Nursing Process - created from Mind Map

Seite 1

Nursing Assessment

Nursing Diagnosis

Nursing Planning

Nursing Implementation

Clinical Reasoning

Nursing Evaluation

Mr. Patience, an 86-year-old male widow, who has recently been relocated to a long-term care

At 0800, he was lying in bed and not rousable

Vitals BP 85/40, HR 54, SpO2 84% in room air, Temperature 36 °C, and RR 8, irregular.

Pt. has decreased LOC, and condition is deteriorating

If it continues he will go into cardiac arrest

Find an oxygen tank and administer O2 via a non-rebreather facemask to the patient

LTC setting doesn't have equipment needed to treat the patient in case of further deterioration and potentially cardiac arrest

call 911 to transfer the patient to a hospital,

Alert the case manager using the iSBAR tool.

Put the plan into action

Prepare environment for ambulance

Call family members

Keep observing Mr. Patience until paramedics arrive

Clinical Judgement

Clinical Decision-Making

Critical Thinking

Go to the hospital to follow-up with Mr.Patience

Check patient outcome and discuss options with the family