Competency-Based Assessments
1
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Sarah, a registered nurse, is working in the emergency department (ED) when a new patient is brought in by ambulance. Mr. Johnson is a 65-year-old male who presents with severe chest pain and shortness of breath. Upon arrival, he appears diaphoretic and anxious. His vital signs show a blood pressure of 180/100 mm Hg, a heart rate of 120 beats per minute, a respiratory rate of 26 breaths per minute, and oxygen saturation of 92 percent on room air. Apply the Clinical Judgment Measurement Model (CJMM) to outline how Sarah will assess and manage the patient’s condition. Break down the approach into the key components of recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.
2
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Consider the following diagnoses and label whether it is a nursing or a medical diagnosis.
- risk for electrolyte imbalance
- impaired urinary elimination
- essential hypertension
- impaired gas exchange
- hyperlipidemia
- chronic obstructive pulmonary disease
- decreased cardiac output
- ineffective tissue perfusion
- urinary tract infection, site not specified
- neoplasm (malignant) related fatigue
3
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A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit with exacerbation of symptoms, including increased dyspnea, productive cough with thick yellow sputum, and decreased oxygen saturation levels. The patient reports difficulty performing activities of daily living due to shortness of breath and fatigue. Upon assessment, crackles are auscultated bilaterally in the lower lung fields, and the patient appears anxious and restless. Based on the scenario provided, formulate a nursing diagnosis for the patient.
Sarah, a 65-year-old female, was admitted to the hospital due to a fall at home. She fractured her hip and underwent surgery for hip replacement. During the assessment, the nurse observed that Sarah is experiencing shortness of breath, coughing, and difficulty breathing. Vital signs indicate an elevated heart rate and increased blood pressure. Sarah reports feeling anxious and worried about her recovery.
4
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Based on the scenario provided, formulate a nursing diagnosis for the patient.
5
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How would the nurse validate the nursing diagnosis?
6
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Scenario update: After implementing interventions such as administering breathing treatments and encouraging the use of incentive spirometry, Sarah's symptoms of dyspnea and coughing persist. Despite these interventions, she continues to experience difficulty breathing and reports ongoing anxiety.
Based on the scenario update, refine the nursing diagnosis for this patient.