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  • Subject Name : Clinical reasoning cycle

Application of Clinical Reasoning Skills for Clinical Patient Scenario

1.1

The acute pain is considered to be one of the common complaints of the patient upon administration and it is considered to be distress feeling that directly increases the discomfort of the individual. The level of the acute pain directly depends on the patient perception and intensity of the pain that has occurred due to stimulus (Ramia et al. 2017). Acute pain is considered to be the unpleasant sensory and emotional feeling that occurs due to any damage which increases the discomfort of the patient. Acute is considered to act as a danger signalling to body that aware the system about the injury by provoking the ‘fight or flight’ responses that directly disturb the different body functioning like heart rate, respiratory rate and dilated pupils.

The acute pain also leads to behavioural change that can due to discomfort faced by the patient which include crying, irritation and resisting touching to the particular area (Jungquist et al. 2017). The acute pain is considered to be mild and serves as a protective agent while chronic pain is considered to the persistent pain that directly decreases the efficiency of the individual. The acute pain act to aware the individual about the injury but if the proper intervention is not used then the transition occur from acute to chronic that increases the difficulty of the individual. The pain can be categorized by the use of a pain score scale that helps to understand the intensity of the pain according to personal perception (Griffioen et al. 2017).

The chronic pain is considered to the persistent pain for around three months that is not bearable which increase the complication of the individual. The chronic pain directly increases the disability of the individual and it became difficult to manage the chronic pain. The post-surgical occur at the site of the incision or related area that increases the postoperative complication of the individual (Glare et al. 2019). The pathophysiological effects of the opioid medication have analgesics effect to manage the pain of the individual. The opioid is of two types natural or synthetic that directly binds to the opioid receptor activation which inhibits the neurotransmitter release.

The decreased release of neurotransmitter cause inhibition of the neuronal excitation that leads to blockage of the spinal cord pain transmission. There are certain side effects associated with opioids like drowsiness, constipation, nausea and vomiting (Mallick‐Searle & Fillman, 2017). The medication is prescribed to William to reduce the post-operative pain and increase the comfort of the patient.

1.2

  • The patient has undergone the ileostomy that leads to the formation of the temporary stoma and there is need to stoma assessment to understand the current status of the patient. The stoma can lead to severe infection that is about 20-35% patient faces stoma infection that increases the need for the post-operative assessment to analyse the current status of the stoma. The stoma assessment initiated by observing the colour of a stoma that indicates the current condition of the stoma. The second step includes palpation that includes touching the stoma which helps to understand the current status of the stoma concerning oedema. The third step to analyse the surrounding skin to increase understating toward the infection that can occur in the peristomal skin which can increase complication (Steinhagen et al. 2017). The deteriorating health status of William increase the need for the stoma assessment as infection in stoma can increase the complication of the patient.
  • The deteriorating health of William is one of the major concerns that require urgent attention of the nurse and there is a need to understand the reason behind the deteriorating health. The systemic approach is considered as the hallmark in the initial assessment of the patient with the deteriorating health condition of the patient. ABCDE assessment is considered to be one of the best methods that can be used to improve the understanding of the health care professional regarding the health issue of the patient. The ABCDE assessment includes every aspect that can contribute to the deteriorating health status which includes airways, breathing, circulation, disability and exposure. The ABCDE assessment chart includes all the different aspect that should be analysed to predict the patient current health status (Smith & Bowden, 2017). The increase in health complication of William increases the need for the assessment to understand the actual complication associated with deteriorating health status.
  • The medical history of William indicates the presence of Crohn’s disease that directly increases the need for the assessment to analyse the urgent health status that will help to predict complication associated with it. Capsular endoscopy is considered to be one of the promising techniques for the assessment of Crohn’s disease. It is the non-invasive technique that helps in endoscopic diagnosis and it has excellent performance. The device contains the wireless camera that is required to image the tract and the patient will swallow the capsule that travels from oesophagus to stomach and small intestine. The capsule is installed with two chips that help to take pictures rapidly that are transmitted with the radio transmitter to the receiver that will be present on the waist of the patient. The picture is then analysed to understand the internal condition of the tract and capsule is flushed out in the toilet (Luján-Sanchis et al. 2016)

The increase complication associated with the Crohn's disease increases the need for assessment to analyse the current condition of William to reduce complication.

