Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.
Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.
Keeping that in mind, answer the following scenario:
You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include:
RN with 12 years of Trauma ED experience
New RN with 6 months ED experience
RN from the Medical Surgical floor with 8 years of experience
The following patients are in the ED, which patient will you give to each of the nurses and why?
A 76-year-old client who was involved in a motor vehicle accident and has hematuria.
A 38-year-old client with kidney stones complaining of severe pain.
A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching.
An 80-year-old client that has not had a bowel movement for 4 days.
NUR2571 Professional Nursing II
Module 2 Discussion
Patient with Hyperkalemia
Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:
What interventions do expect to be ordered for Mr. Sweet? Why?
What type of acid-base disturbance does he have?
What do you think is Mr. Sweet’s Medical Diagnosis?
NUR2571 Professional Nursing II
Module 3 Discussion
Case Scenario: Tuberculosis
Wilson is a 36-year-old migrant worker. He was admitted to the Hospital with a cough, unintended weight loss, and night sweats. He is staying with 6 friends in a one bedroom apartment near the strawberry field where he works. The ED physician suspects Tuberculosis (TB).
What diagnostic testing will the Provider order to confirm a diagnosis of TB?
What Isolation precautions do you expect to be put in place and why?
Describe the recommended treatment regimen for TB, including the rationale for combination drug therapy.
Identify the reason compliance to medication therapy is often a concern in the patient with TB.
What should be done for Wilson’s 6 roommates?
NUR2571 Professional Nursing II
Module 4 Discussion
I-SBAR-R Reporting
Think of a situation from clinical when the Provider needed to be informed of a change in patient condition. Using ISBARR write what you would report to the Provider. You can use the ISBARR form for guidance.
NUR2571 Professional Nursing II
Module 5 Discussion
Patient Teaching: Anticoagulants
Sandra is a 27-year-old female admitted with a possible Deep Vein Thrombosis (DVT). She smokes one pack per day and is on birth control. She has a history of hypertension and obesity. She is admitted to the hospital and placed on bedrest. Heparin drip is started per protocol. The Provider is anticipating on sending her home with Coumadin.
Can Sandra be placed on Coumadin and Heparin at the same time? Explain your answer.
Develop 3 teaching points important for Sandra to know about her medications regimen.
What questions would you ask Sandra to verify that she understand the 3 teaching points?
NUR2571 Professional Nursing II
Module 7 Discussion
Type 1 vs. Type 2 and Patient Education
Compare and contrast risk factors, age of onset, pathophysiology and clinical manifestations of Type 1 and Type 2 Diabetes. What do you think is the most important topic that must be taught to the diabetic patient and why?
NUR2571 Professional Nursing II
Module 8 Discussion
The Older Adult
A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.
Develop a Plan of Care for this patient that includes:
2 Nursing Diagnosis
2 goals for each Nursing Diagnosis
Interventions with rationales
NUR2571 Professional Nursing II
Module 10 Discussion
Bariatric Surgery Patient
EJ is a 28-year-old female. She is being admitted for Gastric Bypass Surgery. She is 5’6” and 265 pounds. She has a history of Diabetes and hypertension, she is not on medications at the time.
What client education topics are important to reinforce for this client?
How will this client’s diet be advanced?
What complications can occur after this surgery?What is Dumping Syndrome and what are some interventions to help prevent its development?
NUR2571 Professional Nursing II
Module 1 Assignment
Bowel and Urinary Disorders
Comparison of Urinary Elimination Disorders:
Stress Incontinence
Benign Prostatic Hypertrophy
Pyelonephritis
Pathophysiology
Etiology
Clinical Manifestations
Interventions
Comparison of Bowel Elimination Disorders:
Diarrhea
Bowel Obstruction
Hemorrhoids
Pathophysiology
Etiology
Clinical Manifestations
Interventions
NUR2571 Professional Nursing II
Module 2 Assignment
Fluid/electrolyte disturbances and ABG interpretation
Complete the Fluid disturbance table and answer the following ABGs (Arterial Blood Gases).
Comparison of Fluid Deficit and Fluid Overload
Fluid Deficit
Fluid Overload
Definition
Causes/Risk Factors
Clinical Manifestations (including laboratory data)
Collaborative Management (Interventions)
Interpret the following Arterial Blood Gases
1. pH 7.33 PaCO2 60 HCO3 34
A. Normal ABG values
B. Respiratory acidosis without compensation
C. Respiratory acidosis with partial compensation
D. Respiratory acidosis with full compensation
2. pH 7.48 PaCO2 42 HCO3 30
A. Metabolic acidosis without compensation
B. Respiratory alkalosis with partial compensation
C. Respiratory alkalosis with full compensation
D. Metabolic alkalosis without compensation
3. pH 7.38 PaCO2 38 HCO3 24
A. Respiratory alkalosis
B. Normal
C. Metabolic Alkalosis
D. None of the above
4. pH 7.21 PaCO2 60 HCO3 24
A. Normal
B. Respiratory acidosis without compensation
C. Metabolic acidosis with partial compensation
D. Respiratory acidosis with complete compensation
5. pH 7.48 PaCO2 28 HCO3 20
A. Respiratory alkalosis with partial compensation
B. Respiratory alkalosis with complete compensation
C. Metabolic alkalosis without compensation
D. Metabolic alkalosis with complete compensation
NUR2571 Professional Nursing II
Module 3 Assignment
Respiratory Disease
Complete the Respiratory Diseases comparison table.
