N6316 Internship for Generalist in Nursing Practice

Clinical Post-Work Week 1 – Critical Thinking and Clinical Reasoning

1. List the two goals you had for the week and evaluate your achievement of the goals-explore
areas you and your preceptor determine that need further improvement.

Goal 1: Assess one situation where critical reasoning/thinking was used during
my clinical experience
Evaluation: One situation where I applied critical reasoning was during the
assessment of my patient presenting with chest pain. In this scenario,
critical thinking was crucial for differentiating between various
potential causes, such as a myocardial infarction, angina, pulmonary
embolism, or non-cardiac causes like GERD.
I gathered comprehensive patient history, conducted a thorough
physical examination and interpreted diagnostic tests like ECGs and
blood tests. I also considered risk factors such as age, family history
and lifestyle, in this case, his alcohol abuse.

Goal 2: Achieve proficiency in performing at least 5 specific cardiac-related

clinical skills (E.g., EKG interpretation, administration of cardiac
medications)
Evaluation: I was able to perform and perfect cardiac auscultation, understanding
and managing hemodynamic parameters, such as blood pressures,
heart rate, oxygen saturation, cardiac output, and administering
cardiac medications. My preceptor suggested I continue with further
improvement in EKG interpretations since we didn’t get to take a look
at a lot of ECG strips during clinical week 1.

2. Thinking of your clinical experience this week, answer the following regarding the 1 patient
that had the most impact on you.
Question
Describe the patient briefly.
Include identification of the
● main medical problem
● system impacted
● main nursing diagnosis
Define the anatomy, physiology
and function of the impacted
system (1 credible source cited)
Identify how the normal process
is being disrupted in relation to
your patient’s current problem.
Patient 1
50-year-old male patient presented to the Carle health
Procter ER with the primary medical concern that appears to
be chest pain, potentially associated with his history of
ascending aortic dilatation, now observed as an ascending
thoracic aortic aneurysm measuring 4.5 cm. Other past
medical history of anxiety, depression, GERD, gout,
hyperlipidemia, class 3 obesity, right total hip replacement.
Patient expressed that he quit drinking 5 days ago and has
had suicide ideations but has no plan and is not trying to
harm himself.
The cardiovascular system is primarily impacted,
considering the aortic aneurysm and chest pain.
The main nursing diagnosis could be Acute Pain related to
the cardiovascular pathology and Risk for Injury related to
the potential for aortic rupture or dissection.
The Medical diagnosis per physician was “Chest pain
syndrome”
The cardiovascular system consists of the heart, blood
vessels, and blood. It is responsible for circulating blood
throughout the body, delivering oxygen and nutrients to
tissues, and removing waste products. The aorta, the largest
artery in the body, originates from the left ventricle of the
heart and distributes oxygen-rich blood to all other arteries.
An aortic aneurysm is an abnormal bulge in the wall of the
aorta, which can lead to its rupture if it becomes too large,
causing life-threatening bleeding or sudden death (Marieb &
Hoehn, 2018).

What were the contributing
factors and/or risk factors in
relation to your patient’s current
problem? Provide a description
of how these factors are related.
Identify the disciplines that were
part of the patient care team
(ex/Cardiology, Neurology,
Physical Therapy, Chaplain).
What did they contribute to the
patient’s care? (ex/labs,
medications, assessment
monitoring)
In this patient, the normal function of the cardiovascular
system is disrupted by an ascending thoracic aortic
aneurysm. The dilatation of the aorta poses a risk of rupture,
which can lead to internal bleeding, reduced blood flow to
vital organs, and potentially fatal outcomes. His chest pain
could be related to the aneurysm, although the cardiac
catheterization did not show obstructive coronary artery
disease (CAD).
1. History of Ascending Aortic Dilatation: Predisposes the
patient to the development of an aortic aneurysm.
2. Hypertension (implied by LVH on EKG): Increases the
risk of aortic aneurysm expansion and rupture.
3. Class 3 Obesity and Hyperlipidemia: These are risk
factors for atherosclerosis, which can weaken the aortic
wall.
4. Alcohol Use and Recent Cessation: Alcohol withdrawal
could contribute to the patient's symptoms, including chest
pain and potential cardiovascular stress.
Patient Care Team Disciplines:
1. Cardiology: Conducted the cardiac catheterization,
manages the aortic aneurysm, and oversees cardiovascular
treatment.
2. Hospitalist/Internal Medicine: Manages overall medical
care, addresses risk factors, and coordinates with other
specialties.
3. Psychiatry: Due to the patient's expressed suicidal
ideations, mental health assessment and management are
crucial.
 4. Nutrition/Dietetics: Given the patient's class 3 obesity
and hyperlipidemia, dietary management is essential.
5. Physical Therapy: May be involved in managing mobility
issues post hip replacement and in overall physical health
improvement.
6. Chaplain/Psychosocial Support: Addresses emotional and
spiritual needs, especially considering the patient's recent
attempts at quitting alcohol and expressed suicidal
ideations.

Contributions to Patient’s Care:

- Labs and Medications: Regular monitoring of blood

parameters, adjusting medications for his various conditions
including cardiac, psychiatric, and metabolic issues.
- Assessment and Monitoring: Regular physical exams,
monitoring of vital signs, and assessment of pain, mental
status, and cardiac function.
- Psychiatric Evaluation: Assessment of mental health,
management of depression, anxiety, and suicidal ideations.
- Dietary Consultation: Tailored dietary advice to manage
obesity and hyperlipidemia.
- Physical Therapy: Rehabilitation and mobility exercises
post hip surgery and to improve overall physical health.
- Emotional and Spiritual Support: Offering support and
counseling to address emotional and spiritual well-being.

