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 NCSBN Clinical Covered in
Case Study Judgment Model 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
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
, 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:
Diabetes, Hypertension, headache, -increased risk for complication due to
runny nose , feeling more Diabetes II and hypertension
weak,achy all over, Cluster -could be COVID 19
symptom of COVID 19 -deal with therapeutically and don't give false assurances
Nagging cough -
patient was
anxious difficulty
breathing,
RELEVANT Data from Social History: Clinical Significance:
lives in Large metropolitan area, -wife puts her in danger of Covid infection.
over 3000 active cases , wife active - lives in crowed place
in his local church -test for COVID stat
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?
have you expose to any one who has COVID?, are you experiencing lost of smell or taste?, how
long you have been having the symptom?,
is your wife showing any symptom?, did you had your yearly influenza immunization?, Do you
smoke ? what medications do you take at home?. Contact tracing: places and people you
visited when you were having the symptom?, Do you follow social distancing?.
3. Based on the clinical data collected, identify what measures need to be immediately implemented using
the following clinical pathway.
test for COVID, Precaution: Provide mask to patient, Isolate the patient , Check vitals .
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
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 NCSBN Clinical Covered in
Case Study Judgment Model 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
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
, 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:
Diabetes, Hypertension, headache, -increased risk for complication due to
runny nose , feeling more Diabetes II and hypertension
weak,achy all over, Cluster -could be COVID 19
symptom of COVID 19 -deal with therapeutically and don't give false assurances
Nagging cough -
patient was
anxious difficulty
breathing,
RELEVANT Data from Social History: Clinical Significance:
lives in Large metropolitan area, -wife puts her in danger of Covid infection.
over 3000 active cases , wife active - lives in crowed place
in his local church -test for COVID stat
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?
have you expose to any one who has COVID?, are you experiencing lost of smell or taste?, how
long you have been having the symptom?,
is your wife showing any symptom?, did you had your yearly influenza immunization?, Do you
smoke ? what medications do you take at home?. Contact tracing: places and people you
visited when you were having the symptom?, Do you follow social distancing?.
3. Based on the clinical data collected, identify what measures need to be immediately implemented using
the following clinical pathway.
test for COVID, Precaution: Provide mask to patient, Isolate the patient , Check vitals .
© 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the
prior written permission of KeithRN
