Novel Coronavirus Disease (COVID-19)
Part II: Admission to MedSurg
Unfolding Reasoning
John Taylor, 68 years old
Primary Concept
Immunity/Gas Exchange
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Communication
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
, Part: II: Admitted to Med/Surg
John Taylor is stabilized in the emergency department and will be admitted
to your Med/Surg unit for observation with a diagnosis of COVID-19. You
receive the following SBAR report in preparation to assume care:
SBAR Handoff to MedSurg Nurse:
Situation:
Name/age: John Taylor is a 68-year-old African-American male
BRIEF summary of primary problem: He presented to the emergency department 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.
Background:
Primary problem/diagnosis: positive for COVID-19
RELEVANT past medical history: hypertension and type II diabetes
Code status: Full code
Assessment:
Most recent vital signs:
• T: 100.6 F/38.8 C (oral)
• P: 112 (regular)
• R: 18 (regular)
• BP: 142/84 MAP: 103
• O2 sat: 93% 2 liters n/c
RELEVANT body system nursing assessment data:
GENERAL SURVEY: Appears anxious, body tense and is sitting upright in bed
RESPIRATORY: Breath sounds fine dry crackles bilat. with diminished aeration on inspiration and expiration in all lobes
anteriorly, posteriorly, and laterally, non-labored respiratory effort, episodic non-productive cough
RELEVANT lab values:
• WBC: 3.5/ Neuts: 84%/ Lymphs: 11%/ Bands: 5%
• Creat: 1.10
• Influenza: Neg/ COVID-19: Pos/ Lactate (Ven): 2.1
How have you advanced the plan of care? I have maintained strict contact and droplet precautions and have been
closely monitoring his vital signs and respiratory status.
Patient response: John understands his current condition and his questions have been answered. He presented to the
emergency department on room air and was 92%, but his O2 sat dropped slightly in the last hour to 91%. He was placed
on 2 L per nasal cannula and his O2 sat has been consistently 93% with no shortness of breath at rest.
INTERPRETATION of current clinical status (stable/unstable/worsening):
His current condition is stable.
Recommendation:
Suggestions to advance the plan of care: John will require ongoing monitoring and assessment of his vital signs
and respiratory status to identify changes if he begins to decline.
© 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
Part II: Admission to MedSurg
Unfolding Reasoning
John Taylor, 68 years old
Primary Concept
Immunity/Gas Exchange
Interrelated Concepts (In order of emphasis)
• Clinical judgment
• Communication
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
, Part: II: Admitted to Med/Surg
John Taylor is stabilized in the emergency department and will be admitted
to your Med/Surg unit for observation with a diagnosis of COVID-19. You
receive the following SBAR report in preparation to assume care:
SBAR Handoff to MedSurg Nurse:
Situation:
Name/age: John Taylor is a 68-year-old African-American male
BRIEF summary of primary problem: He presented to the emergency department 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.
Background:
Primary problem/diagnosis: positive for COVID-19
RELEVANT past medical history: hypertension and type II diabetes
Code status: Full code
Assessment:
Most recent vital signs:
• T: 100.6 F/38.8 C (oral)
• P: 112 (regular)
• R: 18 (regular)
• BP: 142/84 MAP: 103
• O2 sat: 93% 2 liters n/c
RELEVANT body system nursing assessment data:
GENERAL SURVEY: Appears anxious, body tense and is sitting upright in bed
RESPIRATORY: Breath sounds fine dry crackles bilat. with diminished aeration on inspiration and expiration in all lobes
anteriorly, posteriorly, and laterally, non-labored respiratory effort, episodic non-productive cough
RELEVANT lab values:
• WBC: 3.5/ Neuts: 84%/ Lymphs: 11%/ Bands: 5%
• Creat: 1.10
• Influenza: Neg/ COVID-19: Pos/ Lactate (Ven): 2.1
How have you advanced the plan of care? I have maintained strict contact and droplet precautions and have been
closely monitoring his vital signs and respiratory status.
Patient response: John understands his current condition and his questions have been answered. He presented to the
emergency department on room air and was 92%, but his O2 sat dropped slightly in the last hour to 91%. He was placed
on 2 L per nasal cannula and his O2 sat has been consistently 93% with no shortness of breath at rest.
INTERPRETATION of current clinical status (stable/unstable/worsening):
His current condition is stable.
Recommendation:
Suggestions to advance the plan of care: John will require ongoing monitoring and assessment of his vital signs
and respiratory status to identify changes if he begins to decline.
© 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
