Illinois College Clinical Reasoning Appropriate for Patient Disease Discussion Paper

Question Description

Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.

Scenario

You recently finished new graduate orientation in the emergency room (ER) of a rural, 60-bed hospital, and tonight is the first shift you have worked independently. The Intensive Care Unit of the hospital has only four beds and usually sends the sickest clients in need of complex care to a regional medical facility located 50 miles from your location. During orientation, you were told repeatedly the purpose of treatment in this ER is triage, stabilize, and send home or send to a larger network facility.

Tonight your first client is an 82-year-old female named Ruth. Ruth was dropped off at the ER by a neighbor who said that she had nausea and vomiting for a week. Her husband was recently admitted to an Alzheimers Unit at a local Long-Term Care facility, and the neighbor thought stress was making it hard for Ruth to eat, but tonight she vomited up fresh blood and appeared dizzy. The neighbor also brought in a bag of medication she found in the home but was unsure which medication belonged to Ruth or her husband.

When you enter the room to begin the assessment, you find a frail woman sitting in a wheelchair with apparent labored breathing. She appears dirty with matted hair clothed in a bathrobe with numerous food stains and has a heavy smell of cigarette smoke. You notice the chart has a highlighted area noting the client has only Medicaid for insurance. You ask her if she understands why she is in the ER and she asks, Where is my husband? He is usually home by now.

Past medical history:

Two pack per day smoker for 58 years
Type I Diabetic

Assessment data:

Blood pressure: 178/98
Heart rate: 84 beats per minute
Oxygen saturation: 84
Temperature: 101.8 degrees Fahrenheit
Hyperactive bowel sounds in all 4 quadrants
An open wound on the bottom of right foot

Instructions

You are feeling overwhelmed with your first client but remember first you need to evaluate internal and external cues to develop a priority hypothesis to guide clinical reasoning. Create notes for this clients plan of care including:

Design a hypothesis for each of the four modes of inquiry: empirical, ethical, aesthetic and sociopolitical.
Prioritize the most relevant hypothesis aligned with data in the scenario and demonstrate appropriate clinical reasoning.
Design an evaluation plan for the priority hypothesis.

use APA when referencing

Grading Rubric

F	F	C	B	A
0	1	2	3	4
Did not Submit	No Pass	Competence	Proficiency	Mastery
Not Submitted	The hypothesis for all four modes of inquiry was not provided.	A relevant hypothesis designed for all four modes of inquiry and brief or incomplete supporting rationales were provided.	A relevant hypothesis designed for all four modes of inquiry and supporting rationales including appropriate information from the scenario for most of the hypotheses.	A relevant hypothesis designed for all four modes of inquiry and detailed supporting rationales including appropriate information from the scenario for each hypothesis.
Not Submitted	Most relevant hypothesis not prioritized correctly and supporting the rationale for decision making not stated or linked to data in the scenario.	Most relevant hypothesis prioritized correctly, and an attempt made to provide supporting rationale for priority hypothesis but not all data from the scenario appropriately linked.	Most relevant hypothesis prioritized correctly and supporting the rationale for priority hypothesis linked to appropriate data in the scenario.	Most relevant hypothesis prioritized correctly and supporting the rationale for priority hypothesis is detailed and clearly linked to appropriate data in the scenario.
Not Submitted	No attempt made to rank the three remaining hypotheses in order of priority correctly and no supporting rationales provided.	Two of the three remaining hypotheses ranked in order of priority and aligned appropriately with data in the scenario and supporting rationales for the ranking order provided but brief and not all are linked to appropriate data in the scenario.	Remaining three hypotheses ranked in order of priority and aligned appropriately with data in the scenario and supporting rationales for the ranking order provided and linked to appropriate data in the scenario.	Remaining three hypotheses ranked in order of priority and aligned appropriately with data in the scenario and detailed supporting rationales for the ranking order provided and clearly linked to appropriate data in the scenario.
Not Submitted	An attempt made to create an evaluation plan but not relevant to the priority hypothesis and does not contain an obvious goal, a method for data collection, and method of data analysis.	A vague evaluation plan created for the priority hypothesis and included an attempt to create a goal, method for data collection, and method of data analysis.	An adequate evaluation plan created for the priority hypothesis including general descriptions of one goal, method for data collection, and method of data analysis.	A comprehensive evaluation plan created for the priority hypothesis including detailed descriptions of one goal, method for data collection, and method of data analysis.
Not Submitted	Lack of formal style in the document with, numerous spelling, grammar, or APA format errors present. The errors often detracted from the readability and intent of the document.	Formal style reflected in most of the document, but not maintained throughout. Some spelling, grammar, or APA format errors present which occasionally detracted from the readability and intent of the document.	Formal style reflected throughout the majority of the document, with minor spelling, grammar, or APA format errors present which did not detract from the readability and intent of the document.	Formal style reflected throughout the entire document, including no spelling, grammar, or APA format errors present.

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