Clinical judgment review
This page is built from the early NUR 198 course materials supplied for Weeks 1-3. It includes Module 1 older-adult/chronic-illness content and Module 2 fluid, electrolyte, and acid-base concepts. ABG questions are embedded in disease processes rather than tested as isolated number recognition. Questions are mixed and scenario-based so the stem does not tell you which concept is being tested. Several answer choices may be clinically reasonable; choose the option that best fits the current cues, priority, and timing.
Key learning points
Older Adult Physiology
Do not dismiss new findings as normal aging
Expected age-related changes can reduce physiologic reserve, but a new change in cognition, function, mobility, oxygenation, or blood pressure still requires assessment.
Renal reserve decreases
The deck identifies decreased renal blood flow as an expected age-related change. This matters when considering fluid balance and medication safety.
Cardiovascular adaptation is less flexible
Reduced heart-rate variability and orthostatic hypotension are emphasized. Dizziness with position change should trigger blood-pressure assessment and safety planning.
Pulmonary reserve decreases
Decreased chest-wall compliance is an expected age-related change, but new dyspnea is not presented as normal aging.
Neurologic processing may slow
Decreased nerve-conduction velocity is an expected change. Acute confusion, agitation, hallucinations, or sudden decline are not normal aging.
GI motility decreases
The deck identifies decreased gastrointestinal motility as an expected age-related change.
Bone density decreases
The musculoskeletal section emphasizes decreased bone density and calcium plus vitamin D for bone health.
Caloric needs may decrease
The deck states that older adults generally require fewer calories because basal metabolic rate decreases.
Sexual health remains relevant
The course rejects the assumption that older adults are not interested in sexual health and notes that age-related changes can affect sexual function.
Depression requires assessment
Depression is identified as a common mental-health disorder for which nurses should monitor in older adults.
Cognition, Safety, and Medications
Delirium and dementia follow different patterns
Delirium is presented as acute and usually reversible, while dementia is typically progressive and irreversible.
Delirium care emphasizes orientation and environment
Frequent reorientation and a calm, well-lit environment are emphasized in the deck.
Late-day agitation in dementia responds to structure
The module favors a structured routine, calming activities, and reduced evening stimulation.
Elder abuse includes more than physical injury
The deck includes physical, psychosocial, emotional, sexual abuse, abandonment, neglect, and financial exploitation.
Dependence increases vulnerability
Cognitive impairment, mobility limitation, chronic illness, financial dependence, and functional dependence are highlighted as abuse-risk factors.
Promote independence and safety together
Older-adult nursing priorities include cognition, physical safety, independence in self-care, communication, nutrition, socialization, balanced activity and rest, and transitional support.
Polypharmacy changes the risk picture
The deck emphasizes polypharmacy and increased sensitivity to sedatives, analgesics, and anticholinergic medications.
Medication plans may need adjustment
Age-related changes affect pharmacokinetics and pharmacodynamics. The course emphasizes dosage adjustment, start low and go slow, medication review, simple regimens, and adherence support.
Chronic Illness and Disability
Chronic disease and chronic illness are not identical
The condition itself is distinguished from the person’s lived experience, perceptions, and responses.
Self-management is central
Day-to-day management is largely carried out by people with chronic conditions and their families in collaboration with healthcare providers.
Chronic illness changes more than physiology
The deck includes uncertainty, financial burden, role changes, identity threats, social isolation, family functioning, and quality of life.
Prevention and complication avoidance remain nursing goals
Health promotion, regular screening, prevention of progression, and prevention of secondary complications are emphasized.
Supportive care is real nursing care
Monitoring, education, counseling, advocacy, referral, and case management are presented as just as important as direct physical care.
Disability care should be individualized
The course emphasizes individualized care and people-first language. Aging may add self-care and family-role challenges.
Clinical judgment links the module
The case study explicitly uses recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes.
Week 2: Acid-Base and ABG Interpretation
Start with the pH
The course ranges are pH 7.35-7.45. A pH below 7.35 is acidotic and a pH above 7.45 is alkalotic.
Know what CO2 means
PaCO2 below 35 mm Hg is alkalotic and above 45 mm Hg is acidotic. If the pH matches the CO2 direction, the primary disorder is respiratory.
Know what bicarbonate means
HCO3 below 22 mEq/L is acidotic and above 26 mEq/L is alkalotic. If the pH matches the HCO3 direction, the primary disorder is metabolic.
Use the six-step method
Read pH, PaCO2, and HCO3; identify which value matches the pH; determine whether compensation is occurring; then assess PaO2 and the patient context.
Respiratory disorders are compensated by the kidneys
For respiratory acidosis or alkalosis, the kidneys alter bicarbonate and hydrogen ion handling. The deck notes that renal compensation may take several days.
Metabolic disorders are compensated by the lungs
For metabolic acidosis or alkalosis, the lungs change ventilation and therefore PaCO2. The deck notes that respiratory compensation may occur over several hours.
Compensation changes the pH pattern
In the course framework, compensated means the pH has returned to 7.35-7.45; uncompensated means the pH is abnormal and the compensating value remains normal; partial compensation means the pH is still abnormal while both PaCO2 and HCO3 are outside range.
Respiratory acidosis means inadequate CO2 excretion
The deck links respiratory acidosis with inadequate ventilation and identifies dyspnea, altered mental status, hyperkalemia, and the need to improve ventilation.
Respiratory alkalosis follows hyperventilation
Lightheadedness, difficulty concentrating, numbness and tingling can occur. Treatment focuses on correcting the cause of hyperventilation.
Metabolic acidosis is strongly linked with kidney dysfunction in this course
The deck emphasizes kidney injury/failure, Kussmaul-type increased rate and depth, decreased level of consciousness, hypotension, hyperkalemia, and dysrhythmia risk.
Metabolic alkalosis is linked with gastric losses and hypokalemia
Vomiting, gastric suction, long-term diuretic use, and hypokalemia are emphasized causes or associations.
Do not stop after naming the ABG
Connect the values to the patient's condition, determine which organ is causing the problem and which is compensating, identify the immediate risk, and decide what response would show improvement.
Start with the disease process, then predict the ABG
Use the patient story before the numbers. Hypoventilation should push CO2 up and pH down. Hyperventilation should push CO2 down and pH up. Kidney failure or major bicarbonate loss should produce metabolic acidosis. Vomiting or gastric suction should produce metabolic alkalosis. Then use the ABG to confirm or challenge that prediction.
ABGs are not isolated from electrolytes or perfusion
In this module, metabolic acidosis may coexist with hyperkalemia and dysrhythmia risk, metabolic alkalosis may coexist with hypokalemia, and severe fluid losses may cause hypotension, oliguria, and worsening renal function. Prioritize the patient problem created by the whole pattern.
Use trends to judge whether treatment worked
A single ABG labels the moment. Serial pH, PaCO2, HCO3, PaO2, respiratory rate, mental status, urine output, blood pressure, and ECG findings show whether the underlying disease process is improving or worsening.
Clinical application practice
46 mixed questions. Submit each item to see the rationale for every option.
NGN clinical judgment practice
18 complex case-based items using cue selection, matrix, dropdown, SATA, ordered response, trend interpretation, and bow-tie formats.
Progress
NGN items earn the point only when the complete item is correct.
NUR 198 early-course materials for Weeks 1-3, including Module 1: Care of the Older Adult Client, Chronic Illness and Disability, and Module 2 acid-base/ABG content. Questions are grounded in the supplied course decks and use the disease processes, ranges, complications, and nursing priorities taught in those materials.