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Clinical Reasoning Cycle

Question 1. Biophysical, Spiritual and Cultural Impacts of Ted’s surgery (250/RLT model-clinical reasoning cycle)

Roper, Logan and Tierney identified a model based on the nursing theory that focuses on the concept behind the activities of daily living. These are known as ALs or ADLs and is widely used for assessing the patient care and well-being. The model is known to be the RLT model ensures that the nursing care should be based on the activities of living (ALs). There are five main concepts of this models and those are,

  • Independence/dependence continuum
  • 12 activities of daily living (ADLs)
  • Individualizing Nursing
  • Factors influencing the ADLs
  • Lifespan

In the case of Ted’s post operation condition, the Factors influencing the ADLs/ activities of daily living are considered. Specifically, the Biophysical, Spiritual and Cultural Impacts of Ted’s surgery needs to be analysed.

  • Biophysical Impacts – It refers to the condition of the current illness, overall health and anatomy and physiology of the patent. Considering Ted, his abdominal pain has reduced and its 4-5 in the pain scale which will take little more time to heal with the medications. Again, he has started his full fluid diet along with the breakfast. His risk of vomiting has been managed through ondansetron.
  • Spiritual Impacts – Spiritual impacts refers to the sense of self belief and well-being and the way a person gets it through meditation, prayer, religion, etc. This would he a kind of self-healing. Ted is a widower and has been living a lonely life. No specific information about his spiritual life was well known, yet he has been holding a strong positive attitude and mentality.
  • Cultural Impacts – It refers to the non-technical skills and the beliefs and ideologies of a culture. Ted has been living in a retirement village, he has to follow a disciplined life that has added to the cause of achieving well-being and improving treatment

Question 2. CRC stage three process the information and stage four Identify the problems – Pathophysiology and literature references

Health and well-being are interrelated, and nursing care mostly focuses on early recovery and supporting continuation of good health. In case of post-operative cases, where the patient goes through not only physical pain but also through mental and psychological trauma and some extent of loss of self-confidence that would affect the activities of living life. Nursing profession utilizes various modes and media to identify the beat ways that would support in achieving patent well-being. Concept and theory of nursing is supported by a number of collected cues, information processing and understanding of the situation and problem of the patient so that the treatment planning and strategy could be developed. Clinical Reasoning Cycle is a concept that supports the nursing profession and clinicians with clinical judgement and decision-making with the help of the data, cues, etc. collected from the patients. This critical thinking is associated with eight major stages and those are,

Stage 1. Considering the Patient

Stage 2. Collecting the Information or cues

Stage 3. Processing the Information

Stage 4. Identifying the Issues or Problems

Stage 5. Establishing the goals

Stage 6. Taking Appropriate Actions

Stage 7. Evaluating the Outcomes

Stage 8. Reflecting on the New Leaning and Process

This part of the work will focus on Stage 3 and Stage 4 of the Clinical Reasoning Cycle. Stage 3 refers to the processing of the collected cues and information while stage 4 refers to identifying the problems in the medical condition. In stage 3 data of the patient’s current stage is collected and pharmacological patterns and pathophysiology is analysed so that relevant information can be deduced. In stage 4, the gathered data is processed so that the related problems could be identified so that the treatment strategies could be established. Nurses needs to focus on these two aspects so that they can collect the right information that will help in evaluating the exact stage of the patient at the current situation.

Based on the medical history of Ted, he has been in the initial stage of the invasive colorectal cancer as presence of malignant mass could be seen through biopsy. Both internal and external factors are responsible for the occurrence of the malignant mass in the colorectal portion. One is the environmental factor that ignites the risk of occurrence of the colorectal outgrowth. Ideally, presence of symptoms is absent at the early stage and it is difficult to detect. Colonic cancer developed is believed to occur through two types, based on the pathways. One is the conventional adenomas and the other one is the serrated adenomas. The former is known to be the conventional adenoma-to-carcinoma sequence while the later is known as the serrated adenoma-to-carcinoma theory. While the exact reason and the fundamental of the defect of the gene for the serrated adenomas is not known, but mutation of the APC genes leads to the occurrence of the conventional adenomas.

Partial colectomy or Bowel Resection is the surgical process of removal of rectum or part of the colon where the problem actually occurs. There could be many reasons for this like bowel obstruction, diverticulitis, colorectal cancer or even Crohn’s disease. Ideally it does not affect the function and structure of the digestive system but remove the damaged part. The main issue here is that with age the risks gets higher and even the disease condition worsens the health condition. Ted is having diabetic history. S.I. Kabir, S.A. Kabir, R. Richards, J. Ahmed and J. MacFie tried to present the pathophysiology of the colonic cancer along with its management (Kabir, S. I., Kabir, S. A., Richards, R., Ahmed, J., & MacFie, J. (2014). Ota H and Utsunomiya J. tried to focus on the management of the proctocolectomy along with its associated pathophysiology (Ota, H., & Utsunomiya, J. (1984).

