Patient one: JR is a 55- year-old male admitted 8 hours prior for 24-hour hold to evaluate for possible myocardial infarction. Serial Troponins within normal range and 12 lead ECG indicated evidence of prior right anterior wall myocardial damage.
Patient Two: EH is a 40-year-old female admitted within the past hour with acute onset severe right upper quadrant pain and vomiting for the past 36 hours. Waiting on labs, ECG monitoring showing occasional premature ventricular contracts (PVCs).
Patient 3: BW is a 21-year-old male athlete admitted yesterday with fever of 103 and diagnosis of influenza. He rested well overnight. Morning chest x-ray revealed mild infiltrates in left lower lobe.
Record your answers to these statements.
Rank the three scenarios provided in order of priority related to which client you will assess first, second and third.
Defend your selection for the three ranked scenarios.
Review the data below for the priority client to determine what to assess first.
Chest X-ray no abnormalities noted
Abdominal X-ray :diffuse gas throughout the small intestine
Hyperactive bowel sounds in all 4 quadrants and abdomen painful to touch
Pain level 10/10Sodium (Na+) 147 mmol/L
Potassium (K+) 2.9 mmol/L
Chloride (Cl-) 100 mmol/L
Magnesium (Mg2+) 1.4 mg/dL
Calcium (Ca2+) 9.2 mg/dL
Phosphorus (P+) 2.3 mg/dL
Glucose 188 mg/dL
Serum albumin 3.0 g/dL
Amylase 185 unit/L
Serum Creatinine 0.5 mg/dL
BUN 15 mg/dL
Alkaline Phos. 155 unit/L • Protein 8.6 g/dL Bilirubin 3.5 mg/dL
Formulate three hypotheses based on cues provided
Select the priority hypothesis
Defend your selection
Describe an evaluation plan for the priority hypothesis based on expected client outcomes
Describe the next steps in the clinical judgement model including:
Actions if satisfied with client outcomes
Actions if not satisfied with client outcomes
RUBRIC:
A – 4 – Mastery
Accurately ranks the three scenarios provided in order of priority related to which client will be assessed first, second and third. Provides a clear and detailed defense for the three ranked scenarios including internal and external cue recognition.
A – 4 – Mastery
Formulate three hypotheses based on cues provided and select a priority hypothesis including a clearly stated, detailed defense for your priority selection.
A – 4 – Mastery
Provided a clearly stated, detailed descriiption of an evaluation plan for the priority hypothesis based on expected client outcomes.
A – 4 – Mastery
Clearly stated, a detailed descriiption of the next steps in the clinical judgement model including if satisfied with client outcomes and if not satisfied with client outcomes.
