Describe about the Clinical Assessment and Diagnostic Reasoning for Health Care.
The communication between patient and health care practitioners has been seen to improve the quality of health care. There are demands made on the physician which are both intellectual and emotional in nature, the analytical reasoning should be balanced with interpersonal skills to facilitate better care. Here, the analysis of the two case studies will be done where the method of gaining further information, identification of immediate or long-term problems as well as the application of the clinical reasoning will be discussed.
Work sheet 1 Part A
The patient presents with a probable risk of hypovolemic shock which can occur after surgery and needs immediate attention. The patient reports with low blood pressure with 110 /50, pulse rate of 112 being weak and thread as well as low urine output between 25 – 30 ml/hour. This is often accompanied by sweating, confusion, restlessness, cool, moist and pale skin, tingling of lips (Botwinick, 2016) .Thus one should check for signs and gather more information. The patient also shows signs of fluid deficit in spite of being under IV administration of 84ml per hour, this also requires immediate attention. If left unattended then it may cause heart failure, anemia, dysfunction of platelet as well as gastrointestinal problems (Inouye , 2014).
There has to be an implementation where fluid balance is maintained. The patient is of Aboriginal origin and hence developing a relationship with the patient and his family will prove to be an invaluable start to establish trust and naturally ensure a better recovery ( Mercer , 2013). These people tend to stay away from the mainstream health care. It is important to be culturally aware and act appropriately and ask questions in their native language to know more about his past medical history as some details may have been missed as they cling to their idea “shame” and often don’t communicate. As the family of the patient is large and the patient is an elderly, discretion has to be practiced. It is important to remember that the major purpose of asking for family history is assessing additional risk factors for the patient’s current and health in future.
It is important to understand the cultural differences and communicate accordingly to know more about the patient’s eating habits as he has type II diabetes and refer a diet chart accordingly as a mean to attend to his long term problem (Moran , 2013). To impact positively an improvement in psychosocial factors, metabolic control and enhanced self management skills and suggesting necessary life style changes. Smoking cessation programs should be referred to the patient and his family in a gentle way, stressing more on the long-term ill effects of it. This is more important as the patient just went through colon surgery (Ross, 2013). For this case study of the patient, clinical reasoning has been applied by gathering patient information, collecting cues and processing the information. By understanding all these, the nurses can understand the problem or situation of the patient. They plan and implement interventions. In addition, they can evaluate the outcomes as well as learn the process.
Work sheet 2 Part A
The 88 year old patient can be asked questions to assess post-op delirium. Asking Betty the day of the week or to recite the months of the year in a backward fashion can identify delirium up to 93 % (Futurity, 2015). Asking her to rate her pain in a scale from 0-10 may also prove to be helpful as well as factors, which accelerate pain, it should be kept in mind that experiencing pain is subjective in nature. Enquiring more about the chest pain should be done, as she is experiencing chest pain with breathing. As she hasn’t voided in last 24 hours, it would be helpful in asking if she is feeling any signs of dehydration like dry or sticky mouth, tiredness or feeling sleepy (Hooper, 2015). The above information will allow the health care professional to attend to the immediate needs. The immediate action should be to ensure normal oxygen saturation as it is border line of about 95% and this can be a reason behind her agitation, confusion. Another issue is the patient having sinus tachycardia, showed by signs of elevated heart rate and probable sign of no voiding in last 24 hours, suspecting hypovolemia. Pain medication can be given as she complains of chest pain but first the assessment of pain should be done first by asking questions such as time of onset, signs of radiation, severity, length of time the pain have been present, frequency and what were she doing when the pain started and if anything happened to make it worse ("Nursing and Midwifery Board of Australia ", 2016).
She has a history of osteoarthritis and hip and wrist pain. This will require future care as she may have impaired physical mobility and may require mobility aid when tries to move. Aftercare after an ORIF is necessary as proper healing of the hip bone is required. Good sources of vitamin D and calcium are essential in diet along with good source of protein such as meat (Wildman 2016). Taking help of a physical therapist may prove to be essential for better movement and to decrease pain.
Betty has been showing signs of memory problems for past 18 months. She will be benefitted by memory training interventions which will include stress management, promotion of health ( Striling , 2016). Research shows that there is a positive correlation between physical activity and performance of memory where greater physical activity is associated with better memory. Mild exercises for at least 15 minutes or 3 or more occasions a week particularly benefit cognitive performances. In the given case scenario, clinical reasoning has been applied by collecting patient information, gathering cues and processing the information. All these information will help the the nurses in understanding the problem or condition of the patient. They will plan and implement the interventions. Additionally, they will evaluate the outcomes and learn the process.
Botwinick, I., Johnson, J. H., Safadjou, S., Cohen-Levy, W., Reddy, S. H., McNelis, J., ... & Stone, M. E. (2016). Geriatric nursing home falls: A single institution cross-sectional study. Archives of gerontology and geriatrics, 63, 43-48.
Hooper, L., Abdelhamid, A., Attreed, N. J., Campbell, W. W., Channell, A. M., Chassagne, P., ... & Gaspar, P. M. (2015). Clinical symptoms, signs and tests for identification of impending and current waterâ€loss dehydration in older people. The Cochrane Library.
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
Mercer, C. (2013). The Experiences of Aboriginal Health Workers (AHWs) and Health Professionals Working Collaboratively in the Delivery of Health Care to Aboriginal Australians: A Systematic Review. HNE Handover: For Nurses and Midwives, 6(1).
Moran, C., Phan, T. G., Chen, J., Blizzard, L., Beare, R., Venn, A., ... & Pearson, S. (2013). Brain Atrophy in Type 2 Diabetes Regional distribution and influence on cognition. Diabetes care, 36(12), 4036-4042.
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Ross, J., Lim, J., Rudland, K., Gupta, D., & Michael, H. (2013). Structured Training Positively Impacts Nurses Beliefs and Practices On Promotion of Smoking Cessation. In Respirology (Vol. 18, No. Suppl. 2, pp. 11-11). Wiley-Blackwell Publishing Asia.
Stirling, C., Campbell, B., Bentley, M., Bucher, H., & Morrissey, M. (2016). A qualitative study of patients' experiences of a nurse-led memory clinic.Dementia, 15(1), 22-33.
These 2 questions quickly identify delirium - Futurity. (2015). Futurity. Retrieved 20 August 2016, from https://www.futurity.org/delirium-older-adults-hospitals-1004272/
Wildman, R. E., Wildman, R., & Wallace, T. C. (Eds.). (2016). Handbook of nutraceuticals and functional foods. CRC press.