Question 3. Stage five of CRC to establish Goals and Nursing Care Interventions or Strategies

Stage 5 of the Clinical Reasoning Cycle refers to establishing nursing goals. Here the patient’s current situation is analysed and accordingly the nursing goals are established. The established goals should be time and goal oriented and not just open-ended. The goals should be SMART enough to be achieved and valued so that it can help the patient to get well soon. SMART goals refer to,

S – Specific – This specify that the goal needs to be easy to understand and direct to be defined. It needs to be defined clearly.

M – Measurable – The goals needs to be measurable which indicate that the goals should be measurable enough.

A – Achievable – The goals needs to be realistic and free from any kind of assumptions. It should be established based on the resources available, skills and the capabilities.

R – Relevant – The goals needs to be highly relevant with the current and future status and should include broader needs of the department, ward or even organization

T – Timely – The goals needs to be achieved within a given time and that time needs to be framed accordingly

Nursing should focus on the criticality of these established goals that would help in defining the developmental framework of the patient along with keeping the treatment process on track. These goals also help in keeping the nurses focused on the treatment process along with keeping them motivated. It will also support in reducing the stress levels of the nurses along with ensuring that they maintain their roles and responsibilities as per the defined standards. Documentation is yet another major step in patient care as it helps in ensuring that the related activities has been carried out as in medical science, if its not documented, it never happened. Nursing profession utilizes various modes and media to identify the beat ways that would support in achieving patent well-being (Richards, D. A., Hilli, A., Pentecost, C., Goodwin, V. A., & Frost, J. (2018). Concept and theory of nursing is supported by a number of collected cues, information processing and understanding of the situation and problem of the patient so that the treatment planning and strategy could be developed. Clinical Reasoning Cycle is a concept that supports the nursing profession and clinicians with clinical judgement and decision-makings4 with the help of the data obtained. There are five key areas that the nursing should focus on and those are,

  • Safety – The goals should prioritize on the safety of both the patients and the medical staffs
  • Patient Care – The goal should focus on the patient care and fruitful outcome
  • Efficiency – The nursing care should be highly efficient and should be specific
  • Accuracy – Accuracy in care would help in attending the patient and its problems directly. This will help in limiting the loss of time, effort and money as well
  • Professional Development – It is focused on the time-bound goals and this can be achieved through the technical skills and expertise.

Based on the case study of Ted, the five Nursing Care Interventions could be,

1. Helping Ted in overcoming the pain levels

2. Supporting him with continuing the daily activities effectively and trying to make him more independent

3. Evaluating the efficiency of the prescribed medications and physiotherapy

4. Supporting him to keep him motivated and incorporating positivity so that it will help in accelerating the recovery process

5. Ensuring that he takes his medications in timely manner along with following the follow-ups regularly

Question 4. Two Classes of Drugs to be used for Post-Operative Condition of Ted (pharmaco-dynamics, side effects and nursing implications for administration of drug, -250

Drugs are given to the patients based on their health conditions and the requirements (Richards, D. A., Hilli, A., Pentecost, C., Goodwin, V. A., & Frost, J. (2018). In case of post-operative cases, where the patient goes through not only physical pain but also through mental and psychological trauma and some extent of loss of self-confidence that would affect the activities of living life. Nursing profession utilizes various modes and media to identify the beat ways that would support in achieving patent well-being (Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Based on Ted’s current health condition and his medical history, three categories of drugs are given to him which are,

  • Diuretics – Furosemide – This class of drug helps in getting rid of unneeded salt and water from the body with the help of kidney in the form of urine
  • ACE Inhibitor – Captopril – This angiotensin converting enzyme (ACE) inhibitors helps in dealing with the blood pressure of the body along with maintaining the smooth functioning of the heart. It is also used for avoiding heart failure (Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018)
  • Biguanides or Sulfonylureas– Metformin – It is used for managing the insulin production so that the blood sugar level in the body is managed effectively

These class of drugs are selected based on the current state of Ted with an aim of achieving best health outcome.

References for Edward (Ted) Williams Case Study

Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane database of systematic reviews, (9).

Kabir, S. I., Kabir, S. A., Richards, R., Ahmed, J., & MacFie, J. (2014). Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature. International Journal of Surgery, 12(10), 1088-1092.

Ota, H., & Utsunomiya, J. (1984). Pathophysiology and management after proctocolectomy or total colectomy. [Kango gijutsu]:[Nursing technique], 30(1), 21.

Richards, D. A., Hilli, A., Pentecost, C., Goodwin, V. A., & Frost, J. (2018). Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene. Journal of clinical nursing, 27(11-12), 2179-2188.

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