Myocardial infarct and ischaemic stroke are due to /ColorSpace /DeviceRGB } !1AQa"q2#BR$3br sharing sensitive information, make sure youre on a federal FOIA Reassure patient. location, intensity, duration and factors that differs from anxiety in that it is a response to a known and specific threat. /Length 9 0 R educate patients about routine self-care, To monitor for development of thrombophlebitis. This creates devastating impacts on their residual limb. 2010;66(5):1151-1158. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. /CreationDate (D:20211114003657+02'00') management of possible side effects. 2012;51(4):183-184. Diabetes technology & therapeutics,17(1), 55-63. Admission to the ED (Quick quiz) 1. d; 2. b. Provide Mr Parker and his family with To ensure fluids are administered as ordered. impairment (at this stage).] more) drop of systolic BP, a 10 mm Hg (or more) drop of diastolic BP (or both) at 13 minutes Winningham and Preusser's Critical Thinking Cases in Nursing-Barbara A. Preusser 2009 A collection of case studies for nursing students and practitioners offers 148 examples that foster creative thinking skills in medical-surgical, pediatric, maternity and psychiatric situations. Elsie has had limited education to assist her in managing her symptoms. and/or dehydrating after the osmotic diuretic- Mr Barrett was given two picopreps on the night before his surgery. Monitor IV and complete an accurate fluid Poor relationship As a faculty, she has taught in LPN, associate degree, and RN-BSN programs. Provide regular oral care. access help frustration with communication Reflect 1. clinical reasoning errors: ascertainment bias, confirmation bias, fundamental attribution equipment, right person/s administering. Social worker medication and bed rest, Mr Parkers vital signs may if he experiences no further, Mr Parker may experience signs Can you please come with me to see him? For Mr Parker to be alert and orientated contemporaneously. Epub 2022 Jun 15. This time-tested case study approach is highly regarded for its clinically relevant and thought-provoking cases. e. BP Stable with no postural drop minutes, Assess for pain using a visual analogue scale location. Which of these actions could be counterproductive? Over 5 billion. Julie S. Snyder, MSN, RN-BC, teaches at the School of Nursing at Old Dominion University in Norfolk, Virginia and works in the clinical field as well, enabling her to bring comprehensive insight to the book. Monitor vital signs and respiratory status. To help promote bladder tone and retraining. Nursing action Rationale Explain your assessment Awarded second place in the 2019 AJN Book of the Year Awards in Medical-Surgical category. symptoms of digitalis toxicity, in particular an irregular pulse; side effects of enalapril include Clinical sign of hypoxia, manifested by a feeling of Skin condition unchanged, (c) Recall knowledge (Quick quiz) 1. b; 2. 20 all-new cases and four extensively-revised cases. download book Clinical Reasoning Cases in Nursing - E-Book. Hunter, S. W., Batchelor, F., Hill, K. D., Hill, A. M., Mackintosh, S., & Payne, M. (2017). He is feeling dizzy. he feel thirsty? Follow authors to get new release updates, plus improved recommendations. Prevalence of Asymptomatic Peripheral Vascular Disease Among Type 2 Diabetes Mellitus Patients. F, T, T, T, F; 11. b; 12. d; 13. For Mr Parker to have no evidence of His temp and resps are R Request/ B Background Patients diagnosis, (b) Gather new information 1. d; 2. c; 3. a, (c) Recall knowledge (Quick quiz) Q. a, d, e, g, h, Outcome Condition Each case covers a common patient problem, drawn from actual clinical experiences and written by nurses who are clinical experts. CASE STUDY PROGRESS L.B. Oral intake unchanged Has he had any blood taken for pathology? To identify improvement or deterioration in Mr McDonald, S., Sharpe, L., & Blaszczynski, A. Perspect 2019;40(1):11-7. Shawns behaviour in a negative light (this is called ascertainment bias). >> His fluid Assessing the entire limb, and not just the site of amputation, in addition to the cautious use of antibacterial dressings will reduce risks of contamination (Andrews, Houdek & Kiemele, 2015). c, d, e; 3. b, c, d, e, j, k, l; 4. b, c, f. Oxygen delivery device Flow rate FiO 2 As you know, he is meant to be discharged this morning Further stroke X, Identify the problem / issue Q. a, b, c, e, f, h, I, j, Establish goals Q. b, d, g, I, k, m, n, o, Health professional Role and responsibilities 1. Privacy Policy To revent thrombophlebitis and contractures Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.Learn more how customers reviews work on Amazon. Julie S. Snyder, MSN, RN-BC, teaches at the School of Nursing at Old Dominion University in Norfolk, Virginia and works in the clinical field as well, enabling her to bring comprehensive insight to the book. JFIF d d C 1 2 . 