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 Covered NCSBN Covered
Categories in Case Clinical in Case
Study Judgment Study
Model
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 ✔
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https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
, Physiological Integrity Step 6: Evaluate Outcomes ✔
● Basic Care and Comfort ✔
● Pharmacological and ✔
Parenteral Therapies
● Reduction of Risk Potential ✔
● Physiological Adaptation ✔
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, 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:
1.) Age 1.) Older people (over age 65) are more likely to become severely ill or die of
2.) Hx of type two diabetes COVID-19
3.) Hx of hypertension 2.) History of chronic illnesses such as type two diabetes put this patient at a
4.) Patient’s symptoms higher risk of becoming severely ill
5.) Worsening nagging cough 3.) Hypertension is a common underlying condition that many COVID-19
6.) Shortness of breath upon exertion patients have in common
7.) Patient states they feel “anxious” 4.) Complaints of fatigue, headache, SOB, sweating and runny nose for the
symptom criteria for COVID-19
5.) Anxiety can make the situation much worse for the patient’s mental health
RELEVANT Data from Social History: Clinical Significance:
1.) Lives in a highly populated area 1.) There is a higher risk of contracting the virus if you live in a heavily
2.) 3000 confirmed cases of COVID-19 in the populated area
area he lives 2.) Higher case numbers mean more of a chance that John could catch the
3.) His wife is in contact with others as she virus
attends her local church group 3.) His wife may have had come into contact with someone that has been
infected at the church and could have brought back into the house, infecting
John.
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?
1.) Does john feel short of breath when he isn’t performing activities and just sitting idle?
2.) Has john recently taken his temperature?
3.) Has john been out interacting with others? (Friends and family)
4.) Has John
John losttohisbesense
needs testedofassmell
soonorastaste?
possible, preferably at the initiation of patient evaluation. He should be tested based o
5.) Has John experienced any diarrhea?
the fact that he is symptomatic, has a significant underlying condition (diabetes & hypertension), and is older than 60.
3. Based on the clinical data collected, identify what measures need to be immediately implemented using
the following clinical pathway.
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
, 4. What type of isolation precautions does the nurse need to implement if COVID-19 is suspected? What
specific measures must be implemented to prevent transmission?
Type of Isolation: Implementation Components:
At home self-isolation Must be kept out of areas where others
5. What are the six steps in the chain of infection? Apply what is known about COVID-19 to each step.
Six Steps: Coronavirus COVID-19:
1. pathogen COVID-19 aka the novel corona virus, is a never seen before strain of virus from the SARS
family. Scene test are still trying to learn more about this virus and are currently trying to
develop treatment for these patients.
2. reservoir A reservoir is considered the environment in which the pathogen lives, grows and multiplies.
Since the corona virus arose from bats, the reservoir is of animal nature. The corona virus also
makes it’s home within people (human reservoir), growing and multiplying. Eventually
spreading it from person to person via respiratory droplets.
3. portal of exit COVID-19 exits the host via respiratory droplets. When a person breathes in another person’s
respiratory droplets, the pathogen then enters the other person’s body. COVID-19 can also
possibly cross the placenta and infect the fetus of a pregnant women.
4. Means of COVID-19 is spread by “direct transmission”, aka direct contact with surfaces (wood, metal,
transmission plastic, food) that harbor the virus (then letting it enter your body touching your mouth, nose
and eyes without washing your hands), or breathing in droplets from an infected persons
respiratory tract when the breath, talk, sneeze or cough.
5.portal of entry The virus leaves the respiratory tract of an infected patient and the new host contracts the illness
also via the respiratory tract. (Mouth and nose)
6. New host Susceptibility of a host depends on many factors. In this case, people that are most suspect I’ve
are those who are over the age of 65, have chronic/underlying health conditions, are male, live
in nursing homes or crowed living conditions and those with suppressed immune systems.
7. Is this patient a susceptible host? What step in the chain of infection does proper isolation precautions
impact? Why?
This patient is a susceptible host due to the fact that he is older, has underlining medical conditions, and lives in a populated
area where the virus can be easily spread. The step in the chain that isolation impacts is #4, “means of transmission”. If the
patient isolates himself at home, the virus has a drastically less chance of being spread to other people. Since the virus is
spread via respiratory droplets, if this patient stays home and away from others in public, others will not be exposed to the
illness. It is hoped that after 14 days in isolation, the body will be able to recover and fight off the virus, and others will
remain uninflected by the individual.
