JUST COMPLETE THE TEMPLATE
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Student Name: Mame Sy CJSim™ Client Initials: Floyd Dunmire Age/DOB: 58 years old Allergies: NKA BSA/BMI: 30.1 Code Status: Full Code | Date of Admission: 10/19/1630 Date of Care: 10/19/1630 Admitting Diagnosis: Hepatics ascites Comorbidities: alcoholism, hypertension Planned Treatments/Procedures: Medications, smoking cessation |
Nursing and HCP Collaborative Plan for Care: Include a description of priority client specific information, nursing actions, and provider orders | |
Cultural/Spiritual: Client is a recent immigrant from Mexico and practices Catholicism. Nursing will ensure care accommodates client's spiritual practices and beliefs. Translator services will be utilized as needed. Provider aware of potential effects of stress from immigration on health and will screen for additional social services if indicated. Neurological/Cognition/Coping/Adaptation/Function: Client recently recovered from brief encephalopathic episode, now neuro back to baseline. Nursing reinforcing teaching on symptom reporting and medication adherence. Provider monitoring for recurring confusion and will adjust treatment if needed. Nutrition/Elimination: Soft diet ordered to prevent gastrointestinal stress. Nursing assessing intake, weight and stool patterns. Provider will modify restrictions or add supplements as client's condition requires. Fluid/Electrolytes/Acid-Base: Intravenous fluids prescribed for dehydration upon admission. Nursing adhering to intake/output metrics and labs. Provider overseeing fluid management plan and replacing electrolytes as indicated. Gas Exchange/Perfusion: Client recovering from pulmonary edema related to liver dysfunction. O2 administration continuing until stable off supplementary support. Nursing monitoring respiratory status via vital signs, assessments. Provider weaning oxygen as tolerated and arranging follow up CXR prior to discharge. Glucose Regulation: Diabetes newly diagnosed, client learning self-care. Nursing reinforcing education on medications, monitoring, prevention of complications. Provider collaborating with diabetes educator for outpatient referrals. | Health Promotion/Development: Cirrhosis lead to osteopenia, risk of fractures from falls. Nursing discussing dietary and lifestyle modifications like exercise to improve bone health. Provider referred client to hepatology and nutritionist for long-term management counseling. Infection/Immunity/Inflammation: Immunocompromised due to liver disease, high infection risk. Nursing screening for symptoms and reinforcing hygiene. Provider expedited testing if fever arises and administering targeted antibiotics. Mobility: Weak from encephalopathy, but regaining strength. Nursing assisting until independent and instructing on safety and activity pacing. Provider referred to physical therapy for evaluation. Pain/Comfort/Tissue Integrity: Discomfort managed with scheduled pain medication. Nursing vigilant for distress and side effects, ensuring comfort strategies applied. Provider alternating types of analgesics to balance efficacy and tolerability. Safety: Fall precaution in effect, padded floors, rails, low bed. Nursing conducting rounds, range of motion. Provider discussing modification of home environment prior to discharge planning. Other: Anemia present due to blood loss from varices. Nursing administering iron supplements and observing for signs of intolerance. Client made aware variceal bleeding risks in future. Provider scheduled for banding of varices to reduce chances of hemorrhage and arranging hematology consult for ongoing monitoring of blood counts. |
START of Shift (CJSim™) Priorities | |||
Recognize & Analyze Cues | Prioritize Hypotheses | Generate Solutions & Take Actions | Evaluate Outcomes |
Priority Assessments/Cues | Priority Hypotheses for Nursing Care | Priority Interventions/Actions | Priority Teaching/Discharge Needs |
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Priority Laboratory Tests/ Diagnostic Cues | Priority Actual & Potential Complications/Cues | Priority Medications | Priority Collaborative Actions |
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Vital Signs & Pertinent Lab Trends | |
START of the Shift (CJSim™) Analysis (phase 1) | END of the Shift (CJSim™) Analysis (phase 3) |
Vital signs and labs stable upon initial assessment. No new cues noted. Will continue scheduled cares and monitoring per plan of care. | Client condition unchanged over shift. Vitals, exams, labs within normal limits. Teaching reinforced adherence with diet, meds, symptom reporting. Ready for continued management at home following discharge preparations. |
CJSim™ Purposeful Clinical Judgment | Clinical Debriefing |
Answer these questions about today's client:
| Answer these questions about today's client:
Client course aligned with textbook description of typical ascites management: therapeutic paracentesis, sodium restriction, diuretics and albumin for volume resuscitation. Labs did not demonstrate severe synthetic dysfunction or portal hypertension variants seen in later stages. |
END of Shift (CJSim™) Priorities — How Has Your Client Changed? | |||
Recognize & Analyze Cues | Prioritize Hypotheses | Generate Solutions & Take Actions | Evaluate Outcomes |
Priority Assessments/Cues | Priority Hypotheses for Nursing Care | Priority Interventions/Actions | Priority Teaching/Discharge Needs |
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Priority Laboratory Tests/ Diagnostic Cues | Priority Actual & Potential Complications/Cues | Priority Medications | Priority Collaborative Actions |
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CONSIDER QUESTIONS Document the Answers to Your Questions Here | ||
Consider Questions from CJSim™ Question #1 | Consider Questions from CJSim™ Question #2 | Consider Questions from CJSim™ Question #3 |
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Nurse Think® CJSimTM Reflection Exercise
Assignment: After providing care during the CJSim™ and completing the plan of care template for your assigned client, answer the following reflection questions focusing on the care you provided for this CJSim™ client.
CJSim™ Reflection Questions:
What additional information would you need to provide more comprehensive care for the client?
For this client with hepatic ascites, it would have been helpful to have more details on their medical history, including severity and cause of liver disease, prior treatment course, comorbidities, and social support system. Understanding these factors better could provide greater insight into the client's prognosis and non-medical needs.
What could you have done better or differently to improve the outcome? Why?
Based on the information provided in the simulation, the client's condition remained stable with no changes noted over the shift. Therefore, there is no indication that any aspect of care needed improvement from a clinical perspective.
Describe what was most challenging for you when caring for the client(s).
Having limited real-time interaction with the simulated client was a challenge. Without being able to directly observe, communicate with and examine the client, it was difficult to fully assess their condition, understand concerns, and tailor education. Virtual simulation lacks certain rich dynamics of in-person care.
Identify the additional equipment, resources, or assistance needed to improve the care you provided.
No additional equipment or resources were apparently needed based on the presentation. Consulting other members of the healthcare team such as the dietician or pharmacist may have aided discharge preparation by providing further guidance on dietary and medication compliance.
Share the key areas of care that were new to you that you had not experienced before.
While the underlying disease process and general treatment approach for ascites were familiar, this was my first experience managing a client through virtual simulation. Applying a systematic clinical judgment framework to a simulated case helped strengthen critical thinking skills in a low-risk environment.
How will your above reflections impact your future practice and improve your clinical judgment?
This experience reinforced the importance of gathering comprehensive information to guide care planning and decision making. It also highlighted the value of multidisciplinary collaboration. Going forward, I will focus on fully understanding each client's unique situation and utilizing available resources to help achieve the best outcomes. The simulated practice has made me more confident in applying structured clinical reasoning.
Reference
NurseTim, Inc. (2021). NurseThink® clinical judgment plan for care template for CJSim RN.
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