NUR 4153-Deliverable 5-Clinical Judgment is a Dynamic Process

Relational inquiry is a well-thought-out, skilled activity that calls for relational orientation, a solid knowledge basis, sophisticated inquiry, observational and analytical abilities, and strong clinical skills, including clinical judgment, decision-making, and clinical competence (Doane, G, H., & Varcoe, C., 2020). Nursing practice is guided by relational inquiry to enable efficient clinical decision-making that will promote and maximize each patient’s health and well-being. Each person must consider how each clinical choice will be impacted by the interactions of the intrapersonal, interpersonal, and environmental dimensions and how each choice would possibly alter those outcomes. I will be using relational inquiry in a circumstance and analyzing how it was used to direct my nursing care and problem-solving to understand better how it operates.

In addition to Type II DM, COPD with O2 dependence, essential main HTN, peripheral neuropathy, neurogenic bladder with a foley catheter, and recurrent UTIs, 76-year-old Robert lives in a skilled care home. According to my CNAs, working my first-week shift on a Monday, he refused to get out of bed for breakfast this morning. Robert was not one to skip meals, so this instantly made me aware of the situation. The CNAs did not notice anything else odd about him then, so I carried on down my current path and rounded on the remainder of my residents.

I noticed that Robert seemed more tired than usual when I attempted to give him his morning pills. I quickly checked to ensure Robert’s O2 concentrator was operating correctly and that the NC’s prongs were appropriately positioned on him. I measured the following vital signs (VS): BP 132/88, temp 97.4, pulse 118, O2 sat 84 percent on 2 LPM through NC, RR 20, CBG 128. When I verified these data and noticed that his O2 saturation had not improved, I raised his flow rate to 4 LPM. As a result, his O2 saturation climbed to 94 percent, and his heart rate fell to 112. According to a respiratory examination, lung sounds to the anterior bilateral lobes were decreased. According to my evaluation, Robert was aware and oriented X2 (to person and location), which was outside his baseline. His arms’ skin also had a cold, clammy feeling about it.

I immediately told the doctor about the change in his health state and my observations. The doctor and I agreed that a UTI or pneumonia should be the first thing we rule out. The doctor gave me the following directives: Give Rocephin 2 gm through IM Injection once today. Chest x-ray 2-view PA and LAT, Lab for CBC with diff, UA with C&S to be collected via a direct catheter after obtaining all necessary lab specimens, provide.

To prevent flora from Robert’s urine from being contaminated, the Foley catheter was replaced before collecting the urine sample. Some would object that replacing the Foley catheter could spread new or more germs to the region; however, this was done following facility practice, and if the catheter had been in place for more than 14 days, it should have been replaced before specimen collection (Centers for Disease Control and Prevention [CDC], 2021).

The urine sample was brought to the lab, the resident was taken to the neighborhood hospital for lab work, and a chest x-ray, and the Rocephin was given after returning to the Nursing facility.

The resident remained afebrile during the shift, and the doctor and I agreed that we were safe keeping him in the facility as long as he did not develop a temperature and his symptoms did not become worse. The next day, when I returned for my shift, Robert was the same as the day before, less alert and lucid than usual but still receptive and easily stimulated by verbal cues. He also refused to get out of bed for meals, and his intake remained low. His O2 requirements remained excessive, increasing from the typical 2 LPM to 4 LPM, and his lung sounds did not alter from yesterday. His blood pressure was a little lower than usual today, and the first rounds of VS at 7:00 were as follows: BP 120/84, temperature 97.7, pulse 111, RR 18, and O2 at 4 LPM through NC were all within normal ranges. At 8:00 a.m., the resident doctor phoned to check on Robert. She offered the following instructions once I transmitted the information to her: Azithromycin 500 mg PO once more, followed by 250 mg PO three more times daily. Three more days of Rocephin 1 GM through IM INJ QD. The fresh orders were started right away and carried out as directed. I was reassembling the Rocephin when one of my assistants remarked that I seemed a little troubled. She inquired what was happening, and I replied that I was growing worried since Robert was not getting better despite being on two antibiotics.

VS at 1030: BP 112/80, Temp 97.98, Pulse 110, RR 18, O2 sat 93 percent on 4 LPM through NC; despite our treatments, his blood pressure continued