Pharmacology

ClinicalReasoningClinicalJudgementSession1and2worksheet9.20.23.docx

Clinical Reasoning/Clinical Judgment Process Step 1 Step 1: Recognize Cues Learning Objective: Student will recognize expected findings and unexpected findings. This is key to preventing “failure to rescue” (Clayton, 2017; Fontenot, 2022; Herron, 2017).
Step 1: Recognize Cues *Educator Prompts:* “What did you see?” “What cues are relevant or irrelevant?” “What is going on in the environment?” “What EHR data may be important?”	List normal findings to recognize: 1. 2. 3. List abnormal findings to recognize: 1. 2. 3.	Environment cues (setting, presence of family):
	List signs and symptoms to recognize: 1. 2. 3.	Patient Observation cues:
	List key facts to recognize (from H&P, PMH, SH, etc.): 1. 2. 3.	Medical Records cues:
		Time Pressure cues:

Clinical Reasoning/Clinical Judgment Process Step 2

Step 2: Cluster and Analyze Cues

Learning Objective: Student will identify content needed to cluster and analyze cues.

Step 2: Cluster and Analyze Cues

Educator Prompts:

“What data link together?” For example: RR24, WHEEZING, PO2 93% on RA.

“Are there any patterns?”

“Are there any inconsistencies in the data collected?” For example: the client states no pain, yet the nurse sees them tearful, and moaning when moving. The information does not “match”. Further investigation is needed.

“What data can be clustered together to assist in determining a concern?” for example: if a client has a fever, what is the WBC count? Has there been a trend upward or downward in this data?

What is/are the connection(s) between pathophysiology and client presentation? ***This is a major area of focus to help the student begin to understand the why behind the symptoms they are finding/clustering/analyzing.

1.

2.

Requires knowledge of: ***If unsure, look it up!! Ask questions!! Be the safest student nurse you can be!!

1.

2.

3.

Use findings/observations to determine client needs:

1.

2.

Student to develop inquiry:

What questions need to be asked?

What are safety concerns?

What additional information might be needed to develop a hypothesis? (In other words, did a piece of data get missed?).

Faculty teaching activity

Complete a Venn Diagram. This is an important aspect of being able to differentiate conditions. For example: dementia and delirium both have confusion. One is slow onset, one is rapid. Think of your topic for the day. If you are teaching about gastritis, what other conditions have similar symptoms? How can a student differentiate between the two diseases to make the proper clinical judgment? Include in the diagram distinguishing characteristics for similar but different diagnosis. Have the students ask themselves: How are they different? How are they similar?

Disease A: symptoms

Symptoms for both disease A and B

Disease B symptoms

Clinical Reasoning/Clinical Judgment Process Step 3

Expected Behavior(s) : student will identify possible/probable causes of the cues that were found and analyzed. Students will prioritize the hypothesis in a safe and effective manner. Faculty: Use index cards with many client symptoms, have the students generate hypothesis and prioritize what should be addressed first.

Prioritize Hypothesis

Educator Prompts:

“Do you need more information to form a hypothesis?”

What is the priority issue (likelihood, risk, etc.)?

1.

Requires knowledge of:

1.

2.

Indicate resources:

1.

Clinical Reasoning/Clinical Judgment Process Step 4

Expected Behavior(s): Student will i dentify possible solutions to the prioritized hypothesis and minimize possible complications of the actual hypothesis. Faculty: index cards for students in groups. What interventions must be done, what should be avoided? What complications could occur, and how can they be managed?

Step 4: Generate Solutions

Educator Prompts:

“What interventions may be possible?”

“What solutions did the patient need? What evidence did you have for this solution?”

“What risks are related to your solution?”

“What are the potential risks if you do not choose this solution?”

“What complications may arise from the given hypothesis”?

What must the nurse address? Are there potential complications that must be accounted for?

1.

2.

Requires knowledge of: What is the pathophysiology that we are trying to correct/return to homeostasis?

1.

2.

What must the nurse avoid?

1.

2.

image2.png

image3.png

image4.png

image5.png

image6.png

image7.png

image8.png

image1.png

image10.png

clinicaljudgment.docx

clinical judgment/clinical reasoning

Scenario:

You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B, who has just been admitted. He is 22 years old and has been attending the local university and living at home with his parents. R.B. has always been a good student and has been socially active. Last semester his grades began declining. He became very withdrawn and spent most of his time alone in his room. His personal self-care has deteriorated as he can go days without bathing. Before admission, R.B. spent several weeks in seclusion. He refused to join family gatherings, isolated himself, and closed the blinds. Within the past 2 days, he refused to eat, stating, "They have contaminated the food." As you approach R. B., you note that he appears to be talking to himself. When you talk to him, he looks around and answers in a whisper but gives you little information. He states, "They are watching me and told me not to cooperate."

