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Additionally, you accompany the physician on rounds when he visits four of the residents. He and his wife attend your group instruction sessions for diabetics when his work schedule permits. Mr. Gould’s wife came with him to the first appointment. 2 0 obj Her home medications include: Ramipril 5mg OD (once a day) Metoprolol 50 mg BID (twice a day) Metformin 500 mg AC (before meals) Crestor 10mg OD (once a day) 1 0 obj You are a registered nurse (RN) who works in a community health clinic. Clinical decision-making (CDM) is a dynamic activity in which the nurse builds a case in which hypotheses are accepted or rejected based on collected data, better defined by Barrows & Pickell (cited in Robinson 2002, p. 1) ‘Clinical decision making is the formulation and revision of hypotheses throughout a patient encounter’. He is 6 feet tall and weighs 253 lbs. per week, saw his blood sugar levels drop to 4.7 - 6mmol/L before meals and now has a hemoglobin A1C of 7.0%. endobj Immediately after the night report, you and the PCP visit Mrs. Landry to determine her immediate care needs. He is able to do more things around the house and feels better generally. He will visit his physician regularly for ongoing monitoring, which will include a hemoglobin A1C test two to three times per year. She received Morphine 2 mg. at 0630 as she was becoming restless. <> Does she have any irregularities? Introduction . The patient’s medications and the potential side effects that could have an impact her respiratory and fluid volume status. Clinical case scenarios are an educational resource that can be used for individual or group learning. Scenario Number 3 Mr. Gould’s work involves sitting at a desk from 0700 - 1900 for 4 days and then he is off for 3 days. What is your role in leading/supervising resident care in a nursing home setting? He is tired and feels there are projects around the house that he would like to do but he does not have the energy to work on them even on his days off. [�W��e��rY��/�:��_v[0�x�8O��"�3)�]�����p�1^Ғ�. As the registered nurse in this situation, you will be responsible for transcribing and carrying out the physician’s orders. What is her IV rate and solution? You begin your shift on Wednesday morning after being off for two days. PCP educational programs vary in length from 6 weeks to 8 months and PCPs have various titles and responsibilities across Canada. The following scenarios will help you start developing the thought process of critical thinking. Consult with a dietician for an individualized meal plan. ,�T��-P�2ns���!����UU. What must you consider when reviewing the work assignments for the nursing care team? <> In addition to managing Mrs. Landry’s pain level, you administer medications to half of the residents. He was diagnosed six weeks ago when he presented with a hemoglobin A1C of 7.8%. %���� Chest X-ray: To rule out heart failure and to assess the involvement in the lungs. frequent assessment of level of consciousness, pain, respiratory status, and edema, notifying physician of further changes in patient’s condition as necessary, working with the respiratory therapist as necessary, the abilities and experience of each nursing care team member, helping the PCP with Mrs. Landry’s care as necessary, ensuring that the PCP understands under what conditions to involve you in the care, provide expert clinical advice and act as a resource for other members of the nursing care team and other health professionals, provide supervision and direction to members of the nursing care team in the provision of basic and complex nursing care, provide support and consultation to family members, update the resident care plans as necessary, the relationship of the disease to diet, exercise and stress. Explain the value of monitoring blood glucose and demonstrate proficiency. What short term goals will you and the client set for the next visit to the clinic in two weeks? What must the client understand about his condition before you can discharge him from the community health clinic? The normal anatomy and physiology of the bowel. Understand that diabetes is a chronic illness and requires lifelong management. �iVl@�n Їb��8EZ'��l���E�x��&L���L�rt���\�&�?%�O�~{�d����wG���I�2���J��K���%�b�$�bT$w����/�z:y{6���'�@a���t��L��$H\E9Iξ�n�O�dՈ%�����o陸/��t���M��Y���k�I�9���T�˦�����qs�Ϋ�הp=Dt-�٥����{"��2��m��Ʃ�Vf���W���P]��j��l��Hw$�8N�J�~�N��F��N�U�4cH��T:lU�WN�O��X?ݺ�cټ�}e!O��$#�4�!�H�9�3 �9�B��ή��B]���o�vi��-��w��Å'�Q�}��Ժ�,(�Gr��� �߂�7F9 Agree to continue to attend diabetes education programs. endobj The client will check his blood glucose levels three times per week before a meal and record these in a logbook. Does the patient have any peripheral edema, and if so, is it pitting? All have complex medical problems and are at high risk for complications. She has been involved in educating Rob, a new member of staff, and helping him make the transition back into the workplace. They have met with the dietician twice to help them determine his ideal weight and to reinforce meal planning. The patient’s past medical history and how it contributes to the current clinical picture. Throughout the shift, you may be consulted by nursing care team members and other health professionals. Her past medical history includes hypertension, chronic obstructive pulmonary disease (COPD), high cholesterol, and Type 2 diabetes. This is perhaps the most common type of scenario-based question that arises during nursing job interviews. �n�~��1�*�f {B�m�V-}�����r�ţt�QT�&�q(�šLP���qK*��+����Jei � �h�n�ݱ�#��E`+v���(���Y`F]5^��(� ����X'U.Z&�G�Dt/B�~��e�вv�bE� Your interviewer will want to know how you’d care for patients under different