Comparison of Respiratory Disorders:
Asthma
Emphysema
Chronic Bronchitis
Pneumonia
Pathophysiology
Etiology/Population at Risk
Clinical Manifestations including Laboratory data
Typical Nursing Diagnosis
Interventions
NUR2571 Professional Nursing II
Module 4 Assignment
Concept Map-Hypertension
Develop and Concept Map, using the form provided, on the following patient. Include Diagnostic data and medical orders that you expect to be ordered on the patient.
T.J., a 30-year-old African American client, is in his last year of law school and is clerking for a prestigious law firm. He and his fiancé plan to marry as soon as he graduates. During the last week he has had four dizzy spells and a headache at the base of his skull upon awakening for the last 2 days. His father has a history of hypertension, so T.J. is aware that his symptoms may indicate high blood pressure. On his way home from work, T.J. stops by the clinic and asks the nurse to check his blood pressure. The nursing assessment yields the following data.
Subjective data: States he has had four dizzy spells and has awakened with a headache in the occipital lobe the last two mornings. T.J. has 1 glass of wine at lunch and 2-3 beers in the evening to relax from the tension of school and work. Most of his meals are at fast-food establishments and have a high fat content. T.J. does not smoke. He used to jog 4 mornings a week but quit when he started clerking. He has had nocturia for the last 3 weeks. He is not taking any medication. T.J. states he is concerned about having hypertension because he does not want to take medication.
Objective data: T 98.6°F(37°C), AP 78 beats/min, R 16 breaths/min, BP 142/92 mm Hg, Wt 190 lbs (optimum weight 160). No edema noted in hands, feet, or legs.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Possible Medications
Clinical Manifestations
Subjective:
Objective:
Possible Nursing Diagnosis
Medical Diagnosis
Patient Data/Risk Factors
Medical Interventions
Pathophysiology
Nursing Interventions
Diagnostic Data
Patient Education
NUR2571 Professional Nursing II
Module 5 Assignment
Medications affecting Coagulation
Please go through and fill out the table on Medications affecting Coagulation. If need be go back on previous lectures or your textbook for resources to help you complete the assignment.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Medications affecting coagulation
Coumadin
Heparin
Lovenox
Mode of Action
Indications
Dosage/Route
Side Effects
Labs to Monitor
Antidote
Patient teaching
NUR2571 Professional Nursing II
Module 6 Assignment
Inflammatory Diseases
Complete the comparison table for Inflammatory Diseases.
Comparison of Inflammatory Disease:
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Ulcerative Colitis
Pathophysiology
Etiology
Clinical Manifestations
Common Laboratory Tests
Treatment
NUR2571 Professional Nursing II
Module 7 Assignment
Acute Complications of Diabetes
Fill out the Table comparing the Acute Complications of Diabetes.
Comparison of Acute Complications of Diabetes:
Hypoglycemia
Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic Nonketotic syndrome
Clinical Manifestations
Diagnostic Data
Interventions
Patient Teaching
NUR2571 Professional Nursing II
Module 8 Assignment
Otitis Media
An 8-year-old girl comes to your ambulatory care clinic with complaints of left ear pain for the past 3 days. She had respiratory infection a week ago. On physical examination, the tympanic membrane is bulging.
Answer the following questions:
What else should you ask the client?
What teaching would you reinforce to prevent the recurrence of otitis media?
What expected outcomes would be specific to this situation?
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
NUR2571 Professional Nursing II
Module 9 Assignment
Seizures
An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.
Questions:
On the initial home visit by the nurse, what assessments should be made?
The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
NUR2571 Professional Nursing II
Module 10 Assignment
Exemplars
Fill out the Alteration in Metabolism Exemplar Table.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Alterations in Metabolism
Obesity
Hyperthyroid
Hypothyroid
Pathophysiology
Risk Factors
Assessment Findings (including Labs)
Possible Nursing Diagnosis
Interventions (including Medications)
NUR2571 Professional Nursing II
Course Project
Module 02 Course Project-Clinical Question
Clinical Question – Formulate a clinical question using the PICOT format.
P: Patient Population
I: Intervention or area on Interest
C: Comparison intervention or group
O: Outcome
T: Time
Ex: “In acute care hospitals (patient population), how does having a rapid response team (intervention) compared with not having a response team (comparison) affect the number of cardiac arrests (outcome) during a three-month period (time)?”
Module 04 Course Project -Reference Page
Turn in a reference page in APA format. You must use three (3) or more relevant sources; to ensure the readings are relevant and current, the selected peer reviewed article must have been written within the past three (3) years.
Module 07 Course Project-Paper Submission
Your paper for the course project should be a 2-3 page APA paper (not including title page and the reference page) that describes the clinical problem and the following:
Reason for choosing this topic
The PICOT question
Possible integration of the evidenced that you found in clinical practice
Methods to evaluate the effectiveness of implementation
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Module 10 Course Project – Staff Development PowerPoint Due
Your staff development PPT presentation will include the information from your written paper in 10-12 slides (including a title and reference slide in APA format). Make sure to include speaker notes at the bottom of your slide to explain the content of your slide.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
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