thick, and you noticed the nurse suctioning him while instilling saline into his endotracheal tube. The patient turned red and began coughing, indicating that he was in pain. You inquired as to why the nurse was injecting saline into his endotracheal tube. She explained that it was done to loosen the secretions. You informed her that this was no longer a permissible practice. She stated that she had many years of critical care experience and that, regardless of what anyone said, the only way to loosen the patient’s secretions was to instill saline. She also stated that it would be the last time she would assist one of your patients while you were at lunch.
Using the nursing process, devise a plan of care for the patient.
Define each step of the nursing process and link it to critical thinking and clinical decision-making.