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Clinical Reasoning Cycle

Discuss about the Child and Adolescent Nursing.

Nursing is a key domain of health care, where the nursing staffs are responsible for ensuring the maximum health benefits and satisfaction of the patients. In this context, nurses are responsible for diagnosing the actual health issues of the patient followed by the prioritization of the key health issues, based on which the care plan is developed (Jeffries & Jeffries, 2012). For this, effective communication skills are needed, through which nurses can communicate with the patient and patient’s family regarding patient’s health and other requirements.  In this assignment, the focus is 10 years old boy and his nursing diagnosis procedure, according to the standard nursing practice. With the help of clinical reasoning cycle, the case would be evaluated.

Considering the patient

Jack is 10 years old boy, who have been brought to the emergency department by his father Andrew, upon falling from his bike, which caused injury to his left arm. Upon assessment, his arm was shown to be swollen and he appeared to be in considerable pain. For this Jack need a thorough assessment based on which the action plan would be built for him (Doenges, Moorhouse & Murr, 2016).

Collect cues

The patient Jack is assessed thoroughly by the nurse and his vital signs were measures. For instance, upon admission, his respiratory rate was 32; oxygen saturation was 99; temperature was 37 degree C; with systolic pressure 136 mmHg, which was slightly high; capillary refill was less than 3 second; and pain score was 8, measured by FLACC pain scale. In respect to other vital signs, the blood pressure and pain score has been shown to be high enough (Doenges & Moorhouse, 2012).

Process information (Prioritizing initial assessment and nursing management)

Jack has been fallen from his bike, while attempting to jump, causing a severe injury to his left arm. He has been shown to cry constantly, showing the evidence of his pain, which was measured to be 8 on pain score. He is restless and screaming due to pain, which has a relationship with his slightly high BP. Thus, while prioritizing his health issues, pain management would be the first concern. Moreover, upon initial assessment the triage nurse advised that surgery may be needed. For this neurovascular assessment and preparing Jack and his family are other two key priorities (Nieswiadomy & Bailey, 2017).

  1. Severe pain

Pain management is a key issue for Jack, as upon admission, as the key constrain for Jack is his severe pain on his left arm.

  1. Swollen arm

Identify Issues/ Problems

It is an important assessment and key constrain for Jack, as his left arm has been shown a significant swallowing, indicating towards neurovascular injury.

  1. Lack of knowledge regarding surgery

Upon reviewing Jack’s case and completing his initial assessment, Jack has been advised regarding the possibility of undergoing a surgery, for which neither Jack, nor his father was prepared. Thus, preparing them for Jack’s surgery is crucial (Urden et al., 2017).

  1. Pain management (NANDA Diagnosis- Domain 12 comfort)
  1. Communication strategies with Jack and family

Jack has undergone a severe injury on his left arm, which may need surgery. Thus, the nurses need to communicate properly with the patient as well as his parents, in order to ensure that they are also communicating freely with the health care facilities, to convey their needs. For this, a trustworthy relationship with Jack and his parents should be built by the nurse (Butcher et al., 2013). The nurse should show respect, dignity and empathy, while interacting with them, to ensure that their opinion and perceptions regarding Jack’s condition are valued. The nurse is also liable to make them understand the need for the surgery, the pros and cons of the medical procedure, while collecting their consents for these.

  1. Use of paediatric pain scales in pain assessment

In Jack’s case, the paediatric pain scale that has been used for assessing Jack’s pain is FLACC scale, which includes the assessment of face, legs, activity, cry and consolability scale. For each element of the scale, the score of 0 to 10 is provided, based on the child’s condition. This pain scale would help to identify the intensity of his pain, according to which specific group of pain medication would be administered (Gordon, 2014). Upon injury, unlike an adult, a child may not be able to express his actual feeling or degree of pain he is undergoing. Thus, in order to confirm the degree of pain, the scale is suitable to be used for Jack. Jack scored 8 in this pain scale, indicting a massive pain.

  1. Pharmacology of analgesics for Jack

As Jack has been scored 8 in FLACC pain scale, indicating severe pain, the initial responsibility of the nurse is to convey the information to Jack’s physician and administer him with a pain medication, according to the physician’s consultation. Considering Jack’s young age, Non-steroidal anti-inflammatory drug like Ibuprofen should be administer to Jack, as it targets inflammation is also a concern for Jack (Al-Shaer, Hill & Anderson, 2011). Initially, the dosage may be 600 mg trice daily, which may be reduced to 200-400 mg, based on his progress.

  1. Non-pharmacological methods of pain relief

Establish Goal

There are several non-pharmacological procedures for relieving Jack’s pain. These include, interactive distraction, like showing his favourite toy, singing a song to him, allowing him to sit on his father’s or care giver’s lap; changing the position of Jack’s arm frequently; continuously encouraging and praising him for his pain tolerance, giving relaxing massage, continuously providing support through building an homely environment and allowing his dear ones to give him spiritual support (Gulanick & Myers, 2013).

