The oncoming nurse is doing bedside rounds with the offgoing nurse. One of the patients is a 57-year-old male admitted for a poorly healing lower extremity wound. The offgoing nurse stops outside the patient’s room saying, “He has been nasty all day. Nothing anyone does is right. He smells but refuses to be washed. I just go in, do what I have to do, and get out as fast as I can. I’m glad I’m going home.” The oncoming nurse checks the patient’s care plan where the only reference to behavior is that the patient is difficult.

1.

What CUES (Assessment) can the nurse assess?

2.

What HYPOTHESIS (Diagnosis) will the nurse consider?

3.

What ACTION (Plan and Implement) will be most effective for the nurse to take to ensure the patient’s safety in this situation?

4.

How will the nurse evaluate the patient’s OUTCOME (Evaluation) for the purpose of arriving at a satisfactory clinical outcome?