XH 3002 Assignment Clinical Judgment Through Assessment

XH 3002 Assignment

Clinical Judgment Through Assessment

Order ready-to-submit essays - 100% plagiarism-free guaranteed!

Note: Our papers are 100% human-written. 

Need Help Writing an Essay?

Tell us about your assignment and we will find the best writer for your project

Write My Essay For Me

Student Name

Walden University

XH3002: Clinical Judgment Through Assessment

Competency Assessment: Decision Making for Clinical Judgment

Date

Part 1 – Clinical Scenario: Nurse Atsumi Yoshida and Returning Patient Mr. Teo Kimura

• Provide a summary of the details obtained from Nurse Atsumi Yoshida regarding Teo Kimura and his prior visit to the Neighborhood Clinic.

Nurse Atsumi Yoshida gave an explanation to Mr. Teo Kimura about his previous employment in the Neighborhood Clinic (Walden University, 2024a). There was a routine physical examination done during such a visit. One of the few abnormalities was that the blood pressure was slightly increased. Mr. Kimura also complains of lower back pain that has always been there, but his range of motion was normal (Walden University, 2024a). He denied anything that had happened before in terms of accidents or injury that would be a cause of the pain. Working at a grocery store, he admitted that he felt some pressure because of new competitors in the area, but he claimed that he did not feel overwhelmed. Nurse Yoshida understood his comments to be a cultural catchphrase of bravo and was not a major issue. Mr. Kimura did not use any analgesics because he did not like their smell, but complied with the advice of the nurse to apply an over-the-counter, unscented topical gel (Walden University, 2024a). Because no imaging was done, the nurse attributed most of his pain to stress. She reminded him to revisit in case discomfort would be exacerbated, but did not emphasize follow-up.

• Assess how the nurse applied clinical judgment in her statements and provide justification for your evaluation.

Nurse Yoshida also exhibited some of the main points of clinical judgment with an emphasis on noticing, interpreting, responding, and reflecting (Walden University, 2024a). She recognised the elevated blood pressure slightly and gave an estimation on whether there could be some musculoskeletal issues. Given that the physical examination was unremarkable, she had a reasonable cause for stress, which was a contributing factor. She did offer a realistic treatment option, with the suggestion being a topical gel, and she suggested a follow-up in case symptoms continued. Her interpretations were constrained, however, by the lack of diagnostic imaging and other cultural biases in the rejection of bluster in Mr. Kimura (Walden University, 2024a). In general, her clinical judgement was reasonable, yet it might have been enhanced by involving a more in-depth investigation of stress and the opportunities of underlying causes.

• In your appointment with Teo Kimura, explain what you would look for and pay particular attention to based on the information you received from Atsumi Yoshida and your assessment of her clinical judgment.

The first step I would follow during the visit to Mr. Kimura, during the follow-up visit, is to carefully review his vital signs with close attention to his blood pressure. This is necessary since a history of increased measurements can spell the difference between a development towards uncontrolled high blood pressure and a predisposition to cardiovascular complications when undetected (Cimmino et al., 2023). These changes would be monitored to give me a baseline on what modifications should be made in his management plan. The second would be a concentrated musculoskeletal examination where I would look at the intensity and nature of his back pain. Measuring his sphericity, tenderness sources, and the presence of any pain distribution are elements that help in differentiating mechanical sources of pain as muscle strain, and more severe kinds of conditions as nerve damage. This data can inform diagnostic thought as well as proper treatment planning.

Based on the disclosure of Ms. Yoshida regarding his workplace stress, I would also examine the mental health and the emotional stability of Mr. Kimura. Prolonged stress exacerbates musculoskeletal pain as well as increases blood pressure and, thus, connects his psychology to the manifesting and possible diagnoses mentioned (Cimmino et al., 2023). Assessment of stress or mood-related issues will help in providing a better holism in his care. Lastly, I would enquire of him whether or not he used the topical gel advised during the last visit and, to what extent, it offers any meaningful pain relief to him. He would provide feedback on whether he was responding to treatment and how this response might influence future actions, either by modifying pain management approaches or by using other interventions. Through linking these tests -blood pressure, musculoskeletal, stress level, and response to treatment I will be able to see through the interaction of the physical and psychological factors in Mr. Kimura’s case, prioritize the most alarming conditions, and make intelligent clinical decisions about how Mr. Kimura will be further taken care of.