  1. Neurovascular assessment

The purpose of neurovascular assessment is to assess the adequacy of nerve function and blood circulation to different parts of the body, for detecting signs and symptoms of potential complications, arose as a result of Jack’s injury. In this context, besides pain, other elements of the assessment are peripheral pulses, pallor, paresthesia and paralysis. Jack’s pulse was mild, showing normal arterial flow (James, Nelson & Ashwill, 2014). The next element is pallor, i.e. observation of skin colour. Jack was shown pale, indicating reduced blood circulation surrounding the area of injury.

In this context, it is important to identify whether neurovascular and circulatory functions are normal or not. If the surrounding area of the injury is cool, it can be interpreted that the blood circulation is hampered. The next element is paresthesia, feeling of a sensation of numbness, tingling or prickling. However, in Jack’s case, he had not lost sensation in his arm, as he cried out in pain, when the nurse attempted to move his arm a little (Johnston?Walker & Hardcastle, 2011). The final element is loss of movement, i.e. paralysis, although no sign of paralysis was shown in Jack’s case, rather he was feeling significant sensation and pain in his arm, which was not experienced, in case of paralysis. Based on the assessment, Jack was advised for surgery.

  1. Preparing Jack and his family for surgery

Jack’s triage nurse has been advised that based on his injury, Jack may need to undergo a surgery. However, being aware about the need for surgery, Jack and his parents may be nervous regarding the fate of the surgery and the post surgical normal health status of Jack. For this, the nursing staffs need to prepare the patient as well as the family members regarding his surgery; i.e. the type of surgery, the need for the surgery, the pros and cons of the surgery; whether there is health risk for Jack related to the surgery, the precautions needed the post surgical requirements for Jack’s injury healing (Potts, & Mandleco, 2012). While providing information regarding the surgery, the nurse should also provide contentious empathy and support to the family, encouraging them to understand the positive aspects of thee treatment procedure. The consent for the surgery would also be collected in written format from Jack’s parents, for avoiding ethical concerns.  

  1. Health promotion (Growth and development achievements of school aged child)

Take Action

For enhancing awareness off Jack’s parents, a health promotion plan would be created for them, where the growth and development achievements of school aged child would be conveyed to them, in order to ensure that they have provided all the resources to Jack to achieve all the milestone in his growth and development period. For instance, in case of Jack, who is 10 years old, according to the Stages of Development theory by Erik Erikson, Jack is undergoing the stage of Industry vs. Inferiority (Hockenberry, Wilson & Rodgers, 2016). At this stage of life, children busily learn to be competent and productive or feel inferior and unable to do anything well. In this context, his parents need to provide him more support not to feel inferior to his surrounding world, while addressing his additional physical needs for growth.

The outcomes of pain management, surgery and continuous support would help Jack to heal his pain and injury faster. However, he also needs contentious support from the health care staffs. The non-pharmacological pain relief procedures would be helpful for Jack, helping him to cope with the situation (Hockenberry & Wilson, 2014).

Dealing with Jack’s case, it has been revealed that nursing staffs needs to provide additional care, while handling a child with massive injury. It has also been revealed that pain assessment scales has a significant role in identifying appropriate degree of pain in paediatric care (Oliveira Lopes et al., 2012).


In this assignment, the case of 10 years old boy Jack, has been concentrated. Jack experienced injury in his left arm and with the help of clinical reasoning cycle, the key diagnosis issues has been identified for Jack, based on which appropriate care plan has been provided in this assignment.


Al-Shaer, D., Hill, P. D., & Anderson, M. A. (2011). Nurses' knowledge and attitudes regarding pain assessment and intervention. Medsurg Nursing, 20(1), 7.

Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2013). Nursing Interventions Classification (NIC)-E-Book. Elsevier Health Sciences.

de Oliveira Lopes, M. V., da Silva, V. M., & de Araujo, T. L. (2012). Methods for establishing the accuracy of clinical indicators in predicting nursing diagnoses. International journal of nursing knowledge, 23(3), 134-139.

Doenges, M. E., & Moorhouse, M. F. (2012). Application of nursing process and nursing diagnosis: an interactive text for diagnostic reasoning. FA Davis.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nursing diagnosis manual: Planning, individualizing, and documenting client care. FA Davis.

Gordon, M. (2014). Manual of nursing diagnosis. Jones & Bartlett Publishers.

Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences.

Hockenberry, M. J., & Wilson, D. (2014). Wong's Nursing Care of Infants and Children-E-Book. Elsevier Health Sciences.

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2016). Wong's Essentials of Pediatric Nursing-E-Book. Elsevier Health Sciences.

James, S. R., Nelson, K., & Ashwill, J. (2014). Nursing Care of Children-E-Book: Principles and Practice. Elsevier Health Sciences.

Jeffries, P. R., & Jeffries, P. R. (2012). Simulation in nursing education: From conceptualization to evaluation. National League for Nursing.

Johnston?Walker, E., & Hardcastle, J. (2011). Neurovascular assessment in the critically ill patient. Nursing in critical care, 16(4), 170-177.

Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.

Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families. Cengage Learning.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.

Watson, J. (2011). Nursing. University Press of Colorado.

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