CRITICAL THINKING AND
PRIORITIZATION
By: Diana Blum MSN
MCC
NURS 2140
definition
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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.
Key concepts
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Strong formal and informal foundation of
knowledge
Willingness to pursue or ask questions
Ability to develop solutions
Characteristics needed
Inquisitive
 Truth seekers
 Fair minded
 Open minded
 Persistent
 Empathetic
 Independent in
thought
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Good communicator
Honest
Organized
Proactive
Flexible
Realistic
Humble
Cognizant of the rules
Curious
Creative
Committed to excellence
Skills needed
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Interpretation
Analysis
Evaluation
Self regulation
Etc.
Components of critical thinking
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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
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Practice after next lecture
prioritization
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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
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Recognize health problems.
Anticipate complications.
Initiate actions to ensure appropriate and timely
treatment.
Think CRITICALLY !!!!!!
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Determine patient’s strengths and health concerns.
Identify moral and ethical issues.
Determine timing, resources available, and setting.
Anticipate needs.
Interdisciplinary care rounding
#1
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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.
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How do you stabilize the patient and maintain airway and
ventilation while also assessing, stabilizing physical trauma
and the degree of his burns?
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.
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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.
#2
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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??
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#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)