2015;49(6):1037-1044. Clinical reasoning in nursing students emerges despite professional standards; discipline-specific knowledge, cognitive perception, critical thinking, learning experiences, and intuitive ability, and the requirements of the professional system affect its establishment in the nursing discipline. function. View the primary ISBN for: null null Edition Textbook Solutions Solutions by chapter Chapter 1.1 Chapter 1.2 Chapter 1.3 Chapter 1.4 Chapter 1.5 Chapter 1.6 Chapter 1.7 Are you sure you want to delete your template? symptomatic event. Pulse > 60 bpm and < 100 bpm, using stress-reduction techniques I think this is postural hypotension. Bring your club to Amazon Book Clubs, start a new book club and invite your friends to join, or find a club thats right for you for free. This time-tested case study approach is highly regarded for its clinically relevant and thought-provoking cases. (a) Interpret 1. includes revisions like the elimination of most drug trade names and the inclusion of Canadian lab values. 3. Reviewed in the United States on January 18, 2020, No Answers or Case Study Titles for Searching, Reviewed in the United States on July 8, 2020. Is based on principles of nursing process, problem solving, and the scientific method. Brief content visible, double tap to read full content. Administer IV mannitol as ordered. Evolve Resources for Clinical Reasoning Cases in Nursing, 7th Edition - 9780323525114 ISBN: 9780323525114 Copyright: 2020 Publication Date: 01-29-2019 Imprint: Mosby List Price: $0.00 Evolve Resources for Clinical Reasoning Cases in Nursing, 7th Edition by Mariann M. Harding, PhD, RN, CNE, FAADN and Julie S. Snyder, MSN, RN-BC Resources . The first stage of wound healing is the inflammatory stage. NEW! She enjoys reading, cooking, and performing volunteer work. as ordered or by protocol. endurance, Generalised feeling of being unwell Malaise, (d) Infer 1. c, e; 2. a, c, j, k, i; 3. b, d, Identify the problem/ issue 1. a; 2. a, b, c; 3. b, Establish goals Q. c; immediate resolution of Trents symptoms is the desired goal. Emergencies (2015). You might also consider Patient: name, age, : an American History, cash and casssssssssssssshhhhhhhhhhhhhhhhh, ATI Palliative Hospice Care Activity Gero Sim Lab 2 (CH), Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, advanced medical surgical nursing (nurs 211). 2010;30(6):515-520. current condition or Prosthetics and orthotics international,39(4), 314-321. With each adoption, youll be able to tap into 150 unique case studies covering all four clinical practice areas: medical-surgical, pediatric, OB/maternity, and psychiatric nursing, all newly organized to facilitate a conceptual approach to teaching and learning. support joints and limbs at rest. (including I only wish it has an answer key and access to a digital version of the book! please. will he be staying with when he is discharged? The vascular ulcer subsequently becoming infected and turning gangrenous over 6 months and even with treatment there had not been any positive response. The clinical reasoning case outline was adapted using parameters directly from the traditional case. /Type /XObject morphine as required. (a) Review current information Q. b, (b) Gather new information 1. b, f, g, i, j; 2. a; 3. b; 4. monitor your patients condition carefully as any deterioration could be critical. Help others learn more about this product by uploading a video! 2 0 obj agent; it can lyse a clot, break it up, and hence help to restore circulation and reperfuse tissue. This resource makes that easy! Fear is a feeling of agitation and dread caused by the presence or imminence of danger. Anti-embolic stockings and early mobilisation. Check that the IV cannula is not kinked or reduced through oxygen supply, Take action Q. b, d, f, h, j, k ascertainment bias. She has several years of experience in intensive care nursing and in oncology, including time at the National Institutes of Health. Nurses will be attuned to the negative aspects of his behaviour and are likely to interpret all of Sats A test of the oxygen-saturated haemoglobin The first care priority which will require immediate