Evaluate the team’s The involvement of multiple disciplines (Cardiology,

communication and interaction. Psychiatry, Hospitalist, Nutrition/Dietetics, Physical
Give examples of what Therapy, Chaplain/Psychosocial Support) suggests a
contributed to your evaluation. multidisciplinary approach. This implies a level of

3. Describe an issue you encountered this week.
Explain the issue
What evidence or information
sources did you have or utilize to includes: Clinical guidelines and protocols, pharmacology
investigate the issue?
coordination and communication necessary to manage the
complex needs of the patient. For example, the timely
referral to Psychiatry following the patient's expression of
suicidal ideations indicates effective communication
between the nursing staff and the psychiatric team.
Also, the comprehensive assessment of the patient, from
cardiac evaluation to psychosocial aspects, indicates that
there was effective sharing of patient information among
team members. This is crucial for a holistic approach to
patient care. The decision to proceed with cardiac
catheterization, for instance, likely involved sharing
information about the patient's cardiac history and current
symptoms among the cardiology and Hospitalist teams.
The issues I encountered this week was the challenge of
managing complex cardiac medications, and managing
medication schedules on top of other nursing responsibilities.
Information sources and types of evidence typically utilized
textbooks and databases, educational materials from my
nursing program, peer-reviewed journals, professional nursing
organizations, clinical experience and case studies,
mentorship and supervisory feedback, continuing education
course. These resources collectively contribute to
understanding the complexities of cardiac medication
management and provides a framework for developing the
necessary skills and knowledge in this area.
 What influence did your
assumptions/point of view or
that of the other team members
provide?
practice, assumptions about intern preparedness, safety and
risk management perspective, interdisciplinary collaboration
viewpoint, assumptions about learning styles, perspective on
patient education. Each of these perspectives and assumptions
play a role in shaping the approach to managing and
supporting clinical nurse interns in a cardiac unit. Balancing
these viewpoints is crucial to provide a comprehensive, safe,
and effective learning environment for new nurses.

What is your position on the
issue and explain your
hypothesis
My position is that with adequate training, mentorship, and a
supportive learning environment, I can successfully overcome
the challenges of managing complex cardiac medications,
ultimately leading to improved patient care and safety in
cardiac units.

What conclusions and related
outcomes did you arrive at?
In conclusion, addressing the challenges faced by nurse
interns in cardiac medication management through targeted
training, mentorship, and a supportive environment not only
enhances their professional development but also significantly
improves patient care and safety in cardiac units.

4. Reflection – Provide at least 1 resource utilized to complete these questions

Reflection A: Analyze your critical thinking and clinical reasoning skills. You may need to
start with the definitions.

- Critical Thinking: This is the ability to think clearly and rationally, understanding the logical
connection between ideas. In nursing, it involves gathering information, analyzing it objectively,
considering various perspectives, and reaching a conclusion that guides actions (Schub &
Karakashian, 2018).

- Clinical Reasoning: This refers to the cognitive process that is necessary to evaluate and
manage a patient’s medical condition. It involves interpreting patient data, making decisions
about the necessary care, and implementing and evaluating the chosen interventions (Schub &
Karakashian, 2018).

I demonstrated critical thinking by methodically collecting and interpreting relevant information

about the challenges faced by nurse interns, particularly in cardiac medication management. I
incorporated perspectives from different healthcare team members and considered various
educational and practical aspects of nursing in a cardiac unit. Utilizing reputable sources, such as
clinical guidelines and pharmacology databases, reflects an evidence-based approach in critical
thinking.

Reflection B: Why is critical thinking and critical reasoning so important in patient care?

Critical thinking and clinical reasoning are vital in patient care for several reasons:

1. Ensuring Patient Safety: These skills are crucial in avoiding errors, especially in complex
situations like medication management in cardiac care. They enable nurses to assess risks and
make decisions that prioritize patient safety.

2. Quality of Care: Critical thinking leads to more informed and effective decision-making,
directly impacting the quality of care provided to patients. It allows for more personalized,
patient-centered care plans.

3. Problem-Solving: In healthcare, unexpected situations often arise. Critical thinking and

clinical reasoning enable nurses to quickly analyze these situations and find effective solutions.

4. Adaptability to Change: The healthcare environment is constantly evolving. These skills are
necessary for nurses to adapt to new technologies, treatments, and protocols, ensuring that they
provide the most up-to-date care.
5. Interprofessional Collaboration: Effective patient care often requires collaboration among
various healthcare professionals. Critical thinking and clinical reasoning facilitate better
communication and collaboration, ensuring that all perspectives are considered in patient care.

In conclusion, critical thinking and clinical reasoning are indispensable in nursing, as they
underpin the ability to provide safe, effective, and high-quality patient care. These skills enable
nurses to navigate the complexities of healthcare, make informed decisions, and adapt to the
ever-evolving nature of the medical field (Schub & Karakashian, 2018).
 References

Schub, E., & Karakashian, A. L. (2018). Critical thinking: The nursing process and
competent patient care. Cinahl Information Systems.

Marieb, E. N., & Hoehn, K. (2018). Human anatomy & physiology, 11th ed. Pearson.