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Remember to engage in your weekly discussions as they count towards the engagement component of your grade. Make sure to include 1-2 references with your answer to the clinical case below.
Clinical Judgment Challenge 63-1
Patient-Centered Care
The nurse is performing an assessment in the outpatient clinic on a 47 year old male client who was diagnosed with Stage 4, chronic kidney disease (CKD) 4 months ago. The client had an arteriovenous fistula implanted 2 months ago. He has been undergoing hemodialysis for the last 6 weeks. However, he reports missing the last two dialysis appointments because he was “just too tired to go”. The client reports that he cannot afford his medications and following his new diet is too hard and costly. Current assessment: Temperature 102.2 F; BP 188/90; respirations 28, heart rate 89 bpm. His oxygen saturation is 88% on room air, and crackles are noted in bibasilar lung fields. He reports feeling very anxious and states, “It’s all my fault that this is happening.” Current labs include: Potassium 5.4 mEq/L; Sodium 142 mEq/L; Magnesium 2.1 mEq/L; WBC 22,000 mm3
What assessment information in this client situation is the most important and immediate concern for the nurse? (Hint: Identify the relevant information first to determine what is most important.)
What client conditions are consistent with the most relevant information? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)
Which possibilities or explanations are most likely to be present in this client situation? Which possibilities or explanations are the most serious? (Hint: Consider all possibilities and determine their urgency and risk for this client.)
What actions would most likely achieve the desired outcomes for this client? Which actions should be avoided or are potentially harmful? (Hint: Determine the desired outcomes first to decide which interventions are appropriate and those that should be avoided.)
Which actions are the most appropriate and how should they be implemented? In what priority order should they be implemented? (Hint: Consider health teaching, documentation, requested health care provider orders or prescriptions, nursing skills, collaboration with or referral to health team members, etc.)
SCIENCE
HEALTH SCIENCE
NURSING
MED SURG NUR1211
