AGNP BOARD EXAM GASTROENTEROLOGY PRESCRIPTION (2020)

Part I: Emergency Department (ED) SKINNY Reasoning John Taylor, 68 years old Primary Concept Infection/Immunity Interrelated Concepts (In order of emphasis) ● Clinical judgment 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 ● Physiological Adaptation Initial Triage Assessment in ED Present Problem: John Taylor is a 68-year-old African-American male with a history of type II diabetes and hypertension who came to the emergency department (ED) triage window because he felt crummy; complaining of a headache, runny nose, feeling more weak, “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 worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom. 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 metropolitan area that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years and is 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: current symptomatology: headache, runny nose, malaise, generalized weakness, muscle aches, fever and sweating, shortness of breath with exertion, anxiety, worsening nagging cough. Signs and symptoms may be indicative of COVID-19 but also match a variety of other ailments, anxiety could be contributing to shortness of breath. Uncontrolled diabetes may account for some symptoms RELEVANT Data from Social History: Clinical Significance: Active in church community, from large metropolitan area with confirmed cases of COVID-19 Indicates that client may have had exposure to COVID-19 2. What additional clarifying questions does the triage nurse need to ask John to determine if his cluster of physical symptoms are consistent with COVID-19? 3. Based on the clinical data collected, identify what measures need to be immediately implemented using the following clinical pathway. Test for COVID-19 immediately, remain in home isolation if possible until results are confirmed negative, individual has been afebrile without use of antipyretics for 72 consectuive hours, symptoms have improved, and it has been at least 7 days since symptom onset. Any recent travel? Known exposure to someone who has tested positive for COVID-19 within the last 14 days? The patient is a susceptible host due to his age and multiple chronic conditions. Proper isolation reduces transmission of the agent between hosts. John is brought back to a room. As the nurse responsible for his care, you collect the following clinical data: 4. What type of isolation precautions does the nurse need to implement if COVID-19 is suspected? What specific measures