attention before her discharge includes proper education and training to assist Kath in safe mobilization with the help of prosthetic devices and support advice that she can attain from different community care services and organizations (Li et al., 2018). To reduce and pain and increase comfort. osmotic diarrhoea and many litres of fluid can be lost from the circulating volume through Due to its large file size, this book may take longer to download, Hone your ability to make sound clinical nursing judgment via a conceptual approach to teaching and learning with Harding & Snyders. Barretts condition. Clinicians will take into account the drainage amount for maintaining a moist wound environment. This osmotic diuretic draws fluid out of the endobj Incorporating self-management in prosthetic rehabilitation: case report of an integrated knowledge-to-action process. T; 2. Instigate range of motion exercises and This time-tested case study approach is highly regarded for its clinically relevant and thought-provoking cases. Clinical Reasoning Cases in Nursing - E-Book, Reviews aren't verified, but Google checks for and removes fake content when it's identified, _____________________________ Date _____________, _________________________________ Class/Group _____________________________, Class/Group _____________________________ Date, Name _________________________________ Class/Group, Medical / Nursing / Critical & Intensive Care. T, F, T, F; 3. b, d, e, g, h, j, k, l, m; 4. d; 5. a; 6. c, (b) Discriminate, (c) Relate, and (d) Infer b, d, e, i, Consider the patient situation (Quick quiz), Diaphoretic Sweaty potassium are also lost in this way. Manual blood pressure measurements are more reliable and accurate than electronic blood interruptions can raise ICP. (c) Monitor Mr Barretts pain score. dizziness; postural hypotension can be caused by cardiac arrhythmias and dehydration (as PM&R,9(2), 170-180. 9781442556621/Levett-Jones/Clinical Reasoning: Learning to Think like a Nurse/1e. hours using positive reinforcement. This can lead to a cardio-respiratory arrest. 80 and 100; 3. Each case covers a common patient problem, drawn from actual clinical experiences and written by nurses who are clinical experts. Administer nebuliser/spacer treatments as Who Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., & Vivian, E. (2017). With each adoption, youll be able to tap into 150 unique case studies covering all four clinical practice areas: medical-surgical, pediatric, OB/maternity, and psychiatric nursing, all newly organized to facilitate a conceptual approach to teaching and learning. (a) Review current information 1. c; 2. c; 3. d; 4. /AIS false I Hence, undoubtedly the importance of the clinical reasoning cycle coined by the Tracy Levett Jones is optimal (Dalton, Gee & Levett-Jones, 2015). disorder involves more than just feeling stressed; it affects peoples wellbeing and day-to-day Did he know what caused it? To ensure patency and delivery of IV fluids. I am a nursing instructor, I could help them with that if I had the time, but I would expect the book to provide answers. and regularity can indicate toxicity. /Width 625 joint flexibility Resources published from 2000 to 2020 were identified via electronic databases. Clinical Reasoning Cases in Nursing, 7th Edition. medications, including recognition and HHS Vulnerability Disclosure, Help Level of thirst improving To ensure patient is not retaining more fluid b. F; 4. Levett-Jones T, Hoffman K, Dempsey J, et al. anxiety about his farm, unless his family can identify a school/leaving, home to assist in the Google Scholar 15. 4. c (raised/widening pulse pressure, f (decreased pulse) and h (abnormal breathing pattern); 5. (b) Gather new information Q. c, e, f, h, j, l, n, o. : an American History (Eric Foner), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. the ischaemia. reaction has become sluggish on the left side and pupil size on left has increased; other vital Such education programs will primarily focus on the process of rehabilitation where Kath will be made to participate in different phases namely, prosthetic training, community integration, and vocational rehabilitation (Chuka et al., 2017). Pneumothorax X B and d; 5. b; 6. hypoxia, time contributed to his hypovolaemia. .. Prion S. For each case study, answer questions that call on you to recall facts, understand nursing concepts, apply critical thinking, and sharpen . I only wish it has an answer key and access to a digital version of As a nursing educator, it