CNA344 | Clinical Encounter Analysis

CNA344: Becoming a RN: Practice consolidation
Practice Portfolio of Evidence PART B: Clinical Encounter Analysis
Consider the
patient
situation/contex
t
(@150 words)
Provide an
overview of the
encounter. What
happened, how it
occurred, what
was it that alerted
you to that fact
that you needed
to take action in
the encounter.
As part of the my placement at a residential aged care unit, I was assigned to the care of Mr. Jones (pseudonym), a
70 years old man with history of dementia. The patient was admitted to the hospital following a fall in the bathroom.
He sustained a hair line fracture of the ankles and he was in intense pain last night. However, during my assessment
in the morning, he was found to be much more comfortable. I checked his dressings and supported him in changing
his clothes and taking breakfast. The client was responding well to my questions. To ensure that the patient gets a
comfortable environment, I opened the curtains and tried to introduce patient to another patient on the ward so that
he does not feels gloomy all the day. However, as soon as I did this, the patient became very aggressive. He
became out of control and tried to hit me with any possible object he found near him. He was not listening at all and
he tried to open all the saline tube attached to his wrist too.
Review (@150
words)
What key
information was
already available
to you and how
did this influence
your thinking?
(eg: handover,
history, charts,
result of test,
assessments,
medical orders
etc.).
Review:
When I was handed over to Mr. Jones for care, I had reviewed the medical history of patient. The patient had a
history of dementia and memory problems since the past two years. He also had diabetes and hypertension. He was
operated three years ago for an intestinal surgery. Following the fall, blood test and X-ray was done. Mr. Jones was
brought to the hospital by her daughter. He wife was staying at home due to vision problems. Mr. Jones was
attached to his wife. However, since the past two months, he started avoiding contact with his wife and daughter
too. He wanted to be alone all the time. However, the information that I failed to notice was that he had a past
history of violent behaviour particularly when he encountered unfamiliar people all of a sudden.
I found the patient to be worried because of his fracture as throughout my conversation with the patient, I found
that he was gloomy about his future. I decided to make a change to his environment. The main intention of
introducing him to other patient was to distract him. According to Mackintosh-Franklin (2018), use of distraction
technique is important to calm the patient and manage their anxiety related to pain or other health problems.
Relevant medications (where relevant): (not included in word count)
The patient was taking two regular medications for diabetes and hypertension. After hospitalization, Mr. Jones was
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Gather(@150
words)
What was the
new information
you gathered
from additional
assessment?Dot points are
fine for this
section
Recall(@200
words)
Recall and apply
your existing
knowledge to the
above situation to
ensure you have
a broad
understanding of
what is/may be
occurring before
proceeding with
the rest of the
cycle.
What was telling
you that the
encounter was
presenting you
with a problem
being given analgesics for the management of pain.
Gather:
Apart from the review of past medical history, I also conducted pain assessment and cognitive assessment for Mr.
Jones using the PQRST format. PQRST format helps to analyse five factors such as palliation, quality/quantity,
radiation, severity and timing (Gauchan 2019). Based on this assessment, his pain score was found to be 2. The
patient reported getting relief from pain since morning and differences in his pain post the prescribed pain
medication. However, it was also found that raising his legs or putting his foot to the ground increased his pain level
or intensity.
I conducted cognitive assessment of patient to assess cognitive parameters of patient such as orientation to place
and time, memory, attention, thinking, language and executive function. He was found to be oriented to place and
time. He had memory recall issues but he was able to remember things once the event was repeated to him. He had
organized thoughts and good level of concentration. However, his executive functioning seemed affected.
Recall:
Based on the medical history, I conducted cognitive assessment of patient. However, as I failed to pay attention to
the history of aggressiveness issue of Mr. Jones, I avoided doing behavioural assessment. I think I should have
looked at the medical history more thoroughly because this would have helped me to careful assess behavioural
changes and interpret the impact of the issue on the patient. On recalling the knowledge related to nursing
assessment of dementia patient, I feel that monitoring of behavioural changes like anxiety and aggression and the
factors triggering it was important. According to Kales, Gitlin and Lyketsos (2015), apart from psychological
symptoms, dementia patients have many other behavioural issues such as aggression, sleep problems, agitation
and wandering. In addition to the disease related problem, behavioural and psychological symptoms occur due to
other factors like unmet needs, environmental triggers and interaction with others.
Since this was my first encounter with sudden behaviour change of a patient, I became very nervous. This situation
required me to think like a registered nurse. However, since the situation was an emergency issue, engaging in
quick actions to the same became very challenging for me. The behaviour of patient was very unpredictable and it
was challenging for me to decide best intervention to minimize further trauma to the patient and others (ACSQHC
2017). This situation made me act like a registered nurse as I had to reflect to experiences, knowledge and actions
to take decision regarding safe and quality care for patients (NMBA 2017).
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that required
resolution?
Use scholarly,
evidence-based
literature/clinical
guidelines and/or
policy/NSQHS
materials to
substantiate your
discussion
Process
Information
(@4
00 words)
Interpret, Relate and Infer:
The main issue I faced during the clinical encounter was the display of sudden behavioural change in patient
associated with aggression and harm of others. On review of the cause behind aggressiveness and sudden
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