• What questions would you ask Mr. Kimura to understand his physical symptoms?

1. Can you describe the type and location of your back pain?
2. Rate your pain level on the scale between 1 and 10?
3. Do certain activities or movements also make the pain bigger?
4. Has the pain affected your work / daily activities?
5. Was the over-the-counter gel of any help?
6. Have your symptoms changed since I last saw you?

• What questions would you ask Mr. Kimura to understand other factors that may affect his health?

1. Have you felt stressed out or gotten emotionally exhausted recently?
2. Have you observed sleeping disorders, for example, difficulty falling or maintaining sleep?
3. Has this been the first time that your blood pressure has increased, or is it something new?
4. Do you have headaches, dizziness, or shortness of breath?
5. Is the family history positive for hypertension or heart disease?
6. What do you normally do concerning stress in the workplace or at home?

• Explain aspects of clinical judgment, noticing, interpreting, responding, reflecting, that would support your assessment and decision making on Mr. Kimura’s health. 

Using Tanner’s model of four steps related namely the Noticing, Interpreting, Responding, and Reflecting, I convert observations into prioritized actions and decisions when applying clinical judgment to Mr. Kimura.

Noticing

I do this by first collecting objective and subjective data, which is done intentionally. Some objective data that I would document are current blood pressure, comparison with the prior measurements, heart rate, temperature, focal musculoskeletal lumbar spine ROM, point tenderness, gait, straight-leg raise, and focal neurological assessment (Nielsen et al., 2022). Such subjective data as the precise nature and pattern of the back pain (onset, localization, radiation, severity, aggravating/relieving causes), whether the topical gel was applied and what relief it provided, sleep and activity restrictions, and any working psychosocial stresses are also involved. I also filter specifically on the red flag symptoms: fever, continuing to lose weight without cause or intent, major trauma, recent major trauma, cancer history, progressive weakness, or bowel/bladder changes, as their existence makes serious pathology needing an alternate approach that alters the urgency and treatment.

Interpreting

These observations are synthesized by me into some prioritized differentials. Specific pain with normal neurology and intact function is most likely to be because of mechanical low back pain or strain of muscles; pain below the knee, with some cases of dermatomal numbness or shallow reflexes, augurs in radiculopathy. The red flags are known to change the working diagnosis to fracture, infection, malignancy, or cauda equina syndrome, and also need escalation (Nielsen et al., 2022). Higher or increased pressure in the blood should be viewed as both a risk to Cardiovascular conditions over the long term and as a possible enhancer of the sensation of pain; continuing work activities under stress will continue to keep the body in a state of sympathetic stimulation, aggravating the pain and therefore increasing hypertension (Nielsen et al., 2022). A report provided by the patient on the topical gel contributes to the evaluation of whether the situation can be managed through conservative treatment or the requirement of pharmacologic/escalation must be considered.

Responding

All the responses are matched to priority. Provided there are red flags, I would quickly schedule imaging and specialist referral. In case of progressive, I would hasten neuroimaging and emergency consultation. In treating non-urgent, yet limiting its functions to mechanical pain, I would augment activity change of Direction, advise course physiotherapy and comparative activity, and take into account temporary patch medication (topical NSAID gel to augment effectively and oral analgesia only when vital and secure). In the case of high or unregulated blood pressure, I would also check compliance, observe secondary factors (such as high stress), and remove antihypertensive medication or observation as prescribed. I would also treat stress at the workplace directly by providing short-term stress-reduction interventions, a referral to counseling (where necessary), and advice about workplace changes, since not only does an intervention to alleviate psychosocial strain help to regulate blood pressure, but also to reduce pain results (Schmidt & Pilat, 2023). I record the reasons, negotiate risks and benefits with Mr. Kimura, and provide short-term objectives (pain, sleep, work-related tasks, all measurable and with a definite timeframe).

