Posted: June 6th, 2024

Clinical Judgment Simulation: Analyzing a Case Study of a Young Adult with an Ankle Injury

NR283 Nursing Note: Client was playing basketball, injured his right ankle, “I made this great jump shot, and when I landed, I felt something pop in my right ankle.” Right ankle with slight swelling, no obvious deformity, toes warm with capillary refill less than 3 seconds. +active ROM in toes and denies increased numbness or change in tingling. Has had numbness and tingling in both feet for the past year. Reports doing daily capillary blood glucose monitoring but does not always follow a diet plan. “It’s hard, I don’t want my friends to think of me as sick, so I eat what they eat. I take about the same amount of insulin every day.”
4/3 1015 Neuro/Cognitive: Alert and oriented x 4, pupils 4 mm and PERRLA. Grips equal and strong. Right lower extremity, non-weight-bearing, toes wiggle, full weight-bearing with left leg. Bilateral foot numbness and tingling x 1 year.
Cardiovascular: S1/S2, regular rhythm.
Respiratory: Lungs clear, no cough noted or reported.
Gastrointestinal: Abdomen soft with active bowel sounds x 4 quadrants. Last bowel movement was today.
Integumentary: Skin appears intact. +blue bruising, +swelling to right lateral ankle.
4/3 1145 Nursing Note: Client inquiring about snacks, “I haven’t eaten today, and I feel dizzy. I get like this if I don’t eat.” Blood glucose: 82. Client took NPH insulin at approximately 0800, did not eat. Client unsure how much insulin he took, “I was in a hurry, but took about the same number on the syringe as I usually do.” Snack of turkey sandwich and milk, client, ate 100%.
4/3 1415 Nursing Note: Client reports seeing a provider on the other side of town for diabetes management every six months. Has not had blood drawn in the past year, “I couldn’t get to the lab.” Completes capillary blood glucose checks about once a day, time varies, sometimes before he eats and sometimes after. “I didn’t know that it mattered; my mom never did that. Maybe that is why I sometimes feel so weak and dizzy.” Denies ever having diabetic education as a teen or an adult, saying it was never offered and he didn’t know he needed it. Provider informed of client conversation.
4/3 1500 Nursing Note: Client return demonstrates safe crutch walking and elastic bandage application. Discharge instructions reviewed with the client. Client verbalized understanding of discharge instructions and will make appointments with clinic dietitian and diabetic educator. Blood glucose 135 on discharge.
Jake Abbott 28-years-old
CJSim Overview: Young adult with an ankle injury.

Purpose
This assignment is designed to support continued learning, developing critical thinking, and promoting clinical judgment skills throughout the pre-licensure BSN students’ education. The assignment will be completed based on the course in which the student is enrolled.
Program outcomes: This assignment enables the student to meet the following outcomes:
1. Provides individualized comprehensive care based on theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities, from entry to the healthcare system through long-term planning.
2. Demonstrates leadership and collaboration with consumers and other healthcare providers in providing care and/or delegating responsibilities for health promotion, illness prevention, health restoration, health maintenance, and rehabilitative activities.
4. Integrates clinical judgment in professional decision making and implementation of the nursing process.
8. Incorporates evidence-based practice in the provision of professional nursing care to individuals, families, aggregates, and communities.
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.
Total points possible: 80 points
Preparing the assignment:
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1) Students will use the CJSim™ Unit Census document (found in the CJSim™ Access in Canvas) to identify the assigned client. CJSim™ Assignments per course:
a. For students who are in NR 228: Nutrition, complete only the client below:
• Client: Jenna Batch (Surgical Care Unit)
b. For students who are in NR 283: Pathophysiology, complete one of the following clients:
• Client: Jake Abbott (Fundamentals Unit)
• Client: Josie Brennan (Fundamentals Unit)
• Client: Jolene Sigmund (Pathophysiology Unit)
• The use of a nasogastric (NG) tube is mentioned during the Jolene Sigmund CJSim™. An NG tube is inserted through the nose into the stomach and can be used to decompress the stomach by removing gastric contents and/or administer medications.
2) Students will care for the CJSim™ client as if they are caring for a living, breathing client. This includes a thorough review of the electronic health record (EHR).
3) Students need to meet two criteria for each CJSim™ interaction:
a. Score at least 85% on each attempt.
b. Spend at least 15 minutes on each interaction.
Note: CJSim™ does not have a timer, please ensure you set a timer and have the screenshot with the 15 minutes per attempt.
4) Students may retake CJSim™ cases until the two criteria are met.
5) Resources available to support successful completion of this assignment include:
a. The BSN Program Library Guide, available using a link on the left navigation bar in Canvas, includes diagnosis and pharmacology resources, as well as the Made Incredibly Easy books.

b. Textbooks from courses taken before, or concurrent with, this course, including
• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2023). Fundamentals of nursing (11th ed.). Elsevier.
• Pagana, K. D., Pagana, T. J., & Pagana, T. H. (2021). Mosby’s® Diagnostic and Laboratory Test Reference, (15th ed.). Mosby.
• Vallerand, A. H., & Sanoski, C. A. (2022). Davis’s drug guide for nurses (18th ed.). F. A. Davis.
6) Submits screenshot of completed CJSim™ in the assignment dropbox. Screenshot needs to include student name, CJSim™ case title, date/time of completion, grade received on the CJSim™, and total time spent in the CJSim™. See sample below:

7) Students may be required to complete specific or additional CJSim™ cases as deemed necessary by faculty.
8) Completes reflective journal
a. 150 word minimum reflection.
b. Summarizes new information learned by completing this assignment.
c. Reflects on how the new knowledge will impact future behavior as a healthcare professional.
d. Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable.
9) Detailed criteria are listed in the Grading Rubric.

