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 Jumei, 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 beats per minute, respirations 22 breaths per minute, blood pressure 105/70 mmHg, and oxygen saturation 93 percent 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/dL and his hematocrit is 21 percent. 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 has gathered, along with Ahmed’s medical history, Nurse Lucia works in collaboration with RN Jumei to choose a priority hypothesis of impaired peripheral tissue perfusion.

Then, along with RN Jumei, she generates solutions to address Ahmed’s impaired perfusion that will include pharmacologic and nonpharmacologic 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 Jumei notifies the health care provider about Ahmed’s assessment findings, and a transfusion of packed RBCs is ordered. RN Jumei and Nurse Lucia gather the necessary supplies and enter Ahmed’s room.