Medical-Surgical Nursing
CONCEPTS FOR INTERPROFESSIONAL COLLABORATIVE CARE
Based on the Donna Ignatavicius Legacy Framework & NCSBN Clinical Judgment Measurement Model (NCJMM)
MODULE 1: FOUNDATIONS OF CLINICAL JUDGMENT
Modern medical-surgical nursing relies heavily on evidence-based concepts and clinical judgment. As
pioneered by Ignatavicius, clinical judgment is the observed outcome of critical thinking and decision-
making. It is a dynamic, iterative process that requires a synthesis of nursing knowledge, pathophysiology,
and patient-centered contextual cues.
The NCSBN Clinical Judgment Measurement Model (NCJMM)
The National Council of State Boards of Nursing (NCSBN) introduced the NCJMM to assess a candidate's
ability to make safe clinical decisions, particularly within the Next-Generation NCLEX (NGN) framework.
This model translates abstract cognitive tasks into six distinct, sequential operational skills described
horizontally below:
1. Recognize 4. Generate 5. Take Action 6. Evaluate
2. Analyze Cues 3. Prioritize
Cues Solutions Outcomes
Link recognized cues
Hypotheses Implement the
Identify significant Identify expected highest-priority Assess the client's
to the client's clinical Evaluate risks and
data from multiple outcomes and interventions (Drug response compared
presentation and determine which
sources (Vital signs, evidence-based administration, client against the baseline
underlying possibility is the most
lab values, patient interventions to meet teaching, and expected
pathophysiology. urgent or likely.
statements). client needs. procedures). outcomes.
Concepts of Patient-Centered Interprofessional Care
Collaborative care involves a partnership between the patient, family, and the healthcare team. Core
concepts include:
• Safety: Minimizing risk of harm through system effectiveness and individual performance.
• Patient-Centered Care: Respecting patient preferences, values, and expressed needs.
• Interprofessional Collaboration: Joint communication and shared decision-making among
specialties.
• Informatics & Quality Improvement: Leveraging electronic records and data matrices to optimize
care outcomes.
Ignatavicius Medical-Surgical Nursing Reference Page 1 of 5
, MODULE 2: FLUID, ELECTROLYTE, AND ACID-BASE IMBALANCES
Fluid and electrolyte balance is essential to maintain homeostasis. Imbalances can occur in any setting and
frequently co-exist with acute chronic medical disorders. This section details the physiological disruptions
and nursing responsibilities associated with major serum electrolyte shifts.
Color-Coded Fluid & Electrolyte Matrix
The following matrix classifies critical electrolyte imbalances, mapping specific clinical cues to their
corresponding evidence-based nursing actions:
Clinical Manifestations (Recognize & Nursing Interventions (Take
Electrolyte Imbalance
Analyze Cues) Action)
Hypokalemia Generalized muscle weakness, hyporeflexia, Administer oral or IV
Serum K+ < 3.5 mEq/L thready peripheral pulses, constipation, potassium supplements.
paralytic ileus. Ensure continuous ECG
ECG: ST depression, inverted T waves, monitoring. Assess
prominent U waves. respiratory status and bowel
sounds.
Hyperkalemia Muscle twitching progressing to flaccid Administer IV Calcium
Serum K+ > 5.0 mEq/L paralysis, hyperactive bowel sounds, Gluconate (cardiac
diarrhea, numbness in extremities. protection), Regular Insulin +
ECG: Tall peaked T waves, prolonged PR Dextrose 50%, Sodium
interval, widened QRS. Polystyrene Sulfonate
(Kayexalate), or loop
diuretics.
Hyponatremia Neurobehavioral shifts, confusion, headache, Implement fluid restriction
Serum Na+ < 135 mEq/ generalized lethargy, skeletal muscle (if dilutional), administer
L weakness. Severe drops result in seizures, hypertonic saline (3% NaCl)
cerebral edema, and coma. slowly via central line with
strict neuro checks.
Hypernatremia Altered mental status, agitation, profound Administer hypotonic IV
Serum Na+ > 145 mEq/ thirst, dry sticky mucous membranes, fluids (0.45% NaCl or D5W),
L hyperreflexia, hallucinations. initiate seizure precautions,
monitor daily weights and
strict intake/output.
