Objectives

Objectives

 Identify common pathogens that can be spread related to the client's diagnosis

Assemble and identify correct personal protective equipment for the presumed pathogens

Identify the order of Donning and doffing personal protective equipment as instructed by the Centers for Disease Control's guidance

Identify the proper technique in preventing spreading contamination within the care setting

Handoff Report

The patient is a 56-year-old male who is complaining of flu-like symptoms, which have been getting    worse over the last few days.

Case History

 Your patient is a 56-year-old male who is retired.

 He is very lethargic and states his wife is also not feeling well at home.

 He presents with general malaise, fever, a loose productive cough, and diarrhea.

 He states it has become increasingly more difficult to breathe over the last two hours.

Triage Vital Signs

56 Year Old Male, VS T. 103, HR 110, BP 156/60, RR 33, O2 90%. Chief Compliant, Fever, Cough, Shortness of Breath, and a Sore Throat.

Patient Assessment

General Appearance: Anxious, and a little Unkempt

Cardiovascular: Sinus Tachycardia

Respiratory: Rhonchi all fields 

GI: Hyperactive bowel sounds

GU:  Voiding dark yellow urine

Extremities: General weakness

\ Skin: Pale, Hot, Diaphoretic

Neurological: Alert and oriented to person, place, and time

Other Assessment Data

      Labs:  Pending

     Fall Risk:  High

   Pain: 4 out of 10

Social History

    Social drinking

    2 pack-a-day smoker (previously)

   Travel History: None provided by patient.

Provider Orders

IV D5 1/2NS with 20mEq KCL at 125mL/Hr continuous infusion to urine output 30mL/Hr for 4 hours.  Then reduce to 60mL/Hr.

  Call if vital signs indicate: O2 <90% on Oxygen, HR >120 or <60, BP systolic >200 or <90

 O2 dependent at 2 LPM

 Xopenex

 Diagnosis: R/O Flu and COVID-19

 Droplet/Contact Isolation

 Condition: Stable

 Code Status: Full

Patient Presentation

    When initially contacted, the client is pleasant and cooperative, oriented but sleepy.

     He states, ""The last thing I ate before having the diarrhea started was a salad with grilled chicken.""    This was about 48 hours ago.

His skin turgor if fair, while his oral mucosa appear pale and dry. He presented to the emergency     room 6 hours ago Your patient is a 56-year-old male who is retired. He is very lethargic and states his  wife is also not feeling well at home. He presents with general malaise, fever, a loose productive cough, and diarrhea. He states it has become increasingly more difficult to breathe over the last two hours.

 He has been admitted to hospital with a diagnosis R/O Flu and COVID-19

Secondary Assessment:

   Weight 70 kg

Height 5' 9""

 Enlarged lymph nodes

 Lungs with rhonchi and poor air exchange

 Abdomen soft with no pain on palpations

 Lower extremities normal with +1 pitting pedal edema

Distal pulses are weak bilaterally

 

 

 

 

 

 

 

Template of Clinical Reasoning Questions to Develop Nurse Thinking

(Formulate and reflect before and after report, but BEFORE seeing patient the first time)

 1.     What is the primary problem and what is the underlying cause/pathophysiology of this problem?

 The 56 Year Old Male, VS T. 103, HR 110, BP 156/60, RR 33, O2 90%. Chief Compliant, Fever, Cough, Shortness of Breath, and a Sore Throat.

   2.     What clinical data from the chart is RELEVANT and needs to be trended because it is clinically significant?

  3.     What nursing priority captures the ""essence"" of your patient's current status and will guide your plan of care?

  4.     What nursing interventions will you initiate based on this priority and what are the desired outcomes?

  5.     What body system(s) will you focus on based on your patient's primary problem or nursing care priority?

  6.     What is the worst possible/most likely complication(s) to anticipate based on the primary problem?

  7.     What nursing assessments will identify this complication EARLY if it develops?

  8.     What nursing interventions will you initiate if this complication develops?

  While Providing Care...(Review and note during shift after initial patient assessment)

9.     What clinical assessment data did you just collect that is RELEVANT and needs to be TRENDED because it is clinically significant to detect a change in status? 

  10.  Does your nursing priority or plan of care need to be modified in any way after assessing your patient?

  11.  After reviewing the primary care provider's note, what is the rationale for any new orders or            changes made?

 12.  What educational priorities have you identified and how will you address them?

 Caring and the ""Art"" of Nursing

13.  What is the patient likely experiencing/feeling right now in this situation?

  14.  What can I do to engage myself with this patient's experience, and show that he/she matters to me as a person?"

Clinical Reasoning – Questions and Answers

 1. What is the primary issue? What is the reason for existence of this issue or pathology of the condition?

 

 Primary Problem:

 The patient has fever, productive cough, shortness of breath, and diarrheal disease. It is differential with flu and COVID-19 since both present with a clinical condition and the orders of the provider.

 

 Underlying Cause/Pathophysiology:

 

 Flu/ COVID-19: Both lead to fever, cough, worsened breathing due to respiratory system and systemic inflammation. From this disease, one is likely to develop pneumonia and this would result to the development of breathlessness and overall body weakness.

 Dehydration: Indeed, the patient was receiving a milk-based diet and had suffered from diarrhoea, sending her into potentially severe dehydration which was proven due to her pale and dry oral mucosa and fair skin turgor.

 2. What of the clinical data from the chart are relevant and has to be trended out because of its clinical implications?

 

 Vital Signs: Hyperthermia, tachycardia, hypoxemia, hypertension, tachypnea.

