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NRS163 Clinical Reasoning 1
Assessment 2 – 202360
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Thomas Green
NRS163 Assessment 2 // Case Study – Thomas Green
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| Disclaimer (please read before reviewing the case study): The following case study has been developed to support the completion of Assessment 2: Clinical Reasoning Cycle, for NRS163 in the 202360 session. In this scenario, a patient attends a medical centre. The scenario focuses on fundamental nursing care including the importance of therapeutic communication, basic assessment skills and the use of clinical reasoning to guide nursing decisions and actions. This scenario may include elements that you may find confronting. You may have been involved in similar events in your personal, professional or study experiences. If you are distressed by the scenario, please contact the Subject Convenor to discuss and consider contacting the CSU Student Counselling service (free and confidential) – https://student.csu.edu.au/services-support/health wellbeing/counselling. |
Edited by Jennifer Manning 202360.
Reviewed by: QA for SNPHS 18/8/2023 (SL)
© Charles Sturt University
NRS163 Assessment // Case Scenario (Thomas Green)
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Scenario: Thomas Green
| Background Thomas Green is an 18-year-old Year 12 student at High School. He lives with his mother, stepfather, and younger sister on a farm, not far from town. His stepfather has brought him to the Medical Centre as there is no hospital in the town. 18/09/2023 – 0830 Thomas walks into the medical centre with his father. He is seen by the medical centre clerk who identifies that Thomas has been a patient of Dr Stephens at the centre. The clerk notices that he does not look well and calls the registered nurse managing the clinic. Thomas and his stepfather are directed by the clerk to take a seat in the waiting area until they are called by the Registered Nurse. After a few minutes of waiting, Alex (a Registered Nurse who manages the medical centre clinic) asks Thomas to come through to a bed in the clinic to be assessed. Alex asks Thomas’s stepfather to wait in the waiting area and says someone will come and get him soon. In the clinic, Thomas is greeted by Sharon who introduces herself as a Student Nurse who is currently at the medical centre for her first-year work placement. Sharon notices that Thomas is stooped over favouring his right side and is pale and not making eye contact. At that moment Alex is called away by a Doctor and Alex asks Sharon to: • Get all the documentation for Thomas from the clerk and check his personal details; • have Thomas change into a hospital gown and help him to get comfortable on the bed with a warm blanket; • complete a full set of observations (Temp, Pulse, Resp Rate, O2 Sats, BP) and update his health history; • find out what time he last ate and drank, what he ate and drank and if he has vomited; • document all the findings on the SAGO chart, update the Health History form, and any other information on the whiteboard in the clinic; • and ask Thomas’s stepfather to join him. Alex also reminds Sharon to provide plenty of reassurance to Thomas as he looks like he is in pain and very tense. |
NRS163 Assessment 2 // Case Study – Thomas Green
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| 18/09/2023 – 0845 Sharon asks Thomas to change into the gown that is on the bed whilst gathering the blanket and equipment. She notices he is bent over more than before and now holding his right side. Sharon asks Thomas why he has come to the clinic whilst helping him onto the bed and covering him with the blanket to make him comfortable. Thomas does not look at Sharon and states that he has had pain for over a day, over the centre of his abdomen pointing to his umbilicus. He describes the pain as sometimes sharp, but otherwise a dull ache and that he has been vomiting all night. He also states that when he woke up early this morning, he had pain in his right shoulder that is still there. Sharon explains that she needs to do the assessment and what is involved, and Thomas gives his permission. Before the observations are taken, Sharon asks Thomas if there is anything she can do to make him more comfortable because she notices that he is pale and clammy to touch and has a foul-smelling breath. Thomas says no that he is “OK”. 18/09/2023– 0850 Sharon brings a trolley with the equipment closer to Thomas and stands at a 45-degree angle from him as she notices that he is not giving her any direct eye contact. Sharon looks at the forms the clerk gave her and checks with Thomas his date of birth, full name, and address. A full set of vital observations are completed, they are: • Temp 38°C (per axilla). • Pulse (HR) 90 bpm. • RR 25 bpm and panting. • SpO2 95% (RA). • BP 100/65 mmHg. Sharon documents these findings on the SAGO chart (see separate document) and then asks Thomas if she could ask him some questions to update his health history form (see separate form). Thomas agrees and Sharon asks the questions from the form. Sharon works through the form and fills in the pertinent parts for the current presentation. SHARON: Can you please tell me when and what you last ate and drank? THOMAS: Umm, I did not have anything to eat yesterday. The day before I only had black tea and toast. I only had small sips of water yesterday. SHARON: Have you been vomiting, when was the last episode? |
NRS163 Assessment // Case Scenario (Thomas Green)
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| THOMAS: Yes, I have been all night and vomited this morning just before coming into town. THOMAS: I am feeling like I am going to vomit again, and the pain is getting worse. SHARON: I will get you a vomit bag. (Sharon gave him the bag). I noticed that you are sweaty, and your temperature was up when I took it. May I take your temperature, pulse, and blood pressure again? THOMAS: Oh, yes, you can take it again, I am feeling too warm now, I need to take the blanket off. SHARON: That sounds like a good idea. (Sharon removes that blanket and puts a sheet over Thomas). Another set of vitals is taken at 0930, they are • BP 95/60 mmHg; • HR 100 bpm; • RR 30 bpm, panting and foul-smelling breath still; • Temp 38.5°C (per axilla); • SpO2 94% (RA); SHARON: Your observations are different to when I took them before. I will notify Alex and get your stepdad to come in and sit with you. I will also ask Alex if Dr Stephens to see you and give you something for the vomiting and pain. THOMAS: thank you. End of scenario
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