Help with Patient Scenerio Using Skills of Critical Thinking

Nursing Students Student Assist

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Hi! Help me solve this.

Scenario Using Skills of Critical Thinking

Here is the situation:

During assessment, Mr. Fellows relates a history of sudden onset chest pain rated at 10 on a 1 to 10 scale, relieved by rest, which started while he was mowing the lawn. He describes the pain as "crushing, like a truck ran over my chest." His blood pressure is 200/110 mm Hg, temperature is 36.7, pulse is 106 beats/min, and respirations are 24 beats/min. The pulse is irregular and thready, and the respirations slightly dyspneic (labored). The cardiac monitor reveals atrial fibrillation. During the assessment, his wife confides to the nurse that Mr. Fellows was treated 3 years ago for alcohol dependence. Currently, he is complaining of nausea and indigestion. His skin is pale and diaphoretic. He is restless and anxious. His wife is sitting at the bedside very tearful and emotional.

Based on the scenario, discuss your interpretation, analysis, evaluation, inference, explanation, self regulation and how would you use these to resolve a situation related to the PATIENT'S PAIN.

Interpretation (Clarify what the behavior means)

Analysis (During the Assessment, what questions should the nurse ask to determine the best plan of care?)

Evaluation (What outcomes do you expect to achieve with your patient today?)

Inference (What conclusion [explanation for behavior] could the nurse make, based on the analysis)

Explanation (During implementation, how can the nurse justify the actions being initiated)

Self-regulation (What issues should the nurse reexamine to correct or improve the nursing care?)

You need to review s/sx of MI. You also need to learn about ETOH abuse, the s/sx of w/d, and then you will know how to answer the questions. The emotional needs of the spouse are not the #1 priority.

Patient's pain must be put into focus. That must be the center of the analysis.

hey! here is what i've done so far. if i'm wrong, correct me. this is using skills of critical thinking.

interpretation (clarify what the behavior means)

the patient is extremely experiencing chest pain. although his temperature is normal, he has an irregular pulse beat, hypertension, and an abnormal respiratory rate. there is something not good about his heart. the patient is with the wife at the bedside who is very tearful and emotional which is not good for the patient's situation. symptoms of his case includes those which the pt currently complained about: nausea and indigestion. this may be due to the side effects of his alcohol dependence 3 years ago (correct me, will the past 3 yrs of alcohol dependence affect him today??) paleness, diaphoresis, restlessness and anxiety are those observed and can be considered as objective data. the patient's situation implies the his inability to do the adls.

now, this case shows that the patient is experiencing severe pain to which the nurse must set focus upon.

analysis (during the assessment, what questions should the nurse ask to determine the best plan of care?)

during the analysis, here are the questions i may ask the patient to achieve the expected outcome today:

what brought you here? (to know how the pt feels about his pain/how severe it was that made him think of admitting himself to the hospital)

how do you feel about the it? (to know the pt level of agitation about the pain)

how does your pain affect your everyday tasks? can you still do the activities that you are supposed to do? (to know how the pain affects his adls and know the limit of his given responsibility as a father, if any, or a husband at home.)

how do you foresee it? any experience of depression? suicide attempts? (to know his level of restlessness and anxiety, if known, be given proper intervention of other members of the health care team)

are you taking any medications? does it help? (to know if the pt is trying to atleast solve the pain)

how is your eating habits? (to solve his complain about nausea and indigestion)

how is your family's response to your pain? (to evaluate the support/concern that the family gives to the patient to be able to maintain, if not, give proper on-time careful assistance).

how is your relationship with your family? (to know his family role and relationship affected by his pain)

evaluation (what outcomes do you expect to achieve with your patient today?)

with my patient, i expect him to relate improvement of pain and an increase in daily activities as evidenced by him and his wife, maintain family role and relationship throughout pain experience, and improve his lifestyle. to achieve patient's comfort as well.

inference (what conclusion [explanation for behavior] could the nurse make, based on the analysis)

because of extreme pain, the patient's adls, his family and role relationship is affected due to his lifestyle choice. the wife is very tearful and emotional at his bedside which adds to his suffering.

explanation (during implementation, how can the nurse justify the actions being initiated)

improvement of pain is achieved by noninvasive relief measures in order to manage the pain; by the patient's verbalized improvement of pain, by pain assessment scale or by expressed behavior.

self-regulation (what issues should the nurse reexamine to correct or improve the nursing care?)

was i biased? did i know all the facts? did i make an accurate decision? did i implement correct intervention?

this is my answer. i'm open for corrections. :) !!! and added informations! thanks!

