NRSG370 Clinical Integration : Specialty Practice

The 7 Components of a Clinical Integration Network


Mrs. Connie Brownstone


Mrs. Connie Brownstone is a 79 year old women admitted to the Emergency Department (ED).  Connie was brought into the ED by her daughter with a one-day history of fluctuating shortness of breath/dyspnoea unrelieved by medication.

Triage Nurse Assessment:

  • Vital signs: RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 168/70;
  • Physical assessment: Dyspnoea, very anxious, audible expiratory wheeze;
  • Past history: Asthma, allergies to pollen and dust mite, ICU admission 5 years ago (endotracheal intubation and ventilation for 2 days – status asthmaticus).
  • Medications: (1) Ventolin, and (2) Ipratropium bromide.

Due to her respiratory distress, Connie was triaged as a category 2, as per the Australasian Triage Scale, and brought directly from the waiting room into a HDU monitored cubicle where you are the ED nurse allocated to her care (Department of Health and Aging, 2009). Oxygen of 6L/min was applied via the Hudson Mask.

Figure, Australasian Triage Scale Figure. Contributed by Charles Yancey] -  StatPearls - NCBI Bookshelf

Cubicle Nurse Assessment:

  • Vital signs: RR 35, SpO2 89% (6L oxygen), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 172/75;
  • Physical assessment: Pt. seated and leaning forward, use of use of accessory muscles evident (sternocleidomastoid, scalene, and intercostal muscles), bilateral expiratory wheeze on auscultation, height 145cm;
  • Peak Flow 210 L/min (last normal reading 320 L/min)
  • Secondary survey revealed no other abnormalities.


FBE Within normal limits

Urea & Electrolytes Within normal limits

C-Reactive Protein Within normal limits

Blood Cultures Pending

Troponin Within normal limits

Chest XRAY Hyperexpanded lungs, no consolidation or effusion

Arterial Blood Gas (ABG) pH 7.48, PaO2 60, PaCO2 30, HCO3 24 (Respiratory Alkalosis)

Normal ABG Ranges pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26

Student are expected to use the Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care.

Inquiry-based learning and clinical reasoning scaffolds: An action research  project to support undergraduate students' learning to 'think like a nurse'  - ScienceDirect

You are being asked to think through the case scenario and then discuss how data was collected and the type of data collected,

  • identify problems and nursing issues,
  • identify and state the objectives and discuss how care was provided in order to address the issues and evaluate the interventions carried out: (analyse and identify a nursing issues/problems/needs, set objectives,
  • discuss the nursing interventions and evaluate the interventions of care carried out).

As per lecture notes, students are expected to apply the clinical reasoning cycle to address the case scenario:

  • Consider the person’s situation
  • Collect, process and present related health information
  • Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
  • Establish goals for priority of nursing care related to the nursing problem/issues identified
  • Discuss the nursing care of the person; link it to assessment data and history.
  • Evaluate your nursing care strategies to justify the nursing care provided
  • Reflect on the person’s outcomes
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