Please help with critical thinking questions

[sishu]

i am sooo confused with this critical thinking question. our instructor gave us a study guide for the exam. when i read the case study there isn't subjective information (such as patient's pain). i think form the story she is depressed because of her dog died. what exam should i perform? i just think eye exam since she has tear in the corner of her eyes. i really don't know the tear is from eye problem or is she mad? for the 11 gordon's i just pick three of this but i am not sure it is the right one. please help me ..here is the question

betty has been having trouble in school for the past three months. she has been a bright fifth grader who is known for her above average work. her teacher tells you that betty cries easily and becomes frustrated with reading. her friends seem to be pulling away from her. she is in a large class of 35 students and the teacher has had difficulty working individually with betty

you introduce yourself to betty while she is at recess. she is of average height and weight and her blood pressure, pulse and respirations are normal. she is sitting alone and seems to enjoy talking with you. while you are conversing, several of her friends wave at her and she makes no response. when you ask about her family and her friends she tells you that her dog died about a month ago. you notice a tear forms in the corner of her eye when she tells you about her dog. her friends approach and begin to talk with betty. she squints and then begins to converse with them.

a. what history questions would you ask betty? (subjective information) i don't know where to start the questions . do i just ask like how old was your dog? just to start the conversation ...

b. what exams would you perform? be specific. (objective information)

the only objective information i can think of is the vital singns

c. which of the two or three of the 11 gordon's functional health patterns do you think might be most likely in your nursing diagnoses? give rationale for selecting each of the 2-3 functional health patterns you selected.

1) self perception pattern:-

2) roles relationships pattern :- like satisfactions with her friend

3) coping/ stress tolerance:- she is in a lot's of stress

[Destination1]

Well let me tell you straight away that I just started my first semester of nursing school so my opinion might not hold to much weight. The thing about the story I noticed and would investigate..... Can see see? From the story it sounds like vision problems. Above average student suddenly under performing...gets frustrated while reading....Not waving back at her friends (did she even see them wave?) .....tear in the corner of her eye.....she squints when talking to her friends.

She may be upset about the dog but 3 months is a long time to still be that upset. Not being able to see would be extremely stressful.

I know this didn't exactly answer the question but I hope it helped. Good luck.

[llg, PhD, RN]

I agree with Destination1. Betty can't see. There is lots of objective data to support that suspicion.

Yes, she may be taking the death of her dog particularly hard. He may have become her "best friend" as she gradually withdrew from a world that she had increasing difficulty relating to other people.

[Daytonite, BSN, RN]

my first question to you is what has this class been about? assessment? med/surg? psych? pediatrics?

when you are presented with a case study, the first thing you need to do is reduce it to a list of all the data. several things stuck out very noticeably to me.

• having trouble in school for the past three months
  
• fifth grader
  
• betty cries easily and becomes frustrated with reading
  
• friends seem to be pulling away from her
  
• teacher has had difficulty working individually with betty - why?
  
• several of her friends wave at her and she makes no response
  
• she tells you that her dog died about a month ago
  
• a tear forms in the corner of her eye when she tells you about her dog
  
• she squints
  

a. what history questions would you ask betty? (subjective information)

i want to know more about these reading problems she is having and if they are in some way related to her trouble in school for the last three months (her dog only died a month ago). why was she squinting when her friends called out to her? is she having difficulty seeing them? is she having difficulty seeing the blackboard when she is in class? is she having trouble seeing clearly? do her eyes tear up easily or for no reason? i'd also ask her about her friendships and her dog.

b. what exams would you perform? be specific. (objective information)

a visual acuity and eye exam. check ears.

c. which of the two or three of the 11 gordon's functional health patterns do you think might be most likely in your nursing diagnoses? give rationale for selecting each of the 2-3 functional health patterns you selected.

cognitive - perceptual pattern

self-perception pattern

coping - stress tolerance pattern

if you were the school nurse, this child's teacher sent her to the school nurse for a reason. the scenario is giving conflicting information deliberately, but if you read it carefully i think there is enough information there that indicate that this child may have a vision problem. either she doesn't want to say anything about it or just doesn't know how to say it (children sometimes don't know that something is wrong).

[Destination1]

I miss read that. her dog died about 1 month ago. The trouble at school started 3 months ago. 2 months before the dog died. Big clue.

[sishu]

hello all,

it’s for my fundamental class. sorry i forget to mention it

i really appreciate your help…..thank's alot ...

[Daytonite, BSN, RN]

this was only a practice question. you need to be prepared for your test. if you get something similar on a test, what will you do? how will you proceed?

follow the steps of the nursing process:

1. assessment
   
2. nursing diagnosis
   
3. planning
   
4. implementation
   
5. evaluation
   

gordon's functional needs is how you assess a person's health history. in the scenario you were given you needed to start by listing out the data. it didn't specifically ask, but could you sort the data into gordon's patterns if you had been asked to do that? do you know what is assessed in all 11 patterns? what if you are asked about physical assessment?

the next step of the process is to determine the problem. you need to separate out the abnormal data first. they are evidence of the problem(s). in nursing we label them as nursing diagnoses. does any of this sound familiar? you may be asked to demonstrate it on a test.