Consider the person
Clinical reasoning cycle is the process using which nursing professionals collect the cues, available information about the patients and after that processes those information to determine patients concerns. In this given case study, Mrs. Connie Brownstone (79) was admitted to my ward after having the issue of shortness of breathing and dyspnoea. When patient was brought to the healthcare facility, her heartbeats blood pressure, SpO2 and respiratory rates were either elevated or very low and therefore, the patient condition was levelled as triage category 2 by the triage nursing assessment professional. Further, the triage nurse conducted the assessment in which er physical assessment revealed that she is suffering from anxiety, dyspnoea, and audible wheezing. Her daughter, who came along with her to admit her in the hospital revealed her past medical history and mentioned that she suffered from asthma, allergies, she was admitted to ICU for endotracheal intubation and went to ventilation for 2 days. Further, in this aspect the assignment will deal with the ethical, legal and evidence based holistic approach of care so that a realistic and relevant care related goals can be set up (Kable et al., 2013). Moreover, for this assessment the Levett-Jones clinical reasoning cycle will be used to assess the patient condition and intervention goals (Dalton, Gee & Levett-Jones, 2015).
Collect, process and present related health information
As Mrs. Connie Brownstone was shifted to HDU cubicle where I was appointed, I started her further assessment and collected the handover report from the triage nurse. I Observed that the her heart rate was 125 beats per minute with was much more elevated than normal condition, further, her respiratory rate exceeded the normal range as well as her blood pressure was reported very low which is 172/75 (Hansen et al., 2012). Her SpO2 was observed at 89% which determined abnormal vital signs and therefore, a mild fever was also observed. I also observed several physical abnormalities in the patient as while seated, the patient was leaned forward and therefore, use of accessory muscles such as intercostal, sternocleidomastoid and scalene muscle was observed. Further, the sound of wheezing, and abnormal peak flow of 210L/min was also observed. However, no such abnormality were observed in the secondary assessment or survey (Dalton, Gee & Levett-Jones, 2015). In such situation, I was also informed about the patient’s history of hospital admission in which her daughter revealed that she was admitted to ICU five years ago after the asthmatic and allergic condition, which led her to the ventilation for 2 days. her latest reports also revealed that she is not having any abnormality in Arterial Boold Gas or ABG range and as well as her full blood examination, urine tests, C-Reactive protein and troponin tests showed them in normal range (Berry et al., 2015). Therefore, these are the present and past medical conditions that were observed from the patient’s vital conditions and her past medication history (Byrne et al., 2014)
This step of the clinical reasoning cycle processes the vital signs of the patient and then assesses them so that the primary signs and symptoms can be prioritized and depending on that the interventions for patient’s health improvement can be taken (Dalton, Gee & Levett-Jones, 2015). After interpreting her current and previous healthcare symptoms it can be said that her asthmatic condition should be prioritized as her vital signs indicating towards the emergence of acute asthmatic condition in which the respiratory rate, heart rate, blood pressure and others changes drastically as well as her increases lung cavity, involvement of accessory muscles for breathing indicated that she is suffering from acute asthmatic attack (Shen et al., 2015). Therefore, in this I will discriminate her prioritised signs and symptoms from secondary symptoms so that relief can be provided to the patient. Further, her health reports, full blood examination, urine report, ABG report revealed that her physiological condition is normal other than her respiration related condition. Hence, it was predicted that if her asthmatic conditions were treated, her health ca be improved (Yuan & Herbert, 2014). Further, as her blood reports are pending, it should also be kept in mind for further treatment. The second intervention will be applied on her anxiety level as it can affect her blood pressure and respiratory rate. Fir this communication, informed healthcare intervention related strategy will be applied so that the patient can understand the interventions she is and will be going through and can contribute in the healthcare process (Pearson, 2013).
Identify the problem
This phase requires me to process, interpret and discriminate between the vital signs and symptoms of the patient condition and then conduct healthcare interventions for three primary symptoms so that the condition of the patient can be improved. Further, in this course, the primary problem will be treated first after which the potential problems of the patient will be treated (Tyagi and Singh, 2015).
