The Dynamic Process of Clinical Judgment; evaluate factors integral to clinical reasoning.

Posted by: | December 13, 2019

Competency

1. Evaluate factors integral to clinical reasoning.

2. Explain the impact of relational inquiry when recognizing and analyzing cues to action in the process of clinical reasoning.

3. Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.

4. Determine appropriate responses when integrating situated cognition into clinical reasoning.

5. Modify clinical judgement within an iterative, outcome-based cycle of clinical reasoning and client needs.

Scenario

You are a student in the last term of a BSN Program. You are preparing for an end of term exam. To help you prepare, your instructor developed three real world clinical scenarios to provide opportunities for you to apply clinical reasoning and clinical judgement. The instructor stated, “You received reports on these clients. Decide which one you need to see first and then make appropriate nursing decisions based on relevant information to promote positive client outcomes.”

The three scenarios include:

PATIENT 01

JR is a 55 year old male admitted 8hrs prior for a 24hr hold to evaluate for possible myocardial infraction. Serial Troponins within normal range and 12 lead ECG indicated evidence of prior right interior wal myocardial damage.

PATIENT 02

EH is a 40yr old admitted within the past hour with acute onset severe right acute right upper quadrant pain and vomiting for the past 36 hrs. Waiting on labs ECG monitoring shows occasional PVCs…premature ventricular contractions.

PATIENT 03

BW is a 21 year old male athlete admitted yesterday with a fever of 103 and diagnosis of influenza. He rested well overnight. Morning chest x-ray revealed mild infiltrates in lower left lobe.

Instructions

Record your answers to these statements.

Rank the three scenarios provided in order of priority related to which client you will assess first, second and third.

Defend your selection for the three ranked scenarios.

Review the data below for the priority client to determine what to assess first.

Chest X-ray no abnormalities noted
Abdominal X-ray :diffuse gas throughout the small intestine
Hyperactive bowel sounds in all 4 quadrants and abdomen painful to touch
Pain level 10/10
Sodium (Na+) 147 mmol/L
Potassium (K+) 2.9 mmol/L
Chloride (Cl-) 100 mmol/L
Magnesium (Mg2+) 1.4 mg/dL
Calcium (Ca2+) 9.2 mg/dL
Phosphorus (P+) 2.3 mg/dL
Glucose 188 mg/dL
Serum albumin 3.0 g/dL
Amylase 185 unit/L
Serum Creatinine 0.5 mg/dL
BUN 15 mg/dL
Alkaline Phos. 155 unit/L • Protein 8.6 g/dL Bilirubin 3.5 mg/dL

Formulate three hypotheses based on cues provided

Select the priority hypothesis
Defend your selection

Describe an evaluation plan for the priority hypothesis based on expected client outcomes
Describe the next steps in the clinical judgement model including: