The clinical reasoning cycle is a continuum of patient safety evaluation that involves the consideration of patient welfare, the collection of information and indications, the analysis of the information collected, and the setting of appropriate goals (Hunter & Arthur, 2016). Besides, the clinical thought approach also focuses on promoting appropriate interventions to address the primary concern of the patient, helps respond to its dysfunctional clinical nature, and evaluates the resulting outcomes followed by careful consideration of the overall case scenario. This essay explores the case study that nursing personnel uses the Levitt-Jones clinical thinking method for the treatment of Mrs. Mary William.
Ms. Mary William is a woman of 65 years of age who was admitted to the public hospital. She was taken to the Emergency Room after she found her son lying in her apartment. This is Mary's 3rd admission to the hospital, within the last 6 months. The chest x-ray is evidence of fractured ribs and damage to the chest wall. No specifics were given, such as gathering vital signs after her admission to the hospital. The patient was found lying down from her hospital bed after the admission in the ward and was crying in pain. She was conscious when the duty nurse came to know about the incident. She has a history of medical conditions such as osteoarthritis. She also has medical problems, such as asthma and chronic pulmonary obstructive disease (COPD). She is taking prescription medicines for all the medical conditions she is suffering which including Osteo panadol, vitamin D, Symbicort, and Ventolin medicines.
The drugs show she has problems with high blood pressure and is also at risk of heart failure and heart strokes. The patient also suffers from osteoarthritis for which she is taking Panadol Osteo for effective pain relief and aches-related discomfort. She is already on vitamin D supplements because of her age, because the deficit causes fragile and weak bones (Christodoulou et al., 2013). She is aging and loses calcium from the bones which put her at a very high-risk serious fall injury. This is her third fall in the last 6 months and she's more vulnerable to hospital-related fall-risk injuries. The nursing staff has to take care of her that she is assisted to the toilet. The prescribed Ventolin and Symbicort medicines also treat her COPD problem as it relieves muscle in the respiratory tract and increases airflow to the lungs (Lin et al., 2018).
The physical examination should be performed in all patients with a possible thoracic trauma. The complete set of vital parameters including directly measured oxygen saturation and respiratory rate is necessary to note periodically to keep a check on the patient. The patient was in continuous pain and showed signs of uneasiness. the patient also was having bilateral breath sounds. A close examination of the chest showed many bruises. The patient has often reported of extreme chest wall pain and could have tachypnea and femur fractures or pulmonary failure. For flial chest, the chest vibration has to be identified. Assessing respiratory requirements in patients with severe chest injuries can be a good predictor of injury rates and potential treatment plans (Akgul Ozmen, Onat, & Aycicek, 2017).
Pain- Successful treatment of severe pain is dependent upon the correct and reliable experience of pain by a patient. The assessment should use a validated method requiring patient involvement to consistently measure the severity of pain on movement. Mrs. Mary can be used by an epidural catheter to combine a local anesthetic such as bupivacaine with an opioid such as fentanyl. Caution should be used, furthermore, since NSAIDs are reported to minimize osteoblast function (bone-forming cell), because as a client has osteoarthritis (De Luna-Bertos et al., 2013).
Pneumothorax- It is a disease that arises in the lungs that have collapsed and changes in pressure inside the chest. This could be caused by a broken rib in the chest wall separating the lung, or a rupture. Health problems can include breathing issues, swallowing problems, chest pain, and, in some cases, blood coughing (Swierzy et al, 2014).
Nursing interventions involve respiratory management and pain management. The first intervention is to relieve the chest pain that Mrs. Mary William experiences, or at least to ensure that the levels of pain are reduced to a reasonable degree to allow her to carry out daily activities in the best possible manner without any discomfort. Mrs. Mary William should be asked to report on pain levels for herself, as it is the best and correct way to determine if the pressure has plummeted. Healthcare professionals will need to use a clinical evaluation method and an emergency care pain management tool to evaluate opioid impacts (Gélinas, 2016).
A most terrifying issue with broken ribs is the pneumothorax and flail chest in which three or even more rib breaks at two or more points on the involved ribs, creating a floating portion of the rib and forcing this portion to travel perversely along with the rest of the chest. Mortality in the flail chest among the adult varies from 10 to 15 percent (Perera & King, 2018). Also. there is a risk for damage to the lungs or some other organs near the ribs when ribs are broken (Kuo & Kim, 2019). A person with pneumothorax faces significant consequences on respiratory mechanics, so nursing care may include ventilation assistance to encourage blood oxygen levels and potentially repair metal plate fractures. Mrs. Mary has to be also assessed for the kidney function tests as renal injuries may occur if the fractures happen in the eleventh and twelfth ribs. Since the patient is prone to fall risk and has fallen from the hospital bed at night special care has to be given to her in assisting her in routine activities like going to the toilet.
