Clinical Reasoning Appropriate for the Situation
NUR4153: Clinical Reasoning and Clinical Judgement
Hypothesis
Below are the four modes of learning addressing Ruth’s scenario from the most relevant to the list relevant. The modes have the plans of actions well explained with data and supported with clinical reasoning as to why they have been ranked this way.
- Empirical
This learning mode entails the patient’s data, which includes the signs and symptoms noted and is the most relevant. In the case of Ruth, the patient has labored breathing. She is dirty with tangled hair in a bathrobe that has food stains. The robe also has a heavy smell of cigarette smoke, indicating that she smokes. The patient’s blood pressure is high (178/98mmHg), and the oxygen saturation is at 84. The heartbeat rate is at 84 beats per minute, which is normal, and there is the presence of hyperactive bowel sounds in all four quadrants, which indicate that the patient might be having a stomach upset. The patient also appears to be disoriented as she cannot answer questions appropriately.
Ruth needs to be admitted immediately as she has labored breathing, which is shortness of breath. On the other hand, her oxygen saturation levels need to be increased, and the blood pressure controlled. The open would need to be treated for infections and appropriately dressed. Also, she needs to be cleaned as it is evident; she cannot take care of herself. She is old and in a wheelchair.
- Sociopolitical
The patient arrives with labored breathing/ shortness of breath, high blood pressure, high temperature, and is confused. The husband has been admitted to a Long -Term Care facility, which means the patient is lonely in her home. This explains why he is dirty and disorganized, as she has no one to take care of her needs. Additionally, she is old, 82 years old, with only Medicaid insurance.
The patient has a Medicaid Insurance that is usually given to the elderly and low-income earners, meaning she qualifies for home health care when released from the hospital. From how she is unkempt, extra care is needed, but she should be admitted before that. This is the second relevant mode of learning as it gives more information on the patient’s social life, like in the instance of Ruth, her conditions seem to have been influenced by her social life. The patient is being admitted, and information on how bills will be paid and how the patient lives must be considered in the early stages.
- Ethical
Generally, Ruth is in a poor state with the way at which she arrives in the hospital. One, she arrives in the emergency room with labored breath, and her assessment data suggests that her oxygen saturation is at 84, which is low and blood pressure at 178/98, which is very high. Also, she has an open wound on his right foot. Her temperature is not stable as it is at 101.8-degree Fahrenheit.
Ruth has a below-normal level of oxygen in her blood, which needs to be addressed as it has resulted in shortness of breath. The high blood pressure can then be monitored, and the temperature-controlled by giving her fluids. The open wound must be checked by a nurse in charge and dressed appropriately to avoid any further infections.
- Aesthetic
The patient is disoriented with the way she arrives in the emergency room, totally confused and unable to answer questions. According to the neighbor who brought her in, the patient has been vomiting and feeling nauseous for a week. The patient has not been eating and vomited fresh blood and appeared dizzy. The neighbor also points out that Ruth might be stressed because her husband has been admitted to a Long- Term Care facility in an Alzheimer’s Unit. Again, this must-have affected her eating habit. The patient is a heavy smoker from her history (has been smoking two packs of cigarettes for 58 years) and has an open wound on the bottom of the right foot.
The way the patient is answering questions, she seems to be confused. She cannot answer most questions meaning getting to know her history will be difficult. Thus, admitting her and continuously monitoring her will be the most appropriate action. This will be the least relevant learning mode as it will require some time with continuous monitoring to understand the patient’s behavior. Also, to deduce other underlying conditions, the present conditions will have to have been controlled first.
Evaluation Plan
The patient being a daily smoker, the first thing to be evaluated will be the oxygen saturation level. That is, to ensure that it stays above 90. Secondly, her patient’s blood pressure is high and needs to be controlled. The neighbor brought in an empty bottle of medication, which might have been the patient’s medication. Unfortunately, under this circumstance, the patient cannot communicate whether the bottle of medicine was hers or her husbands. With the high blood temperature, however, the patient might have been unable to refill her medication. The goal of the two plans is to ensure that the patient is stable.
The third plan will be to carry out several tests on her blood and urine to check for infections. The patient has diabetic type I and might also be dehydrated with the vomiting the whole week. The fourth plan would be to address the open wound. The nurse in charge of injuries should remove death tissues and dress it first in the emergency room before other actions can be taken on the wound. Lastly, the patient has Medicaid Insurance; a follow up with social work will be appropriate to ensure the patient will be well taken care of. The patient was unkempt, disorganized, and confused, which is a matter of concern, especially now that she is old.
Continuous monitoring and evaluating the patient need to go on for some time, ensuring that the high blood pressure is maintained, the oxygen saturation level is increased, and the open wound is attended to. After some time, a decision on whether the patient should go home or be taken to a facility will be evaluated based on how well she will respond to medication.
References
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse Education in Practice, 18, 73–79. https://doi.org/10.1016/j.nepr.2016.03.002