Development of Critical Thinking and Clinical Reasoning

Development of Critical Thinking and Clinical Reasoning

  1. Your patient rings the call bell and says, “get in here quick.” You enter the room and you find the patient pinching the IV tubing, which you notice has
    approximately 15 cm of air in the line about to enter your patient’s body.

 Describe what you would do in the following situations and why?
What additional questions would you ask?
What further information needs to be collected?
Where would you go from here based on what you know?

  1. As you come on evening shift following a very busy day shift, the following is waiting for you: another department is on the phone wanting to give you report on a patient that you will be receiving, a patient is ringing and would like something for pain, the first set of VS is due on a patient receiving blood, the OR called and they are ready for Mrs. Jones for her surgery, and Mr. Smith would like his discharge papers so that he can go home. What would you do 1st, 2nd, 3rd, etc?
    Why?

 Describe what you would do in the following situations and why?
What additional questions would you ask?
What further information needs to be collected?
Where would you go from here based on what you know?

 

Answer

 

Question One

The first thing I would do when I get to the room is stop the IV infusion and close up the source of air entry to prevent the air in the IV catheter from getting into the patient’s system to avoid air embolism. Air embolism is the presence of air in the vascular system, which occurs when air accidentally gets into the venous system and travels to the pulmonary circulation or the right ventricle (Tufegdizc et al., 2021). Air embolism may have fatal effects on the patient and thus requires fast action. Next is placing the patient on the Trendelenburg position on the left. I would then start an interrogation with the patient, checking whether the patient is experiencing symptoms of air embolism. The additional questions I would ask include the type of IV fluid being administered and the time of starting the fluid. Further information on the suspected embolism case would be gathered by obtaining vital signs and further observing the patient for the symptoms. From there, I would notify the physician about the case, as extra tests are done to identify the diagnosis.

Question Two

The second situation requires arranging the tasks in levels of triaging priority. According to Vilpert et al. (2018), priority levels are assigned according to how immediate an action should be taken. For instance, level one priority includes the patients at a vital risk, requiring immediate action, level two includes patients with urgent situations but do not require immediate action, level three includes patients with sub-acute conditions but are stable. Level five consists of the patients who need some action taken, but not so urgently (Vilpert et al., 2018). I would first receive the report on my next patient. Secondly, I would wheel Mrs. Jones to the OR for surgery. The next thing is attending to the patient requiring pain medications, then finally giving Mr. Smith his discharge papers. I would ask additional questions to the patient asking for pain medication and the one being discharged. Among the questions are the pain’s intensity, location, and characteristics. Among the questions I would ask Mr. Smith include his discharge summary, receipts if there are any drugs he needs and the subsequent appointment date. From there, I would go to collect further information, diagnosis, and the patient’s progress in pain, and record the vital signs for the patient on blood transfusion after every 15 minutes.

References

Tufegdzic, B., Lamperti, M., Siyam, A., & Roser, F. (2021). Air-embolism in the semi-sitting position for craniotomy: A narrative review with emphasis on a single centers experience. Clinical Neurology and Neurosurgery209, 106904. https://doi.org/10.1016/j.clineuro.2021.106904

Vilpert, S., Monod, S., Jaccard Ruedin, H., Maurer, J., Trueb, L., Yersin, B., & Büla, C. (2018). Differences in triage category, priority level, and hospitalization rate between young-old and old-old patients visiting the emergency department. BMC Health Services Research18(1), 456. https://doi.org/10.1186/s12913-018-3257-9

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