NRSG138 Tula Clinical Reasoning Cycle Case Study Sample

• Subject Code : NRSG138
• Subject Name : Nursing

Effective Clinical Reasoning Skills

Introduction to Effective Clinical Reasoning Skills

Effective clinical reasoning skills can make a difference in patient outcomes.A process of clinical thinking goes through structured steps involving logical considerations by every medical professional, particularly doctors and nurses.Implementing this method facilitates the "thought" behind the treatment strategy of the patient, allowing the healthcare professional to move through a series of systematic procedures, ultimately leading to a reasonable decision that determines what is best for the patient in a particular situation.The Levett-Jones Clinical Reasoning Cyclehas been introduced and implemented in this essay to better understand case studies of Tula (Levett-Jones, 2010). In this essay, the first four stages of the Levett-Jonesclinical reasoning cycle were conducted in relation to the case study presented.

Consider the Patient Situation

Tula is a Samoan woman aged 38 who works in a garment factory in Dandenong, Melbourne. She was admitted with a severe dry cough, expiratory paroxysmal wheeze. Tula also said she had developed acute dyspnoea near the end of her 12-hour shift in the factory. She was then transported by ambulance to the local emergency department, her evaluation was carried out and she was admitted to the respiratory unit for evaluation and review of her treatment.

Collect Cues & Information

Tula has got a history of depressionand asthma. The nursing staff need to be aware of her medical background. She has been prescribed Irbesartan for high blood pressure (hypertension) which helped to protect the kidneys from diabetes damage. This is her daily medicine; she has been admitted to the respiratory ward for asthma treatment.Ms. Tula vital BMI is very high that is 44.5. She hada persistent dry cough, paroxysmal expiratory wheeze. There is a lack of information on admission about Tula vitals, which were required to get a clear picture of her condition and to provide holistic treatment.There is a lack of knowledge on Tula vitals entry, which was needed to get a good picture of her condition and provide holistic care. The information also includes her social position and whether, during the hospitalization, she has a family she could rely on.

Process Information

In order to considered Tula health stable,the vital signs should be within a certain suitable range. The usage of vital signs is done to determine the physiological functioning of the body(Kuiken, 2013). According to Limbe et al, the typical range of vital signs for an adult is Respiratory Rate is between 12-22 breaths in a minute, the oxygenation should be above 95%, the systolic blood pressure should be 90-140mmHg, and the heart rate must be 60-100 beats in a minute (Lambe et al., 2016). Vital signs of Ms. Tula are stable so it gives a clear indication that her condition is stable. Considering Ms. Tula have a medical history of hypotension so she has to be monitoredfor the blood pressure levels.She also suffers from Polycystic ovary syndrome (PCOS), which is a chronic disorder caused by high levels of androgen, menstrual disturbances, and/or small cysts on either ovary or both. The disease may be anatomical or primarily biochemical. A clinical characteristic of PCOS may cause follicular growth inhibition, ovarian microcysts, anovulation, and menstrual changes (Ndefo, 2013).

Now she has diagnosed with onset of Asthma, it includes multiple pathophysiological causes, including bronchiolar inflammation with discomfort and respiratory blockage that shows as coughing, short breaths, and wheezing. Asthma could damage the trachea, bronchi, and bronchioles. Inflammatory response might occur despite any visible signs and symptoms of asthma (Andrew, 2019).Ms. Tula should be explained the pharmacological patterns of her medications salbutamol (Ventolin) and salmetreol/fluticasone (Seretide) inhalers. She should be told to use a specially equipped inhaler, which contains the mixture of fluticasone and salmeterol as a paste and an inhalation solution to inhale by mouth. This is usually used twice a day, about 12 hours apart, in the morning and in the evening. The fluticasone and salmeterol can be used roughly the same time daily (Stein et al., 2017).It is suggested that Tula care nurses shouldevaluate, recognize, monitor, and record herhealth condition and communicate the vitals and abnormalities with the physician in charge.