Ignatavicius Medical-Surgical Nursing Reference Page 2 of 5
CONCEPTS FOR INTERPROFESSIONAL COLLABORATIVE CARE
Based on the Donna Ignatavicius Legacy Framework & NCSBN Clinical Judgment Measurement Model (NCJMM)
MODULE 1: FOUNDATIONS OF CLINICAL JUDGMENT
Modern medical-surgical nursing relies heavily on evidence-based concepts and clinical judgment. As
pioneered by Ignatavicius, clinical judgment is the observed outcome of critical thinking and decision-
making. It is a dynamic, iterative process that requires a synthesis of nursing knowledge, pathophysiology,
and patient-centered contextual cues.
The NCSBN Clinical Judgment Measurement Model (NCJMM)
The National Council of State Boards of Nursing (NCSBN) introduced the NCJMM to assess a candidate's
ability to make safe clinical decisions, particularly within the Next-Generation NCLEX (NGN) framework.
This model translates abstract cognitive tasks into six distinct, sequential operational skills described
horizontally below:
1. Recognize 4. Generate 5. Take Action 6. Evaluate
2. Analyze Cues 3. Prioritize
Cues Solutions Outcomes
Link recognized cues
Hypotheses Implement the
Identify significant Identify expected highest-priority Assess the client's
to the client's clinical Evaluate risks and
data from multiple outcomes and interventions (Drug response compared
presentation and determine which
sources (Vital signs, evidence-based administration, client against the baseline
underlying possibility is the most
lab values, patient interventions to meet teaching, and expected
pathophysiology. urgent or likely.
statements). client needs. procedures). outcomes.
Concepts of Patient-Centered Interprofessional Care
Collaborative care involves a partnership between the patient, family, and the healthcare team. Core
concepts include:
• Safety: Minimizing risk of harm through system effectiveness and individual performance.
• Patient-Centered Care: Respecting patient preferences, values, and expressed needs.
• Interprofessional Collaboration: Joint communication and shared decision-making among
specialties.
• Informatics & Quality Improvement: Leveraging electronic records and data matrices to optimize
care outcomes.
Ignatavicius Medical-Surgical Nursing Reference Page 1 of 5
, MODULE 2: FLUID, ELECTROLYTE, AND ACID-BASE IMBALANCES
Fluid and electrolyte balance is essential to maintain homeostasis. Imbalances can occur in any setting and
frequently co-exist with acute chronic medical disorders. This section details the physiological disruptions
and nursing responsibilities associated with major serum electrolyte shifts.
Color-Coded Fluid & Electrolyte Matrix
The following matrix classifies critical electrolyte imbalances, mapping specific clinical cues to their
corresponding evidence-based nursing actions:
Clinical Manifestations (Recognize & Nursing Interventions (Take
Electrolyte Imbalance
Analyze Cues) Action)
Hypokalemia Generalized muscle weakness, hyporeflexia, Administer oral or IV
Serum K+ < 3.5 mEq/L thready peripheral pulses, constipation, potassium supplements.
paralytic ileus. Ensure continuous ECG
ECG: ST depression, inverted T waves, monitoring. Assess
prominent U waves. respiratory status and bowel
sounds.
Hyperkalemia Muscle twitching progressing to flaccid Administer IV Calcium
Serum K+ > 5.0 mEq/L paralysis, hyperactive bowel sounds, Gluconate (cardiac
diarrhea, numbness in extremities. protection), Regular Insulin +
ECG: Tall peaked T waves, prolonged PR Dextrose 50%, Sodium
interval, widened QRS. Polystyrene Sulfonate
(Kayexalate), or loop
diuretics.
Hyponatremia Neurobehavioral shifts, confusion, headache, Implement fluid restriction
Serum Na+ < 135 mEq/ generalized lethargy, skeletal muscle (if dilutional), administer
L weakness. Severe drops result in seizures, hypertonic saline (3% NaCl)
cerebral edema, and coma. slowly via central line with
strict neuro checks.
Hypernatremia Altered mental status, agitation, profound Administer hypotonic IV
Serum Na+ > 145 mEq/ thirst, dry sticky mucous membranes, fluids (0.45% NaCl or D5W),
L hyperreflexia, hallucinations. initiate seizure precautions,
monitor daily weights and
strict intake/output.
Ignatavicius Medical-Surgical Nursing Reference Page 2 of 5
