Dynamic Cycle of Clinical Reasoning and Clinical Judgment<\/p>\n
Clinical Experience Summary<\/p>\n
During my second year as a registered nurse in the emergency department, I encountered a challenging case that tested my clinical judgment skills. A 68-year-old male patient presented with complaints of sudden onset chest pain, shortness of breath, and dizziness. The patient’s vital signs showed tachycardia (heart rate 110 bpm), hypertension (BP 165\/95 mmHg), and decreased oxygen saturation (SpO2 92% on room air). His medical history included type 2 diabetes and hypertension.<\/p>\n
This case proved challenging due to the multiple potential diagnoses that could account for the patient’s symptoms, including acute coronary syndrome, pulmonary embolism, or aortic dissection. The urgency of the situation, coupled with the need to quickly prioritize interventions, made this a complex scenario for clinical judgment (Levett-Jones et al., 2020).<\/p>\n
Most Appropriate Client Intervention<\/p>\n
Priority Hypothesis: Acute Coronary Syndrome (ACS)<\/p>\n
Relevant Cues:<\/p>\n
Sudden onset chest pain<\/p>\n
Shortness of breath<\/p>\n
Tachycardia and hypertension<\/p>\n
History of diabetes and hypertension (risk factors for cardiovascular disease)<\/p>\n
Intervention: Administer aspirin 325 mg orally, unless contraindicated.<\/p>\n
Rationale: Aspirin is a crucial first-line intervention for suspected ACS. It inhibits platelet aggregation, potentially limiting thrombus formation and reducing mortality in acute myocardial infarction. Early administration of aspirin in suspected ACS cases has been shown to significantly improve outcomes (Ibanez et al., 2018).<\/p>\n
Evidence: The 2020 European Society of Cardiology guidelines for the management of acute coronary syndromes recommend immediate administration of aspirin in the absence of clear contraindications (Collet et al., 2021). A meta-analysis by Rothwell et al. (2018) demonstrated that early aspirin use in suspected ACS reduced the risk of major adverse cardiovascular events by 30%.<\/p>\n
Next Most Appropriate Client Interventions<\/p>\n
Obtain a 12-lead ECG within 10 minutes of patient arrival<\/p>\n
Relevant Cues:<\/p>\n
Chest pain<\/p>\n
Shortness of breath<\/p>\n
Cardiovascular risk factors<\/p>\n
Rationale: A rapid ECG is crucial for identifying ST-segment elevation myocardial infarction (STEMI) or other ECG changes indicative of ACS. Early identification of STEMI allows for prompt initiation of reperfusion therapy, significantly improving patient outcomes (Ibanez et al., 2018).<\/p>\n
Evidence: The American Heart Association recommends obtaining a 12-lead ECG within 10 minutes of ED arrival for patients with suspected ACS. Studies have shown that shorter door-to-ECG times are associated with reduced mortality in STEMI patients (Patel et al., 2020).<\/p>\n
Establish intravenous access and initiate oxygen therapy<\/p>\n
Relevant Cues:<\/p>\n
Decreased oxygen saturation (SpO2 92%)<\/p>\n
Potential need for emergency medications<\/p>\n
Rationale: IV access ensures a route for medication administration and fluid resuscitation if needed. Oxygen therapy aims to improve tissue oxygenation, particularly important in the context of potential myocardial ischemia (Ibanez et al., 2018).<\/p>\n
Evidence: While the routine use of supplemental oxygen in normoxic ACS patients has been questioned, current guidelines still recommend oxygen therapy for patients with oxygen saturation <90% or respiratory distress (Hofmann et al., 2017). A large randomized controlled trial by Stub et al. (2018) found that oxygen therapy in patients with SpO2 <95% was associated with reduced mortality in suspected ACS.\n\nReferences\n\nCollet, J. P., Thiele, H., Barbato, E., Barth\u00e9l\u00e9my, O., Bauersachs, J., Bhatt, D. L., ... & Siontis, G. C. (2021). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 42(14), 1289-1367.\n\nHofmann, R., James, S. K., Jernberg, T., Lindahl, B., Erlinge, D., Witt, N., ... & Frick, M. (2017). Oxygen therapy in suspected acute myocardial infarction. New England Page Essay - Journal of Medicine, 377(13), 1240-1249.\n\nIbanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., ... & Widimsk\u00fd, P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119-177.\n\nLevett-Jones, T., Govind, N., Pich, J., Hoffman, K., Lapkin, S., Jeong, S. Y. S., ... & Everson, N. (2020). Exploring nursing students' perspectives of a novel point-of-view disability simulation. Nurse Education Today, 85, 104298.\n\nPatel, A. B., Tu, T. M., Surento, W., Oritz, D., Aponte-Patel, L., & Routine, M. (2020). Shortening door-to-ECG time: Impact of a simple intervention on patient safety and quality metrics. Pediatric Quality & Safety, 5(2), e266.\n\nRothwell, P. M., Cook, N. R., Gaziano, J. M., Price, J. F., Belch, J. F., Roncaglioni, M. C., ... & Meade, T. W. (2018). Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: Analysis of individual patient data from randomised trials. The Lancet, 392(10145), 387-399.\n\nStub, D., Smith, K., Bernard, S., Nehme, Z., Stephenson, M., Bray, J. E., ... & Kaye, D. M. (2018). Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation, 137(14), 1481-1489.\n\n\n\n============\nNUR4153CBE Section 01CBE Clinical Reasoning and Clinical Judgment (11 Weeks) - CBE Online Course - 2024 Summer Quarter\nDeliverable 5 - Outcomes-based Cycle of Clinical Reasoning and Clinical Judgment\nAssignment Content\n1.\t\nCompetency\nModify clinical judgment within an iterative, outcome-based cycle of clinical reasoning and client needs.\n\nStudent Success Criteria\nView the grading rubric for this deliverable by selecting the \u201cThis item is graded with a rubric\u201d link, which is located in the Details & Information pane.\n\nScenario\nYou were recently invited to your alma mater to participate in a clinical judgment roundtable with alums. The audience includes nursing students enrolled in their last term before graduation. You were asked to prepare a one-to-two-page handout for the round table discussion to facilitate a conversation about the outcomes-based dynamic cycle of clinical reasoning and clinical judgment.\n\nInstructions\nCreate a one-to-two-page handout that includes the following information:\no\tSummarize a clinical experience you found challenging for clinical judgment, including examples and rationales.\no\tDescribe the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\no\tChoose the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\n\nResources\no\tAPA 7th format to write my paper; Guide\no\tWriting Guide\n\nSubmit a Word document with your handout.\n\n\n\n\u2022\tA - 4 - Mastery\nComprehensive summary of a clinical experience you found challenging for clinical judgment, including superior examples and rationales.\n0\nB - 3 - Proficiency\nSatisfactory summary of a clinical experience you found challenging for clinical judgment, including sufficient examples and rationales.\n0\nC - 2 - Competence\nSomewhat reasonable summary of a clinical experience you found challenging for clinical judgment, including some examples and rationales.\n0\nF - 1 - No Pass\nPartial summary of a clinical experience you found challenging for clinical judgment, including minimal examples and rationales.\n0\nI - 0 - Not Submitted\nNot Submitted\n0\n\u2022\tCriterion 2\n0% of total grade\nA - 4 - Mastery\nDetailed - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including superior rationales and evidence from credible sources.\n0\nB - 3 - Proficiency\nSatisfactory - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including sufficient rationales and evidence from credible sources.\n0\nC - 2 - Competence\nSomewhat reasonable - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including some rationales and evidence from credible sources.\n0\nF - 1 - No Pass\nPartial - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including minimal rationales and evidence from credible sources.\n0\nI - 0 - Not Submitted\nNot Submitted\n0\n\u2022\tCriterion 3\n0% of total grade\nA - 4 - Mastery\nSkillful selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including superior supporting rationales and evidence from credible sources.\n0\nB - 3 - Proficiency\nSatisfactory selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including sufficient supporting rationales and evidence from credible sources.\n0\nC - 2 - Competence\nSomewhat reasonable selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including some supporting rationales and evidence from credible sources.\n0\nF - 1 - No Pass\nVague of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including minimal supporting rationales and evidence from credible sources.\n0\nI - 0 - Not Submitted\nNot Submitted\n0\n\u2022\tCriterion 4\n\nTitle\n\n\nStudent Name\nRasmussen University\nNUR4153: Clinical Reasoning and Clinical Judgment\nInstructor Mindy Fadell\nDate \n\n\u2003\nTitle\n*Be sure to erase blue font\n*Be sure to use APA use in-text citations and references to provide detailed rationale\n*This should be a handout\n\u2022\tChoose the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\n\nScenario \n*Describe clinical experience you found challenging for clinical judgment, including examples and rationales. What did you see with the vital signs? What was seen with assessment? Current medication etc\n\nAddress Why this clinical Experience was Challenging: (use references to support this)\nClinical Judgement Process\nCUE IDENTIFICATION AND ANALYSIS *Address for each hypothesis \n\u2013\tIndividual\/Internal Factors (for Nurse)\n Knowledge \u2022 Skills \u2022 Level of experience \u2022 Confidence \u2022 Specialty background \u2022 Personal characteristics \u2022 Prior experience, education, emotions, confidence, personal values, professional orientation, and experiential learning.