Clinical Judgment Model Concept Map
Title: Post-op medication allergic reaction Name: Brittany Ferreira Date: 08/11/23
Recognize Cues
Filter information from different sources
(eg: signs, symptoms, medical history, etc)
Analyze Cues
Organizing and linking the recognized cues
above to step to the client’s clinical
presentation. Candidates should establish
probable client needs, concerns, or
problems.
Prioritize Hypothesis
Evaluating and ranking hypotheses
according to priority (urgency, likelihood,
risk, difficulty, time, etc.)
Generate Solutions
Identifying expected outcomes and using
hypotheses to define a set of interventions
for the expected outcome
Take Action
Implementing the solution(s) that
addresses the highest priorities. Important
to recognize that sometimes no action is
an action itself
Evaluate Outcomes
Comparing observed outcomes against
expected outcomes
- Itchiness on the neck and chest
- Hives on neck and chest
- Abdominal discomfort/nausea
- Restlessness
- Tachycardia
- No previous morphine use
All symptoms stated above started approx. 15 mins
after the pt’s first morphine dose administered via PCA
pump. These are all symptoms of an allergic reaction.
The patient has never taken morphine before, so would
be unaware of a medication allergy.
The patient is still alert, oriented and talking, and has no
difficulty breathing, so she is not currently in
anaphylactic shock. This seems to be a mild allergic
reaction.
- Stop the medication infusion and disconnect
the pt from the tubing.
- Call the MRP to inform them of the reaction
and suggest discussing alternative pain
management
- Administer prescribed PRN allergy medication
(i.e. Benadryl)
- Medication stopped, and PIV connected to run
maintenance fluids.
- MRP informed, and is coming to reassess pt and
pain management plan of care.
- PRN Benadryl administered as per MRP’s orders
for symptom relief.
- Pt no longer c/o itchiness and hives are
reducing in size/disappearing
- Pt no longer c/o abdominal discomfort/nausea
- Vital signs have stabilized and returned to
baseline