Critical Thinking and Clinical Judgment

 

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.
How would you prioritize your assessments and activities? How would you describe your critical thinking process and how do you organize and prioritize implementation of care?

Sample Solution

  1. Assess the patient with the most unstable vital signs. This would be the patient with the MI who is having dizziness. This patient is at risk for further cardiac instability and stroke, so it is important to assess them first and intervene as needed.
  2. Assess the patient with the blood sugar fluctuations. This patient is at risk for hypoglycemia and hyperglycemia, both of which can be serious complications. It is important to assess their blood sugar levels frequently and to intervene as needed to keep their blood sugar levels in a safe range.
  3. Assess the patient with the TIA. This patient is at risk for stroke, so it is important to assess them for any changes in their neurological status. If they are experiencing any changes, it is important to report these changes to the doctor immediately.
  4. Assess the other MI patient. This patient is also at risk for further cardiac instability, so it is important to assess them as well. However, since the other patient is experiencing dizziness and the TIA patient is presenting signs of impending stroke, these patients take priority.

Once I have assessed all of the patients, I would prioritize my activities based on the following criteria:

  • Urgency: The most urgent activities are those that are necessary to stabilize the patient’s condition.
  • Severity: The more severe the patient’s condition, the more urgent the activities are.
  • Timeliness: Some activities need to be done immediately, while others can be done later.
  • Complexity: Some activities are more complex than others, and they will take more time to complete.

Once I have prioritized my activities, I would organize them in a way that makes sense. I would create a list of the activities, and I would order them based on the criteria above. I would also make sure to include a timeline for each activity, so that I know when I need to complete it.

I would also communicate with the doctor and other healthcare providers about my assessment and plan of care. This would help to ensure that everyone is on the same page and that the patient is receiving the best possible care.

Here is how I would describe my critical thinking process:

  • I would first gather all of the relevant information, including the patient’s history, their current condition, and their vital signs.
  • I would then analyze the information and identify the most important problems.
  • I would develop a plan of care that addresses the most important problems.
  • I would implement the plan of care and monitor the patient’s response.
  • I would be prepared to adjust the plan of care as needed.

I would organize and prioritize implementation of care by:

  • Creating a list of tasks to be completed.
  • Estimating the time required to complete each task.
  • Assigning tasks to myself and other healthcare providers.
  • Establishing a timeline for completion of each task.
  • Communicating with the doctor and other healthcare providers about the plan of care.

I would also be flexible and willing to adjust the plan of care as needed. This is important because patients’ conditions can change rapidly, and it is important to be able to respond to these changes.

I believe that this approach to prioritizing assessments and activities would ensure that the patients receive the best possible care. It would also allow me to use my critical thinking skills to identify the most important problems and develop a plan of care that addresses those problems.

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