Reflecting

Reflection occurs during the following, i.e., at the follow-up assessments, I reassess pain pattern, neurological status, functional improvement, and blood pressure trend. The reflection questions are the initial interpretation accurate ( did the patient respond as intended? ), and also must the care plan must be escalated (imaging, referral to specialist, alternative medications)? I similarly consider system-related issues (breaches any of the cues, are there obstacles to adherence, do we require multidisciplinary input?) and document these lessons to better decision-making in the future(Schmidt & Pilat, 2023). Such circularity of notice, interpretation, action, and reflection and correction will help necessary findings receive priority and guarantee that potential diagnoses are put to the test and that the plan is continually added to in order to keep Mr. Kimura safe and on track pertaining to recovery.

• Are there questions about cultural competence and/or implicit bias in this scenario? Explain your thinking.

This case also displays cultural issues. The statement by Nurse Yoshida regarding the Asian man manifesting bravado is a form of stereotyping that may underestimate the real stress that Mr. Kimura experienced (Walden University, 2024a). Cultural differences with regard to the style of communication can also affect the way Mr. Kimura communicates his discomfort (Walden University, 2024a). Moreover, his reluctance to ingest painkillers because of the smell dislike probably has roots in the cultural factors and should be respected. These issues can be overcome by awareness and identifying these cultural dynamics, and this would reinforce patient-focused care.

Part 2 – Patient Scenario: Serena Miranda and Her 1-month-old Son, Jorge

• Summarize the information you learned from Serena Miranda that would inform your examination of Jorge and application of clinical judgment.

In the interview, the mother of Jorge, Serena Miranda, complained about why her baby, who was 1 month old, was not growing in weight. Jorge was born with a weight of 6 pounds 5 ounces, and just one month afterwards, he could not weigh 6 pounds (Walden University, 2024b). Serena stated that he at first fed well; however, he now has trouble with finishing bottle feeding, he seldom requests to be fed, and his crying is weak and tearless. She had a suspicion that there was a problem with breastfeeding, and she thought of using formula, but her husband and mother-in-law insisted on breastfeeding only because of the cultural beliefs and financial reasons (Walden University, 2024b). Serena explained how she feels criticized and not supported at home, especially because her in-laws did not support her being pregnant in the first place. Such conflicts in the family, coupled with economic restrictions, did not allow for previous clinic visits.

• Based on this information, what concerns would you have about Jorge’s condition?

Since Jorge has a decreased weight, he does not shed tears, lacks energy, and does not eat his food, my major clinical considerations are poor feeding due to poor intake, developing dehydration, early malnutrition with micro-pathophysiologic implications, and nursing priorities. A plateau in weight is an indication that calories are not being used by the body. In infants, it causes a depletion of glycogen and fat stores followed by the catabolism of the proteins, which also lessens muscle tone and restrains growth and neurodevelopment progress (Franceschi et al., 2021). A plateau in weight is not merely a figure in the chart, however; it is a clinical indication that soon the infant might develop a lack of activity, poor thermoregulation, and increased susceptibility to infection should the energy variability persist.

Low energy, a weak cry, are noteworthy functional signs of decreased physiologic reserve. They speculate that the infant is sleepy during feeds or is hypoglycemic, and s/he need to monitor his/her physical condition (vital signs and bedside glucose) as soon as possible because with weak cry a baby is a red flag to get systemic illness and severe caloric deficit or fatigue due to dehydration. The lack of tears to cry is a definite and alarming symptom of dehydration in children. One of the initial clinical manifestations that is hemodaly lost is tear production; in combination with reduced diaper output or dry mucous membranes, this points to at least moderate dehydration (Walden University, 2024b). The risks associated with dehydration are: circulatory compromise, electrolyte imbalances (with the potential to impact the neurologic condition), and prerenal AKI; all warrant immediate evaluation and, based on the degree of manifestation, oral rehydration or emergency IV fluids.

