Clinical Reasoning Discussion Project

Clinical Reasoning Discussion ProjectNeed to add end-of-life topics to this.

Group 1:

Patient Profile for CR abd abscess.docx

Students in each clinical group must work together to divide the work amongst each other. The group will have 4 days to develop the information, allowing the rest of the class 3 days to

make comments and suggestions on what is posted in the Canvas assignment. Questions the class may use to respond to the initial posting of the patient's story might be:

o Are there any details that are missing that you would like to see in the "patient story" section?

o Anything in the profile that was not brought forward that you think is important?o Any details included that you feel are not helpful (too much information was included)?o Does anyone think there may be a better way to organize the information presented?

Demonstrate.o Do you honestly feel well prepared to enter the patient's room and care for them with just

this information? If not, what else would you like to see? All information obtained from a source (text book, website, journal articles, etc.) must include a

reference (in-text citation not required). Once the patient's story has been told (please post no later than 10/4 Sunday morning), the rest of

the group should respond (everyone else should respond, no later than 10/7 Wednesday morning).

The next section will be started 10/7.

There are no WRONG answers, unless you don't do the assignment. There may be a better way, which is why we are doing this as a discussion - you can learn from each other, or even just listening to ideas that will help you refine your ability to filter the data.

Part 1: Present the Patient

Required: Present the patient to the group using a systems approach to data

Hints:

1. Organize relevant data by system or concept2. You must “give report” to the group

o Paint a picture of what we need to be concerned about (SBAR, AIDET, etc.)o Start with age, gender, allergies

3. Continue with vital signs (not just a list, include a brief interpretation) and reason for admission4. Review relevant data for all systems

o CVo Respiratoryo GIo GUo Neuro and musculoskeletalo Integumento Endocrine or metabolismo Psychosocial, family, social supports

5. This is an exercise in organizing and prioritizing datao Each student should feel prepared to enter the patient’s room and begin taking care of this

patient after you give report6. Not all data is important data

Group 2:

Please make initial post by 10/11 Sunday morning 0800. The rest of the class will have until Wednesday 10/14 0800 to make comments and responses.

Students in each clinical group must work together to divide the work amongst each other. All information obtained from a source (text book, website, journal articles, etc.) must include a

reference (in-text citation not required).


The group will have until 10/11 Sunday 0800 to develop the information, allowing the rest of the class 3 days to make comments and suggestions on what is posted in the Canvas assignment.

Responses need to add to the discussion (saying "that's great" is nice, but you are not adding to the discussion). Responses should ask or answer questions that you or others might have, make suggestions, explain, or otherwise add more information to the discussion.

Questions the class may use to respond to the initial posting of the patient's story might be:o What other medications might this patient benefit from? Why?o Suggestions on formatting to make the information more clear to the reader.o Have you given this medication to a patient before? Did they have questions about it?

What did you tell them?o What kind of patient teaching might you provide for a patient being given this

medication?o Any information that you found on the medication that you think might be important but

is not included in the posting?o Questions on why information was included that you don't think is very important?

Part 2: Medication Review

2. Required: Medication review

Hints:

1. Create a table that shows the class and function of all medications the patient is on. Include the following information about each medication:

o How does the med work?o Why are they on this med? Is it a good choice?o Is the dose appropriate for this patient?

2. How will you know if it is having the desired effect?o Are there interactions you should worry about? What are the COMMON side effects?

What side effects are potentially fatal?o What do you need to know before administering the meds (labs, interactions, etc.)?

Anything you need to watch for AFTER you give it?3. What medications SHOULD this patient be on that they aren’t (GI prophylaxis, etc.)?4. Not all information in the drug book is needed - just the most important stuff. This is an exercise

in prioritizing what information you need to provide the patient with enough information to understand their medications and be safe.

Group 3:





The group will have until 10/18 Sunday 0800 to develop the information, allowing the rest of the class 3 days to make comments and suggestions on what is posted in the Canvas assignment.


Questions the class may use to respond to the initial posting of the patient's diagnostics might be:o What diagnostic results were not evaluated? Is there a reason (were they unnecessary)?o Any other diagnostic tests that the group didn't suggest that you think might be nice?

