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Clinical reasoning cycle is a process by which nurses can collect information, process it, understand the situation and problems of the patient, plan interventions, evaluate the outcomes and then reflect on the whole process (Salminen et al., 2014). Critical thinking influences this clinical reasoning cycle. It is a series of linked clinical encounter (Davies, 2002). Nurses who have good clinical reasoning skills do have a good impact on the outcomes of the patient. When the clinical reasoning skills are not good, patient deterioration can occur (Dreifuerst, 2015). The present writing is on the clinical reasoning cycle of a patient, Mrs Checketts, who is 86-year-old woman and has been admitted in the hospital for respite after getting treatment for her fractured wrist due to a fall she had suffered at home.
Clinical reasoning cycle:
Mrs. Checketts is a petite woman, having sustained a fall at her home and admitted to the hospital for relief after the treatment for her fractured wrist.
The woman lives alone and does her activities in her daily life. Her son stays far off, and her niece visits her few times during a week. She has been suffering from Dementia, even though it is in early stages. The condition of the skin is not good, and there is a pressure injury in her coccyx. She is not steady on the feet and needs the walking frame. Her clothes are not clean, and the smoke from the clothes proves that she is a smoker. She weighs 50 kilograms, and her height is 165 tall. On observation, the temperature was found to be 36.5 C. The heart rate was normal at 82 beats, blood pressure was 105/60. Her breathing was 16 breaths per minute.
The complications that may have been affecting the patient are due to injury in the wrist. The condition that the patient has to deal with is due to the lifestyle of the patient. The patient has been living alone and did all her work by herself. Her son stays away, and the only help that she gets is from her niece who comes a few times in a week. The patient had suffered a fall that led to the fracture of her wrist. As the patient is an elderly person, the complication related to such fractures and the medication is much more complex. Complications of wrist injury include aching, stiffness and disability. Osteoarthritis leads to major problems as the wrist may start swelling (Mellstrand Navarro et al., 2011). The patient is suffering from Dementia. Dementia is a decline in the mental ability of a person that interferes with the daily life of that person. The symptoms related are of a wide range. The memory and thinking skills are severely hampered. The other aspects of a person that becomes impaired are language, communication, attention, capability to focus, judgment and reasoning, visual perception. People with Dementia have short term memory and often the daily chores are hampered due to this (McNamara, 2011). The patient, in this case, is suffering from initial levels of Dementia. Her clothes are not clean, and they are kept in a dirty bag. It can be concluded that this condition is due to her Dementia problems, and she forgets to clean her clothes and keep herself tidy. Her condition of mobility is worse. She needs walking frame to walk. A pressure injury is present in her coccyx. The coccyx is the tailbone of the body. Such pressure injury are caused by sitting on a hard surface for a long time. In patients, this may be due to lying in the bed for a long period. It may be due to an injury too. The body temperature of the patient is 36.5 C. The normal body temperature of a fit person is 37 degree C (Hall, 2012). Her weight at 50 kilograms is a little less than what it is supposed to be. The positive point in her health is that her heart rate is 82 beats per second, which is normal. The blood pressure and breathing rate of a fit person are 120/80 and 10 to 30 breaths per minute (Flegr, 2012). The patient had a breathing rate of 16 breaths per minute. The blood pressure found is thus low. That may be the effect of poor health condition. The breathing rate was normal.
Two key issues those are important in the present case are Dementia and pressure injury in the coccyx. Dementia is a disease that has a major impact in the patient’s life. In such a condition, the activities of daily life are hampered. The main problem is related to memory loss. This is because certain issues come up when the patient is having problems with memory. Moreover, communication is affected due to Dementia (Hallberg et al., 2014). Speech is hampered, and vocabulary is a problem. For a nurse, it is difficult to take care of a patient who has such problems. Nursing gets difficult problematic as these patients need special care. Medicines have to be given on time. The patient cannot be relied with this as she may not remember to take her medicines on time. It has been found that her clothes are kept in a dirty bag which implies that she does not remember to clean her clothes. The nurse has to take care of this problem. Another problem that may come up is the pressure sore in the coccyx. The ulcer is formed due to the reduction of blood supply in the area and starvation of nutrients and oxygen. Lying or sitting in a same position is the main cause leading to such reduction in blood supply to the affected area. The patient is said to have mobility problems. People have a greater risk of such ulcers if there are problems in mobility (Corbett et al., 2012). Dementia may increase the risk (Ahn, 2015).People with Dementia has problems in changing their positions when no help is provided. It is difficult to take care of pressure ulcers.
A list of goals has to be set for getting the good outcomes. Taking care of Dementia has to be the priority. This would take care of the majority of the problems related to the patient. As the patient is an elderly person, treatment for Dementia would be more of taking personal care to her and giving constant support and help. the problem of Dementia can be tackled by some ways. the objectives will include orienting the patient’s energy. An opportunity needs to be given to the patient to take care of the personal belongings. Regular talks have to be done so that the patient can remember all the necessary details. Moral support has to be provided. Praising the patient for achieving goals is a good idea. Treatment of pressure injury would include dressing the affected areas and giving the required medicines. Repositioning of the patient has to be done. That will give strength to the body. Support surfaces will help a lot. Using mattresses, cushions will help. Cleaning and dressing have to be done from time to time. removal of damaged tissue is a good option. this can be achieved by surgical or mechanical debridement. Other interventions include antibiotics, pain management, healthy diet and management of the present incontinence, muscle spam relief. By fulfilling these objectives, the main problem of Dementia will be taken care of. As a result, all the associated factors will be taken care of. the recovery of the patient will be fast in within a limited period.
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Salminen, H., Zary, N., Björklund, K., Toth-Pal, E. and Leanderson, C. (2014). Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning. J Med Internet Res, 16(1), p.e3.
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