NovEx Case ClickStream Clinical Decision Rationale Reflective Tool
Student Name:
Date: October 6,2024
Patient Case: Ms.Barlow
Use this worksheet to help track your thinking process as you work through your case. Use shorthand, bullet
points, paraphrase. Use a different color for each of your 3 attempts.
You should be entering and exiting the patient’s room at minimum 3x. Follow the expectation guidelines.
This is to be submitted before your scheduled debriefing.
Click stream of interventions performed during care and rationale for evidence based clinical decision made.
Signs & symptoms identified from report: Significance or relevance of s/s identified:
71 year-old lady who was complaining of The signs of tachypnea is understandable as because the
“shortness of breath which started yesterday” brain is typing to compensate for the amount of oxygen
Short of breath at rest with minimal excretion that can enter the lungs while there is an embolism. The
Bed bound because of back pain for weeks. absence of chest pain will allow us to rule out the factor of
Epidural injection yesterday and made her feel heart attack will indicate that the problem is within that
better began ambulation around house location however not with the heart. The shortness of
yesterday. No chest pain “I have had a rough breath while laying down can tell us that she is
time for the last several weeks. Just as I was experiencing issues with her lungs rather than heart. The
getting better I start getting short of breath” She mild pitting edema will also indicate that the patient is
is Aox3 mild tachypneic, visible short of breath. suffering from signs of DVT being due to bed bound
Mild pitting edema right ankle however if a DVT is forming we must also count the
Grandson said she cant go home feeling like this possibility for PE. Tachycardia is caused because the
PTT 45 patient is in distress and worried about what will happen
her heart rate is compensating for the stress she’s feeling .
The higher that the PTT appears on he lab tests will
mean how long it is taking the body to clot showing how
the anticoagulant medication is doing or how it is needed.
Chart Review, Hx, Diagnostic tests and/or lab Rationale of correlation and significance of these
results related to patient’s condition, Medications elements
HR: 124 T:98.6 BP:122/66 MAP:86 The patient being SOB even at rest is a huge indicator
02: 91 RR:24 71FWhite 105kg.162 cm Full code that we are battling a sort of pulmonary embolism or
CT scan: extensive bilateral pulmonary emboli. pulmonary issue that isn’t allowing us to fill our lungs
Chest Xray: shows no infiltrates. Troponin less fully and properly. Because she is nervous about moving
than 0.4, BNP: 36 Chloride 111(high) Glucose around and has pain, we would also want to ensure to
126(high) Home medications Zantac 150 mg po care for future DVT’s, VTE, or pressure ulcers that may
BID Mobic 7.5 po BID Neurontin 300 mg in develop. Keeping her immobile for long will expose her
morning, 600 in evening. Hospital Zantac 150 mg to a chance of venous stasis. Because the patient was
po BID Normal Saline 25 ml per hr., Neurontin immobile for so long and then wanted to become mobile
300 mg in morning and 600 mg in evening. causing her relapse into her original situation, we are
Family hx: mother died of coronary artery able to see that the problem goes down deeper and her
, disease at age 71. Father died at age 86. There’s epidural injection to not affect it will indicate PE and what
no history of DVT or PE in family. No smoking her SOB is present but also why her HR is also in play.
lives with grandson who helps care for her. Her chloride being present in the higher range mean she
Chronic back pain and a history of diskectomy at is dehydrated because she gets SOB every time she
L3 , L4, L5 . She has been bed bound because of has to move around. Let’s ensure that there is proper
her back pain for the last several weeks. She has care going on at home of patient. The PTT being at that
been more mobile the last several days after an level is expected because of the anticoagulant
epidural injection and has been getting up to go medication we administered. Her glucose being high as
to the bathroom and into the kitchen. She had a well could just be a simple stress response ensure to
cholecystectomy 10 years ago. She also suffers check it again post admission to see if the patient is
from gastroesophageal reflux disease New after diabetic. The patient is obviously suffering from a lack of
oxygen 95 RR:18 MAP:84 BP: 112/70 PTT:45 oxygenation that is why it’s important that we place her
on 2L of oxygen. However, we are able to see that the
rest of the organs of the patient are fine by her vitals.
When we apply the oxygen and her O2 increases we are
able to see the way that it is beneficial, and her
respiration rate slows down because she feels as her
lungs fill up more. The heart rate improving post use of
anticlot medication allows me to see that it is helping
loosen the PE and where it is occurring. The Ct as well
really allowed us to confirm how we should act moving
forward. The patient is also on Mobic for her hx of pain
so let’s educate her on abuse of pain medication but
also proper administration and usage. Zantac is used for
GERD that she experiencing from acid reflux.
Highest priority / Urgent possible interventions Rationale: (ABCs, Maslow’s, logical prioritization, etc…)
identified:
1. Oxygen Administration 1. Our biggest priority is always the ABC’s and how
2. Vital sign monitoring the patient is breathing, can we improve it and
3. Anticoagulating therapy the flow of oxygen in the body. We had to ensure
to check hers specifically because her O2 stats
where on the lower side of 91%. We must ensure
that every patient is having proper oxygenation to
prevent the chance of death or death to organs.
However over oxygenation could also cause
hypoxia.
2. Monitoring her oxygen as well as her other vital
signs will allows us to see how she is feeling and
how her body is reacting to the situation.
Sometimes we are able to catch certain things
through her vitals before she feels the symptoms.
3. The use of anticoagulation is very important
because it will allow the patient to stop the
formation of clots and preventing that clot from
growing causing the pulmonary embolism from
getting worse.