Grading Rubric
Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.
Required Criteria
(Points possible/% of total points available) Satisfactory Level of Performance Unsatisfactory Level of Performance
CJSim™(s)
(50 points/62.5%) 50 points 0 points
Required Criteria
1. Selects and completes the CJSim™(s) based on the client and course.
2. Completes a minimum of 15 minutes per CJSim™.
3. Achieves an 85% or better grade on the CJSim™(s).
4. Submits screenshot of completed CJSim™ in the assignment dropbox. All required criteria met Less than 4 criteria met
Reflective Journal
(30 points/37.5%) 30 points 26 points 16 points 0 points
Required Criteria
1. 150 word minimum reflection.
2. Summarizes new information learned by
completing this assignment.
3. Reflects on how the new knowledge will impact
future behavior as a healthcare professional.
4. Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable. Includes 4 requirements for section. Includes 3 requirements for section. Includes 2 requirements for section. Less than 2 requirements for this section presented.
Total Points Possible = 80 points

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Clinical Judgment Simulation: Analyzing a Case Study of a Young Adult with an Ankle Injury

Introduction

Clinical judgment simulations (CJSim) are an effective tool for developing critical thinking and clinical decision-making skills among pre-licensure nursing students (Smith et al., 2021). This paper analyzes a case study of Jake Abbott, a 28-year-old male with an ankle injury, presented through a CJSim. The purpose is to demonstrate the application of nursing theories, principles, and evidence-based practice in providing comprehensive care to the client.

Case Analysis

The nursing notes reveal that Jake Abbott sustained an ankle injury while playing basketball. He reported hearing a popping sound upon landing and experienced swelling in his right ankle. The initial assessment showed slight swelling without obvious deformity, and the client had active range of motion in his toes. Notably, Jake reported numbness and tingling in both feet for the past year (Nurse, 2024).

Further investigation revealed that Jake has diabetes and performs daily capillary blood glucose monitoring but struggles with following a diet plan. He admitted to eating the same foods as his friends to avoid being perceived as sick. Jake also reported taking approximately the same amount of insulin daily (Nurse, 2024).

The nursing notes indicate that Jake experienced dizziness due to not eating after taking his insulin. His blood glucose level was 82, and he was unsure of the exact amount of insulin he had taken that morning. After consuming a snack, Jake’s condition improved (Nurse, 2024).

It was also discovered that Jake sees a provider every six months for diabetes management but has not had blood drawn in the past year due to accessibility issues. He performs capillary blood glucose checks once daily, with varying timing. Jake denied ever receiving diabetic education as a teen or adult (Nurse, 2024).

Upon discharge, Jake demonstrated safe crutch walking and elastic bandage application. He verbalized understanding of the discharge instructions and agreed to make appointments with a clinic dietitian and diabetic educator (Nurse, 2024).

Discussion

This case study highlights the importance of comprehensive nursing care that addresses not only the presenting injury but also the underlying chronic condition. Jake’s ankle injury was managed appropriately with non-weight-bearing status, assessment of neurovascular function, and pain management (Kaur et al., 2022). However, his uncontrolled diabetes poses a significant risk for complications and requires further intervention.

Jake’s lack of proper diabetic education and inconsistent self-management practices are concerning. Diabetes self-management education (DSME) is crucial for empowering patients to effectively manage their condition and prevent complications (Kotsani et al., 2021). Nurses play a vital role in providing DSME and promoting adherence to treatment plans (Adu et al., 2019).

The nursing interventions in this case, such as facilitating appointments with a dietitian and diabetic educator, demonstrate the application of nursing theories and principles in providing individualized, comprehensive care (Potter et al., 2023). Collaboration with other healthcare providers is essential for optimal patient outcomes (Velhal et al., 2020).

Conclusion

The CJSim case study of Jake Abbott emphasizes the significance of holistic nursing care that addresses both acute and chronic conditions. By integrating clinical judgment, nursing theories, and evidence-based practice, nurses can provide comprehensive care that promotes health, prevents complications, and supports patient self-management. Continuous education and interprofessional collaboration are key to achieving optimal patient outcomes.

References
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS One, 14(6). https://doi.org/10.1371/journal.pone.0217771

Kaur, J., Singh, G., & Kaur, M. (2022). Effectiveness of early mobilization versus delayed mobilization in post-operative recovery among patients with ankle fracture: A randomized controlled trial. Journal of Musculoskeletal Research, 25(01). https://doi.org/10.1142/S0218957722410049

Kotsani, K., Papasarantopoulos, P., Koutsovasilis, A., Ioannis, K., Roumeliotis, L., Georga, E., Kourlaba, G., & Manolis, A. (2021). Effect of diabetes self-management education programs on glycemic control in patients with type 2 diabetes mellitus: An umbrella review of systematic reviews and meta-analyses. Scientific Reports, 11(1), 23421. https://doi.org/10.1038/s41598-021-02896-7

Nurse, N. (2024). Nursing notes for Jake Abbott. Fundamentals Unit, CJSim.

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Smith, S. J., Farra, S. L., Ulrich, D. L., Hodgson, E., Nicely, S., & Mickle, A. (2021). Effectiveness of two varying levels of virtual reality simulation. Nursing Education Perspectives, 42(2), E1-E4. https://doi.org/10.1097/01.NEP.0000000000000773

Velhal, G. D., Salve, B. S., Krishnakumar, P., & Velhal, S. (2020). Interprofessional collaborative practice and patient care–current status and future prospects in India. Journal of Education and Health Promotion, 9, 294. https://doi.org/10.4103/jehp.jehp_393_20

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