While provide nursing care to the patients, the nurses have to collect cues of the patient condition, process all the care related information collected from the patient and then arrive at an understanding of the presenting health issue of the patient so that adequate care measures can be taken for the patients (Mudd & Sloand, 2015). Followed by which the nurses are required to implement the planned intervention based on the verdict, evaluate the outcome of the care activities planned and then reflect on the entire process to improve the ability to provide individualized care services. The clinical reasoning cycle is an excellent framework that provides the nursing professionals with a systematic protocol with interlinked steps to follow and adhere to each of the care practice components mentioned above. As mentioned by Hunter and Arthur (2016), the nurses that have effective clinical reasoning skills have been reported to have enhanced positive outcomes associated with patient and hence it is necessary for the nurses to have a clear understanding of the clinical reasoning process. In this essay, I will attempt to explore the clinical reasoning cycle and apply this framework utilizing each of the components of the clinical reasoning cycle taking the assistance of a case study.
Considering the patient situation:
This case study represents the care of Mrs. Connie Brownstone as the patient under consideration. Connie is a 79 year old woman who had been admitted to the eme4regncy department of the health care facility due to the pressing health concern of respiratory distress. She had been brought in by her daughter due to the one day history of the patient suffering from shortness of breath which was not diminished or reduced by medication.
Collecting Care Cues:
As discussed by Dalton, Gee and Levett-Jones (2015), collecting care cues is one of the most important parts of the care planning procedure as it guides the care planning procedure and helps the nurses provide patient centred individualized care to the patients. There is a varied range information that the nurse has to collect in order to recognize the exact care needs of the patient, such as handover reports, patient history, patient charts, investigations results, medical assessments, and lastly undertaking new patient assessments (Hunter & Arthur, 2016). Her past medical history as mentioned in the case study is asthma, and she had been admitted to the ICU due to status asthmaticus and required endotracheal intubation and ventilation for two days. The past medical data of Connie also indicated that she had allergies to pollen and dust mite as well which can aggravate asthma attacks.
The triage nurse assessment data reveals that the vital signs of the patient includes RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 168/70; which indicates most imbalance in the homeostasis of the body in most cases (Teach et al., 2015). Next, the physical assessment data indicates that Connie had been suffering from Dyspnoea, extreme anxiety, and audible expiratory wheezing, which in this case indicates signs of considerable respiratory blockage; and hence, she had been considered as category 2. During the cubicle nursing assessment, the oxygen saturation rate and blood pressure of the patient reduced further indicating further complications in the patient. During the physical assessment indicated evident use of accessory muscles while breathing along with bilateral expiratory wheeze. The systematic investigation results carried out for her includes presence of hyper-expanded lungs and signs of abnormal ABG results as well.
While processing the information collected, the nurses generally follow a step by step process of interpreting, discriminating, relating, inferring, matching and then predicting care needs from the information with respect to best available evidence (Dalton, Gee & Levett-Jones, 2015). In this case, Connie had been suffering from acute respiratory distress evidenced by the abnormalities in the vital signs and investigation results. First and foremost, the normal respiratory rate of adult is 12 to 20 minutes and in this case, Connie had almost double the respiratory rate and her oxygen saturation has also dropped to 89%, indicating at extreme oxygen insufficiency. Considering the heart rate and blood pressure, Connie had 125 bpm heart rate and 172/75 mmHg blood pressure; whereas the normal heart rate is 100 bpm and blood pressure is 120/80 mmHg. In explanation I would like to mention that during asthma exacerbation that leads to respiratory distress reduces the oxygen availability in the body significantly, as a result, the cardiac load increases in order to be able to meet the oxygen demand of the body which raises the heart rate and drops the blood pressure as well (Johnson, 2017).
However, the most important information is the presence of hyper-expansion in her lungs and her ABG test results. The ABG results indicated high blood pH, low PaCO2, low PaO2 and high HCO3. As per Reddi (2018), the investigation results of the ABG tests indicates alveolar hyperventilation and hypocapnia resulting from an acute episode of respiratory alkalosis. It has to be mentioned that Connie had been an asthma patient and susceptible to allergies caused by pollution. The respiratory alkalosis in patient can be caused due to the bronchial constriction and resultant alveolar hyperventilation. This has also led to hyper-inflation of her Chest and her wheezing is also indicative of bronchial constriction (Brinkman & Sharma, 2018).
Identifying And Prioritizing Care Needs:
There are various care needs that Connie is exhibiting which requires clinical intervention, however while providing emergency care relief to a deteriorating patient, it is very important for the nurses to prioritizing the care needs by synthesis of facts and inferences. The first and foremost care priority for the patient in this case will be the shortness of breath or dyspnoea which was also the presenting problem that the patient was admitted to the facility with. The second care priority for Connie will be the respiratory alkalosis and maintaining the acid base balance in the blood back to normal. The third care priority for Connie will be the high heart rate which can lead to cardiac emergency if adequate interventions are not given to the patient (Mudd & Sloand, 2015).
Establishing care goals:
Establishing care goals is an integral part of the clinical reasoning cycle as it allows the nurses to set up a benchmark or care outcome in accordance with the exact needs and preferences of the patient and be able to provide accelerated recovery progress for the patient. In this case, the first care goal will be to address the shortness of breath by reducing the respiratory rate back to normal and enhancing the oxygen saturation levels to at least 95-98% within the next 48 hours. The second care goal will be to reduce the blood pH and restore homeostasis in the patient within next 24-48 hours. The third care goal for me will be to address the high heart rate of Connie by reducing the present rate from 125 bpm to 100 bpm within the next 24 hours.