Explain why.o Any questions about how the group evaluated the diagnostic results? Sources? Values?

What's normal?o Any themes? Are there different diagnostic results, maybe even from different tests, that

support each other? Tell a story when put together? (for example, if a client is malnourished, what lab values might be seen? low albumin, low hemoglobin, low vitamins? Any other diagnostic tests that can show deficiencies related to nutrition?)

o Did the group do a good job in organizing the data and presenting their interpretation? If you think there might be a better way, share!

Part 3: Diagnostics

3. Required: Correct and complete interpretation of patient laboratory data.

Hints:

1. The group must review all the simulated patient’s labs.2. Present your labs in a systematic fashion

o If you are looking at sodium, you need to look at chloride as well; if you are looking at potassium, what else should you be looking at?

3. If a lab value is high or low, what does this indicate? How do you plan to fix it? What risk is associated with these abnormalities? Would there be any symptoms?

4. For all lab results tell the group if you expected them to be normal or abnormal for this particular patient.

5. Are there labs that are not valuable and should have been drawn? Are there lab values for which you don’t see a reason to have? Explain why you think the patient should need labs you don’t see; or why you would like to see other lab values.

6. Are there labs that maybe we should consider looking at?7. How frequently would you expect this patient to have which labs drawn?8. Chem 7 every 24 hours to assess hydration and electrolyte balance?9. Is there a reason to watch the ABG or not?

Group 4:



make comments and suggestions on what is posted in the Canvas assignment. Initial post should be done by 0800 10/25; the rest of the class will have until 10/28 to make

comments and suggestions, ask questions, etc. Responses need to add to the discussion (saying "that's great" is nice, but you are not adding to the

discussion). Responses should ask or answer questions that you or others might have, make suggestions, explain, or otherwise add more information to the discussion.

Questions the class may use to respond to the initial posting of the patient's story might be:o Are the priority nursing diagnoses appropriate for this client? Are they the most

important/pressing problems?o Any suggestions on other problems that might be just as important or more important?o Is the problem identified supported in the profile data?o Is the etiology what the patient is experiencing that is causing the problem?o Are the defining characteristics in the patient profile? Are they signs and symptoms that

support the problem?o Is the goal appropriate (a nursing goal, something nurses can help the client achieve)? Is

it related to fixing the problem identified?o Is the goal SMART? How is it measured? How do you know you have achieved the goal?o Are the interventions specific for the client and address preventing or fixing the problem?

The nursing diagnoses book is very limited in this area - tell me what you are going to do with the assessment you say you are doing as an intervention. For example, if you are assessing I&O, what are you going to do if this is decreased?

o Are the rationales telling you how the intervention is going to prevent or fix the problem? All information obtained from a source (text book, website, journal articles, etc.) must include a


Part 4: Nursing Care Plan

4. Required: Nursing Care Plan with 3 appropriate priority problems

Hints:

1. Students are to use the simulated patient data to create a 3-problem care plan.2. Students should decide for themselves how to divide the work.3. Students should strive to select the highest priority problems based on the patient data provided.4. Students should incorporate the same standards for this careplan as they use for their clinical

careplans. This means the nursing diagnoses must be worded correctly (using NANDA), there must be at least 3 patient specific interventions with appropriate rationales, with at least 2-3 nursing initiated interventions and at least one collaborative intervention. Goals must be clearly stated to be specific, measurable, achievable, and realistic and have a time in which the goal is to be met in (SMART). Please refer to your careplan book.

Group 5:

o Please make initial post by 11/1 Sunday morning 0800. The rest of the class will have until Wednesday 11/4 0800 to make comments and responses.

o Students in each clinical group must work together to divide the work amongst each other.

o All information obtained from a source (text book, website, journal articles, etc.) must include a reference (in-text citation not required).


o The group will have until 11/1 Sunday 0800 to develop the information, allowing the rest of the class 3 days to make comments and suggestions on what is posted in the Canvas assignment.

o Responses need to add to the discussion (saying "that's great" is nice, but you are not adding to the discussion). Responses should ask or answer questions that you or others might have, make suggestions, explain, or otherwise add more information to the discussion.

o Questions the class may use to respond to the initial posting of the patient's story might be:

All information obtained from a source (text book, website, journal articles, etc.) must include a reference (in-text citation not required).