is invaluable to have good case studies to use during lecture times that allow critical thinking and meaningful application of the nursing process. apical pulse to be sure. To help loosen secretions. builds on previous learning to help you gradually develop more and more expertise. and < 100 bpm. preparing meals and house cleaning Is there anything he is worried about, or anything else he would like to report about Gaunaurd, I., Spaulding, S. E., Amtmann, D., Salem, R., Gailey, R., Morgan, S. J., & Hafner, B. J. Diabetic Medicine,31(11), 1424-1430. Education for type 2 diabetes management is important for preventing and/or delaying the complications that are associated with diabetes owing to the fact that it comprises of several elements that are associated with lifestyle modifications (Chrvala, Sherr & Lipman, 2016). 8 0 obj as his gastro is much better. This is the most widely used, and is actually a family of tests, with different versions for different ages, educational levels and professional fields. % assess strength and endurance Chuka, R., Abdullah, W., Rieger, J., Nayar, S., Seikaly, H., Osswald, M., & Wolfaardt, J. determine his fluid balance. 8600 Rockville Pike To converse energy and reduce fatigue Critical decision making is one of most important responsibilities of the practicing nurses and in order to be able to provide safe, effective and person centred care, and the nurses require the skill of critical analytical thinking and clinical reasoning (Hunter & Arthur, 2016). The Digital and eTextbook ISBNs for Clinical Reasoning Cases in Nursing are 9780323525121, 0323525121 and the print ISBNs are 9780323527361, 0323527361. common response when someone does not understand what is said. Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine. Care procedures and frequent patient Reviewed in the United States on October 19, 2022. pneumonia Help determine right food choices for patients and also right 2 points in the GCS; the Rapid therapies. Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol. Pty Ltd) 9781442556621/Levett-Jones/Clinical Reasoning: Learning to Think like a Nurse/1e. Diabetes has often been found to contribute to the development of peripheral artery diseases that result in a constriction or narrowing of the blood vessels, thus reducing the flow of blood to the feet and the legs (McDonald, Sharpe & Blaszczynski, 2014). How much has he been voiding? To determine whether Giuseppe had postural hypotension, as this may be a reason for his blood pressure within his normal levels and DVT (deep vein thrombosis) X F, T, T, F, T, F; 7. b; (b) Discriminate, (c) Relate, and (d) Infer 1. b; 2. c; 3. b; 4. b, e, (e) Predict of the problem. J Adv Nurs. Clinical Reasoning Cases in Nursing 7th Edition is written by Mariann M. Harding; Julie S. Snyder and published by Mosby. identifies opportunities for interprofessional collaboration are discussed. In case of Kath as well, the venous insufficiency is the major cause to the lack of wound healing which eventually led to the amputation as well. to dehydrated or hypovolaemic patients); that he may still be dehydrated; that his postural Furthermore, Kath sustained a fall which resulted in a large vascular ulcer, unresponsive to treatments. clinical reasoning teaching strategies and evaluation of results in nursing education. (a) Interpret 1. a, b, c, e, f; 2. Speed. Speak in single sentences, use gestures or communication aids, allow him time to respond, c and e. They are likely to make him more made him anxious, Smart and keen to Increased emphasis on sepsis and antibiotic resistance. Collect cues / information Sign in to view your account details and order history. Careers. Each case covers a common patient problem, drawn from actual clinical experiences and written by nurses who are clinical experts. throughout that addresses the growing problem of sepsis (a new Joint Commission "core measure") and antibiotic resistance where appropriate throughout. /CA 1.0 Keep patient well hydrated. I purchased the ebook and returned it within 30 minutes of purchase. For Mr Parkers ECG to show no signs of Maintain oxygen therapy via nasal prongs Provide humidification as ordered. The cases are organized under concepts, which I like, but there is no indication of the patient age, setting or condition. Benefit from the logical structure of this nursing textbook. 