Clinical Reasoning Process For Person-Centered Care: Essay On Melody King.

Utilise the Clinical Reasoning Cycle (Levett-Jones, 2013) (a clinical decision making framework) to plan and evaluate person-centred care:

Considering the person’s situation, collect, process and present related health information;

• Identify and prioritise at least three (3) nursing problems/issues based on the health

assessment data that you have identified for the person at the centre of care; Establish goals for priority of nursing care as related to the nursing problem/issues identified;

• Discuss the nursing care of the person, link it to assessment data and history;

Evaluate your nursing care strategies to justify the nursing care provided;

• Reflect on the person’s outcomes.

Case Study Details - Melody King, 36, Peritonitis following ruptured:

Ms. Melody King presented to the Emergency department with 2-3 days of severe Right Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix. She has a past medical history of asthma and depression, with her current prescribed and compliant medications list which includes Ventolin, Seretide, Sertraline. Melody’s observations were as follows:

• BP 95/45mmHg
• HR 120
• Temp 38.3°Celcius
• RR 22/min and shallow
• SpO2 95% on room air

She complained of increasing nausea and centralised abdominal pain 7-8 on a scale of 0 to10. Physical assessment showed a distended abdomen and generalised abdominal guarding. To investigate her condition further, pathology results reveal a raised white blood cell (WBC) count and CRP. You are the RN caring for Melody post-operatively on the surgical ward.

Consider the Patient’s Situation

In essence, clinical reasoning, clinical judgment, as well as decision making are considered to be habitually used exchangeable in literature. In this light, clinical rationale is often used to elaborate the overall processor instead the procedure through which a particular nurse tend to gather cues, deal with the information, arrive in a specific understanding of the patient’s situation, prepare as well as execute available interventions, assess the acquired results, and imitate from the entire process (Audétat, Laurin, Dory, Charlin, & Nendaz, 2017). In essence, this process is often reliant on the overall critical thinking characters and is, therefore, affected by the person’s attitude as well as perceptions. In this light, this procedure is not considered to be a simple one, but it can be a conceptual procedure particularly as a coil of the concurrent as well as clinical meet in progress (Higgs, Jones, Loftus, & Christensen, 2018). This paper proposes to discuss in detail the process of clinical reasoning in regards to Ms. Melody King, demonstrate as well as substantiate the reasons as to why nurses are required to study critical thinking.

We have Ms. Melody King who has been presented in the Emergency Department with preferably 2 to 3 days of a severe Right Lower Quadrant abnormal pain. In this light, she requires an emergency laparoscopic surgery particularly for the removal of a ruptured appendix. In essence, Ms. Melody King has been considered to have a past medical history of asthma as well as depression. In this light, she is under a current prescribed and compliant medications list including Ventolin, Sertraline, and Seretide. Notably, she has been complaining about an apparent increase in nausea as well as centralized abdominal pain 7 to 8 on a scale of 0 to about 10. To further investigate her overall conditions, the pathology results indicate a slightly raised white blood cells count and CRP. As a result of the ruptured appendix, Ms. Melody King has obtained peritonitis. In essence, this is a type of infection that has proven to be life-threatening to most individuals across the globe, and therefore Ms. Melody King is in a risky situation.

After considering the situation of Ms. Melody King, the next step of this clinical reasoning cycle would be to try and collect all the relevant cues as well as information regarding the current patient. Notably, this should start by reviewing as well as thinking about Mr. Melody King current observations. Ms. Melody King has been considered to have a slightly past medical history that is attached to asthma as well as depression thus having currently prescribed to medications. In this light, the general observation of the current patient is as follows.

•    BP 95/45mmHg
•    Temperature 38.3o Celsius
•    RR 22/min and shallow
•    SpO2 95% on room air

In this section, the paper will tend to identify other assessment information that is required to be collected. I have determined the current state of the patient and realized that she has abdominal pain with a rather cognitive state which includes restless as well as anxiety. On the other hand, I have checked Ms. Melody King’s BP and I have realized that it is now 80/32, with a temperature of 36 degree Celsius while her epidural was running at a rate of 10ml/hr. although the level of nausea was quite high, it is seen to be lower than before being measured at about 6 to 7 on a scale of 0 to 10.

Collect Cues/ Information

While the overall collection of cue requires an individual to review as well as gather new data or gather information, it as well requires one to be in a position of recalling the related knowledge regarding the situation of a patient. This said it is clear that the amount of fluid status is often related to the overall blood pressure of a patient. In essence, hemodialysis treatment is often regarded to reduce the level of BP and thus the reduction of BP is directly associated with the overall decrease with the intra-dialectic in the plasma volume (Schultz-Krohn & Pendleton, 2017). On the other hand, epidurals often involve the injection of a local anesthetic drug that is derived from cocaine, particularly into the epidural space. In these circumstances, epidurals are assumed to facilitate a drop in an individual’s blood pressure level because they result in vasodilation (Rencic, Trowbridge, Fagan, Szauter, & Durning, 2017). Moreover, it is important for the surgery to be done with an aim of removing the ruptured appendix from the patient.

In essence, Ms. Melody King blood pressure is regarded to be low especially for people who have in the past been diagnosed with other complications such as asthma as well as depression. While her temperature is considered to be a little up, I am not too worried about it but instead, I have been more concerned about her BP as well as her overall pulse rate. Regarding her part condition, I was interested in assessing the air condition in the emergency room to make sure that she is in good condition for recovery and avoid further complications. In this regards, I established that the overall air condition or rather the SpO2 was close to 95 percent on the room air.