Identify the Problem/Issue

Risk of exacerbation of asthma- Ms.Tuna health conditions identify her to be high risk for asthma exacerbations which are associated with exposure to irritants. She works in a textile industry which makes her prone to the risk (Guilbert et al., 2010).The change of seasonsis the most frequent cause of asthma exacerbations, although a temporary rise in dust exposure is also reported as a significant cause. In implementing control and treatment plans, the staff should bring awareness of the risk factors leading to asthma exacerbations in the patients is important (Sanya et al., 2014).

Obesity-Obesity is a chronic or non-communicable disease. Ms. Tuna having a high BMI suffers from obesity. Recent work has explained the biology of weight control, the pathophysiology contributing to excessive weight gain and obese condition maintenance even though appropriate efforts are made to change the lifestyle, and the adverse health effects of general and centralized obesity.

Respiratory tract infection-These infections are related to wheezing disorders in all age groups, it can also affect asthma conditions and become more severe. Respiratory tract infections are caused by bacteria and viruses are considered to play important roles in the pathogenesis of asthma (Wark et al., 2018). Progress is being made in identifying the mechanism by which these factors can cause serious wheezing and affect the pathophysiology of asthma. External conditions are likely to contribute to the risk of development and asthma exacerbation, thecauses may also differ in early-to-adult illness. The complex relationship between the respiratory system and the immune system which makes those with asthma so prone to viral infection.

Conclusion on Tula Clinical Reasoning Cycle Case Study

Clinical reasoning is a concept that defines the method that health care practitioners use to make educated decisions about and solve patient care issues. Health care practitioners must be versatile in their decision-making process and must ensure quality of treatment. The ability of the medical professional to provide healthy, high-quality health care can impact the ability to reason, interpret, and assess, which may be impaired by lack of skills. The case study of Tula has been discussed using the clinical reasoning cycle wherein the health status of the patient is processed and the possible clinical health risks have been discussed.

References for Tula Clinical Reasoning Cycle Case Study

Andrew, B. (2019). Pathophysiological mechanisms of asthma. Frontiers in Pediatrics. 7, 2296-2360. doi 10.3389/fped.2019.00068

Guilbert, T. W., & Denlinger, L. C. (2010). Role of infection in the development and exacerbation of asthma. Expert Review of Respiratory Medicine, 4(1), 71–83. https://doi.org/10.1586/ers.09.60

Kuiken, D. V., & Huth, M.M. (2013). What is “normal”? Evaluating vital signs. Paediatric Nursing. 39 (5), 216-224.

Lambe, K., Currey, J., & Considine, J. (2016). Frequency of vital sign assessment and clinical deterioration in an Australian emergency department. Australasian Emergency Nursing Journal: AENJ, 19(4), 217–222. https://doi.org/10.1016/j.aenj.2016.09.001

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2010). The 'five rights' of clinical reasoning: an educational model to enhance nursing students' ability to identify and manage clinically 'at risk' patients. Nurse Education Today, 30(6), 515–520. https://doi.org/10.1016/j.nedt.2009.10.020

Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: A review of treatment options with a focus on pharmacological approaches. P & T: A Peer-Reviewed Journal for Formulary Management, 38(6), 336–355.

Purnell, J.Q. (2018). Definitions, classification, and epidemiology of obesity. In: Feingold KR, Anawalt B, Boyce A, et al., editors. South Dartmouth (MA): Available from: https://www.ncbi.nlm.nih.gov/books/NBK279167/

Sanya, R. E., Kirenga, B. J., Worodria, W., &Okot-Nwang, M. (2014). Risk factors for asthma exacerbation in patients presenting to an emergency unit of a national referral hospital in Kampala, Uganda African Health Sciences. 14(3), 707–715. https://doi.org/10.4314/ahs.v14i3.29

Stein, S. W., &Thiel, C. G. (2017). The history of therapeutic aerosols: A chronological review. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 30(1), 20–41. https://doi.org/10.1089/jamp.2016.1297

Wark, P., Ramsahai, J. M., Pathinayake, P., Malik, B., & Bartlett, N. W. (2018). Respiratory viruses and asthma. Seminars in respiratory and critical care medicine, 39(1), 45–55. https://doi.org/10.1055/s-0037-1617412

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