Part 5: Skills Review

5. Required: Develop a skills demonstration checklist for two skills that the patient is likely to require. Provide rationale for each step in the skill, provide a chart note (how would you document in the patient’s chart after this intervention?) and explain when you would need to call a physician.

Hints:

1. Based on the simulated patient, the group must select two skills that are likely to be needed for this patient. Try to choose things that are high priority for this patient. (You may also choose a skill that you know your class ought to review, even if it may NOT be the most likely intervention needed for this patient. Do TRY to relate it to your patient as much as possible.)

2. This could be a Foley catheter, detailed neurological assessment, CIWA score, Braden scale, NGT placement, Chest tube management, etc.

3. Essentially any skill or assessment that this patient might need4. Once students have selected the two skills they will need to review with the group, they will need

to create their own “Demonstration form”.5. Based on your textbook or a journal article, what are key steps and why are they important? WHY

did you put them in a particular order? Provide a reference for your demonstration form.6. Your instructor is quite familiar with the many skills checklists and demonstration forms. You

may NOT copy and claim they are yours. If you think a skills checklist or demonstration form is absolutely perfect, you may use it (as long as you acknowledge it is theirs.) You still must explain why the steps are in the order they are in and why each step matters.

7. Students will write a chart note based on the skills they have “performed” on the simulated patient. This chart note should reflect what you know about the patient under discussion as much as possible. You may have to “make up” some details. Your chart document must be should reflect the type of language you might see in an electronic record.

8. Students should discuss why the simulated patient might need the selected skill, the potential benefits and risks associated with it. Students should be able to discuss how they would explain this skill to the simulated patient. Students should also be prepared to answer questions about when they would need to call the physician, and whether an order would be required for a particular skill.

Group 6:

o Please make initial post by 11/8 Sunday morning 0800. The rest of the class will have until Wednesday 11/11 0800 to make comments and responses.

o Students in each clinical group must work together to divide the work amongst each other.

o All information obtained from a source (text book, website, journal articles, etc.) must include a reference (in-text citation not required).


o The group will have until 11/8 Sunday 0800 to develop the information, allowing the rest of the class 3 days to make comments and suggestions on what is posted in the Canvas assignment.

o Responses need to add to the discussion (saying "that's great" is nice, but you are not adding to the discussion). Responses should ask or answer questions that you or others might have, make suggestions, explain, or otherwise add more information to the discussion.

o Questions the class may use to respond to the initial posting of the patient's story might be:

Is the patient education topic appropriate? Is it the most important education this client needs right now?

Does the group use appropriate language and terms for a client (lay man terms, rather than medical jargon)?

Is the education organized well? Any suggestions for different organization? Is there a method that patient learning will be evaluated? Is it appropriate for the

topic? patient? Are the sources used to develop the education reliable?

All information obtained from a source (text book, website, journal articles, etc.) must include a reference (in-text citation not required).

Part 6: Patient Education

6. Required: Pathophysiology down to the cellular level

Hints:

1. Students in this group will determine what two topics the patient needs more information about.2. The group should agree on the two highest priority learning needs.3. You will need to explain to the class why you chose your topics.4. The students will then need to locate evidenced based information to meet this client’s needs. This

must include at least one or two well-respected and evidence-based5. Acceptable websites include the American Cancer Society, the American Diabetic Association,

National Institute for Health (NIH), PubMed, EBSCO, HealWA, WHO, etc. Sites that are .com are business and may have biased information, so stick with .org, .edu and .gov

6. As patient education is legally a high-risk area for nurses, please stay away from sources whose accuracy cannot be guaranteed (Wikipedia, etc.).

7. If you have questions, please ask a librarian. Librarians love to help students find information!8. Students may select a peer-reviewed journal article in place of the second website if they prefer.

The journal article must be from a professional or educational journal, and be less than 5 years old.9. PLEASE NOTE: Each education topic requires at least ONE source. This means that since you

have 2 topics, you will have at least two sources, more is acceptable. Students may decide among themselves how to divide the work.

