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Case Study to Promote Critical Reasoning

Julio works at a large teaching hospital in a major metropolitan area. This institution services
the entire geographical region, including indigent clients and, because of its reputation,
administers care to international clients and individuals who reside in other states. Similar to
all health-care institutions, this one has been attempting to cut costs by using more NAP.
Nurses are often floated to other units. Lately, the number of indigent and foreign clients on
Julio’s unit has increased. The acuity of these clients has been quite high, requiring a great
deal of time from the nursing staff.

Julio arrived at work at 6:30 a.m., his usual time. He looked at the census board and
discovered that the unit was filled, and Bed Control was calling all night to have clients
discharged or transferred to make room for several clients who had been in the emergency
department since the previous evening. He also discovered that the other RN assigned to his
team called in sick. His team consists of himself, two CNAs, and an LPN who is shared by
two teams. He has eight patients on his team:

o Two need to be readied for surgery, including preoperative and postoperative teaching,
one of whom is a 35-year-old woman scheduled for a modified radical mastectomy for the
treatment of breast cancer.

o Three are second-day postoperative clients, two of whom require extensive dressing
changes, are receiving IV antibiotics, and need to be ambulated.

o One postoperative client is required to remain on total bedrest, has a nasogastric tube to

suction as well as a chest tube, is on total parenteral nutrition and lipids, needs a central
venous catheter line dressing change, has an IV, is taking multiple IV medications, and
has a Foley catheter.

o One client is ready for discharge and needs discharge instruction.

o One client needs to be transferred to a subacute unit, and a report must be given to the

RN of that unit.

Once the latter client is transferred and the other one is discharged, the emergency
department will be sending two clients to the unit for admission.

1. How should Julio organize his day? Think about how you would set up an hourly

2. Make a priority list based on the ABC (airway, breathing, circulation) + Maslow method.

3. What type of client management approach should Julio consider in assigning staff

4. If you were Julio, which clients or tasks would you assign to your staff? List all of them.

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