The provided case scenario deals with the patient Fredrick Chiverton, who is 63 year old and has just finished his first ocean pool swim. Upon finishing the swim, the patient appears to be shivering and mentions that his hands feel cold. This essay intends to apply the clinical reasoning model in order to assess the current physical health condition of the client and recommend further assessments so as to diagnose the current condition and devise an appropriate care plan.
The objective cues provided in the case scenario presents the list of vitals that suggest, the temperature of the patient is 35ᵒC, the pulse rate is 102 beats per minute, the respiratory rate is 24 breaths per minute and the blood pressure has been documented to be 150/84 mm Hg. The vitals for 23rd March suggest, the BP to be 124/80, Pulse rate to be 80, respiratory rate equivalent to 14 and temperature to be equivalent to 37.1ᵒC. Also, for the vital signs considered for 24th March, the BP had been documented to be 128/82, pulse rate to be 78, respiratory rate to be 12 and temperature to be 36.7ᵒC.
The subjective cues made available comprises of the patient experiencing cold hands and appearing to shiver after completing the swim.
In relation to the recorded vital signs after the swim, it can be said that the patient has a lower body temperature compared to the normal body temperature range of 36.5ᵒ C to 37.5ᵒ C. Also, considering the documented blood pressure range, it can be said that the patient experiences a higher blood pressure range compared to the normal blood pressure range of 120/80 (Van Kuiken & Huth, 2016). The current pulse rate of the patient has been documented to be 102 beats per minute which is slightly elevated compared to the normal range of 60 to 100 beats per minute (Van Kuiken & Huth, 2016). The respiratory rate has been documented to be 24 breaths per minute which is elevated compared to the normal range of 24 breaths per minute (Van Kuiken & Huth, 2016).
In comparison to the reported vital signs for 23rd March and 24th March; it can be said that the pulse rate, temperature and the respiratory rate recorded were within the normal range. The blood pressure range reported on 23rd March (124/80) and 24th March (128/82) can be considered slightly elevated but within the limits of the normal blood pressure range. As per Thenappan et al. (2018), a blood pressure range that is over 120/80 but less than 140/90 is considered a normal blood pressure range but slightly elevated compared to the recommended standard. It is recommended healthy lifestyle changes should be made to lower the elevated blood pressure reading (Hoeper et al., 2016). Therefore, based on the comparative evaluation of the recorded vitals for the previous two days, it can be stated that the ambiguity in the vitals was due to the participation in the physical exercise (swimming). This is because, the vitals with respect to temperature, respiratory rate and pulse rate was reported to be normal for the previous two days which was documented to be elevated for the day on which the patient completed the first oceanic pool swim. However, it is worth noting in this context, the blood pressure range of the patient has been documented to be elevated throughout. The BP recorded after the participation of the patient in the physical exercise, is indicative of ‘hypertension’ (Buford, 2016). Overall, the elevated range of blood pressure throughout is indicative of an underlying condition of hypertension which requires further assessment and evaluation; due to the unavailability of the previous medical history of the patient (Buford, 2016).
In relation to the available subjective data, it can be said that the patient is experiencing the sensation of shivering and ‘cold’ hands due to the phenomenon of ‘afterdrop’. As per Madrid et al.(2016), the phenomenon of ‘afterdrop’ is common after a swim in cold water. The condition is characterized by a swimmer feeling fine after getting out of the water but starting to feel cold and experiencing shivering after a brief interval (Legriel et al., 2016). The case scenario suggests that the air temperature was 19ᵒ C and the water temperature was 17ᵒC on the say the patient went for a swim. The wind speed has been reported to be 20km/hour. The provided data is indicative of the fact that the temperature of the water was cold.
Research studies suggest that the phenomenon of ‘afterdrop’ occurs due to the shutting down of the blood circulation to the peripheral parts of the body (Paal et al., 2016). This results in pooling warmer blood to the heart. The phenomenon takes place as a coping mechanism of the body to adjust to the cold water environment (Paal et al., 2016). It is important to note in this context that the longer the body stays in the cold water environment; lesser the blood is circulated to the peripheral parts of the body. This results in the fat present at the sub-cutaneous layer to turn into a thermal layer (Vaughan et al., 2018). As the individual comes out of the cold water environment, the process is reversed and the blood starts getting re-circulated to the peripheral blood vessels (Legriel et al., 2016). In the process, the blood starts getting cold and the temperature from the core lowers down to approximately 4.5ᵒC. This results in hypothermia and causes a feeling of being unwell (Paal et al., 2016).
According to Madrid et al. (2016), severe hypothermia can turn out to be fatal for the patient. The further assessments that would be recommended for assessing the physical health status of the patient would comprise of assessing the reasoning power of the patient by asking him questions that require higher reasoning or asking the patient to count backwards from 100 by 9s. Also, conducting a mental health assessment for the patient would be beneficial. This would help to assess the level of brain functioning and assessing the risk of a seizure (Vaughan et al., 2018). Also, the radical pulse assessment of the patient would be assessed followed by addressing routine 24 hour assessment of the vitals to diagnose a potential complication (Legriel et al., 2016).
Therefore, in conclusion it can be said that the research paper has made use of the clinical reasoning model to critically identify the underlying physical health issues experienced by the patient. In addition to the same, the paper has identified the relevant objective and subjective cues in order to formulate a potential diagnosis and has also suggested further assessments that would help to confirm the diagnosis for the patient and develop am appropriate care plan.
Buford, T. W. (2016). Hypertension and aging. Ageing research reviews, 26, 96-111.
Hoeper, M. M., Humbert, M., Souza, R., Idrees, M., Kawut, S. M., Sliwa-Hahnle, K., ... & Gibbs, J. S. R. (2016). A global view of pulmonary hypertension. The Lancet Respiratory Medicine, 4(4), 306-322.
Legriel, S., Lemiale, V., Schenck, M., Chelly, J., Laurent, V., Daviaud, F., ... & Hilly-Ginoux, J. (2016). Hypothermia for neuroprotection in convulsive status epilepticus. New England Journal of Medicine, 375(25), 2457-2467.
Madrid, E., Urrutia, G., i Figuls, M. R., Pardo‐Hernandez, H., Campos, J. M., Paniagua, P., ... & Alonso‐Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database of Systematic Reviews, (4).
Paal, P., Gordon, L., Strapazzon, G., Maeder, M. B., Putzer, G., Walpoth, B., ... & Brugger, H. (2016). Accidental hypothermia–an update. Scandinavian journal of trauma, resuscitation and emergency medicine, 24(1), 111.
Thenappan, T., Ormiston, M. L., Ryan, J. J., & Archer, S. L. (2018). Pulmonary arterial hypertension: pathogenesis and clinical management. Bmj, 360, j5492.
Van Kuiken, D., & Huth, M. M. (2016). What is' normal?'Evaluating vital signs. Nephrology Nursing Journal, 43(1).
Vaughan, J. A., Followay, B. N., Hall, S. R., Laudato, J. A., Arroyo, E., Dulaney, C. S., ... & Glickman, E. L. (2018). Afterdrop Effect during Recovery after Aerobic Exercise in a Cold vs
Moderate Temperature Environment: 1392 Board# 200 May 31 8: 00 AM-9: 30 AM. Medicine & Science in Sports & Exercise, 50(5S), 336.
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