ClinicalReasoningClinicalJudgementSession1and2worksheet9.20.23.docx

Clinical Reasoning/Clinical Judgment Process Step 1 Step 1: Recognize Cues Learning Objective: Student will recognize expected findings and unexpected findings. This is key to preventing “failure to rescue” (Clayton, 2017; Fontenot, 2022; Herron, 2017).
Step 1: Recognize Cues *Educator Prompts:* “What did you see?” “What cues are relevant or irrelevant?” “What is going on in the environment?” “What EHR data may be important?”	List normal findings to recognize: 1. 2. 3. List abnormal findings to recognize: 1. 2. 3.	Environment cues (setting, presence of family):
	List signs and symptoms to recognize: 1. 2. 3.	Patient Observation cues:
	List key facts to recognize (from H&P, PMH, SH, etc.): 1. 2. 3.	Medical Records cues:
		Time Pressure cues:

Clinical Reasoning/Clinical Judgment Process Step 2

Step 2: Cluster and Analyze Cues

Learning Objective: Student will identify content needed to cluster and analyze cues.

Step 2: Cluster and Analyze Cues

Educator Prompts:

“What data link together?” For example: RR24, WHEEZING, PO2 93% on RA.

“Are there any patterns?”

“Are there any inconsistencies in the data collected?” For example: the client states no pain, yet the nurse sees them tearful, and moaning when moving. The information does not “match”. Further investigation is needed.

“What data can be clustered together to assist in determining a concern?” for example: if a client has a fever, what is the WBC count? Has there been a trend upward or downward in this data?

What is/are the connection(s) between pathophysiology and client presentation? ***This is a major area of focus to help the student begin to understand the why behind the symptoms they are finding/clustering/analyzing.

1.

2.

Requires knowledge of: ***If unsure, look it up!! Ask questions!! Be the safest student nurse you can be!!

1.

2.

3.

Use findings/observations to determine client needs:

1.

2.

Student to develop inquiry:

What questions need to be asked?

What are safety concerns?

What additional information might be needed to develop a hypothesis? (In other words, did a piece of data get missed?).

Faculty teaching activity

Complete a Venn Diagram. This is an important aspect of being able to differentiate conditions. For example: dementia and delirium both have confusion. One is slow onset, one is rapid. Think of your topic for the day. If you are teaching about gastritis, what other conditions have similar symptoms? How can a student differentiate between the two diseases to make the proper clinical judgment? Include in the diagram distinguishing characteristics for similar but different diagnosis. Have the students ask themselves: How are they different? How are they similar?

Disease A: symptoms

Symptoms for both disease A and B

Disease B symptoms

Clinical Reasoning/Clinical Judgment Process Step 3

Expected Behavior(s) : student will identify possible/probable causes of the cues that were found and analyzed. Students will prioritize the hypothesis in a safe and effective manner. Faculty: Use index cards with many client symptoms, have the students generate hypothesis and prioritize what should be addressed first.

Prioritize Hypothesis

Educator Prompts:

“Do you need more information to form a hypothesis?”

What is the priority issue (likelihood, risk, etc.)?

1.

Requires knowledge of:

1.

2.

Indicate resources:

1.

Clinical Reasoning/Clinical Judgment Process Step 4

Expected Behavior(s): Student will i dentify possible solutions to the prioritized hypothesis and minimize possible complications of the actual hypothesis. Faculty: index cards for students in groups. What interventions must be done, what should be avoided? What complications could occur, and how can they be managed?

Step 4: Generate Solutions

Educator Prompts:

“What interventions may be possible?”

“What solutions did the patient need? What evidence did you have for this solution?”

“What risks are related to your solution?”

“What are the potential risks if you do not choose this solution?”

“What complications may arise from the given hypothesis”?

What must the nurse address? Are there potential complications that must be accounted for?

1.

2.

Requires knowledge of: What is the pathophysiology that we are trying to correct/return to homeostasis?

1.

2.

What must the nurse avoid?

1.

2.

image2.png

image3.png

image4.png

image5.png

image6.png

image7.png

image8.png

image1.png

image10.png

clinicaljudgment.docx

clinical judgment/clinical reasoning

Scenario:

You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B, who has just been admitted. He is 22 years old and has been attending the local university and living at home with his parents. R.B. has always been a good student and has been socially active. Last semester his grades began declining. He became very withdrawn and spent most of his time alone in his room. His personal self-care has deteriorated as he can go days without bathing. Before admission, R.B. spent several weeks in seclusion. He refused to join family gatherings, isolated himself, and closed the blinds. Within the past 2 days, he refused to eat, stating, "They have contaminated the food." As you approach R. B., you note that he appears to be talking to himself. When you talk to him, he looks around and answers in a whisper but gives you little information. He states, "They are watching me and told me not to cooperate."

