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  • [Solved] BSN 4

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    – a year ago **files (2)** – ## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf – ## BSN4.docx **## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf** Layer 0 Layer 1 Layer 2 Layer 3 Satisfied Evaluation Clinical Judgment Not Satisfied Refine HypothesesForm Hypothese…

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    Assignment Prompt & Instructions

    – a year ago

    **files (2)**

    – ## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf

    – ## BSN4.docx

    **## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf**

    Layer 0

    Layer 1

    Layer 2

    Layer 3

    Satisfied

    Evaluation

    Clinical Judgment

    Not Satisfied

    Refine HypothesesForm Hypotheses

    Client
    Needs

    Clinical
    Decisions

    Recognize
    Cues

    Analyze
    Cues

    Prioritize
    Hypotheses

    Generate
    Solutions

    Take
    Actions

    Evaluate
    Outcomes

    The NCSBN Clinical Judgment Measurement Model

    Copyright ©2019 NCSBN. All Rights Reserved.

    Environmental Factor Examples Individual Factor Examples

    Nursing
    Process

    Layer 4

    Assessment Analysis Planning EvaluationImplementation

    Environment Resources Medical
    Records

    Client
    Observation

    Consequences
    & Risks

    Task
    Complexity

    Time
    Pressure

    Cultural
    Consideration

    Prior
    Experience

    Candidate
    Characteristics

    Level of
    Experience

    SkillsKnowledge Specialty

    **## BSN4.docx**

    NUR4922CBE Section 01CBE Bachelor of Science in Nursing Capstone (11 Weeks) – CBE Online Course – 2025 Spring Quarter

    Deliverable 4 – Making the Best Nursing Decisions

    **Assignment Instructions**

    **Competency**

    Synthesize knowledge from the humanities, physical and social sciences, nursing theory, and applied research as a basis for evidence-based nursing practice and clinical reasoning.

    **Student Success Criteria**

    View the grading rubric for this deliverable by selecting the “Grading rubric” in the right menu.

    **Scenario**

    You finished new graduate orientation yesterday on a general medical surgical unit, and today you will independently care for two clients. As you receive a report on the second client at 0730, your Preceptor stops by to ask how the first day by yourself is coming along and reminds you to complete the final items on your training list today before the end of the 12-hour shift.

    · Complete the new online training model and quiz on the sliding insulin scale

    · Complete the orientation evaluation form

    · Sign up for one of the four nursing committees

    · Complete and sign the orientation reflection journal

    · Attend the new employee luncheon from 1-2 pm sponsored by the hospital physicians

    **Client 1**

    · 25 year old female 24 hours post-op from a Roux-en-Y gastric bypass

    · BMI of 50

    · History of hypertension and sleep apnea

    · No complications post-operative

    · Pain at 4 am, three on a scale of 10

    · Nasogastric tube to gravity

    · NPOMother stayed overnight but left early this morning to shower and will return later in the afternoon

    · Waiting on morning labs

    **Client 2**

    · 46 year old male admitted 72 hours prior with severe GERD and difficulty swallowing

    · History of alcoholism, hypertension

    · Smoked two packs per day for 22 years

    · Endoscopy for Barrett’s Esophagus was negative on the day of admission

    · Pain at 4 am, two on a scale of 10

    · Due to resume clear liquid diet this morning

    · Potential discharge later today home with family

    · The ex-wife has stayed in a room with a client and has been disruptive at times demanding pain medication and food.

    · Waiting on morning labs

    **Client 1**

    Physician orders:

    · Dietary Consult

    · Bariatric Behavioral Therapist Consult

    · 0.45% NS intravenous infusion post op

    **Client 2**

    Medications:

    · Protonix 40 mg once daily, intravenous infusion

    · Switch to oral Protonix 40mg day of discharge

    · IV infusion 0.9% NS 50 ml/hour

    · Resume 50mg Lopressor (metoprolol) PO twice daily after rule out Barrett’s Esophagus

    · 1-2mg Morphine Sulfate IV PRN q 4-6 hours for pain greater than 6 out of 10

    TIME
    _(EVENT)_

    · 0800 – You prioritize the need to assess the 46 year old male first since he has 0900 medications and the physician is rounding and should order discharge today. Assessment and vital signs reveal no concerns, ex-wife not present. A physician writes an order to discharge this client today. The client asks you to return in 30 minutes and go over discharge when ex-wife is present to hear instructions. You administer Lopressor and Protonix.

    · 0830 – You assess the 25 year old post bariatric surgery client. Vital signs and morning labs are within acceptable limits, and client reports pain two on a scale of 10. While assessing for bowel sounds, you notice the nasogastric (NG) tube not secured to the nose, and the client reports the tube partially came out when she blew her nose but she was able to push it back in with no pain. You document NG tube in place and assist the client to the bathroom.

    · 0900 – You return to 46 year old client and review discharge instructions with the client and ex-wife, discontinue the IV infusion, remove the intravenous catheter, and complete discharge summary.

    · 0945 – Transport stops by to take 25 year old client to meet with a support group for bariatric surgery clients — you okay transport.

    · 1000 – Physician stops into see a bariatric client and is upset you let her leave for support group before rounding. You report no concerns, physician reviews chart and writes discharge order for later in the afternoon if no vomiting or pain. The NG tube can be removed at noon by the Nurse Practitioner, and a diet of clear liquids resumed at 6 pm if no vomiting or gastric distention. Call immediately if any vomiting or signs of gastric distention occur.

    · 1030 – You take a break to complete orientation reflection journal, orientation evaluation, and online sliding insulin scale training module and quiz.

    · 1130 – The 25 year old bariatric client returns from the support group, you see her ambulating in the hallway, and you notice the NG tube is missing. The client states the tube fell out of her nose when she stood up to introduce herself. She has no complaints of nausea and no evidence of gastric distention. You document the NG tube was removed accidentally by the client.

