Clinical reasoning case study

Page 1 of 4

ISP: Critical Care Nursing 92473 Assessment 1: Case Study - Information

Name: Bryan Sim MRN: 1234567.UTS Age: 26 years Date of Birth: 02/02/1994 Weight: ~70kg Allergies: Nil known Next of Kin: Dan (Friend) Other: Non-English Speaking Background (NESB) History: Normally fit and well Bryan is an international tourist from Korea, studying in Sydney. Setting the Scene: Bryan Sim is a 26 year old male, pulled from Bondi Beach unresponsive requiring CPR and defibrillation before having return of spontaneous circulation (ROSC) after approximately 6-8 minutes. Ryan is then transported to the hospital where you are the receiving nurse. It is Thursday afternoon, 11th March 2020. You are working in the Emergency Department when you receive the following phone (BAT) Call from the ambulance paramedic enroute with patient Bryan Sim. ____________________________________________________________________________________ Ambulance handover (call via Car 978) I: Bryan Sim, 26 year-old male M: Pulled from the surf at Bondi Beach unresponsive I: Witnessed salt water near drowning with absent respiration and circulation. Submersion time unknown S: Pulseless VT ® CPR & DC shock x 1 > ROSC Ingested water +++ T: C-spine collar insitu Log roll and suction of vomit SpO2 90% in NRB Oxygen 100%, Cardiac monitoring – irregular sinus tachycardia, systolic 90 mmHg Conscious, responsive to voice (GCS 13/15 - E3 V4 M6), speaks minimal English 14Fg cannula to right cubital fossa ETA approximately 5 minutes

Page 2 of 4

Following handover, you complete a clinical assessment and collect the following vital signs:

Airway • Clear • Bryan is mumbling when asked questions by his friend, nil adventitious sounds

Breathing

• Bilaterally equal air entry with bi-basal crackles, decreased at bases, symmetrical chest movements

• Use of accessory muscles • Intercostal and subcostal recession • RR 24 bpm (irregular) • SpO2 92% • Non-rebreather mask insitu at 15L/min

Circulation

• Heart Rate 142 bpm • Blood Pressure 97/54 mmHg • Pale Pink in colour • Centrally cool to touch, peripherally cold and mottled

Disability

• Opens eyes spontaneously • Patient moaning • Incomprehensible sounds • Flexion to painful stimuli • Pupils R/L 5+

Exposure

• Temperature 34.5 degrees (axillar) • Nil rash, bruises or other concerns noted • 14fg PIVC insitu to right cubital fossa – VIP Score = 0, dressing dry and intact • Wet board shorts insitu

Fluids

• 300ml stat dose 0.9% Sodium Chloride administered intravenously • Infusion insitu however, currently clamped for transfer from Ambulance

stretcher to ED

Glucose • BGL: 9.5 mmoLs

Social Friend, Dan is present and assisting with interpretation

Students are required to apply the Clinical Reasoning Cycle by Levett-Jones, T. (ed) 2018 to the case study of Bryan Sim and demonstrate their ability to analyse patient information that supports the provision of best practice nursing care. Students will need to draw upon their understanding of comprehensive patient assessment and prioritisation of patient care needs. Students will then describe how they will interact and deliver the appropriate nursing care to the patient with near drowning.

Page 3 of 4

You may use this to help you structure your assessment. This is not a formal essay, however, referencing guidelines still apply. Percentage of marks is applied to each section with suggested word count.

Clinical Reasoning (2000 Words)

1. Consider the patient situation 5% (50 words) Provide a relevant and concise description of your observation of the context and situation for Bryan

2. Collect cues and/or information 5% (250 words) Review / Gather / Recall: Review current information and gather new information. Support this information through the recall of knowledge

3. Process Information 25% (500 words) Interpret: Analyse the clinical data and come to understanding of the signs / symptoms relevant to Bryan’s presentation

Discriminate: Distinguish the clinical information as either relevant or irrelevant to the current situation

Relate & Infer: Identify relationships in the clinical data that match the signs / symptoms of Bryan’s presentation

Predict: Predict expectations of Bryan’s current situation (if left untreated).

Match: Match Bryan’s current situation to the literature and clinical presentation

4. Identify problems / issues 15% (350 words) Synthesise facts and interferences to make a definitive nursing diagnosis.

5. Establish goals 15% (300 words) Using the A-G approach, identify three immediate goals for Bryan at this time

6. Take Action 15% (200 words) What actions will you take as a nurse in response to the goals identified?

7. Evaluate 15% (200 words) After initiating your interventions, how will you evaluate their effectiveness?

8. Reflect 5% (150 words) What have you learnt through this process that you will incorporate into your future clinical practice?

Page 4 of 4

RADIOMETER ABG800 FLEX

ABG800 UTSABL 1415 11/03/2020 SIMULATED PATIENT REPORT Syringe – S 250uL Sample #13268 ________________________________________________________ Identifications Patient ID 1234567.UTS Patient Last Name SIM Patient First Name Bryan Date of Birth 02/02/1994 Sample Type Arterial FiO2 100 % T 34.5 oC _________________________________________________________ Acid Base Status pH 7.28 pCO2 52 mmHg pO2 62 mmHg sO2 86 % cHCO3-(p)c 16.2 mmol/L cBase(Ecf)c -3 mmol/L Electrolyte Values cNa+ 138 mmol/L cK+ 3.8 mmol/L cCl- 110 mmol/L cCa2+ 1.2 mmol/L Metabolite Values cGlu 9.5 mmol/L cLac 5.0 mmol/L Oximetry Values ctHb 105 g/L FHHb - % FO2Hb - % FMetHb - % FCOHb - % ctO2G - % BO2G - % ……………………………………………………………………………………………………………… Notes C Calculated Value(s) __________________________________________________________ __________________________________________________________ Printed 1415 11/03/2020 User ID: RN 8457291