Student Name:
Date: October 6,2024
Patient Case: Ms.Barlow
Use this worksheet to help track your thinking process as you work through your case. Use shorthand, bullet
points, paraphrase. Use a different color for each of your 3 attempts.
You should be entering and exiting the patient’s room at minimum 3x. Follow the expectation guidelines.
This is to be submitted before your scheduled debriefing.
Click stream of interventions performed during care and rationale for evidence based clinical decision made.
Signs & symptoms identified from report: Significance or relevance of s/s identified:
71 year-old lady who was complaining of The signs of tachypnea is understandable as because the
“shortness of breath which started yesterday” brain is typing to compensate for the amount of oxygen
Short of breath at rest with minimal excretion that can enter the lungs while there is an embolism. The
Bed bound because of back pain for weeks. absence of chest pain will allow us to rule out the factor of
Epidural injection yesterday and made her feel heart attack will indicate that the problem is within that
better began ambulation around house location however not with the heart. The shortness of
yesterday. No chest pain “I have had a rough breath while laying down can tell us that she is
time for the last several weeks. Just as I was experiencing issues with her lungs rather than heart. The
getting better I start getting short of breath” She mild pitting edema will also indicate that the patient is
is Aox3 mild tachypneic, visible short of breath. suffering from signs of DVT being due to bed bound
Mild pitting edema right ankle however if a DVT is forming we must also count the
Grandson said she cant go home feeling like this possibility for PE. Tachycardia is caused because the
PTT 45 patient is in distress and worried about what will happen
her heart rate is compensating for the stress she’s feeling .
The higher that the PTT appears on he lab tests will
mean how long it is taking the body to clot showing how
the anticoagulant medication is doing or how it is needed.
Chart Review, Hx, Diagnostic tests and/or lab Rationale of correlation and significance of these
results related to patient’s condition, Medications elements
HR: 124 T:98.6 BP:122/66 MAP:86 The patient being SOB even at rest is a huge indicator
02: 91 RR:24 71FWhite 105kg.162 cm Full code that we are battling a sort of pulmonary embolism or
CT scan: extensive bilateral pulmonary emboli. pulmonary issue that isn’t allowing us to fill our lungs
Chest Xray: shows no infiltrates. Troponin less fully and properly. Because she is nervous about moving
than 0.4, BNP: 36 Chloride 111(high) Glucose around and has pain, we would also want to ensure to
126(high) Home medications Zantac 150 mg po care for future DVT’s, VTE, or pressure ulcers that may
BID Mobic 7.5 po BID Neurontin 300 mg in develop. Keeping her immobile for long will expose her
morning, 600 in evening. Hospital Zantac 150 mg to a chance of venous stasis. Because the patient was
po BID Normal Saline 25 ml per hr., Neurontin immobile for so long and then wanted to become mobile
300 mg in morning and 600 mg in evening. causing her relapse into her original situation, we are
Family hx: mother died of coronary artery able to see that the problem goes down deeper and her
, disease at age 71. Father died at age 86. There’s epidural injection to not affect it will indicate PE and what
no history of DVT or PE in family. No smoking her SOB is present but also why her HR is also in play.
lives with grandson who helps care for her. Her chloride being present in the higher range mean she
Chronic back pain and a history of diskectomy at is dehydrated because she gets SOB every time she
L3 , L4, L5 . She has been bed bound because of has to move around. Let’s ensure that there is proper
her back pain for the last several weeks. She has care going on at home of patient. The PTT being at that
been more mobile the last several days after an level is expected because of the anticoagulant
epidural injection and has been getting up to go medication we administered. Her glucose being high as
to the bathroom and into the kitchen. She had a well could just be a simple stress response ensure to
cholecystectomy 10 years ago. She also suffers check it again post admission to see if the patient is
from gastroesophageal reflux disease New after diabetic. The patient is obviously suffering from a lack of
oxygen 95 RR:18 MAP:84 BP: 112/70 PTT:45 oxygenation that is why it’s important that we place her
on 2L of oxygen. However, we are able to see that the
rest of the organs of the patient are fine by her vitals.
When we apply the oxygen and her O2 increases we are
able to see the way that it is beneficial, and her
respiration rate slows down because she feels as her
lungs fill up more. The heart rate improving post use of
anticlot medication allows me to see that it is helping
loosen the PE and where it is occurring. The Ct as well
really allowed us to confirm how we should act moving
forward. The patient is also on Mobic for her hx of pain
so let’s educate her on abuse of pain medication but
also proper administration and usage. Zantac is used for
GERD that she experiencing from acid reflux.
Highest priority / Urgent possible interventions Rationale: (ABCs, Maslow’s, logical prioritization, etc…)
identified:
1. Oxygen Administration 1. Our biggest priority is always the ABC’s and how
2. Vital sign monitoring the patient is breathing, can we improve it and
3. Anticoagulating therapy the flow of oxygen in the body. We had to ensure
to check hers specifically because her O2 stats
where on the lower side of 91%. We must ensure
that every patient is having proper oxygenation to
prevent the chance of death or death to organs.
However over oxygenation could also cause
hypoxia.
2. Monitoring her oxygen as well as her other vital
signs will allows us to see how she is feeling and
how her body is reacting to the situation.
Sometimes we are able to catch certain things
through her vitals before she feels the symptoms.
3. The use of anticoagulation is very important
because it will allow the patient to stop the
formation of clots and preventing that clot from
growing causing the pulmonary embolism from
getting worse.