ClinicalReasoningClinicalJudgementSession1and2worksheet9.20.23.docx

Clinical Reasoning/Clinical Judgment Process Step 1 Step 1: Recognize Cues Learning Objective: Student will recognize expected findings and unexpected findings. This is key to preventing “failure to rescue” (Clayton, 2017; Fontenot, 2022; Herron, 2017).
Step 1: Recognize Cues *Educator Prompts:* “What did you see?” “What cues are relevant or irrelevant?” “What is going on in the environment?” “What EHR data may be important?”	List normal findings to recognize: 1. 2. 3. List abnormal findings to recognize: 1. 2. 3.	Environment cues (setting, presence of family):
	List signs and symptoms to recognize: 1. 2. 3.	Patient Observation cues:
	List key facts to recognize (from H&P, PMH, SH, etc.): 1. 2. 3.	Medical Records cues:
		Time Pressure cues:

Clinical Reasoning/Clinical Judgment Process Step 2

Step 2: Cluster and Analyze Cues

Learning Objective: Student will identify content needed to cluster and analyze cues.

Step 2: Cluster and Analyze Cues

Educator Prompts:

“What data link together?” For example: RR24, WHEEZING, PO2 93% on RA.

“Are there any patterns?”

“Are there any inconsistencies in the data collected?” For example: the client states no pain, yet the nurse sees them tearful, and moaning when moving. The information does not “match”. Further investigation is needed.

“What data can be clustered together to assist in determining a concern?” for example: if a client has a fever, what is the WBC count? Has there been a trend upward or downward in this data?

What is/are the connection(s) between pathophysiology and client presentation? ***This is a major area of focus to help the student begin to understand the why behind the symptoms they are finding/clustering/analyzing.

1.

2.

Requires knowledge of: ***If unsure, look it up!! Ask questions!! Be the safest student nurse you can be!!

1.

2.

3.

Use findings/observations to determine client needs:

1.

2.

Student to develop inquiry:

What questions need to be asked?

What are safety concerns?

What additional information might be needed to develop a hypothesis? (In other words, did a piece of data get missed?).

Faculty teaching activity

Complete a Venn Diagram. This is an important aspect of being able to differentiate conditions. For example: dementia and delirium both have confusion. One is slow onset, one is rapid. Think of your topic for the day. If you are teaching about gastritis, what other conditions have similar symptoms? How can a student differentiate between the two diseases to make the proper clinical judgment? Include in the diagram distinguishing characteristics for similar but different diagnosis. Have the students ask themselves: How are they different? How are they similar?

Disease A: symptoms

Symptoms for both disease A and B

Disease B symptoms

Clinical Reasoning/Clinical Judgment Process Step 3

Expected Behavior(s) : student will identify possible/probable causes of the cues that were found and analyzed. Students will prioritize the hypothesis in a safe and effective manner. Faculty: Use index cards with many client symptoms, have the students generate hypothesis and prioritize what should be addressed first.

Prioritize Hypothesis

Educator Prompts:

“Do you need more information to form a hypothesis?”

What is the priority issue (likelihood, risk, etc.)?

1.

Requires knowledge of:

1.

2.

Indicate resources:

1.

Clinical Reasoning/Clinical Judgment Process Step 4

Expected Behavior(s): Student will i dentify possible solutions to the prioritized hypothesis and minimize possible complications of the actual hypothesis. Faculty: index cards for students in groups. What interventions must be done, what should be avoided? What complications could occur, and how can they be managed?

Step 4: Generate Solutions

Educator Prompts:

“What interventions may be possible?”

“What solutions did the patient need? What evidence did you have for this solution?”

“What risks are related to your solution?”

“What are the potential risks if you do not choose this solution?”

“What complications may arise from the given hypothesis”?

What must the nurse address? Are there potential complications that must be accounted for?

1.

2.

Requires knowledge of: What is the pathophysiology that we are trying to correct/return to homeostasis?

clinicaljudgment.docx

ClinicalReasoningClinicalJudgementSession1and2worksheet9.20.23.docx

clinicaljudgment.docx

ClinicalReasoningClinicalJudgementSession1and2worksheet9.20.23.docx

image2.png

image3.png

image4.png

image5.png

image6.png

image7.png

image8.png

image1.png

image10.png

clinicaljudgment.docx

maternal newborn