Clinical PracticeCritical Thinking in Nursing Practice Medical treatment stabilized Mr. Lawson's condition. He had a pulmonary embolus, but he is now on anticoagulants, medications that will reduce likelihood of more clot formation. Knowing that Mr. Lawson is on anticoagulants and has had recent surgery and the processes of normal wound healing (see Chapter 48 (Links to an external site.)Links to an external site.), Tonya believes that the patient is at risk for bleeding from his surgical wound. She acts by increasing assessments of the wound and teaching Mr. Lawson how to avoid placing stress on the wound 1. Describe the critical thinking skill that Tonya is demonstrating.After Tonya assesses the wound, she enters a note in the medical record. She describes the appearance of the incision in detail, reports on the length of the incision, and notes that one suture is loose but there is no drainage. 2. Identify the three intellectual standards that Tonya uses in making a note in the record. 3. Mr. Lawson complains of more discomfort after lying on his right side for 30 minutes. Tonya asks him to describe the pain; it is focused more on his right shoulder and ribs. Tonya sees that the drainage tubing exiting the surgical wound is caught underneath the patient. She moves it, questions the patient further to find out that he has a history of arthritis in the shoulder, and then repositions and aligns him. This is an example of which critical thinking competencies? Nursing Assessment Tonya is planning to return to Mr. Lawson's room and spend more time discussing his concerns about going home and what to expect. She knows that Mrs. Lawson usually comes to visit around 11 AM, just before lunchtime. Tonya believes that Mrs. Lawson will be an important source of support in providing Mr. Lawson's ongoing home care. The surgeon has ordered directions for wound care and standard activity restrictions. 1. Tonya goes to Mr. Lawson's room and asks the patient, “What concerns do you and your wife have about cleaning the wound?” Which type of assessment question is this and why has Tonya asked it? 2. Tonya and Mr. Lawson have the following interaction: Tonya: Mr. Lawson, What do you understand about the reason for the activity restrictions your doctor ordered? Mr. Lawson: I think it will prevent me from not hurting myself.Tonya: Uh huh?…?go on Mr. Lawson: I think the doctor said I could pull my stitches. Tonya's phrase “uh huh?…?go on” is an example of which interviewing technique? Explain why it is useful. 3. Tonya returns to Mr. Lawson's room to discuss his discharge instructions, but she notes as she enters the room that the patient is grimacing. She asks him, “Tell me where the pain is.” Mr. Lawson is asked to rate the pain on a scale of 0 to 10 and rates it a 6. Tonya looks at the patient's surgical wound and notes that the area of separation is still inflamed. Match the assessment technique on the left with the type of measurement on the right.
|1. Patient rates pain 6 on a 0 to 10 scale.||___ A. Determining location of a symptom|
|2. Tell me where the pain is.||___ B. Observation|
|3. Patient is seen grimacing.||___ C. Inspection|
|4. Nurse looks at condition of wound.||___ D. Determining severity of a symptom|
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