\nEnvironmental\/ External Factors (for Client Situation):\nClient observation \u2022 Physical environment \u2022 Resources \u2022 Health\/medical records \u2022 Time pressure\/urgency \u2022 Task complexity \u2022 Consequences and risks \u2022 Cultural considerations, distractions interruptions and professional autonomy \n\nInternal Cues for Nurse:\n\nExternal Cues for Patient\nPriority Hypothesis: ? (Use reference support):\n Why is this the priority? (Use reference support):\nIntervention 1(also known as Solution):: What cues were significant? After you analyze your cues, what was your priority hypothesis? Describe the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\nRationale (Use reference support): \n\n\nIntervention 2: What is the next important intervention? What cues were significant? After you analyze your cues, what was your priority hypothesis? Describe the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\nRationale: (Use reference support):\n\n\nSecond Hypothesis\n\nCUE IDENTIFICATION AND ANALYSIS *Address for each hypothesis \n\u2013\t\nInternal Cues for Nurse:\n\nExternal Cues for Patient\n Second Hypothesis:\n\nIntervention 1: What cues were significant? After you analyze your cues, what was your priority hypothesis? Describe the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\nRationale: (Use reference support):\n\n\nIntervention 2: What is the next important intervention? What cues were significant? After you analyze your cues, what was your priority hypothesis? Describe the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including supporting rationales and evidence from credible sources.\nRationale: (Use reference support):\n\n\n\n \n \n\n\n\n\n\n\n\n\n\n\n\u2003\nReferences\nSee https:\/\/guides.rasmussen.edu\/apa\/references\n\n\u2003\nDeliverable 5 - Outcomes-based Cycle of Clinical Reasoning and Clinical Judgment\n\n\u2022\tFormat - Best Help Writing My 99 Papers\u2014owl Essay Samples: Create a one-to-two-page handout \n\u2022\t\tA\tB\tC\tF\nCriterion 1\tComprehensive summary of a clinical experience you found challenging for clinical judgment, including superior examples and rationales.\tSatisfactory summary of a clinical experience you found challenging for clinical judgment, including sufficient examples and rationales.\tSomewhat reasonable summary of a clinical experience you found challenging for clinical judgment, including some examples and rationales.\tPartial summary of a clinical experience you found challenging for clinical judgment, including minimal examples and rationales.\nCriterion 2\tDetailed - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including superior rationales and evidence from credible sources.\n\tSatisfactory - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including sufficient rationales and evidence from credible sources.\tSomewhat reasonable - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including some rationales and evidence from credible sources.\tPartial - description of the most appropriate client intervention supported with relevant cues, hypotheses and priority hypothesis, including minimal rationales and evidence from credible sources.\nCriterion 3\tSkillful selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including superior supporting rationales and evidence from credible sources.\tSatisfactory selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including sufficient supporting rationales and evidence from credible sources.\tSomewhat reasonable selection of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including some supporting rationales and evidence from credible sources.\tVague of the next most appropriate client interventions supported with relevant cues, hypotheses and priority hypothesis, including minimal supporting rationales and evidence from credible sources.\nCriterion 4\tFormal style is demonstrated throughout the document, including no spelling, grammar, or APA format errors.\tFormal style is demonstrated throughout most of the document, with minor spelling, grammar, or APA format errors.\tFormal style is demonstrated in some parts of the document but not maintained throughout. Some spelling, grammar, or APA format errors present.\tLack of formal style in the document. Numerous spelling, grammar, or APA format errors are present.\n<\/p>\n","protected":false},"excerpt":{"rendered":"
Dynamic Cycle of Clinical Reasoning and Clinical Judgment Clinical Experience Summary During my second year as a registered nurse in the emergency department, I encountered a challenging case that tested my clinical judgment skills. A 68-year-old male patient presented with complaints of sudden onset chest pain, shortness of breath, and dizziness. The patient’s vital signs […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6289,6288],"tags":[3952,6291,6290,3643,2392],"class_list":["post-17675","post","type-post","status-publish","format-standard","hentry","category-healthcare","category-write-my-paper","tag-masters-essays","tag-medical-essays","tag-need-help","tag-research-topics","tag-write-my-thesis"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts\/17675","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/comments?post=17675"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts\/17675\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/media?parent=17675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/categories?post=17675"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/tags?post=17675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}