Process of Clinical Reasoning Cycle-Free-Samples for Students

Question: Discuss about the Process of Clinical Reasoning Cycle. Answer: Introduction: The clinical reasoning cycle is the process by which the nurse collects cues, process information, analyze the nursing situation, construct plan. Develop interventions and then evaluate the effects and reflect on the learning. This report analyses the case of Ms Melody, who is having Peritonitis followed by ruptured appendix. The reflection on the patient-care approach used for the patient is provided here by the application of clinical reasoning cycle (Adams, Maben Robert, 2014). The phase or process used in clinical reasoning cycle is also described here for Ms. Melody to determine appropriate interventions and outcome for her. Reflection based on clinical reasoning cycle: Description of persons conditions, collection of information, process and presentation of the information This will be reflecting on the condition of Ms Melody who is suffering from peritonitis followed by ruptured appendix. It is found out that she was presented in the Emergency department with 2-3 days of severe left lower quadrant abdominal pain. She needed emergency laparoscopic surgery on removal of the ruptured appendix. The following is the current information that was collected about Melody. Then it can be reviewed that her information on past medical history which showed that she had asthma, depression. The present medical cues were followed on the medicaments like ventolin, seretide, straline. It is also observed her current observations which included blood pressure 95/45 mm Hg, heart rate of 120, temperature 38.3 Celcius, RR of 22/ min and shallow, spO2 of 95% on room air. It is also noted that she complained of increasing nausea, abdominal pain which was found to be 7-8 on a scale of 0to10. Her physical evaluation reflected on distended abdomen and generalized abdominal guar ding. Then it was found that she had her raised white blood cells (WBC ) count and CRP. After all the possible cues and the situations of Ms Melody, following information can be processed. On the basis of information, it could be interpreted that she has low blood pressure. She is also facing higher heart rate than the optimal. Her body temperature is moderately increased it was about 100.94 Fahrenheit. Her respiratory rate is within the normal range but she is having tachypnea because of shallow breath . Her SPO2 reading suggests that her oxygen level in the blood is almost normal. While processing her complaints it could be said that she is facing acute Peritonitis. She is suffering from abdominal pain which is high in the scale of 0-10. The abdominal pain mainly presented her situation of peritonitis (Grace, 2017). The nausea that she is having is also due to her present condition. Pathophysiological conditions of peritonitis The clinical issues faced by patient has mainly occurred because of the diagnosis of peritonitis. The pathophysiological explanation of the condition of peritonitis states that it is mainly caused by the inflammation of peritoneum and the tissues which line the inner walls of the abdomen. They are mainly caused by the bacterial and fungal infection (Burkhardt Nathaniel, 2013). The basic pathophysiology behind the conditions is due to immunological response. The initiator effector cells which localize the peritoneum such as the mast cells, macrophages and lymphocytes, increase the secretion of chemokines and influx of neutrophils, monocytes. These lead to inflammation and clinical symptoms of peritonitis. Thus the key points in pathophysiology will include the leakage of contents of abdominal cavity, proliferation, edema, invasion of the blood cells and the immediate response of the intestinal tract (Cherry Jacob, 2016). Identification of 3 nursing problems based on the health evaluation data- While making the person centered care, the nurses can prioritize on the 3 nursing issues on which it will be developing the nursing interventions. The three nursing problems are related to: Pain- The patient is suffering from acute pain. Thus the nurses need to manage the pain problem which will be an important step in my nursing interventions. This will help me manage her condition Infections- The inflammation in the peritoneum will be causing fungal and bacterial infection (Feo et al, 2017). The infection is occurring due to her distended abdomen and the generalized abdominal guarding. This is another cue which the nurses need to handle. 