Where can I find that information?

Before you can make an effective care plan you need to review some things. The cardiac chapter of your Med/Surg nursing textbook will explain the various acute coronary syndromes, s/sx, treatments. ETOH abuse, w/d s/sx, and treatment would be under the substance abuse section in a psych nursing text book. If you have a nursing care plan book that will be extremely helpful. I wouldn't have made it out of nursing school w/o it.

Where can I find that information?

I think I must reduce first his anxiety level and his sense of restlessness and also his pain. I must look at the occurence of his nausea and indigestion. But how can I do that? How will I know? How is it related to chest pain?

Specializes in Emergency, Telemetry, Transplant.

Where does this person stand with their tx for alcohol dependence? If it has not been fully treated, which electrolyte can be quite abnormal with alchohol dependence, and whose deficiency can lead to the abnormal heart rhythm in the question? (kinda an advance question based on the original senario, but something to think about...)

hey! here is what i've done so far. if i'm wrong, correct me. this is using skills of critical thinking.

interpretation (clarify what the behavior means)

the patient is extremely experiencing chest pain. although his temperature is normal, he has an irregular pulse beat, hypertension, and an abnormal respiratory rate. there is something not good about his heart. the patient is with the wife at the bedside who is very tearful and emotional which is not good for the patient's situation. symptoms of his case includes those which the pt currently complained about: nausea and indigestion. this may be due to the side effects of his alcohol dependence 3 years ago (correct me, will the past 3 yrs of alcohol dependence affect him today??) paleness, diaphoresis, restlessness and anxiety are those observed and can be considered as objective data. the patient's situation implies the his inability to do the adls.

now, this case shows that the patient is experiencing severe pain to which the nurse must set focus upon.

analysis (during the assessment, what questions should the nurse ask to determine the best plan of care?)

during the analysis, here are the questions i may ask the patient to achieve the expected outcome today:

what brought you here? (to know how the pt feels about his pain/how severe it was that made him think of admitting himself to the hospital)

how do you feel about the it? (to know the pt level of agitation about the pain)

how does your pain affect your everyday tasks? can you still do the activities that you are supposed to do? (to know how the pain affects his adls and know the limit of his given responsibility as a father, if any, or a husband at home.)

how do you foresee it? any experience of depression? suicide attempts? (to know his level of restlessness and anxiety, if known, be given proper intervention of other members of the health care team)

are you taking any medications? does it help? (to know if the pt is trying to atleast solve the pain)

how is your eating habits? (to solve his complain about nausea and indigestion)

how is your family's response to your pain? (to evaluate the support/concern that the family gives to the patient to be able to maintain, if not, give proper on-time careful assistance).

how is your relationship with your family? (to know his family role and relationship affected by his pain)

evaluation (what outcomes do you expect to achieve with your patient today?)

with my patient, i expect him to relate improvement of pain and an increase in daily activities as evidenced by him and his wife, maintain family role and relationship throughout pain experience, and improve his lifestyle. to achieve patient's comfort as well.

inference (what conclusion [explanation for behavior] could the nurse make, based on the analysis)

because of extreme pain, the patient's adls, his family and role relationship is affected due to his lifestyle choice. the wife is very tearful and emotional at his bedside which adds to his suffering.

explanation (during implementation, how can the nurse justify the actions being initiated)

improvement of pain is achieved by noninvasive relief measures in order to manage the pain; by the patient's verbalized improvement of pain, by pain assessment scale or by expressed behavior.

self-regulation (what issues should the nurse reexamine to correct or improve the nursing care?)

