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Clinical Decision Making in Medical Scenarios

Keywords: prostate cancers decision making

Clinical decision-making (CDM) is a strong activity in which the nurse builds an instance where hypotheses are accepted or rejected based on collected data, better defined by Barrows & Pickell (cited in Robinson 2002, p. 1) 'Clinical decision making is the formulation and revision of hypotheses throughout a patient face'. This scenario-based clinical decision-making exercise is about the application of learned serious theory into professional medical scenario (Robinson 2002).

The following research study outlines the possible nursing problems of your customer, Mr Robbins who was identified as having advanced prostate cancer tumor and was recommended that the only real treatment available for him was palliative carrying out a transurethral resection of the prostate (TURP). After seeking another thoughts and opinions he was located on a every month hormone remedy subdermal transplant for two years and sub. At the moment, Mr Robbins prostate specific antigen (PSA) level is 12 and has been stable for 4 months.

Mr Robbins has a positive attitude towards his condition. He communicates with other victims and doctors from other countries and has a normal connection with his specialist about possibilities for him. He also has a supportive partner and has very lively life in the community that he lives in. His major concern is his osteoporosis and fracture incidence due to bone metastases of his prostate malignancy. He previously several comes but did not undergo any fractures. He calls for Bisphosphonate medication for his bones and feels that his medication has his cancer in order. He recently been admitted in the hospital scheduled to his breasts infections and requires 4 hourly antibiotic intravenously and he's to be discharged the next day to Hospital in the home.

This brief put together offers a basis on which to plan and apply suitable nursing care for Mr. Robbins. By applying the ideas of CDM to the case will develop a coordinated health care pathway for the patient from hospitalization to patient discharge and changeover to home.

Patient History

Prostate malignancy is a malignant tumour of the prostate gland. Nearly all tumours arise in the outer aspect of the prostate gland. Prostate tumor is usually slow-moving growing. The tumour can spread to other areas of the body, particularly the lymph nodes and the bone fragments. It is usually asymptomatic in the first phases but eventually the patients may have symptoms such as difficulty in urinating and erectile dysfunction. Other symptoms can potentially develop during later periods of the disease (Brown & Edwards 2008).

Treatment options for prostate cancers are surgery, rays therapy, hormonal remedy, and chemotherapy. Treatment is determined by the stage of the cancers and the overall health of the patient (Dark brown & Edwards 2008). Mr. Robbins prostate malignancy was classified move forward, meaning the cancer skin cells disperse beyond the localized area of the prostate and in his circumstance it metastasis into his bone fragments.

Coordinated Care and attention Pathway

Coordinated treatment pathway is organized multidisciplinary care strategies which feature essential steps in the care of patients with a specific clinical problem. The purpose of a health care pathway is to enhance the quality of care over the continuum by improving risk-adjusted patient outcomes, promoting patient security, increasing patient satisfaction, and optimizing the use of resources.

The important elements of the Registered Nurse (RN) as the Coordinator of Attention within the Multidisciplinary Team

The nurse health care coordinator will build relationships Mr Robbins, and support him throughout his care and attention plan. The RN will also organize the care and attention and services recognized in the health care plan across cultural health care and other agencies and he/she will also liaise with the other healthcare professionals when it comes to execution of Mr Robbins care and attention plan. The nurse planner also keep an eye on the progress of the care plan by collating information from agencies and those who provide particular elements of a care and attention plan. The RN also act as a communicator between the patient and those providing components of the care intend to ensure the correct passing of relevant information on progress and advancements.


Functional Health Design Assessment

Health Perception/Health Management

Mr. Hay appears to understand how to control his health as he searched for medical assistance for his cough, and believes he copes at home despite no mention of services set up. An evaluation should be conducted to get insight into what he thinks is normal for his time. This may integrate questions regarding his eating and fluid intake; utilizing a dietician or nutritionist if possible. Further questions could be posed regarding his adherence to medications in mention of the antibiotics. He'll also require close monitoring from his doctor in regards to his upper body pain and may need a recommendation to a cardiologist and respiratory specialist in the future.

  • Activity/Safety

Mechanical and gas exchange alterations in the lungs that occur in normal aging, together with his respiratory complications and possible angina, would most likely reduce Mr. Hay's capacity to tolerate exercise (McCance & Huether 2006). His past #NOF may also be impairing ability to move. Therefore, he may require advice about self treatment activities and ambulation whilst admitted.

  • Nutrition/Metabolism

In older people malnutrition is a significant concern, in particular when they are enduring a chronic pulmonary disorder; anticipated to increased energy costs and impaired oxygenation. Therefore maintenance of an acceptable and steady weight is important.

A diet high in energy density, consistent snacking, smooth food, and regular beverages is advisable. Discharge planning should entail assistance in this field such as shopping and meals preparation (Dark brown & Edwards, 2008)

  • Elimination

His elimination pattern could be evaluated by requesting him about the occurrence of bowel and bladder activity and seeking a description. He also needs to be asked if occurrence or pain is experienced with defecating or urinating, if laxatives or enemas are being used, results also needs to be noted. The skin should also be evaluated in conditions of excretory function if increased perspiration, oedema, pruritus and/or redness can be found (Brown & Edwards, 2008, p. 40).

  • Cognition/Perception

Mr. Hay can express himself evidently as evidenced by his claims of breasts pain, and he's also able to recall past occurrences by proclaiming this had took place recently. Although hypoxia and fever could influence his mental state, as alluded to by the discrepancies in the data

  • Sleep/Rest

Laying down results sputum obstructing airways, whilst dyspnoea may lead to anxiety to further impede sleep. Monitoring is vital to avoid skin breakdown on his kept part if pain establishes he lays on that side exclusively, and likewise reduction of further breakdown should he continue steadily to sleep on his right. Whilst the pyrexia could impact sleep as he may be experiencing evening sweats or sense too hot to rest. Extrinsic factors like the hospital environment can amplify sleep disturbances, as Mr. Hay may have to share a room with strangers and endure a loud ward when he's familiar with sleeping together in his home. Not forgetting his own nervousness as a natural reaction to being accepted to medical center.

  • Self perception and personal concept

Mr. Hay seems capable of self care activities and perhaps this is backed as he performed make reference to browsing his doctor, which requires some level of cognitive and physical working. Yet without factual information regarding this visit, the emphasis still is situated on the circumstances the led to this entrance which paint another type of picture.

  • Roles and relationships

Living exclusively, isolated from family along with his neighbour only exploring him after time got elapsed, as well as the fatality of his wife; reveals Mr. Hay's isolation and possible loneliness.

His prior incidents all seem to own coincided with the passage of his better half, as he sustained a #NOF and P. E. in the same time she died, and a season later he seriously burnt his hands; perhaps proof his drop since learning to be a widow.

  • Sexuality/Reproductive Patterns

Mr. Hay's recent widowhood has intended he has been compelled to re-establish himself as a person after years to be part of a romantic relationship. The grief experienced by the remaining spouse due to the lack of closeness in erotic intimacy and overall companionship can manifest into serious health implications.

  • Coping and stress tolerance

It could be studied at face value that Mr. Hay refreshments a nightly scotch, yet alcoholic beverages consumption is associated with ineffective coping mechanisms, especially in men (Cooper et al. 1992). Mr. Hay explained that the guy can cope by himself, yet his history and current injury say otherwise.

  • Values and beliefs

Mr. Hay's positive responses with regards to his home situation and health imply he's independent. In actual situations this would prompt further questions to understand how the patient views their current situation also to anticipate how he might offer with the intrusion to his freedom through better monitoring by applying services as home.


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