Week 4 Case study Covid-19- Skinny Reasoning-Part-1

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Week 4 Case study Covid-19- Skinny Reasoning-Part-1

NR 324 ADULT HEALTH (Chamberlain University)

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Part I: Emergency Department (ED)

SKINNY Reasoning

John Taylor, 68 years old

Primary Concept Infection/Immunity Interrelated Concepts (In order of emphasis)  Clinical judgment NCLEX Client Need Categories Covered in Case Study NCSBN Clinical Judgment Model Covered in Case Study

Safe and Effective Care Environment Step 1: Recognize Cues 

 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 

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-Did you travel recently ?-What was your temperature at home?-Did you practise social distancing in the community?-Does your family or any recent contact showing symptoms of covid-19 such as fever, cough ?-Do you have SOB at rest ?-Hx of smoke, asthma or any other respiratory problems, - Immunization hx (flu vaccine) -provide Mask to the patient -Test patient for covid-19 -Use contact and droplet precaution Initial Triage Assessment in ED

Present Problem:

John Taylor is a 68-year-old African-American male with a history of type II diabetes and hypertension who came to the emergency department (ED) triage window because he felt crummy; complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past two days. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom. John is visibly anxious and asks, “Do I have that killer virus that I hear about on the news?”

Personal/Social History:

John lives in a large metropolitan area that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years and is retired police officer and active in his local church.

• What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse?

(NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: -Hx of DM and HTN -c/o headache, runny nose, persistent nagging cough, SOB, and hot to the touch -age Pt is present with the symptoms of covid-19 and infection is one of the leading cause to develop the complications of the DM such as DM Ketoacidosis.RELEVANT Data from Social History: Clinical Significance: 3000 confirmed cases in his community Lives with wife (social support) Active in local church Pt is present with the symptoms of covid-19 and it is significant to know who he got in contact with and his recent travel history.

• What additional clarifying questions does the triage nurse need to ask John to determine if his cluster of physical

symptoms are consistent with COVID-19?

• Based on the clinical data collected, identify what measures need to be immediately implemented using the

following clinical pathway.

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Yes, patient is a susceptible host and proper isolation precaution should be initaiated at the level of mode of transmission to break the chain of infection.John is brought back to a room. As the nurse responsible for

his care, you collect the following clinical data:

• What type of isolation precautions does the nurse need to implement if COVID-19 is suspected? What specific

measures must be implemented to prevent transmission?Type of Isolation: Implementation Components: Contact precaution Droplet precaution Gloves, gown, Mask and eye wear protection (goggles)

• What are the six steps in the chain of infection? Apply what is known about COVID-19 to each step.

Six Steps: Coronavirus COVID-19:

1. Infection agent : Coronavirus

2. Reservior: Infected human

• Portal of exist: respiratory secretions that are primarily coughed or sneezed out after some incubation
• Mode of transmission: contact with the respiratory secretions of an infected person

5. Portal of entry: mucous membrance in contact with virus (mouth or nose

6. Susceptible Host: Person showing symptoms such as SOB, cough, and fever

• Is this patient a susceptible host? What step in the chain of infection does proper isolation precautions impact?

Why?

Patient Care Begins:

Current VS: P-Q-R-S-T Pain Assessment: T: 100.3 F/38.8 C (oral) Provoking/Palliative: “moving makes it worse” P: 118 (regular) Quality: “achy” R: 20 (regular) Region/Radiation: “all over” BP: 164/88 MAP: 113 Severity: 5/10 O2 sat: 92% room air Timing: continuous

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