Posted: July 11th, 2024
Deliverable 3 – Clinical Reasoning to Prioritize Care and Manage Complications
Deliverable 3 – Clinical Reasoning to Prioritize Care and Manage Complications
This assignment evaluates students’ ability to apply clinical reasoning in a complex emergency department scenario. Assignment Content:
Competency
Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the Details & Information pane.
Scenario
You recently finished orientation in the emergency department (ED) of a rural 60-bed hospital, and tonight is the first shift you have worked independently. The Intensive Care Unit of the hospital has only four beds. Usually, the sickest clients needing complex care are referred to a regional medical facility 50 miles from your location. During orientation, you were told that treatment in this emergency department begins with triage, stabilization, and discharge or referred to the regional medical facility. This scenario presents a challenging case that requires careful assessment and prioritization of care in a resource-limited setting. The limited ICU capacity and distance to the regional facility add complexity to the decision-making process, emphasizing the importance of accurate triage and stabilization.
Tonight, the first client is an 82-year-old female named Ruth. Ruth was dropped off at the emergency department by a neighbor who said that she had been nauseous and vomiting for a week. Her husband was recently admitted to an Alzheimer’s Unit at a local Long-Term Care facility, and the neighbor thought stress was making it hard for Ruth to eat, but tonight she vomited fresh blood and appeared dizzy. The neighbor also brought in a bag of medication she found in the home but was unsure which medication belonged to Ruth or her husband. Ruth’s case highlights the interconnected nature of physical and emotional health, particularly in older adults. The recent change in her living situation, combined with her acute symptoms, necessitates a comprehensive approach to care that addresses both her immediate medical needs and potential underlying psychosocial factors.
You find a frail woman in a wheelchair in the hallway with labored breathing. She appears dirty with matted hair, clothed in a bathrobe with numerous food stains and a heavy cigarette smell. You notice the chart has a highlighted area noting the client has only Medicaid for insurance. You ask her if she understands why she is in the ER, and she asks, “Where is my husband? He is usually home by now.” Ruth’s presentation raises concerns about self-care ability and potential neglect. Her confusion about her husband’s whereabouts suggests possible cognitive impairment or delirium, which could complicate both diagnosis and treatment. The insurance status noted in her chart underscores the importance of considering social determinants of health in care planning.
Past medical history:
o Two pack per day smoker for 58 years
o Type I Diabetic
Assessment data:
o Blood pressure: 178/98 mm Hg
o Heart rate: 84 beats per minute
o Oxygen saturation: 84 percent on room air
o Temperature: 101.8° degrees Fahrenheit
o Hyperactive bowel sounds in all four quadrants
o An open wound on the bottom of the right foot
Instructions
In a Word document, create notes for this client’s plan of care, including:
o Create three hypotheses for the client appropriate for the situation.
o Identify the priority hypothesis and support your choice with data from the scenario.
o Determine three solutions for the priority hypothesis, including supporting rationales and evidence from credible sources.
o Describe two potential complications for the case scenario or the priority hypothesis.
o Develop three solutions to manage the potential complications, including supporting rationales and evidence from credible sources.
This comprehensive care plan should integrate Ruth’s complex medical history, current symptoms, and psychosocial factors. The plan should prioritize immediate stabilization while also addressing underlying chronic conditions and potential barriers to care. Consider how Ruth’s long-term smoking history and diabetes might interact with her current presentation, and how her apparent confusion and self-care difficulties might impact treatment adherence and follow-up care.
Resources
• APA 7th Edition Guide
• Writing Guide
Submit a Word document with your notes for the client’s plan of care.
=======================
Deliverable 3 – Clinical Reasoning to Prioritize Care and Manage Complications
Assignment Content
1.
Competency
Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the Details & Information pane.
Scenario
You recently finished orientation in the emergency department (ED) of a rural 60-bed hospital, and tonight is the first shift you have worked independently. The Intensive Care Unit of the hospital has only four beds. Usually, the sickest clients needing complex care are referred to a regional medical facility 50 miles from your location. During orientation, you were told that treatment in this emergency department begins with triage, stabilization, and discharge or referred to the regional medical facility.
Tonight, the first client is an 82-year-old female named Ruth. Ruth was dropped off at the emergency department by a neighbor who said that she had been nauseous and vomiting for a week. Her husband was recently admitted to an Alzheimer’s Unit at a local Long-Term Care facility, and the neighbor thought stress was making it hard for Ruth to eat, but tonight she vomited fresh blood and appeared dizzy. The neighbor also brought in a bag of medication she found in the home but was unsure which medication belonged to Ruth or her husband.
You find a frail woman in a wheelchair in the hallway with labored breathing. She appears dirty with matted hair, clothed in a bathrobe with numerous food stains and a heavy cigarette smell. You notice the chart has a highlighted area noting the client has only Medicaid for insurance. You ask her if she understands why she is in the ER, and she asks, “Where is my husband? He is usually home by now.”
