CLINICAL REASONING CASE STUDY
Clinical Reasoning Case study
Clinical Reasoning Case Study
Question 1 – Stage 1: Consider the Patient’s Situation
Mr. Rossi, a 76 years-old man, collapsed in his garden. He lives alone after losing his wife 6 months ago. He appears frail, says his heart is racing, has a headache and is thirsty. Ambulance notes indicate that he was afebrile, slightly tachycardic and hypotensive.
Question 2 – Stage 2: Collecting Cues – Assessments
The first assessment is patient history assessment. This assessment includes collecting information on the patient’s biographical, medical, psychological and social history. The assessment will clarify the nature of the current illness, provide information on medications being taken, whether the patient has allergies or reactions to medications, and the immunization status of the patient. In addition, the assessment will explain the family and social history of the patient. As, Fawcett & Rhynas (2012) say, taking a patient’s history is important because it helps in identifying care priorities as well as in deciding the most appropriate interventions to enhance patient outcomes. It is through history taking that the signs and symptoms of Mr. Rossi’s illness is identified as well as the experiences he has had before and after collapsing (Thornbory, 2013).
The second assessment is assessing the general appearance of the patient which involves collecting objective information on head-to-toe observation. Here, the patient’s physical, behavioural and emotional state is recorded. Major considerations in this assessment include; general appearance (skin, hair, nails, mouth, eyes among others) the posture and movement, body and breath odours, attitude, affect and mood, and speech (Haugen, Johansen & Ommundsen, 2014). Assessing the general appearance of the patient can provide clues to the diagnosis of the illness and indications of how severe the situation is. Again, this assessment may indicate the social status, values and personality of the patient (Lowth, 2016).
Vital signs assessment would also be conducted on Mr. Rossi. This include observing and recording baseline indications of temperature, respiratory rate, pulse, blood pressure, oxygen saturation and pain. It also includes recording blood sugar levels, weight and height of the patient. Cardona-Morrel et al (2016) say that vital signs assessment and monitoring does not only aid clinical decision making on diagnosis and intervention, it also help in ensuring patient safety.
Question 3 – Stage 2: Collecting Cues – Questions
How did you feel before the unfortunate incident in your garden?
This question seeks to clarify how Mr. Rossi was feeling before he collapsed in his garden. This is to establish if he was sick prior to the incident or the sickness started in a sudden manner. Interviewing the patient for further information does not only clarify signs and symptoms of the current situation, it also points to predisposing factors associated with the illness (Fawcett & Rhynas, 2012)
Tell me about any medications you are taking or have taken recently?
This question would seek to get further information on the medication history of the patient. As Lloyd and Stephen (2007) suggest, answers to this question indicate what medications the patient is taking and medical problems they were taken for. Additionally, asking this question would provide information on names of medications a patient has taken and when they were started and stopped. FitzGerald (2009) mention that, medication history help in preventing prescription errors and risks to the patient. Medication history also indicate whether a patient has any hypersensitivity reactions to drugs, whether they are taking over-the-counter drugs or alternative medicines.
Kindly describe to me how you are feeling?
This question would help in assessing the speech ability of Mr. Rossi. In addition, it would indicate his attitude and mood while speaking. Furthermore, his emotional state will be observed from what he says and how he says it. This question will achieve two ends. First, the descriptions of how the patient feels clarifies the current situation. Secondly, how he speaks will provide insight in his emotional and psychological state. According Bernstein & Saladino (2007), allowing a patient to express themselves can give important indications into their personality and mental state. Issues like anger, feeling sorry for oneself, irritability and incoherent speech could be indications of other conditions.
Question 4 – Patient Safety and Person Centred Care
Hand hygiene adherence for both health care workers (HCWs) and patients could decrease risk of healthcare-associated infections (HAIs) and pathogen transmission (Landers et al, 2012). Hand hygiene adherence of HCW can be improved by involving patients as monitors of hand hygiene. Mr. Rossi, can be encouraged to find out whether medical practitioners attending him have practised their hand hygiene. In addition, Lander et al (2012) recommend patient hand hygiene adherence would reduce HAI prevention and transmission of pathogens to other patients, HCWs and the environment. Therefore, Mr. Rossi would be encouraged to participate in his own hand hygiene both in his hospital stay and at home. To improve hand hygiene adherence, health institutions should promote the timing and technique of hand hygiene, identify barriers to hand hygiene and get ways of addressing them and provide education and training of hand hygiene for both patients and HCWs
Question 5 – Hand Hygiene Principles and Person-Centred Care
It is recommended that before a nurse touches the patient’s skin, dressing, food and the environment, they should ensure they wash their hands. In addition, hands should be washed after an episode of care. As Landers et al (2012) say, health care providers should observe to wash hands according to the World Health Organization’s moments of hand hygiene recommendation. They include washing hands before “touching a patient, before an invasive or aseptic procedure, after contact with body fluids, after touching the patient and after touching the environment” (p. 15). According to the recommendations given by Landers et al (2012), Mr. Rossi will also be encouraged to adhere to hand hygiene in case he comes in contact with a HCW, other patients or the environment. Wearing of gloves in another way of preventing contamination and pathogen transfer from or to the patient. However, hands may be contaminated when removing the gloves. As such, the care provider should ensure to wash hands after removing gloves.
Bernstein, K. S., & Saladino, J. P. (2007). Clinical Assessment and Management of Psychiatric Patients’ Violent and Aggressive Behaviors in General Hospital. (Cover story). MEDSURG Nursing
Cardona-Morrell, M., Prgomet, M., Lake, R., Nicholson, M., Harrison, R., Long, J., & … Hillman, K. (2016). Vital signs monitoring and nurse–patient interaction: A qualitative observational study of hospital practice. International Journal of Nursing Studies, 569-16. doi:10.1016/j.ijnurstu.2015.12.007
Fawcett, T., & Rhynas, S. (2012). Taking a patient history: the role of the nurse. Nursing Standard, 26(24), 41-46
FitzGerald, R. J. (2009). Medication errors: the importance of an accurate drug history. British Journal of Clinical Pharmacology, 67 (6), 671-675. doi:10.1111/j.1365-2125.2009.03424.x
Haugen, T., Johansen, B. T., & Ommundsen, Y. (2014). The role of gender in the relationship between physical activity, appearance evaluation and psychological distress. Child & Adolescent Mental Health, 19(1), 24-30. doi:10.1111/j.1475-3588.2012.00671.x
Landers, T., Abusalem, S., Coty, M. B., & Bingham, J. (2012). Patient-centred hand hygiene: The next step in infection prevention. American Journal of Infection Control, 40(4), S11-S17.
Lloyd, H., & Stephen, C. (2007). A guide to taking a patient’s history. Nursing Standard, 22(13), 42-48
Lowth, M. (2016). Recognising red flags. Practice Nurse, 46(1), 23-26
Thornbory, G. (2013). Taking a history and making a functional assessment. Occupational Health, 65(3), 27-30
Van Kuiken, D. (2016). What Is ‘Normal?’ Evaluating Vital Signs. Nephrology Nursing Journal, 43(1), 49-59