 Respiratory Findings: Rhonchi and inability to mix fresh and stale air indicates that lower respiratory tract infection is possible or the patient has an exacerbation.

 Urine Output: Impiration of colour to weak brown and dark yellow urine suggest that the body is dehydrated.

 Laboratory Results: Awaiting, but could be used to look for the development of infection, check renal function and electrolyte abnormalities.

 3. Which nursing list reflects the ‘nature’ of your patient and will be the focus of planning?

 

 Unfortunately, in this case and in general status asthmaticus treatment is the primary nursing priority for airway clearance and control of fluid. Because the patient does have SOB, fever, and has the possibilities of being dehydrated, it is essential to address these factors to be able to stabilize the patient and rule out the worsening of problems.

 

 4. Which other nursing interventions will you embark on given this priority and what are the expected outcomes?

 

 Administer IV Fluids as Ordered: To relieve headaches, to regulate metabolism and to prevent the occurrence of dehydration.

 

 Desired Outcome: Optimise the hydration state and renal function.

 Provide Supplemental Oxygen: Minimally, the oxygen level should not drop below 90 percent.

 

 Desired Outcome: Optimise the levels of oxygen and reduce pressure to the respiratory muscles and organs.

 Monitor Respiratory Status: Perform breath sounds, respiratory rate, and oxygen saturation assessment: for example, daily or when indicated by acuity.

 

 Desired Outcome: There should have been early identification of changes in respiratory function and where evident appropriate management should have been done.

 Encourage Deep Breathing and Coughing Exercises: For use in the treatment of lung infections and conditions that compromise the normal functioning of the lungs as well as for coughs and secretions.

 

 Desired Outcome: Enhance lung ventilation and avoid mostly associated risks such as atelectasis.

 Educate the Patient and Family: About some aspects that signal the worsening of conditions and when it is necessary to address to doctors again.

 

 Desired Outcome: Raising he unit level of patient and family engagement in care.

 5. On which body system(s) will you mainly concentrate depending on the patient’s main issue or your main nursing concern?

 

 Respiratory System: Because of respiratory difficulties, they are unable to breathe properly, have a persistent cough, and low oxygen levels.

 Cardiovascular System: Considering that the patient has tachycardia and hypeension.

 Gastrointestinal System: Responding to issues on diarrhea and or dehydration.

 6. From the identified primary problem what is the worse that could happen/ most likely to happen complication(s)

 

 Acute Respiratory Distress Syndrome (ARDS): Because of severe infection that has an impact on lung capacities.

 Severe Dehydration: Resulting in; Electrolyte disorders and renal dysfunction.

 Sepsis: If the root infection is invasive and manifests a systemic nature.

 7. Which of the following will early detect this complication if it occurs in the nursing assessment?

 

 Respiratory Assessments: Supervision for the features of decompensated respiratory deterioration or hypoxaemia.

 Vital Signs: Regular checks to the patient’s temperature, blood pressure, pulse rate and oxygen levels.

 Fluid Status: Appropriate monitoring of the patient’s intake and output especially if the patient is on NPO for a long time, checking of the skin turgor to determine level of dehydration.

 8. Which of these complications will you implement if this complication occurs?

 

 For ARDS: Amplify the oxygen support to the patient in consideration of mechanical ventilation if essential.

 For Severe Dehydration: Bolster bicarbonate infusion rates and check electrolytes.

 For Sepsis: Get the cultures and sensitivities and also give broad-spectrum antibiotics and observe for signs of organ failure.

 While Providing Care. . .

 

 9. What clinical assessment data did you just collect that is germane and must be trended because the change in status is clinically meaningful?

 

 Respiratory Status: In particular, its worsening of breath sounds and oxygen saturation.

 Vital Signs: Variations in pressure and pulse, and any alterations in temperature that is detected.

 Fluid Intake/Output: The continuous evaluation of urine output or features fo fluid retention.

 10. After assessing your patient do you require to change your nursing priority or plan of care in anyway?

 

 Adjustments may be needed based on:Adjustments may be needed based on:

 

 Changes in Respiratory Status: If over this rate is not feasible, the level of respiratory support given has to be increased.

 Fluid Balance: Adjusting the patient’s fluids according to the urinary output along with other symptoms of deterioration or fluid retention.

 11. If there is a new order or alteration of an order, it is articulated what the rationale for the change is, based on the review of note made by the primary care provider?

 

 New orders may address:

 

 Infection Management: Administering antibiotics in cases whereby the dog is infected.

 Fluid and Electrolyte Management: Here the possible changes would be made on the basis of an ongoing evaluation of the situation, regarding the rates of the fluids.

 Oxygen Therapy: Raising the oxygen to at least meet the basal oxygen requirements of the patients.

 12. List of the educational priorities and how you would plan to meet them:

 

 Patient Education: Some of the important facts to include are the ways of dealing with symptoms and sign indicating that conditions are aggravating.

 Family Education: Teach on when to monitor and when to seek help from other professional or service.

 Caritas and the “Fine” Art of Nursing

 

 13. How does the patient feel or what can the patient be going through in a situation that he/she is experiencing such?

 

 The patient may be experiencing anxiety, being preoccupied with the symptoms, and probably fearful for his life. He may also be carrying some health concern of his wife or any of his family members with him.

 

 14. Engage with this patient’s experience of the mental disorder and let him/her know, I care as a person.

 

 Active Listening: Emotion must be displayed, the patient’s worries and emotions must be recognized.

 Provide Reassurance: Be specific when explaining to him the care plan and the measures that are being taken to alleviate his symptoms.

 Involve Family: Incare process involve the family and also help the family as well.