Rn 3 0 Clinical Judgment Practice 3

Caroline Mae

2 min read

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29-12-2024

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This post focuses on enhancing clinical judgment skills for registered nurses with approximately 30 years of experience. While seasoned professionals possess a wealth of knowledge, continuous refinement of judgment is crucial for optimal patient care in an ever-evolving healthcare landscape. This practice session will delve into complex scenarios requiring critical thinking and decisive action.

Scenario 1: The Unexpected Deterioration

Patient: 78-year-old male, admitted for pneumonia, currently on IV antibiotics. Vitals stable for the past 24 hours.

Situation: During your routine assessment, you notice the patient's oxygen saturation has dropped to 88% on room air, despite being previously stable at 96%. He's exhibiting increased respiratory distress, with labored breathing and increased work of breathing. His heart rate has elevated to 110 bpm.

Questions:

1. What is your immediate priority? (Consider ABCs – airway, breathing, circulation).
2. What further assessments are necessary? (Consider auscultation, pulse oximetry trends, chest x-ray indication)
3. What interventions should you initiate? (Consider oxygen therapy, repositioning, notifying the physician, further respiratory support).
4. How would you document your findings and actions? (Emphasize concise and accurate documentation detailing observed changes, interventions, and patient response).

Scenario 2: Medication Error Prevention

Situation: A new medication order is received for a patient with a history of renal insufficiency. The ordered dose appears unusually high based on your understanding of the medication's pharmacokinetics and the patient's renal function.

Questions:

1. What steps should you take to verify the medication order? (Consider contacting the prescribing physician, referencing drug information resources).
2. What are the potential consequences of administering the medication as ordered? (Consider nephrotoxicity, other adverse effects).
3. How can you prevent similar medication errors in the future? (Consider utilizing medication reconciliation protocols, enhanced communication practices).

Scenario 3: Ethical Dilemma

Patient: 65-year-old female with end-stage renal failure, refusing dialysis. She has expressed a desire for comfort care only.

Situation: The patient's family is pressuring you to convince her to continue dialysis, against her wishes. They are emotionally distraught and believe dialysis is her only chance at survival.

Questions:

1. How will you address the family's concerns while upholding the patient's autonomy? (Emphasize patient's rights, clear and compassionate communication)
2. What ethical principles guide your actions in this situation? (Consider autonomy, beneficence, non-maleficence)
3. What resources are available to assist you in navigating this ethical challenge? (Consider ethics committees, hospital policies, spiritual care services)

Reflection and Discussion

These scenarios provide opportunities for critical reflection and discussion. Consider sharing your responses with colleagues, engaging in peer review, and utilizing available resources for continuing education in clinical judgment. Continuous learning and self-assessment are essential for maintaining high standards of patient care throughout your career. Remember, clinical judgment is a dynamic skill refined over time through experience and continuous learning.