Clinical Reasoning to Prioritize Care and Manage Complications

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:

· Two pack per day smoker for 58 years

· Type I Diabetic

Assessment data:

· Blood pressure: 178/98 mm Hg

· Heart rate: 84 beats per minute

· Oxygen saturation: 84 percent on room air

· Temperature: 101.8° degrees Fahrenheit

· Hyperactive bowel sounds in all four quadrants

· 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:

· Create three hypotheses for the client appropriate for the situation.

· Identify the priority hypothesis and support your choice with data from the scenario.

· Determine three solutions for the priority hypothesis, including supporting rationales and evidence from credible sources.

· Describe two potential complications for the case scenario or the priority hypothesis.

· 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

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