NUR4153CBE Rasmussen College Make the Best Choice for the Right Situation HW Scenario One week ago, you started your dream job as an orthopedic nurse at a

NUR4153CBE Rasmussen College Make the Best Choice for the Right Situation HW Scenario

One week ago, you started your dream job as an orthopedic nurse at a Level 1 Trauma Center in a metropolitan city of 3.7 million people. The hospital has ranked as the #5 Trauma Orthopedic Specialty Unit in the United States for eight years. At this point during orientation, you are permitted to care for one stable client per 12-hour shift. Today you start your shift with Ryan; a 25-year-old admitted through the Emergency Room after a motor vehicle accident with rollover resulting in a fractured right femur, multiple rib fractures, sternal bruises, and multiple abrasions. He is two hours post-op from an open reduction internal fixation of the right femur and appears alert and oriented. When you enter the room his first statement is, “Can someone please get me a cigarette or a patch; I have not had a smoke since yesterday morning!”

Assessment Data:

The client is sitting up in bed with thigh-high anti-embolism stockings on the left leg only.
Dressings to multiple abrasions appear dry.
Urine in Foley Bag amber colored and urinary output in the past 2 hours 40cc
Pain reported as 8 on a scale of 10 with a goal of 5

Vital signs:

BP 130/80
Heart Rate 92
O2 Sats 94% on 4L Nasal Cannula

Blood Gases:

pH 7.32
PaCO2 53 mmHg
HCO3 22mmol/L
Pao2 84mm Hg

Physician’s Orders:

Bed Rest Only
Clear Liquid Diet
Oxygen to maintain Spo2 of 92% or greater
ABGs repeated every 4 hours
Discontinue PCA and consult pain management
Administer tetanus and flu immunizations before discharge
Administer 1-2mg Morphine IV every 4-6 hours as needed for breakthrough pain

As you review the assessment data and physician orders, you plan client care and determine six nursing interventions you believe are appropriate and should be completed in this order within the next hour:

Administer 2mg Morphine IV now for breakthrough pain
Apply anti-emoblism stockings bilaterally
Call the physician to get an order for Nicotine Patch and report decreased urinary output with amber urine
Input consult for pain management into the electronic order system
Decrease O2 to 2L Nasal Cannula and continue Sp02 monitoring
Administer tetanus immunization
Instructions

As you write down the proposed interventions, the nurse manager stops by to check on your progress and asks you a few questions regarding your decisions. The nurse manager is disappointed and states, “One of these actions is not correct I want you to write down what you believe is the best choice from your list to do immediately and the action you believe is incorrect and should not be done. I will be back in 10 minutes to discuss your thoughts.”

On a document provide detailed responses to these questions:

What is the best action to perform first from the six actions identified as part of planned client care for this particular client?
What is the best action to perform second from the six actions identified as part of planned client care for this particular client?
What is the best action to perform third from the six actions identified as part of planned client care for this particular client?
What is the best action to perform fourth from the six actions identified as part of planned client care for this particular client?
What is the incorrect action?
Resources
APA Guide NUR4153 Clinical Reasoning Deliv 4 Material
Situated Cognition
Situated cognition is an evolutionary process based on how individuals
interact with knowledge and construction of meaning within a specific
context. The broad premise of situated cognition is based on four beliefs
(PSU, n.d.):
•
•
•
•
Making knowledge is a process that is bound to the context where
created;
Creating knowledge is a lifelong process permanently linked to
experiential behaviors specific to a situation;
Use of knowledge and displays of behaviors accumulate over time
based on contextual insights; and
Enculturation is possible based on insitu behaviors initiated as
action by norms.
Clinical Reasoning
Clinical reasoning involves formal and informal processes combining
cognition, metacognition, and nursing specific knowledge to cluster and
analyze cues and prioritize information necessary to formulate
appropriate actions. Applying clinical reasoning in nursing practice is
affected by personal and professional experiences and interactions of
context and culture.
Four steps comprise the process of clinical reasoning (Koharchik, Caputi,
Robb, & Culleiton, 2015):
1. Noticing is how a nurse expects a situation to occur based on
similar encounters.
2. Interpreting involves cue collection, cluster, and analysis to
determine appropriate actions.
3. Responding is intervening based on expected outcomes while
continuing to evaluate, anticipate, and modify responses.
4. Reflecting is twofold. While intervening the nurse will reflect on a
client’s response and consider new knowledge and behaviors
gained based on the situation.
Situated Learning
Nursing theorist, Dr. Patricia Benner described the relationship between
clinical reasoning and situated cognition as situated learning. “Learning
how and when as well as learning a sense of salience (salience means
that some things just stand out as urgent or more or less important) are
forms of higher order productive thinking because they require situated
thinking in context (Benner, 2018, para. 1).”
A key strategy to apply situated cognition to clinical reasoning is effective
reflection which includes self-awareness, self-assessment, emotional
intelligence and non-judgmental responses toward personal and
professional strengths and weaknesses.
The nursing literature describes three components of reflection within
situated learning, reflection-in-action, reflection-on-action, and reflectionwith-action (Graan, Williams, and Koen, 2016).
References
Benner, P. (2018), Higher-order productive thinking in clinical teaching
and learning. Retrieved from https://www.educatingnurses.com/higherorderproductivethinkinginclinicalteachingandlearning/
Koharchik, L., Caputi, L., Robb, M., & Culleiton, A. L. (2015). Fostering
Clinical Reasoning in Nursing Students. AJN American Journal of
Nursing, 115(1), 58–61. doi: /10.1097/01.NAJ.0000459638.68657.9b
PSU (n.d.), Situated learning, Retrieved from
http://www.personal.psu.edu/wxh139/Situated.htm
Van Graan, A. C., Williams, M. J. S., & Koen, M. P. (2016). Professional
nurses’ understanding of clinical judgment: A contextual inquiry. Health
SA Gesondheid, 21(1), 280–293. doi- 10.1016/j.hsag.2016.04.001

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