    · 1200 – 46 year old male client calls and expresses frustration at a time to discharge. He wants to be home by 3 pm for his son’s birthday party. You call transport who assures you and the client they will arrive before 1 pm to discharge the client.

    · 1215 – Morning documentation complete, all orders are in the system, and both clients are stable. You are amazed at how smooth the first day is going. You head to the new employee luncheon with your Preceptor.

    · 1330 – You return from lunch and find the 46 year old client discharged, and you must prepare for a new admit from the emergency room with rule out pancreatitis. You feel apprehension since this will be your first admit, so you reach out to your Preceptor to review policy and procedure for new admissions.

    · 1345 – While working with your Preceptor, the Certified Nursing Assistant stops by and reports the 25 year old client refused an afternoon visit from a member of the bariatric support group, complaining of fatigue. Her noon vital signs were blood pressure 90/40, heart rate 112, and respiratory rate 28. Your Preceptor assures you these vital signs, and fatigue often occurs with this type of client. She susgest, the client is probably depressed, ready to go home, and suggests to let her rest for the afternoon.

    · 1415 – The new admit from the emergency department arrives with two pages of physician orders and a communication challenge since he speaks and understands only Spanish. He has pain in the abdomen and begins vomiting. Seeing you are now very busy, the Preceptor offers to “look in” on your 25 year old client and will take care of any concerns. Also, she will order a translator to assist with the new admit, while you focus on taking care of the physician orders.

    · 1730 – Finally, all orders for the new admit are in the system; pain decreased, no further vomiting, and he is resting comfortably. While waiting for lab results, you decide to check on the 25 year old client.

    · 1745 – On the way to the client’s room, the Nurse Manager stops and asks you to take a moment to fill out a volunteer form for one of the four nursing committees on the Unit.

    · 1815 – You return to the 25 year old client’s room and find her unresponsive, pale, with no heart beat or respirations. The abdomen is distended and hard. Attempts are made for resuscitation but are not successful. The client is deceased.

    · 1900 – You prepare to leave to go home. The Nurse Manger stops you and asks to debrief the situation. After reviewing the chart and discussing the situation, she is concerned and sees errors in your judgement and actions. She is sure the client’s death will be a sentinel event and warrant a review by the Internal Review Board.

    **Instructions**

    To prepare for debriefing with the Internal Review Board, the Nurse Manager asks you to submit an internal memo with your analysis and perceptions of the events that occurred, including:

    · Description of the errors that occurred

    · Support choices with rationales

    · Description of why the errors occurred

    · Support choices with rationales

    · Strategies for appropriate actions to avoid errors identified

    · Support strategies with rationales, nursing theory and evidence from the literature

    · Ideas stated with professional language and attribution for credible sources with correct APA citation, spelling, and grammar

    **Resources**

    **NCSBN_Clinical_Judgement_Measurement_Model_Flowchart**

    ·
    [Click here for a Library and Learning Services page on Memos in the Writing Guide.](https://guides.rasmussen.edu/writing/letters)

    ·
    [Click here for a Library and Learning Services page on composing a Memo.](http://rasmussen.libanswers.com/faq/32874)

    ·
    [Click here for a Library and Learning Services APA Guide.](http://guides.rasmussen.edu/apa)

    **Submission**

    Text Editor

    _Word count: 0_

    **Details & Information**

    **Assessment due date**

    6/20/25, 11:59 PM (CDT)

    · You cannot submit work after due date

    · You cannot make a new submission attempt after due date

    **Attempts**

    3 attempts left

    **Grading rubric** [This item is graded with a rubric](https://learning.rasmussen.edu/ultra/courses/_171279_1/grades/assessment/_18023680_1/overview/attempt/create/rubric-view?columnId=_6372669_1&courseId=_171279_1)

    **Grading**

    **Maximum points** 4 points

    Save and CloseSubmit

    **## BSN4.docx**

    NUR4922CBE Section 01CBE Bachelor of Science in Nursing Capstone (11 Weeks) – CBE Online Course – 2025 Spring Quarter

    Deliverable 4 – Making the Best Nursing Decisions

    **Assignment Instructions**

    **Competency**

    Synthesize knowledge from the humanities, physical and social sciences, nursing theory, and applied research as a basis for evidence-based nursing practice and clinical reasoning.

    **Student Success Criteria**

    View the grading rubric for this deliverable by selecting the “Grading rubric” in the right menu.

    **Scenario**

    You finished new graduate orientation yesterday on a general medical surgical unit, and today you will independently care for two clients. As you receive a report on the second client at 0730, your Preceptor stops by to ask how the first day by yourself is coming along and reminds you to complete the final items on your training list today before the end of the 12-hour shift.

    · Complete the new online training model and quiz on the sliding insulin scale

    · Complete the orientation evaluation form

    · Sign up for one of the four nursing committees

    · Complete and sign the orientation reflection journal

    · Attend the new employee luncheon from 1-2 pm sponsored by the hospital physicians

    **Client 1**

    · 25 year old female 24 hours post-op from a Roux-en-Y gastric bypass

    · BMI of 50

    · History of hypertension and sleep apnea

    · No complications post-operative

    · Pain at 4 am, three on a scale of 10

    · Nasogastric tube to gravity

    · NPOMother stayed overnight but left early this morning to shower and will return later in the afternoon

    · Waiting on morning labs

    **Client 2**

    · 46 year old male admitted 72 hours prior with severe GERD and difficulty swallowing

    · History of alcoholism, hypertension

    · Smoked two packs per day for 22 years

    · Endoscopy for Barrett’s Esophagus was negative on the day of admission

    · Pain at 4 am, two on a scale of 10

    · Due to resume clear liquid diet this morning

    · Potential discharge later today home with family

    · The ex-wife has stayed in a room with a client and has been disruptive at times demanding pain medication and food.