10. For instance, perhaps you determine that your patient needs to better understand how to take care of his feet now that he has diabetes. The student group should then go to the library and locate websites (and/or an article) that describes diabetic foot care.

11. Make sure your posting includes the evidence to support why they chose this particularly teaching need as a top priority for this particular patient.

12. This will require supporting data from the simulated patient information.13. Students will need to state how they will evaluate that learning has occurred.

o Give a quiz? Have a return demonstration? Etc.14. Students will then need to provide to their fellow classmates the evidence-based information that

they obtained from websites and/or articles. This information will need to be attached to their posting. Nurses do not send patients home with handwritten information.

Group 7:




reference (in-text citation not required). The group will have 4 days to develop the information, allowing the rest of the class 3 days to

make comments and suggestions on what is posted in the Canvas assignment. Questions the class may use to respond to the initial posting of the patient's story might be: The group will have until 11/15 Sunday 0800 to develop the information, allowing the rest of the

class 3 days to make comments and suggestions on what is posted in the Canvas assignment. Responses need to add to the discussion (saying "that's great" is nice, but you are not adding to the

discussion). Responses should ask or answer questions that you or others might have, make suggestions, explain, or otherwise add more information to the discussion.

Questions the class may use to respond to the initial posting of the patient's story might be:o How does HP2020 promote health for this client?o Is HP2020 something to be used for clients in tertiary care (like this client) or is it more

focused on prevention and health maintenance?o How did the group present the information the the client and family? Does it seem

appropriate? What other teaching methods might be used?o Was the demonstration of understanding from client and/or family appropriate?o What developmental concerns should nurses consider for clients with cognitive

impairments?o How might the group modify their teaching plan for children or elderly?o etc.

Part 7: Healthy People 2020

7. Required: Students will show the class two areas from the Healthy People 2020 website that can have a positive impact on the simulated patient.

Hints:

1. Students in this group will need to go to the “Healthy People 2020” website: http://www.healthypeople.gov/2020/default.aspx

2. Under the tab called “2020 Topics & Objectives” the student group will note an alphabetized list of links covering varying topics about health promotion and disease prevention/management.

3. The student group must select two topics that can be applied to the simulated patient and his/her situation.

4. The student group must then plan to present the information from the HP 2020 website to the discussion board. Students should plan to discuss how they would address these topics with the client or family.

Group 8:




reference (in-text citation not required). The group will have 4 days to develop the information, allowing the rest of the class 3 days to

make comments and suggestions on what is posted in the Canvas assignment. Questions the class may use to respond to the initial posting of the patient's story might be:

o Are the competencies chosen by the group priority for this client? If not, what might you suggest as priority?

o Why is safety so important for our patients? For us?o How can we better teach nursing students and new nurses how to provide safe care for

our clients? Does this posting make suggestions that seem reasonable? Do you have other suggestions?

o Do the QSEN competencies appear to provide good guidelines to improve quality and safety in nursing care? Does the posting reflect this? If not, how would you change the information presented so it does?

o etc.

Part 8: Quality and Safety In Educating Nurses (QSEN)

8. Required: Students will show the class two QSEN competencies and how the new nurse would demonstrate safely delivering care to this client.

Hints:

1. Students in this group focus on the nurse caring for the simulated patient, and requires students to go to the website http://qsen.org/competencies/pre-licensure-ksas/

2. This website (QSEN) denotes the quality and safety competencies a nurse is expected to have (including knowledge, skills, and values) when they enter into practice. As you may or may not know, QSEN is becoming a larger and larger focus for nursing schools across the country.

3. Once at the website (be sure you are under the pre-licensure topics and not the graduate ones), scroll down and note that there are 6 topics.

4. Your task is to discuss how a new nurse (such as yourselves) would demonstrate each of these “competencies” in relation to caring for the simulated patient.

For instance, one of the competencies is “patient centered care.” You will need to select one of the subtopics. Look at proper management of pain as an example. You might discuss the proper frequency for assessing this patient’s pain, what scale you might use (is your patient verbal, or not?). If pain management is not the biggest concern for this patient, look at the other sub-topics such as including family, providing emotional support. What might the nurse caring for this patient do to ensure they are meeting this competency?

Each clinical group will work on one part of this assignment; we will work through as many sections as we can get to throughout the rest of the quarter.

