Critical Thinking in Nursing Practice Case Study



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Case Study Discussion #1

Carla is a third-year nursing student assigned to a surgical nursing unit. Mr. Javier Ramirez is a 55-year-old construction worker, admitted to the unit after falling off scaffolding on a construction site. His x-ray films revealed a right fractured femur and right wrist fracture. An abdominal computed tomography (CT) scan shows bruising of the liver. Mr. Ramirez has not been hospitalized in the past. When he first meets Carla, he is very quiet and asks a few questions.
  • What reasons might there be for Mr. Ramirez to be so quiet and ask so few questions?
  • What kinds of responsibilities might Carla have when caring for Mr. Ramirez?
  • Do you think that because Mr. Ramirez is “very quiet and asks a few questions,” he will be easy for Carla to care for?

Case Study Discussion #2

Mr. Ramirez’s leg is in skeletal traction, and his right arm is in a soft cast. Carla decides that she needs to begin her care by assessing Mr.Ramirez and determining his health status. She begins by reviewing his medical history She learns that he has a history of smoking and was diagnosed with type 2 diabetes just 5 years ago
Here we find out a little more about the patient, Mr. Ramirez, and how Carla will care for him.

  • What are the questions that a nurse should ask when caring for a patient? Let’s review them now: What is the patient’s status now?
  • How might it change and why?
  • Which physiological and emotional responses do I anticipate? What do I know to improve the patient’s condition?
  • In which way will specific therapies affect the patient?
  • What should be my first action?
  • Note that Carla decides that she will begin caring for Mr. Ramirez by assessing his health status. Do you think Carla is making the right decision? WHY?

Case Study Discussion #3

Carla knows that Mr. Ramirez is likely to be in pain because he is reluctant to move and take part in any activity. Her options include conducting a thorough pain assessment and learning how Mr. Ramirez feels about his pain. She must also be culturally sensitive and consider how Mr. Ramirez’s Hispanic heritage may influence response to pain. Carla will then take what she learns and use pain control therapies that Mr. Ramirez will be likely to accept.

We just introduced the nursing process, a five-step clinical decision-making approach: assessment, diagnosis, planning, implementation, and evaluation

  • Do you think Carla is following this process? Back up your answer based on what you have read

Case Study Discussion #4

When Carla notices that Mr. Ramirez is slow to respond to her questions, grimaces when shifting weight on his back, and is reluctant to have a bed bath, her critical thinking leads to the inference that Mr. Ramirez is in pain. Carla decides to assess the situation more thoroughly by asking Mr. Ramirez specific questions about his comfort, such as, “Tell me if you are hurting,” “Show me where the pain is located,” and “Is this pain you have felt before?

  • What does Carla notice about Mr. Ramirez in this case study?
  • What does Carla infer from Mr. Ramirez’s behavior?
  • How does Carla’s decision to ask Mr. Ramirez specific questions fit in with your understanding of clinical decision making?
  • Which of the 11 attitudes (found in Potter TABLE 15-3) would you say Carla is exhibiting?
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