    · Waiting on morning labs

    **Client 1**

    Physician orders:

    · Dietary Consult

    · Bariatric Behavioral Therapist Consult

    · 0.45% NS intravenous infusion post op

    **Client 2**

    Medications:

    · Protonix 40 mg once daily, intravenous infusion

    · Switch to oral Protonix 40mg day of discharge

    · IV infusion 0.9% NS 50 ml/hour

    · Resume 50mg Lopressor (metoprolol) PO twice daily after rule out Barrett’s Esophagus

    · 1-2mg Morphine Sulfate IV PRN q 4-6 hours for pain greater than 6 out of 10

    TIME
    _(EVENT)_

    · 0800 – You prioritize the need to assess the 46 year old male first since he has 0900 medications and the physician is rounding and should order discharge today. Assessment and vital signs reveal no concerns, ex-wife not present. A physician writes an order to discharge this client today. The client asks you to return in 30 minutes and go over discharge when ex-wife is present to hear instructions. You administer Lopressor and Protonix.

    · 0830 – You assess the 25 year old post bariatric surgery client. Vital signs and morning labs are within acceptable limits, and client reports pain two on a scale of 10. While assessing for bowel sounds, you notice the nasogastric (NG) tube not secured to the nose, and the client reports the tube partially came out when she blew her nose but she was able to push it back in with no pain. You document NG tube in place and assist the client to the bathroom.

    · 0900 – You return to 46 year old client and review discharge instructions with the client and ex-wife, discontinue the IV infusion, remove the intravenous catheter, and complete discharge summary.

    · 0945 – Transport stops by to take 25 year old client to meet with a support group for bariatric surgery clients — you okay transport.

    · 1000 – Physician stops into see a bariatric client and is upset you let her leave for support group before rounding. You report no concerns, physician reviews chart and writes discharge order for later in the afternoon if no vomiting or pain. The NG tube can be removed at noon by the Nurse Practitioner, and a diet of clear liquids resumed at 6 pm if no vomiting or gastric distention. Call immediately if any vomiting or signs of gastric distention occur.

    · 1030 – You take a break to complete orientation reflection journal, orientation evaluation, and online sliding insulin scale training module and quiz.

    · 1130 – The 25 year old bariatric client returns from the support group, you see her ambulating in the hallway, and you notice the NG tube is missing. The client states the tube fell out of her nose when she stood up to introduce herself. She has no complaints of nausea and no evidence of gastric distention. You document the NG tube was removed accidentally by the client.

    · 1200 – 46 year old male client calls and expresses frustration at a time to discharge. He wants to be home by 3 pm for his son’s birthday party. You call transport who assures you and the client they will arrive before 1 pm to discharge the client.

    · 1215 – Morning documentation complete, all orders are in the system, and both clients are stable. You are amazed at how smooth the first day is going. You head to the new employee luncheon with your Preceptor.

    · 1330 – You return from lunch and find the 46 year old client discharged, and you must prepare for a new admit from the emergency room with rule out pancreatitis. You feel apprehension since this will be your first admit, so you reach out to your Preceptor to review policy and procedure for new admissions.

    · 1345 – While working with your Preceptor, the Certified Nursing Assistant stops by and reports the 25 year old client refused an afternoon visit from a member of the bariatric support group, complaining of fatigue. Her noon vital signs were blood pressure 90/40, heart rate 112, and respiratory rate 28. Your Preceptor assures you these vital signs, and fatigue often occurs with this type of client. She susgest, the client is probably depressed, ready to go home, and suggests to let her rest for the afternoon.

    · 1415 – The new admit from the emergency department arrives with two pages of physician orders and a communication challenge since he speaks and understands only Spanish. He has pain in the abdomen and begins vomiting. Seeing you are now very busy, the Preceptor offers to “look in” on your 25 year old client and will take care of any concerns. Also, she will order a translator to assist with the new admit, while you focus on taking care of the physician orders.

    · 1730 – Finally, all orders for the new admit are in the system; pain decreased, no further vomiting, and he is resting comfortably. While waiting for lab results, you decide to check on the 25 year old client.

    · 1745 – On the way to the client’s room, the Nurse Manager stops and asks you to take a moment to fill out a volunteer form for one of the four nursing committees on the Unit.

    · 1815 – You return to the 25 year old client’s room and find her unresponsive, pale, with no heart beat or respirations. The abdomen is distended and hard. Attempts are made for resuscitation but are not successful. The client is deceased.

    · 1900 – You prepare to leave to go home. The Nurse Manger stops you and asks to debrief the situation. After reviewing the chart and discussing the situation, she is concerned and sees errors in your judgement and actions. She is sure the client’s death will be a sentinel event and warrant a review by the Internal Review Board.

    **Instructions**

    To prepare for debriefing with the Internal Review Board, the Nurse Manager asks you to submit an internal memo with your analysis and perceptions of the events that occurred, including:

    · Description of the errors that occurred

    · Support choices with rationales

    · Description of why the errors occurred

    · Support choices with rationales

    · Strategies for appropriate actions to avoid errors identified

    · Support strategies with rationales, nursing theory and evidence from the literature

    · Ideas stated with professional language and attribution for credible sources with correct APA citation, spelling, and grammar

    **Resources**

    **NCSBN_Clinical_Judgement_Measurement_Model_Flowchart**

    ·
    [Click here for a Library and Learning Services page on Memos in the Writing Guide.](https://guides.rasmussen.edu/writing/letters)

    ·
    [Click here for a Library and Learning Services page on composing a Memo.](http://rasmussen.libanswers.com/faq/32874)

    ·
    [Click here for a Library and Learning Services APA Guide.](http://guides.rasmussen.edu/apa)

    **Submission**

    Text Editor

    _Word count: 0_

    **Details & Information**

    **Assessment due date**

    6/20/25, 11:59 PM (CDT)

