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PL3 stageportfolio (klinisch redeneren en CAT)
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PL3 stageportfolio (klinisch redeneren en CAT)
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PL3 StageportfolioKlinisch redeneren & Onderzoekend vermogen
(CAT)
Naam:
Studentnummer: 1800829
Studiegroepscode: GVE-2DUVF-A
Docent:
Inleverdatum: 24 Januari 2022
Cursuscode: GVE-3.PL3-16 Stageportfolio
1
,Voorwoord:
Voor u ligt de opdracht ‘PL3 stageportfolio’ , waarin twee opdrachten zijn uitgewerkt. Het verslag begint
met de opdracht Klinisch Redeneren en zal worden gevolgd door de opdracht Onderzoekend vermogen.
De opdrachten zijn gemaakt vanwege mijn huidige hbo-opleiding, Verpleegkunde aan de Hogeschool in
Utrecht. Van September 2021 tot en met Januari 2022 heb ik hard gewerkt aan het maken van deze
opdrachten.
De twee opdrachten heb ik om de beurt gemaakt, als eerste had ik klinisch redeneren af. Daarna ben ik
vrij snel begonnen aan de opdracht onderzoekend vermogen. Het zijn twee opdrachten waar veel tijd in
heeft gezeten, en ik ben dan ook zeer tevreden met het eindresultaat.
Ik wens u veel leesplezier toe.
2
,Klinisch redeneren
Inhoudsopgave
Voorwoord:............................................................................................................................................2
Klinisch redeneren..................................................................................................................................3
Voorwoord:............................................................................................................................................6
Stap 1: Probleem oriëntatie/ klinisch beeld............................................................................................7
1.1: Introductie zorgvrager......................................................................................................................7
1.2: De veranderde situatie.....................................................................................................................9
1.3: Ernst van de situatie.........................................................................................................................9
1.4: Hypothetische diagnoses................................................................................................................10
Stap 2: Probleemanalyse......................................................................................................................11
2.1: Disfunctionele orgaansystemen......................................................................................................11
2.2: Verpleegkundige problemen..........................................................................................................13
2.3: Analyse...........................................................................................................................................14
Stap 3: aanvullend onderzoek en diagnose...........................................................................................16
3.1: Aanvullend onderzoek....................................................................................................................16
3.2: Verpleegkundige diagnoses............................................................................................................17
Stap 4: klinisch beleid...........................................................................................................................18
4.1: Verpleegkundige en multidisciplinaire interventies........................................................................18
4.2: Prioritering......................................................................................................................................19
4.3: Besluitvorming................................................................................................................................19
Stap 5: Klinisch verloop:.......................................................................................................................20
5.1: Korte termijn verloop.....................................................................................................................20
5.2: Lange termijn verloop.....................................................................................................................20
5.3: Gevolgen van ziekte/aandoening....................................................................................................21
5.4: Interventies en zelfmanagement....................................................................................................21
5.4.: Mantelzorg en professionele zorg.................................................................................................21
Stap 6: Evaluatie...................................................................................................................................22
6.1: Evaluatie gestelde doelen...............................................................................................................22
6.2: Reflectie op zorgtraject...................................................................................................................22
6.3: Evaluatie van het elektronisch patiëntendossier............................................................................22
Nawoord..............................................................................................................................................23
3
, Literatuurlijst (APA 6e editie):...............................................................................................................24
Bijlage 1: Anamnese.............................................................................................................................26
Bijlage 2: Dyspneu schaal.....................................................................................................................30
Bijlage 3: KATZ- ADL.............................................................................................................................31
Bijlage 4: Valrisico................................................................................................................................31
Bijlage 5: MUST- score..........................................................................................................................31
Critical Appraisal of a Topic (CAT).........................................................................................................32
Samenvatting.......................................................................................................................................32
Stap 1: Probleemanalyse......................................................................................................................34
1.1: Inleiding..........................................................................................................................................34
1.2: Doelstelling.....................................................................................................................................35
1.3: Onderzoeksvraag............................................................................................................................36
1.4: Variabelen.......................................................................................................................................36
Stap 2: Methode...................................................................................................................................37
2.1 Zoekplan..........................................................................................................................................37
2.2 In- en exclusiecriteria.......................................................................................................................39
2.3 Zoektermen.....................................................................................................................................39
2.4 Zoekplan database Pubmed.............................................................................................................39
Stap 3: Resultaten................................................................................................................................41
Artikel 1:................................................................................................................................................41
Artikel 2:................................................................................................................................................41
Artikel 3:................................................................................................................................................42
Artikel 4:................................................................................................................................................42
Stap 4: Discussie...................................................................................................................................42
4.1: Verwachtingen................................................................................................................................42
4.2: Sterke en zwakke aspecten onderzoek...........................................................................................43
4.3: Implicaties.......................................................................................................................................43
Stap 5: Conclusie..................................................................................................................................44
Stap 6: Advies.......................................................................................................................................44
Nawoord..............................................................................................................................................45
Literatuurlijst (APA 6e editie)................................................................................................................46
Bijlage 1: Beoordelingsformulieren wetenschappelijke onderzoekpublicaties van de Hogeschool
Utrecht.................................................................................................................................................48
4
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