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
(ED)
SKINNY Reasoning
John Taylor, 68 years old
Primary Concept
Infection/Immunity
Interrelated Concepts (In order of
emphasis)
● Clinical judgment
NCLEX Client Need Covered NCSBN Covered
Categories in Case Clinical in Case
Study Judgment Study
Model
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 ✔
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
, Physiological Integrity Step 6: Evaluate Outcomes ✔
● Basic Care and Comfort ✔
● Pharmacological and ✔
Parenteral Therapies
● Reduction of Risk Potential ✔
● Physiological Adaptation ✔
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
, 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:
1.) Age 1.) Older people (over age 65) are more likely to become severely ill or die of
2.) Hx of type two diabetes COVID-19
3.) Hx of hypertension 2.) History of chronic illnesses such as type two diabetes put this patient at a
4.) Patient’s symptoms higher risk of becoming severely ill
5.) Worsening nagging cough 3.) Hypertension is a common underlying condition that many COVID-19
6.) Shortness of breath upon exertion patients have in common
7.) Patient states they feel “anxious” 4.) Complaints of fatigue, headache, SOB, sweating and runny nose for the
symptom criteria for COVID-19
5.) Anxiety can make the situation much worse for the patient’s mental health
RELEVANT Data from Social History: Clinical Significance:
1.) Lives in a highly populated area 1.) There is a higher risk of contracting the virus if you live in a heavily
2.) 3000 confirmed cases of COVID-19 in the populated area
area he lives 2.) Higher case numbers mean more of a chance that John could catch the
3.) His wife is in contact with others as she virus
attends her local church group 3.) His wife may have had come into contact with someone that has been
infected at the church and could have brought back into the house, infecting
John.
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?
1.) Does john feel short of breath when he isn’t performing activities and just sitting idle?
2.) Has john recently taken his temperature?
3.) Has john been out interacting with others? (Friends and family)
4.) Has John
John losttohisbesense
needs testedofassmell
soonorastaste?
possible, preferably at the initiation of patient evaluation. He should be tested based o
5.) Has John experienced any diarrhea?
the fact that he is symptomatic, has a significant underlying condition (diabetes & hypertension), and is older than 60.
3. Based on the clinical data collected, identify what measures need to be immediately implemented using
the following clinical pathway.
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
, 4. What type of isolation precautions does the nurse need to implement if COVID-19 is suspected? What
specific measures must be implemented to prevent transmission?
Type of Isolation: Implementation Components:
At home self-isolation Must be kept out of areas where others
5. What are the six steps in the chain of infection? Apply what is known about COVID-19 to each step.
Six Steps: Coronavirus COVID-19:
1. pathogen COVID-19 aka the novel corona virus, is a never seen before strain of virus from the SARS
family. Scene test are still trying to learn more about this virus and are currently trying to
develop treatment for these patients.
2. reservoir A reservoir is considered the environment in which the pathogen lives, grows and multiplies.
Since the corona virus arose from bats, the reservoir is of animal nature. The corona virus also
makes it’s home within people (human reservoir), growing and multiplying. Eventually
spreading it from person to person via respiratory droplets.
3. portal of exit COVID-19 exits the host via respiratory droplets. When a person breathes in another person’s
respiratory droplets, the pathogen then enters the other person’s body. COVID-19 can also
possibly cross the placenta and infect the fetus of a pregnant women.
4. Means of COVID-19 is spread by “direct transmission”, aka direct contact with surfaces (wood, metal,
transmission plastic, food) that harbor the virus (then letting it enter your body touching your mouth, nose
and eyes without washing your hands), or breathing in droplets from an infected persons
respiratory tract when the breath, talk, sneeze or cough.
5.portal of entry The virus leaves the respiratory tract of an infected patient and the new host contracts the illness
also via the respiratory tract. (Mouth and nose)
6. New host Susceptibility of a host depends on many factors. In this case, people that are most suspect I’ve
are those who are over the age of 65, have chronic/underlying health conditions, are male, live
in nursing homes or crowed living conditions and those with suppressed immune systems.
7. Is this patient a susceptible host? What step in the chain of infection does proper isolation precautions
impact? Why?
This patient is a susceptible host due to the fact that he is older, has underlining medical conditions, and lives in a populated
area where the virus can be easily spread. The step in the chain that isolation impacts is #4, “means of transmission”. If the
patient isolates himself at home, the virus has a drastically less chance of being spread to other people. Since the virus is
spread via respiratory droplets, if this patient stays home and away from others in public, others will not be exposed to the
illness. It is hoped that after 14 days in isolation, the body will be able to recover and fight off the virus, and others will
remain uninflected by the individual.
This study source was downloaded by 100000808701186 from CourseHero.com on 02-01-2022 10:57:16 GMT -06:00
https://www.coursehero.com/file/63927299/STUDENT-COVID-19-SKINNY-Reasoning-Part-1-copydocx/
