Chapter 1: Critical Thinking in Health Assessment

1. Discuss the role of assessment as the starting point of all models of clinical
reasoning.
Assessment is the collection of data about the individual’s health state. The
purpose of assessment is to make a judgment or diagnosis. An organized
assessment is the starting point of every approach to clinical reasoning, because
all health care treatments and decisions are made based in the data you gather
during assessment; it is the paramount that your assessment be factual and
complete.
2. Describe the use of diagnostic reasoning in clinical judgment.
Diagnostic reasoning is the process of analyzing health data and drawing
conclusions to identify diagnoses is based on the scientific method. It has four
major components: 1. attending to initially available cues; 2. formulating
diagnostic hypotheses; 3. gathering data relative to the tentative hypotheses; and
4. evaluating each hypothesis with the new data collected, thus arriving at a final
diagnosis.
3. Discuss the use of nursing process in clinical judgment.
The nursing process is also based on scientific method and includes 6 phases:
assessment, diagnosis, outcome identification, planning, implementation, and
evaluation. The nursing process is a problem solving approach to clinical
judgments, the way in which we apply the process depends on our level and time
of experience. A new nurse may not pick up the signs of a patient being in distress
and would probably not do the accurate thing.
4. Differentiate between novice, proficient, and expert practitioner.
A novice practitioner is new to their healthcare environment and had no
experience with a specified patient population and uses rules to guide
performance. Proficient practitioner understands a patient situation as a whole
rather than as a list of tasks. The proficient practitioner sees long term goals for
the patient. An expert practitioner vault over the steps and arrive at a clinical
judgment in one leap. The expert nurse has an intuitive grasp of a clinical
situation and zeroes in on the accurate solution.
5. Describe the use of critical thinking in diagnostic reasoning and clinical
judgment.
Critical Thinking is the means by which we learn to asses and modify, if
indicated, before acting. Critical thinking is required for sound diagnostic reasoning and
clinical judgment, and knowing how to critical think will assist us in be able to sort
through vast amounts of data and information in order to make the sound judgments to
manage patient care. Critical thinking enables us to analyze complex data about patients,
make decisions about the patients’ problems and alternate possibilities, evaluate each
problem to decide which applies, and to decide on the most appropriate intervention for
the situation.
6. Differentiate first level, second level, and third level priority problems.
 First level priority: are those that are emergent, life threatening, and needs
immediate attention. Examples: Airway problems, breathing problems,
cardiac/circulation problems, signs (vital signs concerns).
Second level priority: are those requiring prompt intervention to forestall further
deterioration. Immediate, after treatment for first level problems is initiated. Example:
Mental status change, Acute pain, Acute urinary elimination problems, Untreated
medical problems requiring immediate attention (e.g., a diabetic who hasn’t had insulin),
Abnormal laboratory values, Risks of infection, safety, or security, (for the patient or for
others). Mnemonic MAA-U-AR
Third level priority: are those that are important to the patient’s health but can
be addressed after more urgent health problems are addressed (later proprieties).
Example: Health problems that do not fit into the above categories: problems with lack
of knowledge, activity, rest, family coping.

7. Contrast medical diagnosis with nursing diagnosis.

Medical diagnosis: are more specific and related to a pathological disease process;
where as a Nursing diagnosis: is based on the client’s physical, sociocultural,
psychological, and spiritual responses to an illness or health problem.

8. Discuss the expanded concept of health and relate it to the process of data
collection.
The expanded concept of health he expanded concept of health is the view of seeing
illness more than just disease or healthy. It involves wellness, holistic health and health
promotion and disease prevention. Within each concept certain questions should be asked
to make sure that everything is covered. With health promotion and disease prevention,
each person is responsible for their own health state and the health professional should be
there to guide them through the process.

9. Relate the patient situation to the amount of data collected.

Depending on what the patients are being seen for well determine what kind of data
will be collected. Complete Data Base (Total Health): This includes a complete health
history and a full physical examination. This forms a baseline against which all future
changes can be measured. It yields the first diagnosis. This is collected in primary care
settings, such as pediatric or family practice clinic, women health care agency, visiting
nurse agency, or community health agency. Episodic or Problem-Centered Data Base:
This is for limited or short termed problem. Collect a “mini” data base, smaller in scope
and more focused than the complete data base. It concerns mainly one problem, one cue
complex, or one body system. Follow-Up data base: This type of data base is used in all
settings to follow up short term or chronic health problems. Emergency Data Base: This
calls for a rapid collection of the data, often complied concurrently with lifesaving
measures. Diagnosis are swift and sure.

10. Relate the patient age and health status to the frequency of health assessment.
During different developmental stages, each client should be evaluated according
to the appropriate age and wellness of the patient. Gathering data from a toddler is
completely different school-aged children. The same way goes for teenagers, adults, and
older patients. Also depending on the patient’s health status differs. With someone who is
very ill, you would want to make the health assessment straight to the point with yes and
no question.