    · You cannot submit work after due date

    · You cannot make a new submission attempt after due date

    **Attempts**

    3 attempts left

    **Grading rubric** [This item is graded with a rubric](https://learning.rasmussen.edu/ultra/courses/_171279_1/grades/assessment/_18023680_1/overview/attempt/create/rubric-view?columnId=_6372669_1&courseId=_171279_1)

    **Grading**

    **Maximum points** 4 points

    Save and CloseSubmit

    **## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf**

    Layer 0

    Layer 1

    Layer 2

    Layer 3

    Satisfied

    Evaluation

    Clinical Judgment

    Not Satisfied

    Refine HypothesesForm Hypotheses

    Client
    Needs

    Clinical
    Decisions

    Recognize
    Cues

    Analyze
    Cues

    Prioritize
    Hypotheses

    Generate
    Solutions

    Take
    Actions

    Evaluate
    Outcomes

    The NCSBN Clinical Judgment Measurement Model

    Copyright ©2019 NCSBN. All Rights Reserved.

    Environmental Factor Examples Individual Factor Examples

    Nursing
    Process

    Layer 4

    Assessment Analysis Planning EvaluationImplementation

    Environment Resources Medical
    Records

    Client
    Observation

    Consequences
    & Risks

    Task
    Complexity

    Time
    Pressure

    Cultural
    Consideration

    Prior
    Experience

    Candidate
    Characteristics

    Level of
    Experience

    SkillsKnowledge Specialty

    **## BSN4.docx**

    NUR4922CBE Section 01CBE Bachelor of Science in Nursing Capstone (11 Weeks) – CBE Online Course – 2025 Spring Quarter

    Deliverable 4 – Making the Best Nursing Decisions

    **Assignment Instructions**

    **Competency**

    Synthesize knowledge from the humanities, physical and social sciences, nursing theory, and applied research as a basis for evidence-based nursing practice and clinical reasoning.

    **Student Success Criteria**

    View the grading rubric for this deliverable by selecting the “Grading rubric” in the right menu.

    **Scenario**

    You finished new graduate orientation yesterday on a general medical surgical unit, and today you will independently care for two clients. As you receive a report on the second client at 0730, your Preceptor stops by to ask how the first day by yourself is coming along and reminds you to complete the final items on your training list today before the end of the 12-hour shift.

    · Complete the new online training model and quiz on the sliding insulin scale

    · Complete the orientation evaluation form

    · Sign up for one of the four nursing committees

    · Complete and sign the orientation reflection journal

    · Attend the new employee luncheon from 1-2 pm sponsored by the hospital physicians

    **Client 1**

    · 25 year old female 24 hours post-op from a Roux-en-Y gastric bypass

    · BMI of 50

    · History of hypertension and sleep apnea

    · No complications post-operative

    · Pain at 4 am, three on a scale of 10

    · Nasogastric tube to gravity

    · NPOMother stayed overnight but left early this morning to shower and will return later in the afternoon

    · Waiting on morning labs

    **Client 2**

    · 46 year old male admitted 72 hours prior with severe GERD and difficulty swallowing

    · History of alcoholism, hypertension

    · Smoked two packs per day for 22 years

    · Endoscopy for Barrett’s Esophagus was negative on the day of admission

    · Pain at 4 am, two on a scale of 10

    · Due to resume clear liquid diet this morning

    · Potential discharge later today home with family

    · The ex-wife has stayed in a room with a client and has been disruptive at times demanding pain medication and food.

    · Waiting on morning labs

    **Client 1**

    Physician orders:

    · Dietary Consult

    · Bariatric Behavioral Therapist Consult

    · 0.45% NS intravenous infusion post op

    **Client 2**

    Medications:

    · Protonix 40 mg once daily, intravenous infusion

    · Switch to oral Protonix 40mg day of discharge

    · IV infusion 0.9% NS 50 ml/hour

    · Resume 50mg Lopressor (metoprolol) PO twice daily after rule out Barrett’s Esophagus

    · 1-2mg Morphine Sulfate IV PRN q 4-6 hours for pain greater than 6 out of 10

    TIME
    _(EVENT)_

    · 0800 – You prioritize the need to assess the 46 year old male first since he has 0900 medications and the physician is rounding and should order discharge today. Assessment and vital signs reveal no concerns, ex-wife not present. A physician writes an order to discharge this client today. The client asks you to return in 30 minutes and go over discharge when ex-wife is present to hear instructions. You administer Lopressor and Protonix.

    · 0830 – You assess the 25 year old post bariatric surgery client. Vital signs and morning labs are within acceptable limits, and client reports pain two on a scale of 10. While assessing for bowel sounds, you notice the nasogastric (NG) tube not secured to the nose, and the client reports the tube partially came out when she blew her nose but she was able to push it back in with no pain. You document NG tube in place and assist the client to the bathroom.

    · 0900 – You return to 46 year old client and review discharge instructions with the client and ex-wife, discontinue the IV infusion, remove the intravenous catheter, and complete discharge summary.

    · 0945 – Transport stops by to take 25 year old client to meet with a support group for bariatric surgery clients — you okay transport.

    · 1000 – Physician stops into see a bariatric client and is upset you let her leave for support group before rounding. You report no concerns, physician reviews chart and writes discharge order for later in the afternoon if no vomiting or pain. The NG tube can be removed at noon by the Nurse Practitioner, and a diet of clear liquids resumed at 6 pm if no vomiting or gastric distention. Call immediately if any vomiting or signs of gastric distention occur.

    · 1030 – You take a break to complete orientation reflection journal, orientation evaluation, and online sliding insulin scale training module and quiz.

    · 1130 – The 25 year old bariatric client returns from the support group, you see her ambulating in the hallway, and you notice the NG tube is missing. The client states the tube fell out of her nose when she stood up to introduce herself. She has no complaints of nausea and no evidence of gastric distention. You document the NG tube was removed accidentally by the client.