Past medical history:
o Two pack per day smoker for 58 years
o Type I Diabetic
Assessment data:
o Blood pressure: 178/98 mm Hg
o Heart rate: 84 beats per minute
o Oxygen saturation: 84 percent on room air
o Temperature: 101.8° degrees Fahrenheit
o Hyperactive bowel sounds in all four quadrants
o An open wound on the bottom of the right foot
Instructions
In a Word document, create notes for this client’s plan of care, including:
o Create three hypotheses for the client appropriate for the situation.
o Identify the priority hypothesis and support your choice with data from the scenario.
o Determine three solutions for the priority hypothesis, including supporting rationales and evidence from credible sources.
o Describe two potential complications for the case scenario or the priority hypothesis.
o Develop three solutions to manage the potential complications, including supporting rationales and evidence from credible sources.
Resources
• APA 7th Edition Guide
• Writing Guide
Submit a Word document with your notes for the client’s plan of care.
Title of Paper
Your Name
Rasmussen University
NUR4153: Clinical Reasoning and Clinical Judgment
Instructor Mindy Fadell
Date
Title of Paper
Introduction to the Case study
*Remember to erase Blue Font
*Remember to use reference support and in-text citation throughout
(What are important elements in this scenario?)
Three Hypothesis
Hypothesis One: (What cues led you to this hypothesis?)
Hypothesis Two: (What cues led you to this hypothesis?)
Hypothesis Three: (What cues led you to this hypothesis?)
Priority Hypothesis: (Why is this the priority over the others)
Three Solutions for Priority Hypothesis
(What are areas to improve? For example, improving mobility for a patient. Be sure that each solution is going to improve the priority hypothesis)
Solution One:
Solution Two:
Solution Three:
Two Potential Complications
(What are complications that could occur with your priority hypothesis? If a patient’s priority hypothesis is high blood pressure in a pregnant patient, a complication would be Pre-eclampsia)
Complication One:
Complication Two:
Three Solutions for the Potential Complications
(What are different ways the hypothesis can be resolved?)
Solution One:
Solution Two:
Solution Three:
Conclusion
References
See https://guides.rasmussen.edu/apa/references
Author’s Last Name, First initial. Middle initial. (Year). Title of article. Journal Title, Volume Number(Issue number), Page numbers.
Clinical Reasoning Appropriate for the Situation
Format: Word Document
4 Mastery 3 Proficiency 2 Competence
Criterion 1 Three hypotheses included. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. Less than three hypotheses included.
Criterion 2 Well-developed hypotheses included detailed supporting data from the scenario and superior rationales. Mostly accurate hypotheses included satisfactory supporting data from the scenario and sufficient rationales. Somewhat reasonable hypotheses included occasional supporting data from the scenario and some logical rationales. Attempted to develop hypotheses with minimal supporting data from the scenario and vague rationales.
Criterion 3 Skillfully selected priority hypothesis with detailed supporting data from the scenario and superior rationales. Mostly accurate priority hypothesis with satisfactory supporting data from the scenario and sufficient rationales. Somewhat reasonable priority hypothesis with occasional supporting data from the scenario and some logical rationales. Attempted to select a priority hypothesis with minimal supporting data from the scenario and vague rationales.
Criterion 4 Three solutions for the priority hypothesis included. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. Less than three solutions included for the priority hypothesis.
Criterion 5 Skillfully selected solutions for the priority hypothesis with superior rationales and significant evidence from credible sources. Mostly accurate solutions for the priority hypothesis with sufficient rationales and satisfactory evidence from credible sources. Somewhat reasonable solutions for the priority hypothesis with some logical rationales and occasional evidence from credible sources. Attempted to determine solutions for the priority hypothesis with vague rationales and minimal evidence from credible sources.
Criterion 6 Two potential complications included. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. Less than two complications included
Criterion 7 Well-developed description of potential complications with superior rationales and evidence from credible resources. Mostly accurate description of potential complications with sufficient rationales and evidence from credible resources. Somewhat reasonable description of potential complications with some logical rationales and evidence from credible resources. Attempted to describe potential complications with vague rationales and evidence from credible source
Criterion 8 Three solutions for the potential complications included. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. The achievement of this criteria is assessed at either the Emerging or Mastery levels. Demonstration of this action or skill is either achieved or not achieved. Less than three solutions included for the potential complications.
Criterion 9 Skillfully selected solutions for the potential complications with superior rationales and significant evidence from credible sources. Mostly accurate solutions for the potential complications with sufficient rationales and satisfactory evidence from credible sources. Somewhat reasonable solutions for potential complications with some logical rationales and occasional evidence from credible sources. Attempted to determine solutions for the potential complications with vague rationales and minimal evidence from credible sources.
Criterion 10 Formal style is demonstrated throughout the document, including no spelling, grammar, or APA format errors. Formal style is demonstrated throughout most of the document, with minor spelling, grammar, or APA format errors. Formal style is demonstrated in some parts of the document but not maintained throughout. Some spelling, grammar, or APA format errors present. Lack of formal style in the document. Numerous spelling, grammar, or APA format errors are present.
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Sample Homework Assignments & Research Topics
Tags:
Clinical reasoning skills,
Deliverable 3 - Clinical Reasoning to Prioritize Care and Manage Complications,
Emergency department triage,
Geriatric acute care
