NUR 4153-Deliverable 3-Clinical Reasoning Appropriate for the Situation

According to Dr. Campbell-O’Dell, during the live class, a hypothesis is a plan of action. When creating an idea, we use the four modes of inquiry: empirical, ethical, aesthetic, and sociopolitical. By implementing these modes, it helps to develop the integration of the different methods of investigation. In this scenario, the nurse’s specific plan of action follows those four modes of inquiry (Doane & Varcoe, 2014). Hire our assignment writing services in case your assignment is devastating you.

Empirical

 In this scenario, empirical data was presented upon observation of an 82- year old elderly patient with acute confusion and labored breathing patient has been a two-pack-a-day smoker for 58 years and is a type 1 diabetic. The neighbor reports the Patient had an episode of nausea and vomiting earlier in the week, and tonight vomited up fresh blood and became dizzy. The Patient appears unkempt, with matted hair, food-stained clothing, and a heavy cigarette smell. The assessment data is as follows: blood pressure 178/98, heart rate 84 beats per minute, oxygen saturation 84, temperature 101.8 degrees Fahrenheit, and hyperactive bowel sounds in all four quadrants. The Patient also has an open wound on the bottom of the right foot. Based on the Patient’s assessment data, the hypothesis could be that the patient has chronic bronchitis, as evidenced by fresh blood in vomit and low oxygen saturation with a history of smoking. Possible bronchitis and smoking have contributed to the severe inflammation of the airway and blood in vomit due to punctured capillaries in the lung; the forced breathing results from the low O2 saturation. This Patient shows evidence of failure to maintain/follow the medication regime, resulting in uncontrolled blood pressure and diabetes, leading to peripheral neuropathy, contributing to the wound on the right foot.

Minor injuries usually go unnoticed until they develop into more severe injuries due to the damaged nerve endings caused by type 1 diabetes (Donges et al., 2019).

Based on these findings’ Patient would need a chest x-ray, labs drawn, ABGs, and blood cultures to rule out or confirm sepsis and blood glucose levels checked and monitored as this could contribute to the Patient’s confusion. Patient would need supplemental O2 to increase O2 sats to a safe level; consult with WOC to evaluate an open wound on the right foot’s bottom. Admission due to acute confusion, ineffective breathing pattern, self-care deficit/failure to thrive, and medication regime noncompliance. Ethical

82- year elderly Patient arrives at the ER with acute confusion, labored breathing -O2 sat in the low 80s, and an open wound on the bottom of the right foot, dirty with the heavy odor of smoke. The ethical mode of inquiry is that the staff is violating the code of conduct in the emergency room (ER) from observation from the case study that the Patient is having a heavy smell of smoke, which indicates that the Patient might be smoking in the ER and yet no one asked her to stop smoking in the hospital premises. As nurses, we must use a humanistic approach when faced with challenges to meet patients’ needs. In this scenario, reaching out to next of kin or locating a health care surrogate to aid in assistance best for the Patient. Ethical conflicts also may arise when there are financial barriers between our view and the best possible medical care; patients’ chart shows that Medicaid only insinuates patients may have issues paying for treatment. Placing physicians in the ethical dilemmas of their professional and ethical obligations; therefore, working with a social worker to find the best health coverage for her socioeconomic status is essential.

Sociopolitical

 The 82-year-old female who lives alone arrives at the emergency department and appears frail, with labored breathing, elevated BP, and acute confusion, with obvious signs of failure to thrive. The patient’s hair is matted, and she is clothed in a dirty, food-stained robe with a heavy odor of cigarettes’ The husband was recent admission to long-term care; the Patient has no help at home with respect. Based on the sociopolitical mode of inquiry, the hypothesis could be that the Patient has a poor income source as the provider points out the Patient only has Medicaid as health insurance ( a government-supported program that supports individuals’ health care expenses of individuals with poor source of income.) Also, given in the data, the husband has Alzheimer’s and has been admitted to LTC. Indicating that she no longer has his payment, which reduces the overall income, making it very low and unable to meet expense