    · 1200 – 46 year old male client calls and expresses frustration at a time to discharge. He wants to be home by 3 pm for his son’s birthday party. You call transport who assures you and the client they will arrive before 1 pm to discharge the client.

    · 1215 – Morning documentation complete, all orders are in the system, and both clients are stable. You are amazed at how smooth the first day is going. You head to the new employee luncheon with your Preceptor.

    · 1330 – You return from lunch and find the 46 year old client discharged, and you must prepare for a new admit from the emergency room with rule out pancreatitis. You feel apprehension since this will be your first admit, so you reach out to your Preceptor to review policy and procedure for new admissions.

    · 1345 – While working with your Preceptor, the Certified Nursing Assistant stops by and reports the 25 year old client refused an afternoon visit from a member of the bariatric support group, complaining of fatigue. Her noon vital signs were blood pressure 90/40, heart rate 112, and respiratory rate 28. Your Preceptor assures you these vital signs, and fatigue often occurs with this type of client. She susgest, the client is probably depressed, ready to go home, and suggests to let her rest for the afternoon.

    · 1415 – The new admit from the emergency department arrives with two pages of physician orders and a communication challenge since he speaks and understands only Spanish. He has pain in the abdomen and begins vomiting. Seeing you are now very busy, the Preceptor offers to “look in” on your 25 year old client and will take care of any concerns. Also, she will order a translator to assist with the new admit, while you focus on taking care of the physician orders.

    · 1730 – Finally, all orders for the new admit are in the system; pain decreased, no further vomiting, and he is resting comfortably. While waiting for lab results, you decide to check on the 25 year old client.

    · 1745 – On the way to the client’s room, the Nurse Manager stops and asks you to take a moment to fill out a volunteer form for one of the four nursing committees on the Unit.

    · 1815 – You return to the 25 year old client’s room and find her unresponsive, pale, with no heart beat or respirations. The abdomen is distended and hard. Attempts are made for resuscitation but are not successful. The client is deceased.

    · 1900 – You prepare to leave to go home. The Nurse Manger stops you and asks to debrief the situation. After reviewing the chart and discussing the situation, she is concerned and sees errors in your judgement and actions. She is sure the client’s death will be a sentinel event and warrant a review by the Internal Review Board.

    **Instructions**

    To prepare for debriefing with the Internal Review Board, the Nurse Manager asks you to submit an internal memo with your analysis and perceptions of the events that occurred, including:

    · Description of the errors that occurred

    · Support choices with rationales

    · Description of why the errors occurred

    · Support choices with rationales

    · Strategies for appropriate actions to avoid errors identified

    · Support strategies with rationales, nursing theory and evidence from the literature

    · Ideas stated with professional language and attribution for credible sources with correct APA citation, spelling, and grammar

    **Resources**

    **NCSBN_Clinical_Judgement_Measurement_Model_Flowchart**

    ·
    [Click here for a Library and Learning Services page on Memos in the Writing Guide.](https://guides.rasmussen.edu/writing/letters)

    ·
    [Click here for a Library and Learning Services page on composing a Memo.](http://rasmussen.libanswers.com/faq/32874)

    ·
    [Click here for a Library and Learning Services APA Guide.](http://guides.rasmussen.edu/apa)

    **Submission**

    Text Editor

    _Word count: 0_

    **Details & Information**

    **Assessment due date**

    6/20/25, 11:59 PM (CDT)

    · You cannot submit work after due date

    · You cannot make a new submission attempt after due date

    **Attempts**

    3 attempts left

    **Grading rubric** [This item is graded with a rubric](https://learning.rasmussen.edu/ultra/courses/_171279_1/grades/assessment/_18023680_1/overview/attempt/create/rubric-view?columnId=_6372669_1&courseId=_171279_1)

    **Grading**

    **Maximum points** 4 points

    Save and CloseSubmit

    **## BSNNCSBN_Clinical_Judgement_Measurement_Model_Flowchart.pdf**

    Layer 0

    Layer 1

    Layer 2

    Layer 3

    Satisfied

    Evaluation

    Clinical Judgment

    Not Satisfied

    Refine HypothesesForm Hypotheses

    Client
    Needs

    Clinical
    Decisions

    Recognize
    Cues

    Analyze
    Cues

    Prioritize
    Hypotheses

    Generate
    Solutions

    Take
    Actions

    Evaluate
    Outcomes

    The NCSBN Clinical Judgment Measurement Model

    Copyright ©2019 NCSBN. All Rights Reserved.

    Environmental Factor Examples Individual Factor Examples

    Nursing
    Process

    Layer 4

    Assessment Analysis Planning EvaluationImplementation

    Environment Resources Medical
    Records

    Client
    Observation

    Consequences
    & Risks

    Task
    Complexity

    Time
    Pressure

    Cultural
    Consideration

    Prior
    Experience

    Candidate
    Characteristics

    Level of
    Experience

    SkillsKnowledge Specialty

    **## BSN4.docx**

    NUR4922CBE Section 01CBE Bachelor of Science in Nursing Capstone (11 Weeks) – CBE Online Course – 2025 Spring Quarter

    Deliverable 4 – Making the Best Nursing Decisions

    **Assignment Instructions**

    **Competency**

    Synthesize knowledge from the humanities, physical and social sciences, nursing theory, and applied research as a basis for evidence-based nursing practice and clinical reasoning.

    **Student Success Criteria**

    View the grading rubric for this deliverable by selecting the “Grading rubric” in the right menu.

    **Scenario**

    You finished new graduate orientation yesterday on a general medical surgical unit, and today you will independently care for two clients. As you receive a report on the second client at 0730, your Preceptor stops by to ask how the first day by yourself is coming along and reminds you to complete the final items on your training list today before the end of the 12-hour shift.

