Preparing for Clinical Practice

Critical Thinking in Nursing Practice

Medical treatment stabilized Mr. Lawson’s condition. He had a pulmonary embolus, but he is now on anticoagulants, medications that will reduce likelihood of more clot formation. Knowing that Mr. Lawson is on anticoagulants and has had recent surgery and the processes of normal wound healing (see  Chapter 48 (Links to an external site.)Links to an external site. ), Tonya believes that the patient is at risk for bleeding from his surgical wound. She acts by increasing assessments of the wound and teaching Mr. Lawson how to avoid placing stress on the wound

1. Describe the critical thinking skill that Tonya is demonstrating.After Tonya assesses the wound, she enters a note in the medical record. She describes the appearance of the incision in detail, reports on the length of the incision, and notes that one suture is loose but there is no drainage.

2. Identify the three intellectual standards that Tonya uses in making a note in the record.

3. Mr. Lawson complains of more discomfort after lying on his right side for 30 minutes. Tonya asks him to describe the pain; it is focused more on his right shoulder and ribs. Tonya sees that the drainage tubing exiting the surgical wound is caught underneath the patient. She moves it, questions the patient further to find out that he has a history of arthritis in the shoulder, and then repositions and aligns him. This is an example of which critical thinking competencies?

Nursing Assessment

Tonya is planning to return to Mr. Lawson’s room and spend more time discussing his concerns about going home and what to expect. She knows that Mrs. Lawson usually comes to visit around 11 AM, just before lunchtime. Tonya believes that Mrs. Lawson will be an important source of support in providing Mr. Lawson’s ongoing home care. The surgeon has ordered directions for wound care and standard activity restrictions.

1. Tonya goes to Mr. Lawson’s room and asks the patient, “What concerns do you and your wife have about cleaning the wound?” Which type of assessment question is this and why has Tonya asked it?

2. Tonya and Mr. Lawson have the following interaction:

Tonya: Mr. Lawson, What do you understand about the reason for the activity restrictions your doctor ordered?

Mr. Lawson: I think it will prevent me from not hurting myself.Tonya: Uh huh … go on

Mr. Lawson: I think the doctor said I could pull my stitches.

Tonya’s phrase “uh huh … go on” is an example of which interviewing technique? Explain why it is useful.

3. Tonya returns to Mr. Lawson’s room to discuss his discharge instructions, but she notes as she enters the room that the patient is grimacing. She asks him, “Tell me where the pain is.” Mr. Lawson is asked to rate the pain on a scale of 0 to 10 and rates it a 6. Tonya looks at the patient’s surgical wound and notes that the area of separation is still inflamed. Match the assessment technique on the left with the type of measurement on the right.

Managing Patient Care

You are a staff nurse on a 32-bed cardiac step-down unit. You are assigned as the preceptor for Tony, RN, a new graduate nurse, who just started his nursing career on your floor.

1. You and Tony just received morning shift report on your patients. You are assigned the following patients. Which patient do you and Tony need to see first? Explain your answer.

1. Mr. Dodson, a 52-year-old patient who was admitted yesterday with a diagnosis of angina pectoris. He is scheduled for a cardiac stress test at 0900.

2. Mrs. Wallace, a 60-year-old patient who was transferred out of intensive care at 0630 today. She had uncomplicated coronary artery bypass surgery yesterday.

3. Mr. Workman, a 45-year-old patient who experienced a myocardial infarction 2 days ago. He is complaining of chest pain rated as 6 on a scale of 0 to 10.

4. Mrs. Harris, a 76-year-old patient who had a permanent pacemaker inserted yesterday. She is complaining of incision pain rated as a 5 on a scale of 0 to 10.

2. As you work with Tony on your unit, you notice that he has trouble with time-management skills when providing patient care. Which strategies will you suggest to Tony to help him improve organization of his delivery of patient care?

3. Sonya, a nursing assistive personnel (NAP), is paired to work with you and Tony. You overhear Tony giving Sonya directions for what she needs to do. Tony says, “Sonya, assist Mrs. Harris in room 418 with her afternoon walk. Take her pulse before and after she walks and record it in her chart. I’ll check with you when you’re finished to see how she did.” On the basis of what you know about delegation, did Tony give appropriate or inappropriate directions to Sonya? Provide rationale for your answer.