These findings are linked through incomplete feeds: they could be a result of loss of effective milk transfer (poor latch, weak suck), maternal supply inadequacy, infant oral-motor complications or infant illness. Some incomplete feeds will soon follow, which will result in a rapid stagnation and dehydration of a young infant, when it is the immediate cause. The corresponding nursing recommendations based on this analysis include obvious and focused: assess the accurate weight and chart it on the growth chart; assess the intake and output (record the number of wet diapers in excessive of 24) and screen diagnostic tests (fontanelle, mucous membranes, skin turgor, capillary refill) and dermatological glucose; observe a full feeding to check the latch/suck and virtual pre/post feed weights if available; invite a lactation person to the treatment, and stigmatize the presence of postpartum depression in Serena The patient, Jorge, needs escalatory care to the emergency care in case he is lethargic, in case of persistent vomiting, urine output very low, and the fontanelle is sunken, or there was evidence of poor perfusion. The presentation of the signs in that manner (symptom – possible physiologic process – clinical risk – immediate nursing actions) exemplifies the level of clinical reasoning and reflects how the identified findings lead to prioritized, quantifiable nursing decisions at the BSN-level.

• If your concern were failure to thrive, what questions would you ask to understand more?

1. What is the average length of the breastfeeding session?
2. Is Jorge able to choke, gag, or fall asleep when fed?
3. How many soaked, sticky diapers does he have each day?
4. Have you lost weight, do you have loose skin, or is clothing the same as when you were born?
5. Is the eye looking or sound responsive? Jorge looks or listens?
6. Has there been any change of activity, evidence of his growing weaker or more flabby than formerly?
7. Has he vomited, had diarrhea, or difficulty breathing?

• When you examine Jorge, explain what you would look for and pay particular attention to in your examination based on the information you gathered.

On performing the evaluation on Jorge, I would ensure that I first identify his weight, his length, and his head circumference, which are then plotted against standardized growth charts. This comparison is important as it not only reveals his current status of growth but also reveals whether or not he is tapering off the expected percentiles, a major indicator of inability to thrive. Of particular interest here is the head circumference, used to measure brain development and neurodevelopment, which may be interfered with in case malnutrition is persistent (Walden University, 2024b). It would then be time to examine his hydration level by checking his skin turgor, mucous membranes, fontanelle, and the number of diapers/24 hours. Such results are fundamental in the process of establishing the intensity of dehydration, along with providing a guideline on whether the supportive levels of dehydration, like oral rehydration, are effective or necessitate urgent decisions on the possibility of using some IV fluids.

Reflex evaluation, especially the suck reflex and swallowing, is an evaluation of his capacity to feed. Incomplete feeds and poor weight gain may potentially be related to neurologic immaturity, fatigue, or underlying disease, and may be associated with weak or absent reflexes (Sultana et al., 2021). The overall neurologic integrity and energy maintenance is further diagnosed in muscle tone, and responsiveness to stimuli, including eye contact or to sound, and indicates whether suboptimal intake alone is the cause, or it is part of broader developmental or health issues.

Last but and by no means, is observing Jorge directly during a feeding. The ease with which he latches and the duration with which he supports sucking and fatigability- whether he fatigues easily or not give direct information as to whether his latched feeding difficulties are attributable to bad technique or bad coordination, or to lack of stamina. Such observations inform the care plan by mentioning whether directing the main intervention is feeding support (e.g., lactation consultation, fortified feeds) or medical assessment of the underlying disease (Sultana et al., 2021). The examination allows to see a holistic view of the health conditions affecting Jorge, evaluates immediate potential risks (like dehydration), and focuses on long-term issues (like growth and developmental delays) to ensure that the implementation of interventions becomes prioritized.

• Explain your next steps for Jorge and Serena Miranda based on components of the nursing process and your reasoning.