    · Complete the new online training model and quiz on the sliding insulin scale

    · Complete the orientation evaluation form

    · Sign up for one of the four nursing committees

    · Complete and sign the orientation reflection journal

    · Attend the new employee luncheon from 1-2 pm sponsored by the hospital physicians

    **Client 1**

    · 25 year old female 24 hours post-op from a Roux-en-Y gastric bypass

    · BMI of 50

    · History of hypertension and sleep apnea

    · No complications post-operative

    · Pain at 4 am, three on a scale of 10

    · Nasogastric tube to gravity

    · NPOMother stayed overnight but left early this morning to shower and will return later in the afternoon

    · Waiting on morning labs

    **Client 2**

    · 46 year old male admitted 72 hours prior with severe GERD and difficulty swallowing

    · History of alcoholism, hypertension

    · Smoked two packs per day for 22 years

    · Endoscopy for Barrett’s Esophagus was negative on the day of admission

    · Pain at 4 am, two on a scale of 10

    · Due to resume clear liquid diet this morning

    · Potential discharge later today home with family

    · The ex-wife has stayed in a room with a client and has been disruptive at times demanding pain medication and food.

    · Waiting on morning labs

    **Client 1**

    Physician orders:

    · Dietary Consult

    · Bariatric Behavioral Therapist Consult

    · 0.45% NS intravenous infusion post op

    **Client 2**

    Medications:

    · Protonix 40 mg once daily, intravenous infusion

    · Switch to oral Protonix 40mg day of discharge

    · IV infusion 0.9% NS 50 ml/hour

    · Resume 50mg Lopressor (metoprolol) PO twice daily after rule out Barrett’s Esophagus

    · 1-2mg Morphine Sulfate IV PRN q 4-6 hours for pain greater than 6 out of 10

    TIME
    _(EVENT)_

    · 0800 – You prioritize the need to assess the 46 year old male first since he has 0900 medications and the physician is rounding and should order discharge today. Assessment and vital signs reveal no concerns, ex-wife not present. A physician writes an order to discharge this client today. The client asks you to return in 30 minutes and go over discharge when ex-wife is present to hear instructions. You administer Lopressor and Protonix.

    · 0830 – You assess the 25 year old post bariatric surgery client. Vital signs and morning labs are within acceptable limits, and client reports pain two on a scale of 10. While assessing for bowel sounds, you notice the nasogastric (NG) tube not secured to the nose, and the client reports the tube partially came out when she blew her nose but she was able to push it back in with no pain. You document NG tube in place and assist the client to the bathroom.

    · 0900 – You return to 46 year old client and review discharge instructions with the client and ex-wife, discontinue the IV infusion, remove the intravenous catheter, and complete discharge summary.

    · 0945 – Transport stops by to take 25 year old client to meet with a support group for bariatric surgery clients — you okay transport.

    · 1000 – Physician stops into see a bariatric client and is upset you let her leave for support group before rounding. You report no concerns, physician reviews chart and writes discharge order for later in the afternoon if no vomiting or pain. The NG tube can be removed at noon by the Nurse Practitioner, and a diet of clear liquids resumed at 6 pm if no vomiting or gastric distention. Call immediately if any vomiting or signs of gastric distention occur.

    · 1030 – You take a break to complete orientation reflection journal, orientation evaluation, and online sliding insulin scale training module and quiz.

    · 1130 – The 25 year old bariatric client returns from the support group, you see her ambulating in the hallway, and you notice the NG tube is missing. The client states the tube fell out of her nose when she stood up to introduce herself. She has no complaints of nausea and no evidence of gastric distention. You document the NG tube was removed accidentally by the client.

    · 1200 – 46 year old male client calls and expresses frustration at a time to discharge. He wants to be home by 3 pm for his son’s birthday party. You call transport who assures you and the client they will arrive before 1 pm to discharge the client.

    · 1215 – Morning documentation complete, all orders are in the system, and both clients are stable. You are amazed at how smooth the first day is going. You head to the new employee luncheon with your Preceptor.

    · 1330 – You return from lunch and find the 46 year old client discharged, and you must prepare for a new admit from the emergency room with rule out pancreatitis. You feel apprehension since this will be your first admit, so you reach out to your Preceptor to review policy and procedure for new admissions.

    · 1345 – While working with your Preceptor, the Certified Nursing Assistant stops by and reports the 25 year old client refused an afternoon visit from a member of the bariatric support group, complaining of fatigue. Her noon vital signs were blood pressure 90/40, heart rate 112, and respiratory rate 28. Your Preceptor assures you these vital signs, and fatigue often occurs with this type of client. She susgest, the client is probably depressed, ready to go home, and suggests to let her rest for the afternoon.

    · 1415 – The new admit from the emergency department arrives with two pages of physician orders and a communication challenge since he speaks and understands only Spanish. He has pain in the abdomen and begins vomiting. Seeing you are now very busy, the Preceptor offers to “look in” on your 25 year old client and will take care of any concerns. Also, she will order a translator to assist with the new admit, while you focus on taking care of the physician orders.

    · 1730 – Finally, all orders for the new admit are in the system; pain decreased, no further vomiting, and he is resting comfortably. While waiting for lab results, you decide to check on the 25 year old client.

    · 1745 – On the way to the client’s room, the Nurse Manager stops and asks you to take a moment to fill out a volunteer form for one of the four nursing committees on the Unit.

    · 1815 – You return to the 25 year old client’s room and find her unresponsive, pale, with no heart beat or respirations. The abdomen is distended and hard. Attempts are made for resuscitation but are not successful. The client is deceased.

    · 1900 – You prepare to leave to go home. The Nurse Manger stops you and asks to debrief the situation. After reviewing the chart and discussing the situation, she is concerned and sees errors in your judgement and actions. She is sure the client’s death will be a sentinel event and warrant a review by the Internal Review Board.