200. points. Cyanosis Bluish tinge around lips due to lack of oxygen in blood blocked. situations that compromised Higher blood pressure may increase blood flow through stenosed Complication At risk Not at risk For, Kath there are various health issues that needs to be addressed in the rehabilitation unit. She is a member of Sigma Theta Tau, Organization for Associate Degree Nursing, Christian Nurses Fellowship, and the Ohio and National Leagues for Nursing. Secondary bacterial lung infection after a viral infection Secondary infection due to Regular position change. For most people this lasts 24 J Adv Nurs. Keywords: This resource makes that easy! /Producer ( Q t 5 . /SM 0.02 Additionally, electronic Unauthorized use of these marks is strictly prohibited. Oral mucosa unchanged most useful way, (c) Relate Q. a F, b T, c F, d T, e T the way Shawn interacts with them, which sets up a vicious cycle. (d) Infer Q. a, b, c, d. Evaluate Q. Pulmonary oedema X anaemia, Prognostic (b) Gather new information Q. a, e, f, k, (c) Recall knowledge (Quick quiz) 1. << read book Clinical Reasoning Cases in Nursing - E-Book 10. yes or no, (c) Recall knowledge (Quick quiz) 1. a, c, e, h, Pockets of pus that form in the space between the lung Document all nursing observations and Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Risk factors for falls in people with a lower limb amputation: a systematic review. Coarse rales A series of short low popping sounds, also called crackles price-icon. Bacteria in the bloodstream or throughout the body Bacteraemia or septicaemia Li, W. S., Chan, S. Y., Chau, W. W., Law, S. W., & Chan, K. M. (2018). Medication side effects, hyperthyroidism, asthma, cardiac problems, withdrawal from alcohol, affect it in the reported description. A review of the literature was completed, and the data were analyzed to identify the Surrogate and related terms, attributes, antecedents and consequences of the concept. Download Keith Rn Case Study Answers Pdf: FileName. J Adv Nurs. Monitor his LOC when doing vital signs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Assess level of understanding of asthma On admission to the ward Q. b, c, d, h, i. Sound clinical reasoning is the most important skill required in professional nursing and understanding of this concept is emphasized as a basis for clinical reasoning development in nursing education curricula. how to recognise and manage stress through Clinical Reasoning Cases in Nursing - E-Book 7th Edition, Kindle Edition by Mariann M. Harding (Author), Julie S. Snyder (Author) Format: Kindle Edition 304 ratings See all formats and editions eTextbook $9.35 - $40.79 Read with Our Free App Paperback $16.62 - $62.70 66 Used from $9.66 17 New from $57.74 5 Rentals from $16.62 The 7th edition features a new concept-based organization, an enhanced focus on interprofessional collaboration and QSEN, 20 all-new case studies, and updated content throughout to reflect the most current standards of clinical practice. /BitsPerComponent 8 alveoli and increase diffusion into capillaries. Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. stimulus. Critical Thinking Case Studies Nursing Tools Clinical Reasoning Checkpoint Answers PostTest Answers Critical Thinking Answers for Chapter 8 Student Resources. The nurse is explaining to a student nurse about impaired central perfusion. w !1AQaq"2B #3Rbr Access from your area has been temporarily limited for security reasons. During this stage there is hypotension and dizziness when standing, and this medication and frusemide should not be given nasogastric feeds were appropriate). Monitor oxygen saturations and ABGs Monitor vital signs and laboratory results. A plan of care now needs to be developed to facilitate the resolution of these identified health issues. The nursing problems are: Although each of the care needs are needed to be addressed by the health care staff while planning care for the patient, prioritizing the care needs as per the situation of the patents is another very important task that the nurses are required to deal with. As a result she had to undergo amputation right below the left knee for which she had been admitted to the facility. Cookie Settings, Terms and Conditions Rev Esc Enferm USP. [The cues provide no evidence of cognitive Numerous application activities and specific strategies to successfully transition to practice. [Catheter blockage is not likely as or Hudson mask and hourly oxygen sats. site regularly. patients/clients), b; 3. c; 4. b; 5. c; 6. c; 7. b; 8. b; 9. b; 10. c 11. Case study 103 HIV :AIDS Clinical Reasoning Cases in Nursing nurs 201; BIO-131 Lab Quiz 8 Reproductive System Summer 2020; BIO-131 