Question

Module 05 Discussion - Critical Thinking and Clinical Judgment Scenario

You have been assigned 4 patients on an Intermediate Medical Care Unit. Two of the patients are post myocardial infarctions at various stages of their infarctions with multiple types of arrhythmias, the third patient is having drastic blood sugar fluctuations 218 down to 50 within minutes and its rebounds back up with changes in mentation and the fourth is reported to be having frequent TIA's. One of the MI patients is having some dizziness and your TIA patient is presenting signs of impending stroke.

1. How would you prioritize your assessments and activities?

2. How would you describe your critical thinking process?

3. How do you organize and prioritize implementation of care?

Answer 1

My first thought to this scenario is that it is not a realistic assignment for one nurse to handle. I would prioritize my assessments and activities by first applying the ABC’s (airway, breathing and circulation). Under these circumstances all of the patients have patent airways and are breathing. Therefore, I would first address the TIA patient with signs of impending stroke because of the risk of occluded circulation. My assessment would consist of a full set of vital signs, facial drooping, slurring of speech or uneven muscle strength in bilateral extremities.

Second, I would address the patient post myocardial infarction with dizziness. Dizziness could be a symptom of several issues such as medications or another MI. Therefore, I would do further assessment such as ECG and updated labs. Third, I would address the patient with the blood sugar fluctuations with mental changes, fluctuations in the blood sugars can cause cardiac issues so this patient's medications need to be addressed and monitored to get them stable. Finally, the last patient to be seen is the patient post myocardial infarction because this patient appears to be the most stable at this time.

As stated above this is definitely not a scenario that one nurse would be managing on their own. In addition, I believe this is more of a ICU type of patient scenario. These patients on this unit need critical care and multiple nursing staff to manage all of these conditions and potential complications.

Refeences:

Alegre F., Landecho M. F., Huerta A., et al. Design and performance of a new severity score for intermediate care. PLoS ONE. 2015;10(6). doi: 10.1371/journal.pone.0130989.e0130989

Harding A. D. What can an intermediate care unit do for you? The Journal of Nursing Administration. 2009;39(1):4–7. doi: 10.1097/NNA.0b013e31818fe3f4.

Vincent J., Rubenfeld G. D. Does intermediate care improve patient outcomes or reduce costs? Critical Care. 2015;19(1):p. 89. doi: 10.1186/s13054-015-0813-0.