    **Instructions**

    To prepare for debriefing with the Internal Review Board, the Nurse Manager asks you to submit an internal memo with your analysis and perceptions of the events that occurred, including:

    · Description of the errors that occurred

    · Support choices with rationales

    · Description of why the errors occurred

    · Support choices with rationales

    · Strategies for appropriate actions to avoid errors identified

    · Support strategies with rationales, nursing theory and evidence from the literature

    · Ideas stated with professional language and attribution for credible sources with correct APA citation, spelling, and grammar

    **Resources**

    **NCSBN_Clinical_Judgement_Measurement_Model_Flowchart**

    ·
    [Click here for a Library and Learning Services page on Memos in the Writing Guide.](https://guides.rasmussen.edu/writing/letters)

    ·
    [Click here for a Library and Learning Services page on composing a Memo.](http://rasmussen.libanswers.com/faq/32874)

    ·
    [Click here for a Library and Learning Services APA Guide.](http://guides.rasmussen.edu/apa)

    **Submission**

    Text Editor

    _Word count: 0_

    **Details & Information**

    **Assessment due date**

    6/20/25, 11:59 PM (CDT)

    · You cannot submit work after due date

    · You cannot make a new submission attempt after due date

    **Attempts**

    3 attempts left

    **Grading rubric** [This item is graded with a rubric](https://learning.rasmussen.edu/ultra/courses/_171279_1/grades/assessment/_18023680_1/overview/attempt/create/rubric-view?columnId=_6372669_1&courseId=_171279_1)

    **Grading**

    **Maximum points** 4 points

    Save and CloseSubmit

  • [Solved] BASED ON DATA

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    How to make an effective decision with understanding data – a year ago

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    How to make an effective decision with understanding data

    – a year ago

  • [Solved] 6011

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    – a year ago **files (1)** – ## assess6011pt1.docx **## assess6011pt1.docx** For this assessment, you will complete an evidence-based patient-centered needs assessment of prospective health care technology that will improve patient engagement. You will write a 4-5 page paper explaining the process a…

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    Assignment Prompt & Instructions

    – a year ago

    **files (1)**

    – ## assess6011pt1.docx

    **## assess6011pt1.docx**

    For this assessment, you will complete an evidence-based patient-centered needs assessment of prospective health care technology that will improve patient engagement. You will write a 4-5 page paper explaining the process and considerations that went into completing the patient needs assessment.

    Expand All

    **Introduction**

    Evidence-based practice is a key skill in the toolkit of the master's-prepared nurse. Its goal is that health care practitioners use the best available evidence to improve population health outcomes and make the best clinical decisions (Gallagher et al., 2020). In essence, evidence-based practice is all about ensuring quality care.

    For this assessment will begin to apply some of the evidence-based practice strategies you have learned to ensure quality care for an individual patient. The primary strategy that you will utilize to accomplish this is an evidence-based patient-centered needs assessment. A patient-centered needs assessment can help you organize the relationships between ideas, challenges, or terms to utilize the best evidence to plan interventions. The overall goal of the resources and this assessment is to allow you the opportunity to apply evidence-based practice and personalized care concepts in order to improve the health of a single patient.

    **Reference**

    Gallagher, F. L., Koshy Thomas, B., Connor, L., Sinnott, L. T., & Melnyk, B. M. (2020). The effects of an intensive evidence‐based practice educational and skills building program on EBP competency and attributes.
    _Worldviews on Evidence-Based Nursing_,
    _17_(1), 71–81.

    **Professional Context**

    Patient-centered needs assessment is a critical element in nursing care. The findings from the needs assessment can be effective tools for organizing a plan of action, prioritizing patient care strategies, and developing personalized care approaches that improve patient engagement. In addition to organizing care, they can aid in ensuring that the patient's care is individualized to their health conditions as well as familial, cultural, and environmental circumstances.

    **Scenario**

    The purpose of a needs assessment is to identify priorities of a community or patient population. The findings of a needs assessment can be an extremely useful tool to help organize and plan care decisions for a specific patient or group. By conducting a needs assessment, a nurse can then use the best evidence to guide the interventions selected to meet the identified needs and improve patient engagement.

    **## assess6011pt1.docx**

    For this assessment, you will complete an evidence-based patient-centered needs assessment of prospective health care technology that will improve patient engagement. You will write a 4-5 page paper explaining the process and considerations that went into completing the patient needs assessment.

    Expand All

    **Introduction**

    Evidence-based practice is a key skill in the toolkit of the master's-prepared nurse. Its goal is that health care practitioners use the best available evidence to improve population health outcomes and make the best clinical decisions (Gallagher et al., 2020). In essence, evidence-based practice is all about ensuring quality care.

    For this assessment will begin to apply some of the evidence-based practice strategies you have learned to ensure quality care for an individual patient. The primary strategy that you will utilize to accomplish this is an evidence-based patient-centered needs assessment. A patient-centered needs assessment can help you organize the relationships between ideas, challenges, or terms to utilize the best evidence to plan interventions. The overall goal of the resources and this assessment is to allow you the opportunity to apply evidence-based practice and personalized care concepts in order to improve the health of a single patient.

    **Reference**

    Gallagher, F. L., Koshy Thomas, B., Connor, L., Sinnott, L. T., & Melnyk, B. M. (2020). The effects of an intensive evidence‐based practice educational and skills building program on EBP competency and attributes.
    _Worldviews on Evidence-Based Nursing_,
    _17_(1), 71–81.

    **Professional Context**

    Patient-centered needs assessment is a critical element in nursing care. The findings from the needs assessment can be effective tools for organizing a plan of action, prioritizing patient care strategies, and developing personalized care approaches that improve patient engagement. In addition to organizing care, they can aid in ensuring that the patient's care is individualized to their health conditions as well as familial, cultural, and environmental circumstances.

    **Scenario**

    The purpose of a needs assessment is to identify priorities of a community or patient population. The findings of a needs assessment can be an extremely useful tool to help organize and plan care decisions for a specific patient or group. By conducting a needs assessment, a nurse can then use the best evidence to guide the interventions selected to meet the identified needs and improve patient engagement.

