Clinical Reasoning cycle
Case Study
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Introduction
Clinical reasoning cycle is defined as a process through which the nurses collect cues, process the information, develop an understanding of the situation or problems faced by the patient, and synthesize goals for interventions and further evaluate the outcomes (Hunter & Arthur, 2016). A clinical reasoning cycle is concluded through reflective analysis of the process of learning in the clinical scenario (Daly, 2018; Levett-Jones, 2018). This essay will aim to apply the initial steps of the clinical reasoning cycle for the provided case study of Tula. This essay will, therefore, assess the patient situation, identify the patient cues, process the gained information, and identify the primary problems.
Patient situation
Tula is a 38-year-old textile work who has been diagnosed with adult-onset of asthma. The patient has a medical history of hypertension and PCOS with an unhealthy BMI of 44.5. The patient is also a single mother who takes care of her 10-year-old daughter in joint custody with the father, Tom, who is supportive and caring. The patient requires a medical certification to resume to her job and is also showing concern over her use of inhalers.
Patient cues
The patient was admitted with complaints of persistent and dry cough, paroxysmal respiratory wheeze and acute dyspnea after long shift hours at the textile factory. The medical history of the patient identifies that the patient had fractured ulna at the age of 6 and is hypertensive and also had PCOS diagnosed at the age of 17. The patient works in the textile industry and is also obese with a BMI of 44.5. Obesity has been identified as one of the key risk factors. Therefore, the onset of asthma in the patient can be associated with both, occupational hazard due to excessive contaminants that are released in the textile industry and also via obesity (Peters et al., 2018).
Information processing
The patient has been diagnosed with adult-onset of asthma. The low molecular weight sensitizers and the chemicals often used in textile manufacturing can act as irritants and trigger the onset of asthma (Hekking et al., 2018). Asthma creates respiratory distress in the patients by blocking the airways and hindering respiration by hyperactivity and inflammation of airways, mucus secretion, and tissue remodelling. This affects the respiratory rate of the patient and increases it to compensate for the required oxygen demand of the patient (Ferreira et al., 2019). Tula has a high respiratory rate of 19 breaths per minute, which is a healthy patient should be between 12 breaths per minute to 16 breaths per minute (Habib et al., 2019). The heart rate of the patient is normal at 92 beats per minute and ranges within the normal category of 60-100 beats per minute for the healthy individual (da Costa et al., 2018). The oxygen saturation levels in the current situation are at 96% and are normal. The patient is hypertensive and therefore, has a blood pressure of 127/89mmHg that is higher than normal 120/80mmHg (Habib et al., 2019). The psychological and mental state of the patient can be classified as concerned and little confused where she wishes to get a medical certificate to showcase for her job, and is ambiguous about the absolute need of inhalers for her health. The chest auscultations of the patient revealed an audible wheeze with symmetrical lung movements. The patient is also alert and is functioning independently in the care setting. The patient is also unaware of the absolute importance of asthma inhalers required for her wellbeing and is bewildered about its necessity and is also expressing concerns about the need to resume to her job with a medical certificate to justify her absence.
Problems identified
The primary problem identified in the case scenario is the high risk of asthma exacerbation in the patient due to occupational hazard. The patient works in a textile factory and therefore has an increased risk of incidences of asthma exacerbation (Maher et al., 2016). The patient also possesses an unhealthy BMI that can further worsen asthma. The obese adults have difficulty in controlling asthma pushing them to an increased risk of respiratory distress in exacerbation of the condition. This can, therefore, serve to be a problem associated with the well being of Tula (Gomez-Llorente et al., 2017). Moreover, the patient is unaware of the need for inhalers for the maintenance of her diagnosed condition. Patient education is an essential component of effective nursing. The Nursing and Midwifery Board of Australia identifies patient education to be an essential component of care as it helps the patients understand the care needs, make informed decisions, and reciprocate the importance of interventions to ensure their well-being and beneficence (Cashin et al., 2017). Therefore, effective patient education is an integral part of health promotion and core responsibilities of healthcare professionals. In the given case scenario, the patient lacks adequate knowledge about the importance of inhalers for asthma and this can serve to be a problem for the management of her condition as it can lead to non-adherence and affect her well-being (Dekhuijzen et al., 2018).
Conclusion
This essay provides a case analysis of Tula, through the application of the first four stages of clinical reasoning cycle, that are a collection of patient information, patient cues, information processing and problem identification. Prolonged exposure to the contaminates in the textile industry can result in the onset of asthma in the patients. Further, the unhealthy BMI of Tula can also cause problems with its management. The essay also assesses the patient vitals and analyses the identified problems. Along with health conditions, limited knowledge of the importance of inhalers prescribed to Tula can also be considered a major problem as it can lead to non-adherence and further worsen her health condition.
References
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., … & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.
da Costa, C. A., Pasluosta, C. F., Eskofier, B., da Silva, D. B., & da Rosa Righi, R. (2018). Internet of health things: Toward intelligent vital signs monitoring in hospital wards. Artificial Intelligence in Medicine, 89, 61-69.
Daly, P. (2018). A concise guide to clinical reasoning. Journal of Evaluation in Clinical Practice, 24(5), 966-972.
Dekhuijzen, R., Lavorini, F., Usmani, O. S., & van Boven, J. F. (2018). Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here?. The Journal of Allergy and Clinical Immunology: In Practice, 6(3), 785-793.
Ferreira, M. A., Mathur, R., Vonk, J. M., Szwajda, A., Brumpton, B., Granell, R., … & Magnusson, P. K. (2019). Genetic architectures of childhood-and adult-onset asthma are partly distinct. The American Journal of Human Genetics, 104(4), 665-684.
Gomez-Llorente, M., Romero, R., Chueca, N., Martinez-Cañavate, A., & Gomez-Llorente, C. (2017). Obesity and asthma: a missing link. International Journal of Molecular Sciences, 18(7), 1490.
Habib, C., Makhoul, A., Darazi, R., & Couturier, R. (2019). Health risk assessment and decision-making for patient monitoring and decision-support using wireless body sensor networks. Information Fusion, 47, 10-22.
Hekking, P. P., Loza, M. J., Pavlidis, S., De Meulder, B., Lefaudeux, D., Baribaud, F., … & Bansal, A. T. (2018). Pathway discovery using transcriptomic profiles in adult-onset severe asthma. Journal of Allergy and Clinical Immunology, 141(4), 1280-1290.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse Education in Practice, 18, 73-79.
Levett-jones,T. (2018). Clinical Reasoning: learning to think like a nurse (2nd ed.) Frenschs Forest: Pearson.
Maher, M., Wided, B., Souhail, C., Ezzeddine, G., Houda, K., Houda, K., … & Habib, H. S. (2016). Epidemiology of Occupational Asthma in Tunisia: Results of a First National Study. Occupational Diseases and Environmental Medicine, 4(2), 27-36.
Peters, U., Dixon, A. E., & Forno, E. (2018). Obesity and asthma. Journal of Allergy and Clinical Immunology, 141(4), 1169-1179.
Appendix
Clinical Reasoning Cycle
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