NR 537: Developing an Evolving Case Study

In the field of nursing education, the use of evolving case studies has proven to be an effective strategy for fostering critical thinking and clinical decision-making skills among learners. This essay delves into the development of an evolving case study, specifically focusing on the management of acute polycythemia vera in an emergency room setting. The case study is designed to challenge learners, particularly visual learners who are new graduate registered nurses (RNs) working in the emergency department (ER). The primary objective is to present the concept of homeostasis and regulation in the context of polycythemia vera, guiding learners through a realistic and dynamic clinical scenario.

Overview of the Evolving Case Study

The evolving case study centers on the management of a 72-year-old African American male patient named Charles Smith. The patient presents to the ER with symptoms of shortness of air, confusion, and fatigue, all of which are indicative of a potential exacerbation of his underlying medical conditions, including polycythemia vera, hypertension, chronic obstructive pulmonary disease (COPD), stroke, and congestive heart failure (CHF). The learners are required to navigate the complexities of this case, utilizing their clinical knowledge and critical thinking skills to stabilize the patient and address his acute medical needs.

The primary learning objective of this case study is to equip learners with the ability to manage acute polycythemia vera effectively. This involves understanding the pathophysiology of the condition, recognizing the signs and symptoms of an acute episode, and implementing appropriate interventions to prevent complications. Additionally, the case study aims to enhance the learners' ability to apply the concept of homeostasis and regulation in a real-world clinical setting, emphasizing the importance of maintaining physiological balance in patients with complex medical histories.

Description of the Evolving Case Study

The evolving case study is purposefully designed to simulate a realistic and challenging clinical scenario that requires the application of critical thinking and decision-making skills. The primary purpose of this case study is to provide learners with an opportunity to engage in a dynamic and interactive learning experience, where they can apply theoretical knowledge to a practical situation. By working through the case study, learners will gain a deeper understanding of the complexities of managing polycythemia vera in an acute setting, as well as the importance of timely and appropriate interventions.

The target learner for this case study is a visual learner who is a new graduate RN working in the ER. Visual learners benefit from seeing information presented in a visual format, such as diagrams, charts, and videos, which help them to better understand and retain complex concepts. Given the fast-paced and high-pressure environment of the ER, it is crucial for these learners to develop the ability to quickly assess and respond to rapidly changing clinical situations. The case study is designed to challenge their ability to synthesize information, prioritize care, and make informed decisions in a timely manner.

The key concept presented in this case study is homeostasis and regulation, specifically in relation to polycythemia vera. Polycythemia vera is a myeloproliferative disorder characterized by the overproduction of red blood cells, which can lead to increased blood viscosity and a higher risk of thrombotic events. Maintaining homeostasis in patients with polycythemia vera requires careful monitoring of blood counts, hydration status, and the prevention of complications such as thrombosis and hemorrhage. Through this case study, learners will explore the physiological mechanisms underlying homeostasis and how they can be disrupted in patients with polycythemia vera.

Description of the Setting

The setting for this evolving case study is a busy emergency room, a high-stakes environment where healthcare professionals must be prepared to manage a wide range of medical emergencies. The ER is characterized by a fast-paced and unpredictable atmosphere, where patients present with a variety of acute conditions that require immediate attention. In this setting, learners are exposed to the realities of working in an environment where time is of the essence, and the ability to think critically and act quickly can mean the difference between life and death.

The ER setting also provides learners with the opportunity to develop their communication and teamwork skills, as they must collaborate with other healthcare professionals, including physicians, paramedics, and fellow nurses, to provide comprehensive care to their patients. The dynamic nature of the ER environment makes it an ideal setting for an evolving case study, as learners must constantly adapt to new information and changing patient conditions.

Description of the Patient

The patient in this evolving case study is Charles Smith, a 72-year-old African American male who presents to the ER with shortness of air, confusion, and fatigue. He has a complex medical history, including hypertension, COPD, stroke, polycythemia vera, and CHF. His height is 5’10” and he weighs 210 lbs. He also has a history of a right lower lobectomy in 2018 and has allergies to sulfa and codeine. Socially, Charles has a significant nicotine addiction, smoking two packs of cigarettes per day.

Given his medical history and presenting symptoms, the primary medical diagnosis for Charles is shortness of air, likely exacerbated by his underlying conditions. The learners are required to take a holistic approach to Charles’s care, considering his medical history, current symptoms, and social factors as they develop a management plan. The case study challenges learners to identify potential complications, such as thrombosis or heart failure, and implement appropriate interventions to stabilize the patient.

Report that Learners Receive Prior to the Start of the Evolving Case Study

Before the start of the case study, learners receive a report using the SBAR (Situation, Background, Assessment, Recommendation) format. The report is provided at 6 PM by the paramedic who brought Charles into the ER, as well as by his spouse. The SBAR format is used to ensure that the report is clear, concise, and focused on the most critical aspects of the patient’s condition.

The report provides learners with essential information about Charles’s current condition, including his presenting symptoms of shortness of air, confusion, and fatigue, as well as his relevant medical history. This information serves as the foundation for the case study, guiding learners as they assess the patient and develop a management plan. The use of the SBAR format also reinforces the importance of effective communication in the healthcare setting, particularly in high-pressure environments like the ER.

Conclusion

The development of an evolving case study for the management of acute polycythemia vera in an emergency room setting provides learners with a valuable opportunity to apply their clinical knowledge and critical thinking skills in a realistic and dynamic scenario. By focusing on the concept of homeostasis and regulation, the case study challenges learners to navigate the complexities of caring for a patient with a complex medical history, while also developing their ability to think critically and make informed decisions in a fast-paced environment. This evolving case study serves as a powerful tool for enhancing the learning experience of visual learners and preparing them for the challenges of working in the ER.