Additionally, I was much interested in checking her urine output as well as her O2 statistics. Her tachycardia, as well as hypertension as a result of depression, could be a clear sign and symptoms of an impending shock. On the other hand, there is a high likelihood that her BP would go down due to the surgery that she is about to undergo (Murphy & Stav, 2018). Additionally, her BP is expected to go down throughout the operation due to loos of high volume of blood in this process (Norman et al., 2017). In case I would not have given her enough fluid before and after the surgery, she would have fallen into an imminent shock or even die in the process. In this light, Ms. Melody King is expected to improve gradually over some few days.

At this stage, I would bring together the entire information that I have collected as well as the inferences that I have made with the aim of establishing a rather definitive nursing diagnosis of Ms. Melody King main issues or rather problems (Vaughan?Graham & Cott, 2017). In this light, Ms. Melody King is Hypervolemia and dehydration, and thus the Peritonitis has worsened her BP thus causing vasodilation. Additionally, due to her increased nausea, she might be considered to be Hypovolaemia and dehydration (Hege, Kononowicz, Nowakowski, & Adler, 2017).

Process Information

Before I consider implementing any action to improve the condition of Ms. Melody King, it is imperative to consider specifying what I want to happen and when they should take place. In this light, I want to improve the overall hemodynamic status by getting her BP up while setting her temperature and further reduce her level of nausea (Fava, Cosci, Guidi, & Tomba, 2017).

In this step, I intend to arrange the doctor for taking the overall instructions regarding the current patient with the aim of raising her IV scale as well as providing the aramine in case it is required alongside other medications (Lockwood, 2017). Notably, this will come after I have notified Ms. Melody King’s doctor regarding her condition. In this light, I will make sure that Ms. Melody King is reassured of improvement regarding her situation. I will as well make sure that I have measured Ms. Melody King Pain score while ensuring that I have measured her drain, stoma as well as wound. To ensure that her past condition is in check, I will ensure that I have monitor Ms. Melody King’s vital signs as well as oxygen saturation level. Finally, I will make sure that Ms. Melody King’s fluid rate is increased as ordered.

It is now close to an hour since Ms. Melody King was admitted to the emergency department where she was given fluid challenge as well as having her IV increased to about 125 mL per hour every sign and symptom of Ms. Melody King were critical in providing data with the aim of making determination on whether or not the taken interventions have been effective thus illustrating whether her conditions are improving (Lopes, Bregagnollo, Barbosa, & Stamm, 2018). In this light, it is clear that her BP level has increased for now although we need to keep a close eye on it because she may still need some aramine later (Gruppen, 2017). Additionally, her fluid status has no doubt improved to some level and therefore there is a need of contacting the doctor again.

As a medical student, I have gained a lot regarding the current case study especially when handling a patient in the same situation or rather condition. For instance, I have learned the importance of evaluating the issues that a particular patient is undergoing and thus coming up with the correct diagnosis in a specific time. Furthermore, I have learned the importance of considering a patient’s past conditions with the aim of improving their current situations. In case I was involved in a similar situation in the future, I intend to improve patient’s experience more especially by reassuring patients and ensuring that their concerns are attended to in time. The practice has also let me know and understand how the overall potential advantages of the entire clinical governance as a reasoning tool that tend to create excellence in a various nursing procedure is examined

Conclusion

For one to come up with a rather patient-centered type of care, it is important for all the nurses to create a nursing power especially with the overall capability for critical thinking, reflective exercise as well as clinical reasoning.

References

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Gruppen, L. D. (2017). Clinical Reasoning: Defining It, Teaching It, Assessing It, Studying It. Western Journal of Emergency Medicine, 18(1), 4.

Hege, I., Kononowicz, A. A., Nowakowski, M., & Adler, M. (2017, June). Implementation of process-oriented feedback in a clinical reasoning tool for virtual patients. In Computer-Based Medical Systems (CBMS), 2017 IEEE 30th International Symposium on (pp. 175-176). IEEE.

Higgs, J., Jones, M. A., Loftus, S., & Christensen, N. (2018). Clinical reasoning in the health professions. Elsevier Health Sciences.

Lockwood, P. (2017). Teaching clinical reasoning skills to undergraduate medical students: an action research study(Doctoral dissertation, University of Liverpool).

Lopes, D. M., Bregagnollo, G. H., Barbosa, B. M., & Stamm, A. M. N. D. F. (2018). The Process of Clinical Reasoning among Medical Students. Revista Brasileira de Educação Médica, 42(1), 115-120.

Murphy, L. F., & Stav, W. B. (2018). The Impact of Online Video Cases on Clinical Reasoning in Occupational Therapy Education: A Quantitative Analysis. The Open Journal of Occupational Therapy, 6(3), 4.

Norman, G. R., Monteiro, S. D., Sherbino, J., Ilgen, J. S., Schmidt, H. G., & Mamede, S. (2017). The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Academic Medicine, 92(1), 23-30.

Rencic, J., Trowbridge, R. L., Fagan, M., Szauter, K., & Durning, S. (2017). Clinical reasoning education at US medical schools: results from a national survey of internal medicine clerkship directors. Journal of General Internal Medicine, 32(11), 1242-1246.

Schultz-Krohn, W., & Pendleton, H. M. (2017). Application of the occupational therapy practice framework to physical dysfunction. Pedretti's Occupational Therapy-E-Book: Practice Skills for Physical Dysfunction, 24.

Vaughan?Graham, J., & Cott, C. (2017). Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors. Journal of evaluation in clinical practice, 23(5), 935-948.