Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
Bill Hill, 71 years old
Primary Concept
Perfusion Gas
Exchange
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Patient education
• Communication
• Collaboration
NCLEX Client Need Categories Covered in Case NCSBN Clinical Covered in Case
Study Judgment Model Study
Safe and Effective Care Environment Step 1: Recognize Cues ✓
• Management of Care ✓ Step 2: Analyze Cues ✓
• Safety and Infection Control Step 3: Prioritize Hypotheses ✓
Health Promotion and Maintenance ✓ Step 4: Generate Solutions ✓
Psychosocial Integrity ✓ Step 5: Take Action ✓
Physiological Integrity Step 6: Evaluate Outcomes ✓
• Basic Care and Comfort ✓
• Pharmacological and ✓
Parenteral Therapies
• Reduction of Risk Potential ✓
• Physiological Adaptation ✓
Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
, Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
Part I: Initial Nursing Assessment Present
Problem:
Bill Hill is a 71-year old male with a past medical history of benign prostatic hyperplasia (BPH), peripheral vascular
disease and myelodysplastic syndrome MDS) two months ago after a bone marrow biopsy. Six weeks ago, Bill was
admitted because he had a syncopal episode. He was diagnosed with paroxysmal atrial fibrillation and acute anemia with a
Hgb of 6.9 and received a transfusion of one unit of PRBCs.
Bill presents to the emergency department today with increasing weakness, fatigue, sinus congestion, fever, and
chills the past week. He was around grandchildren with colds two weeks ago. Bill woke up at 6 a.m. today feeling short
of breath, and coughing harshly with clear sputum. He had difficulty walking back to bed after getting up to the
bathroom. His wife, who is a retired nurse, noted that he was much paler, took his vital signs, which were BP: 96/62,
HR: 140 irreg, RR: 24. Bill admits to losing 15 lb (6.8 kg) over the last 2-3 months.
Personal/Social History:
Mr. Hill is retired and lives at home with his wife in a rural area. His two adult children live out of state. He has been an
active, healthy male who enjoys gardening, hunting, and splits wood to heat his home in the winter. Since he has been
dealing with changes in his health he has not been able to participate in these activities as much. In the past, he has been
employed as a minister who has a strong Christian faith. He denies smoking, alcohol use, and illicit drug use.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- Peripheral vascular disease - R/F heart problems
- A-fib and acute anemia, HGB - Anemia & a-fib can cause many of these symptoms
- Weakness, fatigue, congestion, fever, chills - Could be infection
- SOB, harsh coughing, clear sputum - Respiratory issues possibly related to cardiac issues.
- BP: 96/62, HR: 140 irreg. RR:24 - BP: hypotensive. HR: TACHY. RR: tachypnea
- Weight loss 15lbs 2-3 months - Abnormal must be looked into
RELEVANT Data from Social History: Clinical Significance:
- Enjoys the outdoors such as - In now less active in these roles due to declining
hunting, gardening, and chopping health and can cause emotional response and
wood make treating difficult.
- Christian faith - This can play an effect in how the patient gets
treatment and what kind of care to give as well
as certain advanced directives.
Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
Fibrillation/Heart Failure (2/4)
Bill Hill, 71 years old
Primary Concept
Perfusion Gas
Exchange
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Patient education
• Communication
• Collaboration
NCLEX Client Need Categories Covered in Case NCSBN Clinical Covered in Case
Study Judgment Model Study
Safe and Effective Care Environment Step 1: Recognize Cues ✓
• Management of Care ✓ Step 2: Analyze Cues ✓
• Safety and Infection Control Step 3: Prioritize Hypotheses ✓
Health Promotion and Maintenance ✓ Step 4: Generate Solutions ✓
Psychosocial Integrity ✓ Step 5: Take Action ✓
Physiological Integrity Step 6: Evaluate Outcomes ✓
• Basic Care and Comfort ✓
• Pharmacological and ✓
Parenteral Therapies
• Reduction of Risk Potential ✓
• Physiological Adaptation ✓
Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
, Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
Part I: Initial Nursing Assessment Present
Problem:
Bill Hill is a 71-year old male with a past medical history of benign prostatic hyperplasia (BPH), peripheral vascular
disease and myelodysplastic syndrome MDS) two months ago after a bone marrow biopsy. Six weeks ago, Bill was
admitted because he had a syncopal episode. He was diagnosed with paroxysmal atrial fibrillation and acute anemia with a
Hgb of 6.9 and received a transfusion of one unit of PRBCs.
Bill presents to the emergency department today with increasing weakness, fatigue, sinus congestion, fever, and
chills the past week. He was around grandchildren with colds two weeks ago. Bill woke up at 6 a.m. today feeling short
of breath, and coughing harshly with clear sputum. He had difficulty walking back to bed after getting up to the
bathroom. His wife, who is a retired nurse, noted that he was much paler, took his vital signs, which were BP: 96/62,
HR: 140 irreg, RR: 24. Bill admits to losing 15 lb (6.8 kg) over the last 2-3 months.
Personal/Social History:
Mr. Hill is retired and lives at home with his wife in a rural area. His two adult children live out of state. He has been an
active, healthy male who enjoys gardening, hunting, and splits wood to heat his home in the winter. Since he has been
dealing with changes in his health he has not been able to participate in these activities as much. In the past, he has been
employed as a minister who has a strong Christian faith. He denies smoking, alcohol use, and illicit drug use.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- Peripheral vascular disease - R/F heart problems
- A-fib and acute anemia, HGB - Anemia & a-fib can cause many of these symptoms
- Weakness, fatigue, congestion, fever, chills - Could be infection
- SOB, harsh coughing, clear sputum - Respiratory issues possibly related to cardiac issues.
- BP: 96/62, HR: 140 irreg. RR:24 - BP: hypotensive. HR: TACHY. RR: tachypnea
- Weight loss 15lbs 2-3 months - Abnormal must be looked into
RELEVANT Data from Social History: Clinical Significance:
- Enjoys the outdoors such as - In now less active in these roles due to declining
hunting, gardening, and chopping health and can cause emotional response and
wood make treating difficult.
- Christian faith - This can play an effect in how the patient gets
treatment and what kind of care to give as well
as certain advanced directives.
Case study NextGen UNFOLDING Reasoning Atrial
Fibrillation/Heart Failure (2/4)
