CRITICAL THINKING KHUDAZI AULAWI

Critical Thinking

Definition Critical Thinking Skills  Intellectual activities used in complex thinking process such critical analysis, problem solving, and decision making

Critical Thinking in Clinical Scenarios

Clinical Scenarios  (1) applying concepts and theories to clinical practice  (2) learning how to analyze a clinical situation  (3) identifying problems and solutions  (4) comparing alternate decisions possible and developing decision making ability  (5) considering multiple perspectives in a clinical situation  (1) applying concepts and theories to clinical practice  (2) learning how to analyze a clinical situation  (3) identifying problems and solutions  (4) comparing alternate decisions possible and developing decision making ability  (5) considering multiple perspectives in a clinical situation

Applying Concepts and Theories to Practice Case 1  The nurse visits a patient who was sent home from the hospital two days after the normal delivery of her third child. The baby is jaundiced and appears dehydrated. When the nurse tells the mother that she is calling the doctor, the mother begins to cry and yells, "I can't handle this right now. ” Case 1  The nurse visits a patient who was sent home from the hospital two days after the normal delivery of her third child. The baby is jaundiced and appears dehydrated. When the nurse tells the mother that she is calling the doctor, the mother begins to cry and yells, "I can't handle this right now. ”

Questions  1. What are possible reasons for the baby's jaundice? Describe the physiology of this occurrence in the newborn.  2. What should the nurse do now? Why?  3. Select one theory that can help explain the mother's reaction.  Analyze the mother's response in terms of this theory.  1. What are possible reasons for the baby's jaundice? Describe the physiology of this occurrence in the newborn.  2. What should the nurse do now? Why?  3. Select one theory that can help explain the mother's reaction.  Analyze the mother's response in terms of this theory.

Analyzing a Clinical Situation Case 2  Mrs. K is in her 32nd week of pregnancy. Her ankles and hands are swollen, and her blood pressure is 160/90.  1. Discuss the relationship between Mrs. K's swelling of the ankles and hands and her blood pressure.  2. What additional data should be collected at this time? Why is this information important? Case 2  Mrs. K is in her 32nd week of pregnancy. Her ankles and hands are swollen, and her blood pressure is 160/90.  1. Discuss the relationship between Mrs. K's swelling of the ankles and hands and her blood pressure.  2. What additional data should be collected at this time? Why is this information important?

Identifying Problems and Solutions Case 3  Mr. Z, 26 years old, was admitted with extensive burns on his face and ears. When walking toward the room, you see him crying while looking in the mirror. When you walk into the room to console him, he stops and says, "I'm fine now. ” Case 3  Mr. Z, 26 years old, was admitted with extensive burns on his face and ears. When walking toward the room, you see him crying while looking in the mirror. When you walk into the room to console him, he stops and says, "I'm fine now. ”

 1. What are two possible responses you could make to Mr. Z? Provide a rationale for each of these.  2. What problems need to be solved in this scenario?  3. What approaches would you plan for Mr. Z's continuing care? Why would these be effective?  1. What are two possible responses you could make to Mr. Z? Provide a rationale for each of these.  2. What problems need to be solved in this scenario?  3. What approaches would you plan for Mr. Z's continuing care? Why would these be effective?

Developing Decision Making Skills Case 4  You overhear your friend telling a new nurse on the unit not to worry about wearing sterile gloves when changing the patient's dressings because "he has an infection any way."  1. What are your options?  2. What are the consequences of each of these options?  3. What would you do? Why? Case 4  You overhear your friend telling a new nurse on the unit not to worry about wearing sterile gloves when changing the patient's dressings because "he has an infection any way."  1. What are your options?  2. What are the consequences of each of these options?  3. What would you do? Why?

Considering Multiple Perspectives Case 5  Ms. P is 18 years old and dying from bone cancer. She has severe pain that is not relieved with medications. She asks you if she can refuse her next dose of chemotherapy because it is "not working any way. I am only taking the chemotherapy because my mother wants me to. ” Case 5  Ms. P is 18 years old and dying from bone cancer. She has severe pain that is not relieved with medications. She asks you if she can refuse her next dose of chemotherapy because it is "not working any way. I am only taking the chemotherapy because my mother wants me to. ”

 1. How would you respond to Ms. P? Why is this an appropriate response?  2. What questions would you ask her?  3. What assumptions did you make about Ms. P?  4. What are issues to be resolved in this situation?  5. What are Ms. P's options?  1. How would you respond to Ms. P? Why is this an appropriate response?  2. What questions would you ask her?  3. What assumptions did you make about Ms. P?  4. What are issues to be resolved in this situation?  5. What are Ms. P's options?

Scenario for Interdisciplinary Education Case 6  Mr. P was involved in an accident at the factory where he worked resulting in a closed head injury, when he arrived at the emergency department, the admitting nurse recorded in the medical record that the patient was "restless and incoherent." His vital signs were: BP 130/80 HR 92bpm Respirations 20/minute. Case 6  Mr. P was involved in an accident at the factory where he worked resulting in a closed head injury, when he arrived at the emergency department, the admitting nurse recorded in the medical record that the patient was "restless and incoherent." His vital signs were: BP 130/80 HR 92bpm Respirations 20/minute.

 After admission Mr. P became increasingly incoherent and drowsy. The physician ordered a computed tomography (CT) scan that showed a left-sided epidural hematoma.

 1. Describe the pathophysiology of an epidural hematoma, what are anticipated responses of the patient to an epidural hematoma that is left-sided?  2. what is the classic clinical picture of epidural hematoma? Are Mr. P's responses consistent with this diagnosis? Why or why not? What additional data should be collected?  1. Describe the pathophysiology of an epidural hematoma, what are anticipated responses of the patient to an epidural hematoma that is left-sided?  2. what is the classic clinical picture of epidural hematoma? Are Mr. P's responses consistent with this diagnosis? Why or why not? What additional data should be collected?

 3. The physician is concerned about an uncal hernation. Describe this condition from a medical perspective. What observations should the nurse make?  4. Discuss surgical and medical options for the patient. Compare these in terms of effectiveness.  3. The physician is concerned about an uncal hernation. Describe this condition from a medical perspective. What observations should the nurse make?  4. Discuss surgical and medical options for the patient. Compare these in terms of effectiveness.

 5. Mr. P is sent for another CT scan. What actions by the technician could result in increased intracranial pressure? What actions by other providers might increase intracranial pressure? Why?

 6. What pharmacologic agents decrease cerebral edema for a patient with an epidural hematoma? How do these work?  7. As a group, plan care for Mr. P. How would you include occupational health?  6. What pharmacologic agents decrease cerebral edema for a patient with an epidural hematoma? How do these work?  7. As a group, plan care for Mr. P. How would you include occupational health?