Keith RN and Clinical Reasoning Key Studies

Introduction

• Topic: Clinical Reasoning in Nursing Education
• Key Advocate: Patricia Benner
• Publication: Educating Nurses, 2009
• Key Concept: Emphasize clinical reasoning in nursing education

Definition of Clinical Reasoning

• Ability of the Nurse: Think in action, Reason as the Situation Changes
  • Understand significance of clinical trajectories
  • Grasp essence of current clinical situation
  • Filter clinical data (most to least important)
  • Identify actual problems
• Clinical Reasoning Goals: Make Correct Clinical Judgments
  • Determine if a problem is present
  • Identify nursing priorities

Case Studies on Clinical Reasoning

• Platform: Keith RN
• Current Topics Available: 15
• Key Objectives:
  • Situate and contextualize clinical reasoning to scenarios
  • Three Levels of Case Studies (Today's Focus: Fundamental Reasoning)

Fundamental Reasoning

• Target Group: First-year, first-semester nursing students
• Focus Areas:
  • Applied sciences (pharmacology, fluid, and electrolytes)
  • Basic clinical relationships of data
  • Nursing assessment
• Goal: Identify basic clinical relationships to put the clinical puzzle together

Case Study: Heart Failure

Patient Overview:

• Name: Carlos Botranium
• Age: 68 years old
• History: Systolic heart failure (secondary to ischemic cardiomyopathy), ejection fraction 15%
• Recent Symptoms:
  • Shortness of breath (SOB) progressing from activity to rest over 3 days
  • Increasing edema in legs
  • Gained 6 pounds in 3 days
• Vital Signs:
  • Temp: 98.6
  • Pulse: 82 (irregular)
  • RR: 26
  • BP: 162/54
  • O2 Saturation: 90% on 6L O2

Relevant Clinical Data:

• Past Medical History: Ischemic cardiomyopathy, MI, afib, hyperlipidemia, chronic renal insufficiency
• Lab Values:
  • Sodium: 133
  • Potassium 5.5
  • BUN: 34
  • Creatinine: 2.7
  • BNP: 1855
  • INR: 2.5
• Chest X-ray: Bilateral diffuse pulmonary infiltrates

Points of Focus

• Key Symptoms: SOB, progression trend, inability to sleep lying down, speech difficulty
• Vital Signs: Increased respiratory rate, elevated BP, low O2 saturation
• Physical Examination: Labored breathing, crackles in lungs, pitting edema, CO skin
• Lab Values: Elevated BNP and potassium, worsening creatinine
• Diagnosis: Exacerbation of heart failure

Clinical Priorities and Nursing Actions

• Initial Priorities:
  • Oxygenation: Increase O2 flow
  • Diuresis: Administer Lasix
  • Preload reduction: Initiate nitroglycerin drip

Pharmacology and Mechanism of Action

• Lasix: Loop diuretic, increases urine output, loss of sodium/potassium
• Nitroglycerin: Vasodilator, decreases preload and workload of heart
• Patient Meds: Carvedilol, hydralazine, torsemide, potassium chloride, warfarin

Educational Priorities for Heart Failure Patients

• Topics for Patient Education:
  • Diet
  • Daily weights
  • Medication adherence
  • Symptom monitoring
• Goal: Prevent readmissions, promote self-management

Importance of Caring in Nursing

• Questions for Students:
  • What is the patient experiencing?
  • How can you comfort the patient?
  • How to demonstrate that the patient matters?

Conclusion

• Emphasis: Clinical reasoning mirrors real-world nursing practice
• End Goal: Better student learning outcomes, improved patient care
• Resources: Free sepsis download on Keith RN's website

Useful Resources

• Website: Keith RN