Clinical judgment and decision making

In her book, Mooi Standing provides an understanding to pre-registered nursing students that aid them to recognize, improve and apply this expertise for them to practice safely and efficiently (Eisenberg, 2015). The book configuration assists the student advancement in operational decision making starting from their first to the last year of study by linking concepts to prior student’s practices and clinical situations to demonstrate how to apply this skills practically. Clinical reasoning is a course by which nurses and other clinicians gather cues, process info, comprehend the patient’s condition, strategize and implement interventions, assess results and reflect on and learn from the process. Thinking like a nurse is a custom of betrothed ethical reasoning where the educational practices should aid the student engross with deep apprehension for their well-being.

In his book, Levett Jones use a series of realistic situations to design a clinical reasoning directory in the clinical reasoning process and challenge nursing students to think critically on the nursing care they provide. Singh using ABCDE. The assessment will also emphasize on the standardized decision making, risk factor, psychosocial factor and care pathway in order to enhance Mr. Singh life quality and prevent more deterioration. Clinical judgment is the use of reflection, intuition and critical thinking after assessing and observing a patient and evaluates the best available nursing options. Clinical decision making is a daily role for healthcare professionals in making decisions on the care they should provide to patients. Singh respiratory rate, look for any distress in the breathing rate, consciousness level, hyperventilation, symmetry and his breath depth could aid in giving information on any life threatening condition.

The respiratory rate for Mr. Singh was 16 and this is considered standard and therefore recording NEWS total of zero. Oxygen saturation was also recorded to be 100% on air and therefore providing a NEWS total of zero. In case the saturation dropped below 94%, then Mr. In order for the body to control the blood pressure, it increases water and sodium retention leading to reduction of urine output. Kidneys also play a vital role and once affected, it will lower the amount of urine output indicating cardiogenic shock that alters capillary refill time and the blood pressure. Mr. Singh blood pressure was recorded being 160/100 mm/hg which is slightly high but record a score of zero on NEWS chart. BP of 160/100 can be categorized as phase 2 hypertension and being on amlodipine shows that Mr.

However, regular reassessing for agitation and confusion due to insufficient oxygen is important and can be a sign of cardiogenic shock. Mr. Singh temperature was recorded to be 36. Despite it being normal, Mr. Singh might spike to low grade fever. The decision making cycle will aid in the identification of all issues and problems after the information has been processed and interpreted. Mr singh reported that the pain was gone after arrival. However, regular assessment will be necessary and Morphine will be used to manage chest pain by applying a starting dose of 8mg that will be administered at an interval of 5-15 minutes in a reducing rate until the pain is under control. Pain increases anxiety and attending to it immediately is important.

Blood test will be done to test the level of troponin I and T level at an interval of 10-12 hours once the pain is acknowledged. Therefore, Mr. Singh health will be maintained effectively by considering his daily activities and put him in integrated care. His care plan will be communicated to him and offer emotional support to his new psychological and pre-existing problems. Management of NSTEMI Non –ST segment elevation myocardial infarction (NSTEMI) is a type of heart attack and can have unacceptable mortality rate when it goes unrecognized Hasan, 2017). It is the most common type of heart attack in comparison with STEMI and its determined using an electrocardiogram that displays each heartbeat as a waveform. Sing history shows he has diabetes and experienced symptoms that relates to NSTEMI.

Physical examination will examine at CAD complications that include failure and arrhythmias, precipitation conditions or identifying non-ischaemic cardiac or non-cardiac resultants of pain like pneumothorax, aortic dissection or pulmonary embolism. ECG tests will also be repeated at an interval of 3-9 hours or immediately the symptom will re-occur. BARC and NICE introduced a standard that comprised of the seven primary themes that should be included in the rehabilitation programmers’ the United Kingdom (British Thoracic Society, 2017, 22). The pathways are divided into four phases. He will be provided with access to skilled psychological specialists who will be responsible in reviewing his medication and the potential to engage in the rehabilitation activities. Phase two will emphasize on providing Mr. Singh with home-based support after release and denoting him back to his GP and constant review of his psychological, social and physical requirements after MI.

