CASE STUDY Essay Example

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
  • Page:
    2
  • Words:
    1100

Clinical Reasoning

Introduction

Clinical reasoning implies the description of the process through which nurses collect cues, process the data, understands the patient’s situation or problem, plan and execute interventions, assess outcomes, and have reflection on as well as learn from the clinical process (Alfaro-LeFevre, 2013, pg 20). Nurses who have effective skills in clinical reasoning have a helpful impact on the outcomes of the patient (Lippincott Williams & Wilkins, 2007, pg 30). On the other hand, the ones with poor skills in clinical reasoning frequently fail to identify patient deterioration (Alfaro-LeFevre, 2013, pg 23). With this regard, this paper analyses the phases in clinical reasoning in reference to Mr. Gordon’s case study.

Patient Situation

This phase of the process involves description of the patient. A 74 year old male is admitted via ambulance after the wife observed him ‘fainting’ at home. He had been previously complaining of feeling dizzy and lightheaded. No reports of chest pain, during these episodes. Recently he suffered from food poisoning with excessive vomiting and diarrhea only resolving in the last 24 hours. Mr. Brown is still complaining of dizzy spells and ‘feeling lightheaded’. No recent change in medications.

Collection of Information/Cues

This phase involves reviewing current information such as patient history, nursing assessment, and patient charts (Lippincott Williams & Wilkins, 2007, pg 70). The patient has a past history of hypertension, anxiety, and high cholesterol. His Blood pressure is normally well controlled. At 1700 his temperature was 37.1 degrees Celsius. His pulse was 118 bpm, respiration was 22 bpm. His blood pressure was 98/45mmHg. On inspection, the patient appears pale. JVP appears decreased. On palpation, the patient is peripherally cool to touch, it is not easy to palpate peripheral pulses and the capillary refill is <4 secs. On percussion, the size of the heart appears normal. He has normal heart sounds under auscultation. This phase also involves gathering new information through undertaking patient assessment (Lippincott Williams & Wilkins, 2007, pg 72) hence new vital signs that are not yet charted are: BP 90/40, pulse 115 bpm, RR 22 bpm, and temperature 37 degrees. With the patient’s information/cues, a nurse who is skilled in critical reasoning is able to interpret the patient’s situation and provide effective nursing care to the patient.

Process Information

This phase involves data interpretation whereby the nurse comes to understand the patient’s symptoms and signs (Lippincott Williams & Wilkins, 2007, pg 72). Considering that Mr. Gordon is hypertensive with regards to his past history, his current BP is low. The normal blood pressure in an adult is 120/80 mmHg (Jevon, 2008, pg 38). His pulse is 115 beats per minute when the normal range of heart rate is 60-100 beats in a minute (Taylor, 2011, pg 15). In order to distinguish irrelevant from relevant information in discrimination, Mr. Gordon appears pale but it is better to focus on his BP and pulse. Checking his O2 saturations and urine output is essential. This is because with regards to clustering cues together, his hypotension, decreased JVP, peripherally cool to touch and tachycardia could be impending shock’s indicators.

Inferring involves making deductions or forming opinions that tag along logically through interpretation of objective and subjective cues (Lippincott Williams & Wilkins, 2007, pg 73). A sudden blood pressure fall can be dangerous ((Taylor, 2011, pg 34). It is argued that an alteration of merely 20mmHg for instance can bring about fainting and dizziness once the brain is not able to receive enough blood supply (Taylor, 2011, pg 35). This is the case in the case study since the patient experiences episodes of fainting and dizziness. Another cause of Mr. Gordon’s hypotension is dehydration. This is exhibited through excessive vomiting and diarrhea. It is imperative to note that Mr. Gordon’s BP may possibly be low as a result of the medications he took or takes to manage his conditions, because normally, anti-anxiety medicines, high blood pressure medications and those used to manage high cholesterol cause hypotension (Taylor, 2011, pg 45). With respect to outcome prediction, if Mr. Gordon is not managed by intravenous fluid he might go into shock. Tissue oxygenation is also vital for hypotensive patients (Taylor, 2011, pg 55)

With regards to problem identification following synthesis of facts as well as inferences, a definitive diagnosis for Mr. Gordon’s problem is that he is hypovolaemic. Identifying and treating the underlying cause is important (Taylor, 2011, pg 70) hence; one of the nursing priorities for this patient is to assess him following the Airway, Breathing, Circulation, Disability approach and monitor his vital signs as well as hemodynamic parameters hourly. The rationale behind this is that hemodynamic parameters disclose information concerning adequacy of the volume status of the fluid ((LeMone, P, 2008, pg 45). The second nursing priority is prompt planning for fluids administration to raise the volume of intravascular fluid. The rationale is that both colloids and crystalloids might be used to enhance intravascular volume according to the fluid loss cause (LeMone, P, 2008, pg 50).

A collaborative measure is important in nursing care in order to promote patient outcome (LeMone, P, 2008, pg 25). This will be seen through working with the physician who will offer pharmacological management to the patient. Expected outcome is that the patient will experience sufficient fluid volume as well as electrolyte balance as seen by increase in urine output, BP and HR within the normal range, and normal turgor of the skin. With regards to process reflection, I now understand that early identification of cues and prompt interventions may prevent patient deterioration.

Conclusion

In conclusion, experienced nurses in clinical practice engage in several episodes of clinical reasoning for every patient within their care. Nurses who are experienced may go into the patient’s room and instantly observe important data, make conclusions concerning the patient thereby initiating suitable care. Due to their skill, knowledge, and experience, nurses who are experienced might seem to carry out these procedures in a manner that appears instinctive or automatic. On the other hand, clinical reasoning is actually a learnt skill. With reference to the case study, effective clinical reasoning skills are imperative so that Mr. Gordon’s situation or problem is managed properly.

Reference

Alfaro-LeFevre, R, (2013), Critical thinking, clinical reasoning, and clinical judgment: A practical approach, St. Louis, MO: Saunders/Elsevier.

Jevon, P, (2008), Treating the Critically Ill Patient, Oxford: Wiley Blackwell.

Lippincott Williams & Wilkins, (2007), Critical care nursing, Philadelphia: Lippincott Williams & Wilkins.

LeMone, P, (2008), Medical Surgical Nursing, Upper Saddle River, NY: Prentice Hall.

Taylor, C, (2011), Fundamentals of nursing: The art and science of nursing care, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.