After conducting patient assessment, understanding her medical history and witnessing her health reports, it was observed that patient was suffering from acute asthmatic attack which she faced five years ago and ended up being admitted to ICU and followed by 2 days in ventilation. One day prior to admission to this healthcare facility she suffered from breathing ssues and dyspnoea (Tulaimat et al., 2016). Therefore after this process, her vital signs were discriminated depending on the severity level and then it was interpreted that, as per her vital signs and medical history, acute asthma will be her primary problem for which interventions will be applied, after that potential problems such as dyspnoea and anxiety will be included in the healthcare intervention. This is an important decision for the patient as it will help to improve her health condition as the health priorities were prepared depending on the clinical reasoning cycle by Levett-Jones (2015).
Establish the goals
For Mrs. Connie Brownstone, two type of goals will be finalised such as short-term goals so that instant relief can be provided and long term goals so that permanent cure can be done to her ailments. The short term goal will be directed to her asthmatic condition and for that ample amount of oxygen will be provided to her lungs so that saturated level of oxygen can be provided to her (Tulaimat et al., 2016). This short term goal is expected to provide desired outcome within 24 hour of admission. Further, to relief her pain and make her body strong enough to bear the pain, 0.5% saline water will be provided to her with catheter so that she could be provided with ample amount of rest. Within that saline, pain killer medication will be injected to relive her pain (Osadnik, McDonald & Holland, 2013). Further, the long term goals will be directed for her anxiety and dyspnoea or breathing issues, after the normal breathing condition she will be provided with interventions so that she can face such situation with proper intervention. For this 1 week will be the time limit as it will require the patient to be confident about her healthcare interventions and hence, she will be provided with healthcare education (Chang et al., 2012). These goals, directed to her primary and potential problem will be extended if within the assigned time limit it fails to help the patient and in such situation advanced healthcare interventions will be applied on patient (Velickovski et al., 2014).
Depending upon the prioritized symptoms and prepared goals, a series of action were taken for Mrs. Connie Brownstone and her health condition. This following tables includes the plan of action, healthcare interventions that were taken so that proper care can be provided to the patient (Brukner, 2012). While preparing this action plan I was concerned about the nursing ethics and code of conduct do that patients’ rights can be protected. The action and rationale to it is as follows.
She will be provided with 6L/Hour oxygen so that her acute asthmatic condition can be prevented. The primary aim in this situation is to maintain the oxygen saturation to more than 92%.
This is important as beyond the rate, the oxygen is dispersed completely in the body and hence, her elevated heart rate, respiratory rate and low blood pressure can be controlled (van den Wijngaart, Roukema & Merkus, 2015).
The second action will be increasing the peak flow so that normal peak condition can be achieved
This will help in the maintaining normal breathing pattern and respiratory patterns.
The third intervention will be educating the patient about her interventions so that her anxiety can be decreased
This will help in calming the patient’s situation as due to extensive healthcare intervention, there is a possibility that the patient may suffer from depression and anxiety (Chang et al., 2012)
The fourth intervention will be providing her interventions like inhalers so that dyspnoea condition can be treated.
This will help to relieve the patient condition within short span of time.
Evaluation process will assess the degree of effectiveness of the action plan designed to provide relief to the patient. Further time will be another factor in determining effectiveness (Velickovski et al., 2014). The evaluation will start with observing patients vital condition again and all the physiological tests will be performed so that effectiveness of the interventions can be determined. After this, if the patient did not show any improvement, the time limit of the interventions will be extended so that the ultimate goal of making the patient condition better can be achieved (Shen et al., 2015).
After complying with the entire goals and process of action plan, I expected positive results as all the goals and actions were directed to improve the patient’s acute asthmatic condition. I observed that due to healthcare educational sessions patient is comfortably allowing healthcare experts to apply interventions hence, positive results were observed within the time limit. However, I was unable to see the changes in her pain related condition and hence, I will be applying such interventions in future. I was able to see positive result of applying intervention such as inhalers and other medication that was applied to provide instant relief to the patient.
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