Fundamental Reasoning Activity:
Developing Critical/Clinical Thinking by Identifying Relationships:
Clinical Scenario:
Chief complaint/History of Present Illness:
Social/Personal History:
Initial Assessment:
VS:
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T:
P:
R:
BP:
O2 sats:
Assessment:
 RESP: breath sounds clear with equal aeration bilat., non-labored
 CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremities
 NEURO: alert & oriented x4
 GI/GU: active BS in all quads, abd. soft/non-tender, voiding without difficulty, urine clear/yellow
 MISC: denies pain, skin integrity intact
Diagnostic Tests:
(list several labs and allow students to decide what they think is relevant or most important for this patient for
question #7))
Physician Orders:
(copy and paste these same orders into the box for question #8)
1. What is the relationship of your patient’s past medical history (PMH) and current medications?
(Which medication treats which disease? Draw a line to connect)
(NCLEX Client Need Category:pharmacological therapies)
PMH:
© 2011 Keith Rischer/www.KeithRN.com
Home Medications:
2. One disease process often influences the development of other illnesses. Based on your knowledge
of pathophysiology, in your patient (if applicable) which disease likely developed first that then
initiated a “domino effect” in their life?
(NCLEX Client Need Category:Physiological Adaptation)
PMH:
What Came First:
What then followed:
3. What is the relationship of your patient’s PMH and current chief complaint?
What prior medical history above is relevant and likely influenced his current problem and chief complaint?
Explain your rationale
(NCLEX Client Need Category:Management of Care/ Physiological Adaptation)
RELEVANT PMH:
Rationale:
4. Based on your knowledge of nursing theory and assessment findings, what is the most likely
medical problem that your patient is presenting with?
(NCLEX Client Need Category:Management of Care)
5. What is the relationship between your patient’s chief complaint & identified primary medical
problem? (look at pathophysiology and how it influences patient’s chief complaint)
(NCLEX Client Need Category: Management of Care)
Chief Complaint:
© 2011 Keith Rischer/www.KeithRN.com
Pathophysiology cause/relationship to chief complaint:
6. What is the relationship between your patient’s abnormal VS and assessment data & identified
primary medical problem?
(NCLEX Client Need Category: Management of Care/Reduction of Risk Potential)
RELEVANT VS/assessment data:
Relationship to primary medical problem:
7. What is the relationship between your patient’s RELEVANT abnormal diagnostic labs & identified
primary medical problem?
(NCLEX Client Need Category: Management of Care/Reduction of Risk Potential)
RELEVANT Diagnostic results:
Relationship to primary medical problem:
8. What is the relationship between the following physician orders/meds and your patient’s primary
medical problem?
(how will mech. of action of these meds/treatments impact this patient at a pathophys level to help resolve his primary problem?)
(NCLEX Client Need Category: pharmacological & parenteral therapies)
Physician orders:
How it will help resolve primary problem:
© 2011 Keith Rischer/www.KeithRN.com
F&E/Lab Values Application
9. Choose two of the most relevant abnormal labs for your patient and address the following:
(NCLEX Client Need Category: Reduction of Risk Potential/Physiological Adaptation)
Lab
Relevance
What caused
derangement?
Treatment
Nsg. Assessments/interventions
required:
Relevance
What caused
derangement?
Treatment
Nsg. Assessments/interventions
required:
Value
Normal range
Critical value
Lab
Value
Normal range
Critical value
© 2011 Keith Rischer/www.KeithRN.com