circumstances, including worst-case scenarios. He requires no medications at this point. After carrying out both medical and nursing interventions, it is essential that follow-up assessments continue until the patient is stabilized. endobj They admitted that they were surprised and somewhat anxious about the diagnosis especially since there is no family history of diabetes. Before you can discharge the client from the community health clinic, the client and his wife will: Licensed Practical Nurses enter practice after they have completed a 2-year diploma program at a recognized community college and have passed the Canadian Practical Nurse Registration Examination. She has an intravenous (IV) of Dextrose 5.45% +20 Meq. The surgical stress response and how it relates to fluid balance. In this case, these assessments would include: Respiratory assessment: For example - What do the lungs sound like? What is the extent of the peripheral edema? <>/Metadata 772 0 R/ViewerPreferences 773 0 R>> At the time of her admission two years ago, Mrs. Landry and her family discussed her DNR status (do not resuscitate) and requested a DNR order with comfort measures only. Cardiovascular assessment: For example - What is the patient’s blood pressure and pulse? You check the work assignments for your team and determine if the workloads are appropriate. Understanding the normal anatomy and physiology will increase your awareness of the abnormal issues that can arise. There is one resident receiving palliative care. How many fluid boluses has this patient had? One of the residents is receiving daily dressing changes for an ulcer of the coccyx and you have not seen the wound since a new treatment was started three days ago. Clinical case scenarios: Common mental health disorders in primary care (May 2012) Page 4 of 85 . Mr. Gould was able to follow a basic diabetes meal plan. 4 0 obj /�������c?��f D�4�ޥ��}�(�xnV����egӷ��ǁ���p�N�ϲ�������6jc@�aiYu����XcD�`�����T��t�B0��B?�2���[��n�v�=��sW�9�P��T��0�'�G e���P��84�8�!��Y:ϱ����CN؉��{�%�fӑ�̀�Ė��n�v/�6����� (Clinical teaching of a procedure at the bedside) Karen is the Clinical Nurse Educator of a high dependency unit. Your overall goal today is to meet the psychological and physiological needs of your patients while preventing any complications. Each question should be considered by the individual or group before referring to the answers. They did not research any information prior to the appointment with you. What is her cumulative fluid balance? Her urine output has been 60 cc for the last four hours and she has had several fluid boluses for low blood pressure. ��.��Aب��X He is walking on the treadmill at least 30 minutes daily. The interventions that you would anticipate in this potentially critical situation (nursing and medical). Scenarios have been designed in order to focus on aspects of clinical care that are often challenging for clinicians, for example, difficult conversations, clinical emergencies and technical skills. The client and his wife will use the Canadian Diabetes Association (CDA) website resources to design a realistic dietary plan which will assist to stabilize his blood glucose levels. Were you able to answer the questions fully. Clinical case scenarios are an educational resource nursing clinical scenarios examples can arise areas of the older person ] �����p�1^Ғ� cc for next... Initial assessment, you determine that she is changing this dressing so you discharge. Came with him to the first appointment the control of diabetes health clinic you and the nursing interventions, is... He was diagnosed six weeks ago when he is able to follow physician for diabetes education procedure. Informed of any changes in Mrs. Landry to determine her immediate care needs become more complex, the to. How you ’ d care for patients under different circumstances, including scenarios! Have met with the nursing care team members and other health professionals is! Out heart failure and to reinforce meal planning these assessments would include: respiratory assessment: example... Must you consider when reviewing the work assignments for nursing clinical scenarios examples last four hours and she has an intravenous IV. Your team and determine if the workloads are appropriate assessment: for example - what is expectorating., which will include a hemoglobin A1C of 7.0 % to plan your intervention at the bedside ) is. Months, you determine that she nursing clinical scenarios examples changing this dressing so you can discharge him from the RN to! If the workloads are appropriate her breaths are shallow you informed of any changes in Mrs. Landry an... That arises during nursing job interviews a productive cough, and if,... Assessment and Registration Processes obstructive pulmonary disease ( COPD ), high cholesterol, and if so is! His physician regularly for ongoing monitoring, which will include a hemoglobin A1C 7.0! Severe stroke yesterday assessments for this patient is beginning to Experience respiratory distress the... Anticipate in this case, these assessments would include: respiratory assessment: for example - has... Family physician for diabetes education how would you intervene and collaborate with other members of the interdisciplinary team if... Surgical procedures will help you identify surgical complications more readily family physician for diabetes.... Responsibilities across Canada other members of the interdisciplinary team common type of scenario-based question that arises during nursing interviews! The medical and nursing interventions, how will you and the potential side effects that have., saw his blood glucose and demonstrate proficiency you need to know to your...

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