  • [Solved] 512 mod 7 disc

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    Assignment Prompt & Instructions

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  • [Solved] CT-II

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    – a year ago **files (1)** – ## CT_II.docx **## CT_II.docx** CT-II Unit VI Assignment Assignment Instruction This reflection assignment measures your mastery of ULO 3.1. In this lesson, you learned about the value of curriculum codification, planning, and mapping. Please use the [Unit VI Assignmen…

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    – a year ago

    **files (1)**

    – ## CT_II.docx

    **## CT_II.docx**

    CT-II

    Unit VI Assignment

    Assignment Instruction

    This reflection assignment measures your mastery of ULO 3.1.

    In this lesson, you learned about the value of curriculum codification, planning, and mapping. Please use the
    [Unit VI Assignment Template](https://online.columbiasouthern.edu/bbcswebdav/pid-17284809-dt-asiobject-rid-174653841_1/xid-174653841_1) to reflect on the concepts presented and list three things you learned, two things you found interesting, and one question you have. Sources are not required, but properly cite and reference any sources used

    UNIT VI ASSIGNMENT TEMPLATE

    Three Things I Learned:

    1.

    2.

    3.

    Two Things I Found Interesting:

    1.

    2.

    One Question I Have:

    1.

    Unit VII Assignment

    Assignment Instruction

    This assignment measures your mastery of ULOs 2.4, 3.1, and 4.1.

    For this assignment, you will continue your work on your curricular recommendation. Thus far, you have identified a curricular need, provided a rationale for the curricular change, and offered two recommendations to address the need.

    Using your previous research and conducting additional research, address how your curricular recommendations would impact the following bulleted areas. In your submission, identify at least one curriculum theorist with whom you feel your curriculum recommendation most aligns and explain why. Provide evidence of support for your response.

    · Content Instruction

    · Assessment (including progress monitoring)

    · Differentiation

    · Technology

    · Learning Strategies

    · Behavior/Classroom Management

    · Diversity

    Your submission should be six pages in length, not counting title or references pages. Each of the seven evidence/researched-based practices addressed for each item above should be properly cited and referenced.

    Adhere to APA Style when constructing this assignment, including in-text citations and references for all sources that are used. Please note that no abstract is needed.

    Unit VIII Assignment

    Assignment Instruction

    This assignment measures your mastery of ULO 2.1.

    **Reflection**

    Write a reflection paper about the topics discussed in this course and what you have learned about curriculum. Based on where curriculum has been and where it is currently, briefly express where you feel curriculum might be in the future. Additionally, share how you feel your curricular recommendations might impact your future vision of curriculum.

    Your paper should be three to four pages in length. Although references will not be required for this assignment, adhere to APA Style when constructing this assignment, including in-text citations and references if optional sources are used. Please note that no abstract is needed.

    **## CT_II.docx**

    CT-II

    Unit VI Assignment

    Assignment Instruction

    This reflection assignment measures your mastery of ULO 3.1.

    In this lesson, you learned about the value of curriculum codification, planning, and mapping. Please use the
    [Unit VI Assignment Template](https://online.columbiasouthern.edu/bbcswebdav/pid-17284809-dt-asiobject-rid-174653841_1/xid-174653841_1) to reflect on the concepts presented and list three things you learned, two things you found interesting, and one question you have. Sources are not required, but properly cite and reference any sources used

    UNIT VI ASSIGNMENT TEMPLATE

    Three Things I Learned:

    1.

    2.

    3.

    Two Things I Found Interesting:

    1.

    2.

    One Question I Have:

    1.

    Unit VII Assignment

    Assignment Instruction

    This assignment measures your mastery of ULOs 2.4, 3.1, and 4.1.

    For this assignment, you will continue your work on your curricular recommendation. Thus far, you have identified a curricular need, provided a rationale for the curricular change, and offered two recommendations to address the need.

    Using your previous research and conducting additional research, address how your curricular recommendations would impact the following bulleted areas. In your submission, identify at least one curriculum theorist with whom you feel your curriculum recommendation most aligns and explain why. Provide evidence of support for your response.

    · Content Instruction

    · Assessment (including progress monitoring)

    · Differentiation

    · Technology

    · Learning Strategies

    · Behavior/Classroom Management

    · Diversity

    Your submission should be six pages in length, not counting title or references pages. Each of the seven evidence/researched-based practices addressed for each item above should be properly cited and referenced.

    Adhere to APA Style when constructing this assignment, including in-text citations and references for all sources that are used. Please note that no abstract is needed.

    Unit VIII Assignment

    Assignment Instruction

    This assignment measures your mastery of ULO 2.1.

    **Reflection**

    Write a reflection paper about the topics discussed in this course and what you have learned about curriculum. Based on where curriculum has been and where it is currently, briefly express where you feel curriculum might be in the future. Additionally, share how you feel your curricular recommendations might impact your future vision of curriculum.

    Your paper should be three to four pages in length. Although references will not be required for this assignment, adhere to APA Style when constructing this assignment, including in-text citations and references if optional sources are used. Please note that no abstract is needed.

  • [Solved] 502 case study 7

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  • [Solved] Create a Power Point for Paper

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    Please see paper attached. Power point should be 5-8 minutes to read. – a year ago **files (1)** – Particum2Paper.docx **Particum2Paper.docx** This file is too large to display. [View in new window](https://www.sweetstudy.com/files/particum2paper-docx) **Particum2Paper.docx** This file is too large …

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    Please see paper attached. Power point should be 5-8 minutes to read.

    – a year ago

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    – Particum2Paper.docx

    **Particum2Paper.docx**

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  • [Solved] Lesson Plan

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  • [Solved] Planning & Instruction | Lesson Internalization: Supporting Student Learning

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  • [Solved] Planning & Instruction | Lesson Internalization: Defining Student Success

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