1.3

The first intervention is going to address the difficulty of William during respiration as he is given with the oxygen therapy to improve his oxygen saturation. The breathing exercise can become an effective way to improve the breathing rate of the individual and improving the capacity of the lungs. The breathing exercise included a different set of that directly aim to improve the endurance of the individual like diaphragm breathing exercise, lip breathing, inspiratory breathing exercise and expiratory breathing exercise. The breathing exercise help to reduce the breathing burden of the individual that has increased his/her complication and it will assist to slowly improve the breathing rate of the individual. The nurses with the therapist can help the patient to perform the breathing exercise that will directly help the patient to reduce the complication associated with breathing (Kang et al. 2016).

  • The second intervention that can be used to improve the health status of the William by using the medicine that will help to raise the blood pressure that is causing decrease health status of the William. The fludrocortisone is one of the medicines that is used to raise the blood pressure and reduce the complication associated with decrease blood pressure. The medicine directly helps to regulate the electrolyte balance and carbohydrate metabolism. The medicine directly helps to increase sodium retention and increase the potassium excretion to maintain the blood pressure. There is some side effect that is associated with the administration of the drug-like headache, mood disturbance, stomach upset and sweating (Veazie et al. 2017). The nurses are expected to follow the doctor prescription during medicine administration and provide the patient with accurate information regarding the side effect of the medina to increase his/her awareness.
  • The last intervention will be provided to improve the lifestyle of William that has disturbed due to multiple disorders. The lifestyle intervention will improve the health status of the patient by working over multiple aspects. The first aspect includes dietary intervention which includes following the diet chart to maintain the proper nutrition intake in the individual. The diet chart will help to reduce the diet-related complication that can lead to deteriorated health status. The second aspect includes including improving physical activity that includes slow walking, yoga and meditation that will help in physical and mental health wellbeing. The last aspect includes cognitive behavioural therapy that will help nurse and patient to work in a collaborative way to improve understanding toward a patient that can be addressed by the nurse to improve quality of care (Duff et al. 2018).

1.4

Morphine is considered to be a promising method that is used as an analgesic to reduce the pain of the patient. It is the affinity for the delta, kappa and mu-opioid receptor and on binding with this receptor activates the descending inhibitory pathway that directly reduces the nociceptive transmission. There are four routes of administration of the morphine but nurses are expected to prefer the patient choice during morphine administration. The four methods that are used for administration include orally, intravenously, epidural and intrathecal.

The benefit associated with morphine admiration includes a reduction in pain, sedation, high potency and haemodynamic stability increase in use in reducing the post-operative pain. The adverse reaction that associated with morphine administration includes dizziness, constipation, vomiting, nausea and sedation. The dose of the morphine should be according to the patient current health status as higher dose can cause a toxic reaction to the patient like asthma, misbalance in respiratory rate. The morphine administration can cause serious complication so the patient should be aware of the treatment process so that he can know the side effect associate with morphine that he/she can encounter during treatment (Hartley et al. 2018).

The William has prescribed morphine with patient-controlled analgesia that is required to reduce the pain that has occurred due to the post-operative pain. The patient-controlled administration helps the patient to self-administer the medicine by the help of a computerized pump. The use of a computerized pump for the administration of the medicine requires an accurate understanding of the pump. The nurses are expected to increase understanding of the patient toward correct use of the pump. The nurse is expected to continuously monitor the patient using the analgesic to understand the effect of the morphine on the individual and can assist the patient during any issue or side effect. The patient should be monitored about the correct use of the pump to reduce the complication that can occur due to incorrect use of the computerized pump. The patient-controlled analgesia is also associated with one disadvantage that occurs due to error in the software that leads to complication (Koh et al. 2015).

The nurses should aware the William about the morphine administration and its effect over the and why it is used to reduce the pain. The nurses should also help the patient to understand the different side effect associated with the morphine administration that will help to increase the understanding of the patient.

1.5

The morphine is one of the analgesic medicines that is used to reduce the acute or chronic in the patient has major suffering. Morphine administration leads to many side effects that directly deteriorate the health status of the patient prescribed with morphine. Nausea and vomiting are the most common side effect that is associate with morphine administration and that directly increase the discomfort of the patient. There is some other side effect that involved increasing the discomfort of the patient which include sweating and dry mouth that alter the dietary intake of the patient. There is some other side effect hat is associate with medication like sedation, constipation, respiratory depression, dizziness, and confusion.