In this phase, close persons to Mr. Singh will be required to be intricate in the care like resuscitation physical activity. Singh to quit smoking since it increases chances for heart diseases especially due to the independent factors like ethnicity, age, gender and family history (Steele, 2017). The first step will be to get it right the reasons as to why he is smoking and provide him with options after he quits smoking. However, it should be understood that Mr. Singh has every right to smoke and this should be offered just as a piece of advice. The psychological conditions should be considered too before addressing the issue of quitting smoking for it to be effective in the long term. The right cues Recognizing and noticing cues and clusters is the fundamental basis of CR (Timmis, 2017).

Cues are the noticeable psychosocial or psychological changes a patient is experiencing and are perceived through assessment or history. The information is then analyzed and understood by comparing it to a specific body of philosophical beliefs, knowledge framework of maintenance and the surrounding clinical situation. Mr. Singh Cues include the acute chest pain, history with type II diabetes, hyperlipidemia and hypertension, anxiety and depression. However, from the patient background, the nurse was able to discover that Mr. Singh was having a medical history for hypertension, hyperlipidemia and diabetes type 2 and currently he was taking the prescription for anxiety and depression. Systems like Early Warning Scores (EWS) and Modified Early Warning Scores (MEWS) can utilize the physiological dimensions to trace victims prone to acute illness.

Right time Nurses encounter many complex and unpredictable contexts where they actively engross in numerous CR incidents each day for every patient in their maintenance. Time is therefore significant in CR (Ashley, 2015, 51). Singh was admitted to the emergency ward where careful examination can quickly be done. Nursing students should learn on how to synthesize realities and implications and create a decisive nursing diagnosis and select the best option among the available alternatives (Doyen, 2014). Before calling for the medical emergency team (MET), a nurse should acquire all cues and make a comparison to their decision framework. In the case of Mr. Singh, the nurse had gathered all the relevant information especially his background and taking the right action was now easier. The work defines decision making and collective decision along with the epidemiology of CHD in the United Kingdom.

It emphasized on Mr. Singh ABCDE methodical valuation and deliberated the supervision of Mr. Singh MI and chest pain. The paper also emphasized on the four phases of cardiac reintegration Mr. A. , Cooper, S. , Bogossian, F. and First2Act Investigators, 2016. An analysis of nursing students’ decision‐making in teams during simulations of acute patient deterioration. and Bradley, E. A process to assess clinical decision-making during human patient simulation: A pilot study.  Nursing Education Perspectives, 36(3), pp. Ashley, J. and Stamp, K. M. , Dochterman, J. M. M. and Wagner, C. Guenancia, C. , Stamboul, K. , Hachet, O. , Yameogo, V. , Garnier, F. R. Routine Primary PCI; Whether and When Necessary for the Management of NSTEMI—An Evidence Based Evaluation. World Journal of Cardiovascular Diseases, 5(12), p.

Pandor, A. , Pollard, D. and Timmis, A. High-sensitivity cardiac troponin at 3 hours: is the cat among the pigeons?. Sheik-Ali, S. , Ranjan, K. and Okoro, S. International journal of cardiology, 174(3), pp. Timmis, A. A single blood test to rule out myocardial infarction?. BMJ: British Medical Journal (Online), 350. Cramer, H. Steele, A. , Greenwood, M. and Desai, H. ABCDE assessment and the out-of-hospital cardiac arrest. Dental Update, 44(10), pp. Clinical Simulation in Nursing, 10(3), pp. e119-e127. Bliss, M. and Aitken, L. M. T. Y. , Mordiffi, S. Z. , Ang, S. and Paterson-Brown, L. Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital. Journal of Education and Training Studies, 5(6), pp. Walshe, N. , O’Brien, S. , Fagel, N. D. , op Reimer, W.