By offering compassionate care the patients were at ease with the staff. If patients feel relaxed with nurses, they are more likely to become transparent about their pain and discomfort levels. Ms. Mary should be tested and reassessed in terms of pain levels and when she does not experience relaxed pain levels. The care techniques also helped her to lower the pain levels. She should be able to carry out her everyday life-activity. Her issues with the breathing were fixed. She is given health education and is made aware of her symptoms so that by minimizing the causes she can prevent breathing problems. Since the patient is having osteoporosis a good calcium-rich diet and supplements have helped her in bone strengthening. The nursing care has helped her to be aware of her fall risk and helped her to understand the situation.
I felt disheartened when the patient under the care fell off from the hospital bed causing more worse health conditions than at the admission time. Another shortcoming I found in the case was the missing of the vital signs. Being a care provider I always ensure that the patient is handed over correctly using methods such as ISOBAR. However, in this situation, Ms. Mary missed medical specifics that are essential to administering clinical therapy that was not provided to me during the handover. I was not happy regarding this from my colleague who handed over the patient to me also I was hesitant in asking for the same. No specifics were given, such as gathering vital signs after her admission to the hospital. As part of the medical team, I should have asked the members of the multidisciplinary health team for all the pertinent details about the nursing care of Mrs. Mary (NMBA, 2020). When caring for the elderly, nurses should also be mindful of the potential diseases and conditions and the care. They need to determine the physical, mental and cognitive capacities of the patient; identify their acute and chronic health problems; and common health problems, such as dropping, bladder problems, irregular sleeping patterns, etc.
I also understand how important communication skills and prompt actions are to my becoming an acute hospital nurse. Accurate and comprehensive reporting, organizational skills, and good interaction can separate a patient's life from his death. The growth of clinical knowledge and logical thinking in nurses helps to encourage open-minded patient care and compassionate treatment which is the positive side of this career.
The clinical reasoning process is important because it allows nurse practitioners to develop logical reasoning and consideration. The clinical review evaluated Mrs. Mary's particular case and offered valuable insights into the patient's health condition by collecting medical information and signs and analyzing them. They also included the pathophysiology of the primary health condition defined, set goals for nursing care, and expected results after successful interventions were implemented. This rationale loop helps to adapt during her hospitalization to her unstable clinical presence in the medical ward and to ensure that she achieves the best possible good result in less time as a patient.
Akgul Ozmen, C., Onat, S., & Aycicek, D. (2017). Radiologic findings of thoracic trauma. Therapeutics and Clinical Risk Management, 13, 1085–1089. https://doi.org/10.2147/TCRM.S143845
Christodoulou, S., Goula, T., Ververidis, A., & Drosos, G. (2013). Vitamin D and bone disease. BioMedical Research International, 396541. https://doi.org/10.1155/2013/396541
De Luna-Bertos, E., Ramos-Torrecillas, J., García-Martínez, O., Guildford, A., Santin, M., & Ruiz, C. (2013). Therapeutic doses of nonsteroidal anti-inflammatory drugs inhibit osteosarcoma MG-63 osteoblast-like cells maturation, viability, and biomineralization potential. The Scientific World Journal, 809891. https://doi.org/10.1155/2013/809891
Gélinas C. (2016). Pain assessment in the critically ill adult: Recent evidence and new trends. Intensive Critical Care Nursing. 34, 1‐11. doi:10.1016/j.iccn.2016.03.001
Kuo, K., & Kim, A. M. (2019). Rib Fracture. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541020/
Lin J, Zhou X, Wang C, Liu C, Cai S, Huang M. (2018) Symbicort® Maintenance and Reliever Therapy (SMART) and the evolution of asthma management within the GINA guidelines. Expert Review Respiratory Medicine. 12(3), 191‐202. doi:10.1080/17476348.2018.1429921
Nursing and Midwifery Board of Australia. (2020). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Perera TB, King KC. (2019). Flail Chest. [Updated 2019 Nov 29]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534090/
Swierzy, M., Helmig, M., Ismail, M., Rückert, J., Walles, T., & Neudecker, J. (2014). Pneumothorax [Pneumothorax]. Zentralbl Chir. 139(1), S69‐S87. doi:10.1055/s-0034-1383029
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