The direct effect of the morphine affects the physical as well as mental wellbeing of the individual and directly decreases the wellness of the individual (Zeilmaker-Roest et al. 2018). The case study indicates that William has much side effect that is associated with morphine administration like unconscious, misbalanced pulse and breathing difficulty. The deteriorated health status of the patient concerning the morphine administration requires urgent reporting to the senior staff to provide accurate care to the patient. Nursing and Midwifery Board (2017) standard state that nurses are expected to immediately report to the senior staff if they encounter any negative effect of the care over the patient that is involved to increase the discomfort of the patient. The deteriorated health status of the William is due the morphine and nurse should immediately report the scenario to the senior nurses so that appropriate action can be done to improve the health status of the patient by providing accurate care.

References

Duff, W., Haskey, N., Potter, G., Alcorn, J., Hunter, P., & Fowler, S. (2018). Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance. World journal of gastroenterology, 24(28), 3055–3070. https://doi.org/10.3748/wjg.v24.i28.3055

Glare, P., Aubrey, K. R., & Myles, P. S. (2019). Transition from acute to chronic pain after surgery. The Lancet, 393(10180), 1537–1546. doi:10.1016/s0140-6736(19)30352-6

Griffioen, M. A., Greenspan, J. D., Johantgen, M., Von Rueden, K., O’Toole, R. V., Dorsey, S. G., & Renn, C. L. (2017). Acute pain characteristics in patients with and without chronic pain following lower extremity injury. Pain Management Nursing, 18(1), 33–41. doi:10.1016/j.pmn.2016.10.002

Hartley, C., Moultrie, F., Hoskin, A., Green, G., Monk, V., Bell, J. L. & Slater, R. (2018). Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial. The Lancet, 392, 2595-2605. doi:10.1016/s0140-6736(18)31813-0

Carla, J., April, V., Corinna, S., Kyung, K & Rosemary, P. (2017). Assessing and Managing Acute Pain: A Call to Action. AJN, American Journal of Nursing. 117. 4-11. 10.1097/01.NAJ.0000513526.33816.0e.

Kang, J. I., Jeong, D. K., & Choi, H. (2016). The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease. Journal of physical therapy science, 28(2), 500–505. https://doi.org/10.1589/jpts.28.500

Koh, J. C., Lee, J., Kim, S. Y., Choi, S., & Han, D. W. (2015). Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients. Medicine, 94(45), 1-7. https://doi.org/10.1097/MD.0000000000002008

Luján-Sanchis, M., Sanchis-Artero, L., Larrey-Ruiz, L., Peño-Muñoz, L., Núñez-Martínez, P., Castillo-López, G., González-González, L., Clemente, C. B., Albert Antequera, C., Durá-Ayet, A., & Sempere-Garcia-Argüelles, J. (2016). Current role of capsule endoscopy in

Crohn's disease. World journal of gastrointestinal endoscopy, 8(17), 572–583. https://doi.org/10.4253/wjge.v8.i17.572

Mallick‐Searle, T., & Fillman, M. (2017). The pathophysiology, incidence, impact, and treatment of opioid‐induced nausea and vomiting. Journal of the American Association of Nurse Practitioners, 29(11), 704–710. doi:10.1002/2327-6924.12532

Murphy, P. B. & Barrett,M. J. Morphine.Treasure Island, United Kingdom: StatPearls Publishing; 2020 Jan-.

Nursing and Midwifery Board. (2017). Professional Standard. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Ramia, E., Nasser, S. C., Salameh, P., & Saad, A. H. (2017). Patient Perception of Acute Pain Management: Data from Three Tertiary Care Hospitals. Pain Research and Management, 2017, 1–12. doi:10.1155/2017/7459360

Smith , D., & Bowden , T. (2017). Using the ABCDE approach to assess the deteriorating patient. Nursing Standard, 32(14), 51–63. doi:10.7748/ns.2017.e11030

Steinhagen, E., Colwell, J., & Cannon, L. M. (2017). Intestinal Stomas-Postoperative Stoma Care and Peristomal Skin Complications. Clinics in colon and rectal surgery, 30(3), 184–192. https://doi.org/10.1055/s-0037-1598159

Veazie, S., Peterson, K., Ansari, Y., Chung, K. A., Gibbons, C. H., Raj, S. R., & Helfand, M. (2017). Fludrocortisone for orthostatic hypotension. The Cochrane Database of Systematic Reviews, 2017(12), CD012868. https://doi.org/10.1002/14651858.CD012868

Zeilmaker-Roest, G.A., van Rosmalen, J. & van Dijk, M. (2018). Intravenous morphine versus intravenous paracetamol after cardiac surgery in neonates and infants: a study protocol for a randomized controlled trial. Trials 19(318), 1-11.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Clinical Reasoning Assignment Help

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