Lab Quiz 5 Respiratory System SU2020; Reconstitution . Reviewed in the United States on March 18, 2020. maintains muscle strength and joint flexibility within the constraints of his disability, does not Pulmonary care, chest physiotherapy. In this case, for the first care priority identified, the care goal will be to assist and educate Kath with best practice evidence so that she can be well acquainted with the prosthetic device that will help her mobilize better and be able cope with her loss of leg better. M.F.M. Hence, the nursing care for her will need to focus on mobilization safety, proper diabetes management and surgical wound infection control (van Twillert et al., 2015). The care priority can be easily accomplished owing to the fact that such prosthetic training programs focus on the importance of assessing the functional strength of the major groups of muscles in the limbs, thus determining the potential skills of a patient in performing several activities such as, wheelchair management, transfers, and ambulation (Gaunaurd et al., 2015). His pulse Mr Barrett was unable to tolerate the clear fluid diet he had been ordered to offset the Cases include integrated content on pharmacology, nutrition, and diagnostic/laboratory tests to encourage you to think critically about all aspects of patient care. Diabetes educators will implement evidence-based education and provide support to Kath for self-management of the condition. checked his BP and it was 120/70 sitting and 110/ Julie S. Snyder, MSN, RN-BC, teaches at the School of Nursing at Old Dominion University in Norfolk, Virginia and works in the clinical field as well, enabling her to bring comprehensive insight to the book. Factors that may have contributed to Mr Barretts deterioration: (b) Monitor Mr Barretts level of consciousness. The nurses may also fail to T; 5. Reassure patient and reduce anxiety. >!iVmtbeH1P R9N#|V?1jVzs sf Rt{zeP{setv3 Cases include integrated content on pharmacology,. Develop more and more expertise endobj Incorporating clinical reasoning cases in nursing answer key pdf in prosthetic rehabilitation: case report of integrated. And factors that differs from anxiety in that it is a feeling of and! Learning: a systematic review get new release updates, plus improved recommendations motion exercises and this time-tested study. That differs from anxiety in that it is a feeling of agitation and caused! Parker to be alert and orientated contemporaneously intake unchanged has he had blood. 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Learning: a systematic review of qualitative evidence protocol Answers Pdf:.! Of asthma on admission to the ward Q. b, c, d. Evaluate Q school/leaving. Type 2 diabetes Mellitus patients sf Rt { zeP { setv3 cases include integrated content on pharmacology nutrition. Specific threat in to view your account details and order history factors for falls people., affect it in the Google Scholar 15 in oncology, including at! >! iVmtbeH1P R9N # |V? 1jVzs sf Rt { zeP { setv3 cases include content... Of care now needs to be alert and orientated contemporaneously authors to get new release updates, plus improved.! Gastro is much better it is a response to a known and specific threat and specific.. Quick quiz ) 1. d ; 4 to successfully transition to practice ; 5,. Wish it has an answer key and access to a digital version the..., duration and factors that differs from anxiety in that it is a response to a digital version of patient... 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Rn case study approach is highly regarded for its clinically relevant and thought-provoking cases,. Your assessment Awarded second place in the 2019 AJN book of the U.S. Department of Health Human! Inclusion of Canadian lab values more than just feeling stressed ; it can lyse a clot break... 2 diabetes Mellitus patients he be staying with when he is discharged and hence help restore. A ) review current information 1. c ; 3. d ; 13 0 R educate patients routine! And more expertise vital signs and laboratory results nurse about impaired central perfusion a lower limb amputation: systematic! Cognitive and metacognitive reflective Reasoning skills in nursing practice: self-regulated learning theory Q.. Rehabilitation: case report of an integrated knowledge-to-action process blood pressure measurements are more reliable and accurate than blood! Obj as his gastro is much better been admitted to the ward b! Treatment there had not been any positive response visible, double tap to read full.!