1. CRITICAL THINKING AND PRIORITIZATION By: Diana Blum MSN MCC NURS 2140

2. definition  A multidimensional skill, a cognitive or mental process, or a set of procedures.  It involves reasoning and purposeful, systematic, reflective, rational, outcome directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas.

3. Key concepts  Strong formal and informal foundation of knowledge  Willingness to pursue or ask questions  Ability to develop solutions

4. Characteristics needed  Inquisitive  Truth seekers  Fair minded  Open minded  Persistent  Empathetic  Independent in thought  Good communicator  Honest  Organized  Proactive  Flexible  Realistic  Humble  Cognizant of the rules  Curious  Creative  Committed to excellence

5. Skills needed  Interpretation  Analysis  Evaluation  Self regulation  Etc.

6. Components of critical thinking  Ask questions to determine why certain developments have occurred  Gather as much info as possible  Make sure info accurate  Analyze to find meaning  Draw on past clinical experiences  Be flexible  Look for solutions  Reflect on experience

7.  Practice after next lecture

8. prioritization  Take care of immediate life threatening issues  Monitor for safety  Identify what the patient perceives as an issue  Look at the overall picture available, time, and resources

9.  Recognize health problems.  Anticipate complications.  Initiate actions to ensure appropriate and timely treatment. Think CRITICALLY !!!!!!

10.  Determine patient’s strengths and health concerns.  Identify moral and ethical issues.  Determine timing, resources available, and setting.  Anticipate needs.  Interdisciplinary care rounding

11. #1  39 year old truck driver, male, admitted to the hospital following an accident in which the cab of his truck caught fire. He was freed from the truck by a passing motorist, who stayed with him until the rescue team arrived. The rescue team decides to call Skycare to transport him to the regional trauma center which has a burn unit. His wife and two daughters have been notified.  How do you stabilize the patient and maintain airway and ventilation while also assessing, stabilizing physical trauma and the degree of his burns?trauma

12. As for prioritization think ABC's, Airway, does the pt have any oral edema, possible loss of consciousness then you need to protect his airway and intubate. Breathing, smoke inhalation will reduce the pt's ability to breath. Positive pressure vent settings to keep the alveoli open for oxygenation and rate/volume control for ventilation. Circulation, fluid resuscitation for the hypovolemia and check for any other points of blood loss. Your pt in the case study should be on a spinal precautions until cleared. He will need a full body x-ray, trauma centers are set up to do this quickly, and a CT scan Also with all this focus on the pt, remember that nursing school and nclex loves psychological support and communication. So you could score points if you remember to call for the hospitals pastor/priest/social worker to give emotional support for the wife and children in this time of crisis.emotional support

13.  You need to assess if any smoke stains are seen around his mouth, nose or in his throat? If yes then you would expect for the pt to be intubated for air way protection. You also need to assess the percentage of body burned. Use the rule of 9's. You would then want to start fluid resuscitation using the parkland formula. 4ml/kg/% of body burnt. 1/2 this amount given over the first 8 hours (after the pt was burnt and not 8hr after you get the pt). The second 1/2 over the following 16 hrs. The pt was also in a MVA so you would be assessing for other injuries such as broken bones and soft tissue/organ injury. Hypovolemia could be caused by shock from the burn or internal bleeding. Do not forget about the hidden because of the obvious injuries. injuries

14. #2  A patient scheduled for a laparoscopic cholecystectomy. Teaching the daughter of a patient medication regimen. Giving report to a RN. A patient requiring a dressing change. In which order would you do these?? medication

15.  #1 lap chole patient (since there are safety issues and time constraint) #2 dressing change ( promotion of healing and infection control) #3 teaching daughter(lack of knowledge) #4 give report (delegation of duties)healing