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Competencies

1. Evaluate factors integral to clinical reasoning.
2. Explain the impact of relational inquiry when recognizing and analyzing cues to action in the process of clinical reasoning.
3. Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.
4. Determine appropriate responses when integrating situated cognition into clinical reasoning.
5. Modify clinical judgement within an iterative, outcome-based cycle of clinical reasoning and client needs.

Scenario

You are a student in the last term of a BSN Program. You are preparing for an end of term exam. To help you prepare, your instructor developed three real world clinical scenarios to provide opportunities for you to apply clinical reasoning and clinical judgement. The instructor stated, “You received reports on these clients. Decide which one you need to see first and then make appropriate nursing decisions based on relevant information to promote positive client outcomes.”

The three scenarios include:

Patient One:

JR is a 55- year-old male admitted 8 hours prior for 24-hour hold to evaluate for possible myocardial infarction. Serial Troponins within normal range and 12 lead ECG indicated evidence of prior right anterior wall myocardial damage. 

Patient Two:

EH is a 40-year-old female admitted within the past hour with acute onset severe right upper quadrant pain and vomiting for the past 36 hours. Waiting on labs, ECG monitoring showing occasional premature ventricular contracts (PVCs).

Patient Three:

BW is a 21-year-old male athlete admitted yesterday with fever of 103 and diagnosis of influenza. He rested well overnight. Morning chest x-ray revealed mild infiltrates in left lower lobe.