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ING Clinical Reasoning Case Study: Perfusion & Ethics Simulation Collection Tesent Problem: uy is a 66 vear old female with a past medical history of hypertension, type 2 diabetes mellitus, com e, non-ST elevated myocardial infarction in 2016 treated with life-long daily aspirin, chronic kidne ring hemodialysis twice a week former smoker quit in 2017, and depression Her home medication She presented to the emergency room two days ago with reports of increasing shortness of breath stions and lower extremity edema She was admitted to the medical-telemetry unit for management ne Medications: 1. Lisinopril 40mg daily PO 2. Furosemide 20mg daily PO 3. Aspirin 81mg daily PO 4. Sevelamer 800mg TID PO with meals 5. Calcium carbonate 500mg chewable daily PO 6. Insulin detemir injection Sunits BID Subcutaneous Social History: 3 divorced. She has two adult children ages 32 and 36. The 36 year old helps to bring her to doctors’ ents and grocery shopping. She has a housekeeper who comes twice a week to maintain her apartment sy. She used to drive herself to the YMCA for open swimming with her friends, but stopped doing this er kidney disease was becoming too overwhelming for her. Erly mother, age 89. is still alive and well. She visits Viriam once a week to bring her any prescription : er father passed away at the age of 78 from complications of coronary artery disease. a from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse? VANT Data from Present Problem: Clinical Significance: EVANT Data from Social History: Clinical Significance: a hp NUR2025 One disease process often influences the development of other illnesses. Based on pathophysiology, (if applicable), which disease likely developed FIRST that then i their life? (20) Circle what PMH problem likely started FIRST. Underline what PMH problem(8) FOLLOWED as domino(s). II. Patient Care Begins: The client is admitted to the me Current VS: WILDA Pain Assessment (56 VS): T: (aral) Words: Denies pain at this time, 0 out of 10 on a nume P: (regular) 112 Intensity: R:_(regular) 25 Location: BP: 95/60 Duration: 02 sat: Aggravate on?L NC Alleviate: What VS data is RELEVANT that must be recognized as clinically significant to the RELEVANT US Data: Clinical Significance: Current Physical Assessment: HEIGHT AND WEIGHT 155 1b (70.5 kg) GENERAL Client repositions self in bed frequently. Appears worried APPEARANCE: RESP: Breath sounds crackles with equal aeration bilaterally, lat CARDIAC: Cool, pallor and moist. 3-pitting lower extremity edema pulses weal; equal with palpation at radial pedal post-tiba NEURO: Alert & oriented to person, place, and time (x3), but need 01..1.-1.4-1. — 1. – 1.1. O a During the admission process, the client verbalizes feelings of emptiness and is worried that she on her friends and family. She reports to the murse that she does not enjoy life recently and has b her resuscitation status to “Do Not Resuscitate” (DNR). She mentions that her quality of life “Sisc What additional questions should the nurse ask to gather more data about the dient’s current Pertinent assessment questions The nurse applies the cardiac telemetry leads. Which lead is placed where? (write green, white, b appropriate anatomical locations) (5b, 6b) (hp NUR2025 The nurse assesses the 6-second cardiac telemetry strip after placing the client on the monit Cardiac Telemetry Strip: Tele #1: Time 0800 سیرالیا۔ اسرارالہ Interpretation (2b): Tele #1: : Clinical Significance (2c): Tele #1: Evidence-based practice treatment options (3a, 2c): Tele #1 This rhythm is new for the client. After communicating the dusrhythmia to the provider, the provic medication order: Medication Math Heparin IV Infusion: Bolus the client with 60 units kg and start infusion at 12 units kg ly. Available: Heparin sodium 20.000 units in 1,000 mL DSW Crimunto the following a hp Comments Medication Math Heparin IV Infusion: Bolus the client with 60 units/kg and start infusion at 12 unitz/kgh Available: Heparin sodium 20,000 imits in 1,000 mL D5W Calculate the following: 1 Heparin bolus dosage- 2 Infusion rate for the IV: units/hr 3. Infusion rate in mlho mehr Perfusion and Ethics Scenario NUR2025 IIL. Clinical Reasoning Begins… What is the primary problem that your client is most likelt presenting with? (c) What is the underlying cause/porlophysiology of this concern? (e) Comments III. Clinical Reasoning Begins… What is the primary problem that powr dient is most likely presenting with? (2c) What is the underlying cause pathophysiology of this concern? (2c) What nursing priority(s) captures the “essence” of your client’s current status care? (of more than one-list in order of PRIORITY) (2b, 3c, 3b) What interventions will you pritiate based on this priority? (2b) Nursing Interventions: Rationale: What body system(s) will you most thoroughly assess based on the primary problem or What is the worst possible/most likely complication to anticipate based on the primary What nursing assessments will identify this complication EARLY if it develops? (3a, 36 What nursing interventions will you initiate if this complication develops? (b, 3a. 36, Medical Management: Rationale for Treatment & Expected Outco Care Provider Orders: Rationale: Full code
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