Order Description
Case Study Discussion #5

Before Carla begins her questions, she repositions Mr. Ramirez to make him more comfortable. As she does so, she observes an area of redness over his left heel. Redness could be due to inflammation or pressure on the skin. Carla palpates the area, noting that it is tender to touch and warm.
She asks Mr. Ramirez if he has been moving his leg much, and he says, “No, I haven’t. I am afraid I will hurt my other leg.” These initial findings imply that excess pressure is being applied to the heel.
•What discovery does Carla make as she is helping to reposition Mr. Ramirez?
•What knowledge does Carla possess that helps her in this part of the assessment?
•We know that every patient a nurse cares for will not have the exact same health status and needs. How does a nurse prepare to meet the challenge of each new patient’s care needs?
Case Study Discussion #6
Carla gently applies pressure to the area with her finger and notes that after pressure is released, the area does not blanch or turn white, a key sign of excess pressure. She thinks about what she knows about normal skin integrity, the effect of immobility, and the effects of pressure on the skin. The information she collects leads her to determine that Mr. Ramirez has an early-stage pressure ulcer. The nursing diagnosis would be “Impaired skin integrity.”
Review the five steps of the nursing process clinical decision-making approach—assessment, diagnosis, planning, implementation, and evaluation—and the 11 attitudes that a nurse will need (TABLE 15-3)—confidence, independence, fairness, responsibility, risk taking, discipline, perseverance, creativity, curiosity, integrity, and humility.
•How would you rate Carla as to her competencies at each step of the nursing process?
Carla is clearly showing curiosity. What other attitudes and competencies is Carla displaying or using?
Case Study Discussion #7
?Carla continues to gently encourage Mr. Ramirez to describe any symptoms or sensations that he is experiencing. He tells Carla that he does have pain in his stomach. Carla asks him to place his hand over the area of discomfort. Mr. Ramirez places his hand over the lower right quadrant of his abdomen.
?On a scale of 0 to 10, Mr. Ramirez rates his pain at 7. Carla inspects the area more closely and palpates gently over the abdomen for the presence of tenderness. She notes that the abdomen feels very tight.

Do you think Carla anticipated this latest information from Mr. Ramirez?
•How important do you think it is for a nurse to be adaptable?
•What do you think Carla will do next?
Case Study Discussion #8
Carla does what she can to position Mr. Ramirez more comfortably and makes sure his leg discomfort is under control. She knows that the increased pain and tightness he is experiencing suggest that something is causing pressure in the abdomen.
It could mean the patient is having bleeding from his bruised liver. Carla decides to call Mr. Ramirez’s physician immediately.
•Carla’s thought that Mr. Ramirez has pressure developing in his abdomen is an example of what critical thinking competency? Explain.
•Describe the intellectual standards that Carla applied when asking Mr. Ramirez to rate his pain.
•What knowledge did Carla apply in this clinical situation? Do you think Carla made the right decision? Why?