was i biased? did i know all the facts? did i make an accurate decision? did i implement correct intervention?

this is my answer. i'm open for corrections. :) !!! and added informations! thanks!

this is what i came up.
Specializes in Complex pedi to LTC/SA & now a manager.

check the links i posted before. focus on the current symptoms. the wife is justifiably upset (imho and should be expected) the patient is likely to be very anxious secondary to pain, and shortness of breath plus fear of the unknown.

check out a nursing diagnosis/care plan book or a website such as this: nursing care plan | nursing crib . sometimes matching the symptoms up to a nursing diagnosis such as "acute pain" "impaired gas exchange", "risk for decreased cardiac output" or "ineffective tissue perfusion" nursing diagnosis for cardiovascular diseases | nursing crib

as well as review your med surg book on cardiac pathophysiology & psych for alcohol withdrawal symptoms.

this sentence makes no sense: the patient is extremely experiencing chest pain.

the patient is complaining of acute onset of severe chest pain, relieved only by rest

did you check a pulse ox or a 12-lead ecg? has oxygen been given to the patient for the restlessness, pain & dyspnea?

i think you are focusing too much on his 3yr old history of being treated for alcohol dependence and his wife's expressions of fear/anxiety and not enough on the patient 'before you" and the signs & symptoms most critical in nature. (as in what is going to kill him first....crushing chest pain with diaphoresis, dyspnea, hypertension, & nausea or a 3 year old history of treatment for alcohol dependence and possible current alcohol withdrawal. review your med surg books...does alcohol withdrawal cause chest pain when mowing the lawn relieved by rest? hint> alcohol withdrawal symptoms - symptoms associated with alcohol withdrawal and alcohol withdrawal: medlineplus medical encyclopedia what is most likely to be the cause of the chest pain (as linked in at least two other posts earlier) 911 - warnings signs of a heart attack heart attack warning signs heart attack symptoms and warning signs on medicinenet.com

heart attack: medlineplus

The bold indicates that you haven't learned about or have forgotten what you have learned about ACS. Your care plan is based on the pt diagnoses. If you don't understand ACS and ETOH w/d or can't differentiate between the two you can't create a care plan that makes sense.

You need to find out how each issue will present, how they are diagnosed and treated before you make the care plan. One stinking care plan in nursing school can result in hours of reading that you don't have the time for but that's school...no getting around it. You have to have a better understanding of ACS and ETOH w/d before you can go any further with this.

I think I must reduce first his anxiety level and his sense of restlessness and also his pain. I must look at the occurence of his nausea and indigestion. But how can I do that? How will I know? How is it related to chest pain?

Thanks for reminding! But I am just a starting freshman student and doesn't know more about that. This scenario is focused on the application of the skills of critical thinking to find interpretation, analysis, evaluation, inference, explanation, and self-regulation to resolve a situation related to patient's pain.

Your ideas, information and corrections to my previous answer is gladly appreciated. That would be of help to me!

Understandable. O.K so the focus is the pts pain. From the s/sx and health h/x the pt has give you what do you gather is the cause of the pain?

Thanks for reminding! But I am just a starting freshman student and doesn't know more about that. This scenario is focused on the application of the skills of critical thinking to find interpretation, analysis, evaluation, inference, explanation, and self-regulation to resolve a situation related to patient's pain.

Your ideas, information and corrections to my previous answer is gladly appreciated. That would be of help to me!

Specializes in Emergency, Telemetry, Transplant.

It seems wierd to me that the senario focuses on how to simply 'resolve' the pain. The pain could possible be due to an acute MI or, at the very least, angina. I suppose it could be due to something less serious like a hiatal hernia. Either way, you need to find out why he is having the pain (STEMI?) and will it kill him (like a STEMI likely will) before you write a detailed care plan on how to treat the pain. Also, yes, the wife is not helping the situation, but her behavior is of much less concern than life threatening conditions effecting her husband. Deal with her in time, but not the primary concern right now.

What's first in the nursing process? Assessment. Before you treat the pain, assess the pt and determing what is causing it. Oh, and I still think the etOH use has something to do with the clinical condition of the pt.

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