Novel
Coronavirus Disease (COVID-19)
UNFOLDING Reasoning
John Taylor, 68 years old
Primary Concept
Immunity
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Communication
NCLEX Client N
...
Novel
Coronavirus Disease (COVID-19)
UNFOLDING Reasoning
John Taylor, 68 years old
Primary Concept
Immunity
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Communication
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 ✓
Part I: Initial Nursing Assessment
Present Problem:
John Taylor is a 68-year-old African-American male with a history of type II diabetes and hypertension. He came to the emergency department (ED) triage window because he felt crummy, complaining of a headache, runny nose, feeling weaker, “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 get worse throughout the day. 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 inner-city that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years, and is a retired police officer and active in his local church.
1. 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 T2DM, HTN Comorbidities
Reports feeling weak, headache, hot, Symptoms of illness
diaphoretic, cough, anxious, African Psychological state
American Places him at higher risk
RELEVANT Data from Social History: Clinical Significance:
Heavily populated residence, 3000 confirmed cases, attends church, married High risk of transmission
Attends public gatherings (church) increasing changes of transmission
Risk of spreading infection to his wife
2. What additional clarifying questions does the triage nurse need to ask John to determine if his cluster of physical symptoms is consistent with COVID-19?
3. Based on the clinical data collected, identify what measures need to be immediately implemented using the
following clinical pathway.
4. 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:
Standard precautions (all patients), contact and droplet precautions Airborn
precautions PPE, (N95 mask, face shield, gown, gloves), hand hygiene, no visitors For aerosolizing procedures, negative pressure room
Part II: Patient Care Begins in the ED:
........................................Continued.....................
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