Case study - Personal hygiene: Nursing

Nurse Melinda works on a medical-surgical floor and is caring for Beatrice, an 80-year-old with a history of iron-deficiency anemia. In collaboration with the registered nurse, RN Elijah, Nurse Melinda goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Beatrice’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Melinda recognizes important cues including Beatrice’s vital signs, which are temperature 98.6 F or 37 C, heart rate 90 beats per minute, respirations 19 breaths per minute, and blood pressure 123/88 mmHg. During bedside report, Nurse Melinda learns that Beatrice tires easily, becomes short of breath with activity, and needs assistance to get up to the bathroom.

Nurse Melinda then gathers information from Beatrice.

Nurse Melinda: Hi Beatrice, how are you this morning?

Beatrice: I’m tired. I want to get cleaned up, but it takes so much energy.

Nurse Melinda: I can help you get cleaned up. How about you do as much as you can, and when you feel tired, I can take over?

Beatrice: Okay.

Nurse Melinda analyzes these cues. She reviews the electronic health record, or EHR, and notes that prior to admission, Beatrice lived independently, but began having trouble performing activities of daily living, or ADLs, due to fatigue.

Nurse Melinda understands that iron is essential to produce hemoglobin in red blood cells, or RBCs, which deliver oxygen to the tissues, and that iron-deficiency anemia develops when there’s not sufficient iron to sustain normal hemoglobin production. As a result, there’s not enough hemoglobin to fill a normal-sized RBC, so the bone marrow starts producing microcytic, or smaller, cells that contain less hemoglobin. She also knows that a lack of hemoglobin can cause decreased oxygenation, leading to symptoms like weakness, fatigue, and reduced exercise tolerance, making it difficult to perform ADLs. Nurse Melinda recognizes that Beatrice needs assistance with bathing and oral care to promote comfort, maintain hygiene, and prevent infection.

Now using the information she has gathered along with Beatrice’s medical history, Nurse Melinda reports her findings to RN Elijah, and together they choose a priority hypothesis of altered self-care.