3- The deficient fluid volume which was detected from her low BP and high pulse rate (Gee et al, 2015). This section also requires high care and management by my nursing interventions. Nursing goals or key care priorities Pain- The nursing goal will focus on controlling the acute pain as it was almost 7-8 in a scale of 0-10. The nursing interventions will be planned in such a way that it will provide relaxation skills and methods that will promote comfort from this. Infections- The goal here is to achieve timely healing, free of erythema, verbalize the goals according to the individual causative risk factors (Holloway Galvin, 2016). Here the nurses must set up the goal according to situation of Melody who can face infections due to ruptured Deficient fluid volume- The nurse will try to improve the fluid balance which will be evident with the adequate urinary output with normal specific gravity, stability in vital organs, moist mucous membranes, good skin turgor, capillary refill will be prompt and the weight within the acceptable range. This will also follow with the goal to maintain the blood pressures and heart rate of the patient (Griffith Tengnah, 2017). Discussion on nursing care Pain: To managepain ofpatient, the nurse gave the following nursing interventions topatient. The nurse investigated the pain report ofMs Melody. In this section, the nurses noted the duration and intensity of pain. She hadpain level of 7-8 in0-10 scale. The pain tends to be constant and itdiffuse over the entire abdomen when the inflammation process will accelerate (Hunter Arthur, 2016). The nurses will maintain thesemi-fowlers position. This will facilitate the fluid and wound drainage by gravity reducingthe abdominal irritation and reducing pain (Johnstone, 2015). The nurses moved the patient slowly and deliberately, splinting the painful area. This will reduce the muscle tension and guarding and minimize the pain (Mikkonen, Kyngs Kriinen, 2015). The nurses also provided comfort measures like massage, back rubs that helped in patients relaxation. Infections- The nursing interventions I took are listed below, The nurses noted the risk factors that are due to ruptured appendicitis. This will influence the choice of intervention. The nurse will access and evaluate the vital signs like decreased blood pressure, tachycardia, fever and tachypnea. This will help to evaluate any complications in patient and promote early action (Ignatavicius et al, 2015).They have to strictly monitor the urine output because oliguria can develop due to bacterial infections. They will have to maintain aseptic conditions while handling the open wounds, dressings. This will minimize the infecting organisms or cross contaminations. They will have to observe the drainage of wounds and provide the status of infection (Li et al, 2016). Deficient fluid volume- Looking at the signs and symptoms of Melody, the nurses took some of the nursing interventions to manage this condition, They monitored the vital signs that are the blood pressure, tachycardia, tachypnea. They also measured the central venous pressure. This has aided in assessing the fluid deficit and the effectiveness of the fluid replacement.The nurses will maintain accurate I and O and will be co relating the weights every day. They will evaluate the overall hydration status. They measured the urine specific gravity that will also reflect upon the hydration status and the renal function. They will observe if the patient had dry mucous membrane. This will reflect on the conditions of hypovolemia (Doenges et al, 2014). They will change the positions frequently and provide skin care that may arise to deficiency in fluid. The edematous tissues are compromised in circulation and are prone to breakdown (Parahoo, 2014). If necessary, they will be administering fluid, electrolytes and diuretics. This will be helpful to replenish the circulating fluid and electrolyte volume (Sommers et al, 2014). Evaluation of care After nursing care interventions were adopted on the patient for managing pain condition, the patient showed a little improvement with the relief in pain. With proper evaluation of the infection level and maintaining the aseptic conditions, the infections decreased in case of Melody. The evaluation results in deficiency of fluid showed that her vital signs improved a lot. These interventions taken for curing and relieving the issues in peritonitis is effective. The nursing process that should be followed also reflected patient-centred care approach as major focus was on identify immediate care needs of patient and taking patients preference before initiating any nursing actions. This action is also in relevance with the ethical and legal code of conduct for nursing practice because this code emphasizes on maintaining autonomy of patient during care process (Sidani Fox, 2014). Conclusion The last part of the reasoning cycle describes the contemplating the issues that the nurses will learn. Hence, my reflection from this activity or experience is that the nurse learnt to identify the specific issues and take patient centered caring process for peritonitis. The nursing interventions taken after accessing and processing the overall conditions of the patient helped in recovery of patient. This form of patient-care approach will help me in the future to implement strategic interventions and identify specific rationales too. It can also reflect team of nurses and other professional act as great means of support when we require guidance in relation to nursing actions required for challenging situations. References Adams, M., Maben, J., Robert, G. (2014). 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