So, once all three groups have done a primary posting on a section, they will be assigned a new section (for example, we have 3 clinical groups, each group is likely to eventually complete 3 parts of this assignment, if we can get though that many).


make comments and suggestions on what is posted in the Canvas assignment. Then the next group can start posting their section. All information obtained from a source (text book, website, journal articles, etc.) must include a


Group 9:

Part 9: Case study based on provided patient data




9. Required: This work group must provide a written document

1. The task for this group involves making a mini-case study based on the data that has been presented in the simulated patient information.

2. Pick an issue or problem for your patient to develop. It needs to be something that might be a problem for a patient with this scenario going on.

3. For example, a 64-year-old hip fracture patient can NOT suddenly be pregnant. Your patient may NOT have 4 kidneys just because you saw it on the health channel once. Also, no waking people up from persistent vegetative states

4. Pick something plausible that as a nurse caring for a particular patient with a particular ailment ought to be looking out for.

5. Look up common complications for whatever is wrong with the simulated patient and consider choosing one of those.

6. Adjust vital signs and pertinent labs to reflect this.7. The problem is up to you, but try and stay with mainstream, or common complications of

hospitalization: DVT, pneumonia, a reaction to one of their medications, alcohol withdrawal, delirium, a pressure ulcer, constipation, nausea and vomiting, hypovolemia, hypervolemia, acute kidney failure, bowel obstruction, etc.

8. You need to give your classmates changes in the simulated patient that will help them figure out 1) That there is a new problem; 2) What the problem is; and 3) What they ought to do about it.

9. Please note: the goal is not to stump your classmates, which they will find frustrating and not at all enjoyable.

10. Your goal is to help them reason their way, using data you provide.11. On the other hand, try not to give your peers the answer outright, either. If they do not ask you

about a certain system, then don’t feel like you need to tell them.12. Areas to address may include some (probably not all) of the following.

o Assessment datao Laboratory datao Changes in medso Dieto Activities

13. Also, please do not kill your simulated patient. As a general rule, (in case studies and simulation) students typically do not respond well when their patients die, even if the patient was

never real in the first place. If you feel you must kill the simulated patient, review it with the instructor first (you will have to have a good reason). If it is determined that patient demise is acceptable, your classmates must be told at the beginning of the scenario that this is part of the expected outcome.

o Also include anything that your patient might say that is significant (for instance “I have terrible pain in my stomach!).

Don’t worry. This does not have to be perfect. Be creative, but realistic.

Group 10:






Questions the class may use to respond to the initial posting of the patient's diagnostics might be:o What other complications might occur that the group did not suggest?o What other interventions may be done for managing this client and preventing

complications?o How would re-admission impact this client? the hospital/facility?o Why are nurses so concerned about re-admission?o etc.

Part 10: Common complications: Identification, management, and prevention

10. Required: Pathophysiology down to the cellular level

Hints:

1. Determine two complications the nurse would need to be aware of or watching for related the simulated patient’s healthcare needs. The first complication should be the most likely, or most common complication. You will need to explain what led you to the conclusion that this was the mostly likely complication based on the patient data and your understanding of the patient’s status (physical, spiritual, mental).

2. Once you have determined the most common complication, use your resources to determine early and late signs of the complication, management strategies, and how the complication could have been prevented as well as how likely the patient is to recover.

3. The second complication should be the most serious or critical complication you can think of. It can be a medication reaction, DIC, suicide attempt, post-op bleeding, etc. Remember nurses must always be aware of the very serious complications that can occur, even if they aren’t common. Using your resources, you will list out early and late complications, management strategies, and prevention strategies. You also discuss the prognosis based on what you know about the simulated patient.

4. You will need references for this assignment. Either your textbooks or a reliable websites (see above for what is considered reliable websites). It is not enough to just regurgitate what you got

from a book or website. You must explain how these complications would affect the patient being discussed.

5. Your information should be detailed. This means down to the cellular level.o If this is about the lungs, be sure to include the alveoli. If it is about the kidney, be sure to

mention the effect on the nephrons and glomeruli, BUN and creatinine, etc.

Clinical Reasoning Discussion Project

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