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UNRS412 Clinical Residency Nursing

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Description: This competency will serve to fulfill remaining requirements in the UNRS412 course. Students will test online with a faculty member and should be prepared to describe the provision and patient care management of the following case(s) consistent with the course student learning outcomes (SLOs).
1.    Apply complex skills and knowledge of assessment, diagnosis, planning, intervention, and evaluation in utilization of the nursing process with acutely ill patients and families.
2.    Demonstrate the ability to set appropriate priorities of care for acutely ill patients including scientific/theoretical rationale for clinical decisions.
3.    Discuss research findings related to the care of acutely ill patients in the assignments. 
4.    Demonstrate leadership in collaboration with preceptors and members of the health care team in coordinating services to patients, families and aggregates
5.    Analyze clinical situations and individual performance through reflective journaling and student self-evaluation
 
Patient Diagnosis: GI Bleed/Liver Failure
History/Information:
The patient is a 52-year-old male with a 10-year history of alcohol abuse. He is married with one grown child. Although he is employed full-time, he has been increasingly absent from work in the past six months due to lethargy and fatigue. About 18 months ago, he was diagnosed as having alcoholic cirrhosis. Six months ago he underwent endoscopic variceal band ligation for bleeding esophageal varicies. Medications include lactulose, an antibiotic (name unknown) for bronchitis and a persistent cough for the past four days, oral metronidazole and aldactone. He was last seen by the healthcare provider last week. His liver function tests at that time indicated severe liver disease. He is on a low protein, low sodium and high carbohydrate diet.
 
During the night, the patient began swatting at flies in the air that were not there, insisted there were spiders crawling on the wall and tried to leave the house “to catch a bus.” He became increasingly agitated and confused. The wife reports the patient had a large, watery black stool in the early morning. One hour later, the patient vomited bright red blood with large amounts of coffee ground appearing emesis. The patient’s wife and brother brought the patient to the
 
Emergency Department after this emesis. The family further reports a two-day history of hematemesis in small amounts. The patient is unable to recall information regarding past or current physical symptoms but admits to continued daily consumption of alcoholic beverages. He has been admitted to the Surgical Intensive Care Unit with a diagnosis of liver failure, hematemesis and new onset confusion.
 

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