NextGen SKINNY Reasoning
Atrial Fibrillation/Heart Failure (2/4)
Bill Hill, 71 years old
Primary Concept
Perfusion Gas Exchange
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Patient education
• Communication
• Collaboration
NCLEX Client Need Categories C...
Bill Hill, 71 years old
Primary Concept
Perfusion
Gas Exchange
Interrelated Concepts (In order of emphasis)
Clinical judgment
Patient education
Communication
Collaboration
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Step 1: Recognize Cues
Environment
Management of Care Step 2: Analyze Cues
Safety and Infection Control Step 3: Prioritize Hypotheses
Health Promotion and Maintenance Step 4: Generate Solutions
Psychosocial Integrity Step 5: Take Action
Physiological Integrity Step 6: Evaluate Outcomes
Basic Care and Comfort
Pharmacological and
Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
, Part I: Initial Nursing Assessment
Present Problem:
Bill Hill is a 71-year old male with a past medical history of benign prostatic hyperplasia (BPH), peripheral vascular
disease and myelodysplastic syndrome MDS) two months ago after a bone marrow biopsy. Six weeks ago, Bill was
admitted because he had a syncopal episode. He was diagnosed with paroxysmal atrial fibrillation and acute anemia with a
Hgb of 6.9 and received a transfusion of one unit of PRBCs.
Bill presents to the emergency department today with increasing weakness, fatigue, sinus congestion, fever, and chills
the past week. He was around grandchildren with colds two weeks ago. Bill woke up at 6 a.m. today feeling short of
breath, and coughing harshly with clear sputum. He had difficulty walking back to bed after getting up to the bathroom.
His wife, who is a retired nurse, noted that he was much paler, took his vital signs, which were BP: 96/62, HR: 140 irreg,
RR: 24. Bill admits to losing 15 lb (6.8 kg) over the last 2-3 months.
Personal/Social History:
Mr. Hill is retired and lives at home with his wife in a rural area. His two adult children live out of state. He has been an
active, healthy male who enjoys gardening, hunting, and splits wood to heat his home in the winter. Since he has been
dealing with changes in his health he has not been able to participate in these activities as much. In the past, he has been
employed as a minister who has a strong Christian faith. He denies smoking, alcohol use, and illicit drug use.
This study resource
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential)
RELEVANT Data from Present
Problem:
Clinical Significance:
was
RELEVANT Data from Social Clinical Significance:
History:
Bill is transferred to a cart in the ED and quickly brought to a room. You
introduce yourself, and collect the following clinical data:
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 99.6 F/37.6 C (oral) Provoking/Palliative:
P: 148 (irreg) Quality: Denies
R: 24 (reg) Region/Radiation:
BP: 104/60 Severity:
O2 sat: 88% room air Timing:
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