Video Case Study - Caring for Patients With Anemia

Nurse Lucia works on a medical surgical unit and is caring for Ahmed, a 61 year old with a history of peptic ulcer disease, who was admitted several days ago for gastrointestinal bleeding.

In collaboration with the registered nurse RN Jumay, nurse Lucia goes through the steps of the clinical judgment measurement model to make clinical decisions about Ahmed's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, nurse Lucia recognizes important cues, including Ahmed's vital signs, which are temperature 98.6 °F or 37 °C, heart rate 102 BPM, respirations 22 breaths per minute, BP 105/70 millimeters of mercury, and oxygen saturation 93% on room air.

Ahmed appears pale and states that he has no energy. He also reports mild headache pain, which he rates as 3 out of 10.

Next, nurse Lucia analyzes these cues. She reviews the electronic health record, or EHR and notes that Ahmed's latest hemoglobin is 7.1 g per deciliter, and his hematocrit is 21%.

Nurse Lucia recognizes that Ahmed is exhibiting clinical manifestations of anemia, that can occur when a bleeding peptic ulcer causes gastrointestinal blood loss.

She also knows that blood loss can result in loss of iron, which is needed to sustain normal hemoglobin production. This impairs the oxygen-carrying capacity of the blood, resulting in impaired tissue perfusion, and symptoms like weakness, fatigue, headaches, as well as signs like pallor and tachycardia.

Nurse Lucia realizes that Ahmed needs management of his anemia to promote effective tissue perfusion and oxygenation. Now using the information she's gathered along with Ahmed's medical history, nurse Lucia works in collaboration with RN Jumay to choose a priority hypothesis of impaired peripheral tissue perfusion.

Then along with RN Juma, she generates solutions to address Ahmed's impaired perfusion that will include pharmacologic and non-pharmacologic measures, and they establish the expected outcome that after intervening, Ahmed will demonstrate evidence of improved tissue perfusion by the end of the shift.

Then they take action to implement these solutions. RN Jumay notifies the healthcare provider about Ahmed's assessment findings, and a transfusion of packed red blood cells is ordered.

RN Jumay and nurse Lucia gather the necessary supplies and enter Ahmed's room. RN Jumay initiates the blood transfusion and monitors Ahmed for the first hour.

After that, nurse Lucia continues to monitor Ahmed, collects his vital signs per facility protocol, and watches him for any adverse reactions of the transfusion.

While the blood infuses, nurse Lucia promotes rest to decrease Ahmed's oxygen consumption by dimming the lights in Ahmed's room and providing a warm blanket.

She also gives him a cool cloth for his headache. When the transfusion is complete, nurse Lucia takes Ahmed's vital signs and draws a repeat hemoglobin and hematocrit as ordered.

At the end of the shift, nurse Lucia enters Ahmed's room to evaluate the outcome of her actions. She takes Ahmed's vital signs, which are temperature 98.6 °F or 37 °C, heart rate 86 BPM, R 16 breaths per minute, BP 128/86 millimeters of mercury, and oxygen saturation 97% on room air.

She then reviews the results of Ahmed's blood work, which is hemoglobin 8.2 g per deciliter, and hematocrit 24%. Ahmed reports his headache has resolved, and his pain is 0 out of 10.

Nurse Lucia also notes that he appears less pale. Alright, as a quick recap, nurse Lucia recognized and analyzed cues related to Ahmed's impaired peripheral tissue profusion, and in collaboration with RN Jumay, prioritized hypotheses and generated solutions to address this problem.

Nurse Lucia and RN Juey then implemented pharmacologic and non-pharmacologic measures and evaluated Ahmed's outcomes and compared them to the expected outcome.

Since Ahmed demonstrated evidence of improved peripheral tissue profusion, they determined the plan of care was successful.