Part I: Emergency Department (ED) SKINNY Reasoning

Part I: Emergency Department (ED) SKINNY Reasoning John Taylor, 68 years old Primary Concept Infection/Immunity Interrelated Concepts (In order of emphasis) • Clinical judgment NCLEX Client Need Categories Covered in Case Study NCSBN Clinical Judgment Model Covered in Case 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  Initial Triage Assessment in ED Present Problem: John Taylor is a 68-year-old African-American male with a history of type II diabetes and hypertension who came to the emergency department (ED) triage window because he felt crummy; complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past two days. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom. John is visibly anxious and asks, “Do I have that killer virus that I hear about on the news?” Personal/Social History: John lives in a large metropolitan area that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years and is retired police officer and active in his local church. 1. What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: Diabetes, Hypertension, headache, runny nose , feeling more weak,achy all over, Cluster symptom of COVID 19 Nagging cough patient was anxious difficulty breathing, -increased risk for complication due to Diabetes II and hypertension -could be COVID 19 -deal with therapeutically and don't give false assurances - RELEVANT Data from Social History: Clinical Significance: lives in Large metropolitan area, over 3000 active cases , wife active in his local church -wife puts her in danger of Covid infection. - lives in crowed place -test for COVID stat 2. What additional clarifying questions does the triage nurse need to ask John to determine if his cluster of physical symptoms are consistent with COVID-19? 3. Based on the clinical data collected, identify what measures need to be immediately implemented using the following clinical pathway.