NSG1NMA Template – Clinical Reasoning Written Task
Consider the patient situation: (100 words)
Using the handover provided, identify your initial impression of the patient and any important features of the
situation you identify as clinically significant.
The patient brought to the hospital is Tej Perara. Tej produces sputum frequently, and the skin around his
wrinkles appears blue on first impression when brought to the hospital. The patient frequently coughs,
which is accompanied by mucus production. After reviewing the medical records, I discovered that Tej
had been previously diagnosed of chronic obstructive pulmonary disease (COPD), a condition that makes
breathing hard for people. Wheezing sounds are produced when the patient breathes. The patient has lost
weight, indicating that the disease has interfered with his daily routine. The patient shows difficulties
moving around the facility, indicating he has low energy.
Collect Cues and Information: (200 words)
1) Identify the priority-focused assessment you would complete for your patient.
2) Discuss your rationale for performing this focused assessment concerning the case study, with evidence to
support your choices/rationale.
3) Identify 3 subjective and 3 objective elements of the priority-focused assessment you would perform.
1) My priority assessment will be a physical inspection of the patient, which will be focused on checking
sputum color, shortness of breath, and skin color.
2) Shortness of breath, sputum production, and skin color changes are primary symptoms associated with
COPD (Anzueto & Miravitles, 2018). Shortness of breath is caused by obstructed and restricted
ventilation. Sputum production is caused by the overproduction of mucus that blocks the bronchial cavity.
Tej had been experiencing difficulties in breathing when he was brought to the hospital, which shows that
his airways might be blocked. Bluish discoloration of fingernails shows diminished perfusion and
oxygenation of the blood vessels in the upper limbs (Anzueto & Miravitles, 2018). It might also indicate
reduced red blood cells in the affected tissues. Assessment of health-related quality of life, such as
shortness of breath, shows the disease burden in the patient (Masror-Woodsary et al., 2021). A focused
assessment is needed to establish the extent to which COPD has affected the patient before recommending
1
, NSG1NMA Template – Clinical Reasoning Written Task
medication.
3a) Subjective assessment the nurse can perform on the patient include:
1. Have you been exposed to smoke or dust before the visit?
2. How often do you cough, and is your cough accompanied by sputum production?
3b) How often do you experience shortness of breath? Which time of the day are the symptoms worse?
Three objective assessments to be performed on the patient include:
1. Inspection
2. Palpitation
3. Auscultation.
Process Information: (600 - 650 words)
Consider the 3 objective elements of the focused assessment you have chosen to perform above. Discuss the
rationale for each assessment, the significance of each assessment, and any expected findings that might
result from when/in assessing concerning the case study.
Physical inspection.
The nurse should inspect the patient's breathing patterns, sputum production, and skin color are symptoms
related to respiratory diseases. The nurse should check the patient's gait to ascertain if there are any
disturbances. Rhythm deterioration in gait is assciated with increased airflow limitation leading to lower
forced expiratory volume. Gait disturbances are linked to increased risks of falling, affecting the function
and mobility of the patient (Park et al., 2020). Patients with COPD lose their cilia, making it hard to
control mucus secretion. Nurses should assess the level of the patient's consciousness as hypoxemia is
linked to low oxygen in the blood. The nurse should also check for nasal flaring, indicating troubled
breathing due to swelling and mucus buildup (Chatreewantakul et al., 2022). Another area nurses should
consider is the clubbing of fingers. The nurse should check for bulging of the distal portion of the finger
or soft nail beds that indicate inflammation of the blood vessels that could indicate lung abscess (Reader
et al., 2018). The breathing rate in a normal person should be unlabored and in a regular rhythm. Audible
2
Consider the patient situation: (100 words)
Using the handover provided, identify your initial impression of the patient and any important features of the
situation you identify as clinically significant.
The patient brought to the hospital is Tej Perara. Tej produces sputum frequently, and the skin around his
wrinkles appears blue on first impression when brought to the hospital. The patient frequently coughs,
which is accompanied by mucus production. After reviewing the medical records, I discovered that Tej
had been previously diagnosed of chronic obstructive pulmonary disease (COPD), a condition that makes
breathing hard for people. Wheezing sounds are produced when the patient breathes. The patient has lost
weight, indicating that the disease has interfered with his daily routine. The patient shows difficulties
moving around the facility, indicating he has low energy.
Collect Cues and Information: (200 words)
1) Identify the priority-focused assessment you would complete for your patient.
2) Discuss your rationale for performing this focused assessment concerning the case study, with evidence to
support your choices/rationale.
3) Identify 3 subjective and 3 objective elements of the priority-focused assessment you would perform.
1) My priority assessment will be a physical inspection of the patient, which will be focused on checking
sputum color, shortness of breath, and skin color.
2) Shortness of breath, sputum production, and skin color changes are primary symptoms associated with
COPD (Anzueto & Miravitles, 2018). Shortness of breath is caused by obstructed and restricted
ventilation. Sputum production is caused by the overproduction of mucus that blocks the bronchial cavity.
Tej had been experiencing difficulties in breathing when he was brought to the hospital, which shows that
his airways might be blocked. Bluish discoloration of fingernails shows diminished perfusion and
oxygenation of the blood vessels in the upper limbs (Anzueto & Miravitles, 2018). It might also indicate
reduced red blood cells in the affected tissues. Assessment of health-related quality of life, such as
shortness of breath, shows the disease burden in the patient (Masror-Woodsary et al., 2021). A focused
assessment is needed to establish the extent to which COPD has affected the patient before recommending
1
, NSG1NMA Template – Clinical Reasoning Written Task
medication.
3a) Subjective assessment the nurse can perform on the patient include:
1. Have you been exposed to smoke or dust before the visit?
2. How often do you cough, and is your cough accompanied by sputum production?
3b) How often do you experience shortness of breath? Which time of the day are the symptoms worse?
Three objective assessments to be performed on the patient include:
1. Inspection
2. Palpitation
3. Auscultation.
Process Information: (600 - 650 words)
Consider the 3 objective elements of the focused assessment you have chosen to perform above. Discuss the
rationale for each assessment, the significance of each assessment, and any expected findings that might
result from when/in assessing concerning the case study.
Physical inspection.
The nurse should inspect the patient's breathing patterns, sputum production, and skin color are symptoms
related to respiratory diseases. The nurse should check the patient's gait to ascertain if there are any
disturbances. Rhythm deterioration in gait is assciated with increased airflow limitation leading to lower
forced expiratory volume. Gait disturbances are linked to increased risks of falling, affecting the function
and mobility of the patient (Park et al., 2020). Patients with COPD lose their cilia, making it hard to
control mucus secretion. Nurses should assess the level of the patient's consciousness as hypoxemia is
linked to low oxygen in the blood. The nurse should also check for nasal flaring, indicating troubled
breathing due to swelling and mucus buildup (Chatreewantakul et al., 2022). Another area nurses should
consider is the clubbing of fingers. The nurse should check for bulging of the distal portion of the finger
or soft nail beds that indicate inflammation of the blood vessels that could indicate lung abscess (Reader
et al., 2018). The breathing rate in a normal person should be unlabored and in a regular rhythm. Audible
2
