Assignment: Discuss Clinical Judgment
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Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.
Keeping that in mind, answer the following scenario:
You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include:
RN with 12 years of Trauma ED experience
New RN with 6 months ED experience
RN from the Medical Surgical floor with 8 years of experience
The following patients are in the ED, which patient will you give to each of the nurses and why?
A 76-year-old client who was involved in a motor vehicle accident and has hematuria.
A 38-year-old client with kidney stones complaining of severe pain.
A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching.
An 80-year-old client that has not had a bowel movement for 4 days.
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Question 2
Module 1 discussion
Preventative Care / Care of Women and Children
Respond to each discussion prompt as your initial post. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
Group A:
Healthy People 2010 – is a guide to promote preventative care. Review primary, secondary and tertiary prevention and relate this to women and children at risk in your community. Identify those risk factors that a prevention program could impact the health of the group you identify.
This video is the Healthy People 2020 initiative
Group B:
Please research medical technological advances that may be unique to the care of women and children. Discuss how this technology will improve care to women and children. (ideas may be: genetic screening, public health initiatives, mammography, cervical screening, Fetal monitoring, Electronic medical records, telemedicine).
Which technological advances have been utilized in your local hospital? How has it impacted the care of women and children?
Module 2 discussion
Emergency Contraception / Emergency Department
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
Group A will complete the following discussion and then respond to Group B discussion.
Emergency Contraception:
A16 year old reports to the local Family Planning clinic with concerns regarding pregnancy. She relates she had unprotected intercourse 2 nights ago and believes she may be ‘fertile’. She wants to learn more about the ‘morning after pill’
What additional information should you obtain from her?
What do you know about emergency contraception and the side effects?
What educational points should you provide to her?
Group B will complete the following discussion and respond to Group A’s discussion post.
Vaginal Bleeding in pregnancy:
A pregnant patient arrives in the Emergency Department with complaints of vaginal bleeding. You will choose the gestational age of your patient, and based on that gestational age answer the following questions:
Knowing the gestational age, provide information on LMP, and EDD
What are the possible reasons she is bleeding at this gestational age?
What are your nursing interventions for this issue, and please include education to your patient.
Module 3 discussion
Labor Management
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
Part 1: An 18 year old Primigravida presents to Labor And Delivery with what appears to be active labor. Upon questioning, you discover she has received no prenatal care. In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for stress, and denies any support system. The Father of the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins – they were too hard to swallow. She has no idea when her LMP was and she relates always being very irregular. * remember LMP is to ask the first day of the Last Menstrual cycle, not when the bleeding stopped*
What other questions are essential for her safe care?
What lab values do you need to obtain?
What exam findings should you obtain at this time?
What education will you provide for her?
She asks you how long this will take to have the baby – what is your best response?
Group B
Part 2: Objective information:
Fetal heart tones are 130, with minimal variability
Vaginal exam is 4 cm/90%effaced/ -1 station
She is complaining of pain – 8/10 on a numerical scale.
An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.
How can you provide non pharmacological comfort to this patient?
What are the pharmacological methods to use?
Without prenatal records or history GBS is unknown. What must you provide?
Contractions are 5 minutes apart and you receive an order to augment labor – what non pharmacological methods can you employ (or ask the MD to provide?)
Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?
Preterm Labor Management
Preterm labor
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