Next steps in nursing care of Jorge begin with a detailed assessment, including full physical data; analysis of feeding, hydration, and family psychosocial background (Walden University, 2024b). Based on this information, proper nursing diagnoses may be formulated, e.g., Ineffective breastfeeding, Risk for imbalanced nutrition: less than body requirements, and Parental role strain. Planning would be where the development of a care plan is done, based on priorities to gain weight, proper feeding, and caregiver education. Such nursing interventions may entail providing breastfeeding education, regarding the use of supplemental formula when essential, and connecting the family with communal or financial assistance to augment access to formula during implementation. It is also important to support and counsel Serena emotionally so as to make her a better caregiver and to mitigate stress (Walden University, 2024b). The review period would involve reevaluating the systolic and diastolic inheritance of Jorge and re-evaluating his progress during follow-up in terms of weight, hydration, and feeding, and updating the care plan as required.

• Explain aspects of clinical judgment, noticing, interpreting, responding, reflecting, that would support your decision making. 

In the case of Jorge, there is a deficiency in the fact that the individual is not gaining weight, has a weak cry, and is not able to feed adequately. Claiming these results hints at a potential failure to thrive (FTT) as a result of a lack of caloric nutrients and potential dehydration. As urgent measures, attending to weight, checking the level of hydration, lactation assessment, and inclusion of formula agitation in case breastfeeding is not adequate are all my responses (Franceschi et al., 2021). Reflectively, in the last case, the nurse can decide whether the interventions are yielding by following up on the progress of Jorge ( feeding, hydration, weight gain) and assessing how much more confident and empowered she is in her role as a caregiver.

In this case, cultural and family dynamics also contribute greatly. The strong resistance to the formula of the husband and mother-in-law of Serena is perhaps because of the culturally oriented beliefs on breastfeeding (Franceschi et al., 2021). In addition, financial stress increases the problem (Guan et al., 2022). Being able to respect their viewpoint and keep Jorge safe would need the use of culturally sensitive language, engaging the family in the education process, contextualizing formula as a medical aid, and no refusal of breastmilk.

Need a high-quality paper for XH 3001 Assignment Person-Centered Holistic Care? Get professional assistance now!

References for XH 3002 Assignment Clinical Judgment Through Assessment

Cimmino, G., Natale, F., Alfieri, R., Cante, Covino, S., Franzese, R., Limatola, Marotta, L., Molinari, R., Mollo, N., Loffredo, F., & Golino, P. (2023). Biomedicines, 11(9), 2353. https://doi.org/10.3390/biomedicines11092353

Franceschi, R., Rizzardi, C., Maines, E., Liguori, A., Soffiati, M., & Tornese, G. (2021). Failure to Thrive in Infants and Toddlers: A Practical Flowchart-Based Approach in a Hospital Setting. Italian Journal of Pediatrics, 47(1), 62. https://doi.org/10.1186/s13052-021-01017-4

Guan, N., Guariglia, A., Moore, P., Xu, F., & Janabi, H. (2022). Public Library of Science (PLOS) One, 17(2), e0264041. https://doi.org/10.1371/journal.pone.0264041

Nielsen, A., Gonzalez, L., Jessee, M., Monagle, J., Dickison, P., & Lasater, K. (2022). Current practices for teaching clinical judgment. Nurse Educator, 48(1), 7–12. https://doi.org/10.1097/nne.0000000000001268

Assessing a child or adolescent with low back pain is different from assessing an adult with low back pain. Journal of Paediatrics and Child Health, 58(4), 566–571. https://doi.org/10.1111/jpc.15933

Schmidt, H., & Pilat, C. (2023). Complementary Therapies in Medicine, 72, 102924. https://doi.org/10.1016/j.ctim.2023.102924

Sultana, Z., Hasenstab, K. A., & Jadcherla, S. R. (2021). Pharyngoesophageal motility reflex mechanisms in the human neonate: importance of integrative cross-systems physiology. American Journal of Physiology-Gastrointestinal and Liver Physiology, 321(2), G139–G148. https://doi.org/10.1152/ajpgi.00480.2020

Walden University, LLC. (2024a). Clinical judgment through assessment: Patient: Young mother Serena Miranda [Interactive media]. Walden University Brightspace. https://mytempo.waldenu.edu

Walden University, LLC. (2024b). Clinical judgment through assessment: Nurse: Atsumi Yoshida [Interactive media]. Walden University Brightspace. https://mytempo.waldenu.edu