Principles of Nursing: Medical

Slide 2: introduction

Clinical Reasoning cycle is the process of identification of essential cues, identify and priorities the patient needs, develop goals, and ensure application of suitable interventions that assist in recovery and management of the health condition of the patient. This presentation will apply the principles clinical reasoning cycle focused on the perspective of a particular case study.

Slide 3: Concept map (Step 1 of CRC)

The given flow chart represents the medical, familial, and social conditions of the patient, Aaliyah who has been admitted in the clinical setting with the incidence of COPD exacerbation. The patient is a single mother who has been working for long hours without any protection in a flour mill resulting in increased exposure from fine particles resulting in COPD exacerbation. The patient is also hypertensive and diabetic with a family history of stroke.

Slide 4: Importance of step 1

The step one of CRC is of prime importance as it helps in understanding the needs of the patient by providing details regarding the patient background, recording of the past clinical and medical assessments and conditions and thus also assists in the application of the suitable intervention. It also helps in understanding the social and cultural needs of the patient and thus promotes holistic care.

Slide 5: Step 2 of CRC

The primary cues associated with the patient are:

High respiratory rate: 24 breaths per minute (Normal: 12-16 breaths per minute), Excessive breathlessness, fatigue., oxygen saturation levels at 93% on RA (Normal: 95% or above at room air). Blood pressure: 142/96mmHg (Normal: 120/80mmHg)

Slide 6: Importance of step 2 of CRC

Identification of cues are of primary importance as it helps in the development of suitable interventions and also assists in its application through prioritization.

Slide 7: Pathophysiology of COPD exacerbation

Increased airways resistance develops in COPD usually as a result of worsening airway inflammation triggered by an irritant. (In case of the patient, excessive flour mill residue), this results in adverse functional changes this starts with damage to the airways and alveoli and progress from a cough with mucus to difficulty breathing. The inflammatory reaction triggered results in loss of elasticity of alveoli, inflamed airways and hyper mucus secretion. As a result, the patient develops difficulty in breathing.

Slide 8: Step 3 of CRC

As the patient struggles to breathe in COPD exacerbation, breathlessness is observed. The airways are hindered and reach of oxygen to the body is limited. As a consequence, the respiratory rate of the patient increases and the oxygen saturation level drops. The blood pressure increases as the heart try to compensate for the lack of oxygen availability to the vital organs.

Slide 9: Step 4 of CRC: Respiratory rate

The primary concern of the nurse should be to manage the respiratory rate of the patient. This should be done by positioning the patient in a high flower’s position as a nursing intervention. The respiratory rate management will help in minimizing respiratory distress.

Slide 10: Oxygen saturation levels

Management of the oxygen saturation levels is of prime importance as it helps in the determination of oxygen availability in the body. Thereby, immediate management should be done to prevent hypoxia. The management can be done through oxygen supplementation

Slide 11: High blood pressure

High BP in the patient can give rise to cardiopulmonary complexities and enhance the risk of stroke or circulatory problems in the patient. Management through controlling the respiratory distress and medication already prescribed to the patient due to medical history of hypertension can help in normalization.

Slide 12: Changes in life

The Roper Logan Tierney model identifies twelve classical changes that one may have to adopt. In the given case study, the patient will need to adopt changes in terms of working. The patient works at a flour mill increasing the risks of exacerbation due to a high number of molecules in the air that can function as an irritant. Therefore, the patient might have to change the job or work in a mill only with effective protective gear to prevent further exacerbations. The patient will also have to bring changes in the daily activities and limit going out to places with a high pollution risk to ensure a safe environment. Therapeutic approaches and medical attention will be required to make changes in breathing through respiratory exercises.

Slide 13: Conclusion

Application of CRC is crucial in nursing as it promotes critical thinking and analytical approach. This presentation focused on the application of clinical reasoning cycle on the case study of Miss Aaliyah. A concept map has been developed to present the patient context. The patient has been identified to be suffering from COPD in regard to which pathophysiology has been used to relate to the essential cues for identification. Suitable nursing priorities and lifestyle changes that will be required by the patient have also been listed with an evidence-based approach.

Slide 14: References for Clinical Reasoning of Nursing Students

Butler, A., Walton, G. M., & Sapey, E. (2018). Neutrophilic inflammation in the pathogenesis of chronic obstructive pulmonary disease. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(4), 392-404. https://www.tandfonline.com/doi/abs/10.1080/15412555.2018.1476475

Daly, P. (2018). A concise guide to clinical reasoning. Journal of Evaluation in Clinical Practice, 24(5), 966-972. https://onlinelibrary.wiley.com/doi/abs/10.1111/jep.12940

Gautam, S. S., & O'Toole, R. F. (2016). Convergence in the epidemiology and pathogenesis of COPD and pneumonia. COPD: Journal of Chronic Obstructive Pulmonary Disease, 13(6), 790-798. https://www.tandfonline.com/doi/abs/10.1080/15412555.2016.1191456

Gonzalez, L. (2018). Teaching clinical reasoning piece by piece: A clinical reasoning concept-based learning method. Journal of Nursing Education, 57(12), 727-735. https://www.healio.com/nursing/journals/jne/2018-12-57-12/%7B97055325-5654-48d2-b49a-a7378054395f%7D/teaching-clinical-reasoning-piece-by-piece-a-clinical-reasoning-concept-based-learning-method

Holland, K., & Jenkins, J. (Eds.). (2019). Applying the Roper-Logan-Tierney model in practice-E-Book. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=erKMDwAAQBAJ&oi=fnd&pg=PP1&dq=Roper+Logan+Tierney+model+&ots=cBa8y7MZNw&sig=3wvNRKoOuhRKZmNRP_wHySVcS6U

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions. Nurse Education in Practice, 18, 73-79. https://www.sciencedirect.com/science/article/pii/S147159531630004X

Le Rouzic, O., Pichavant, M., Frealle, E., Guillon, A., Si-Tahar, M., & Gosset, P. (2017). Th17 cytokines: novel potential therapeutic targets for COPD pathogenesis and exacerbations. European Respiratory Journal, 50(4). https://erj.ersjournals.com/content/50/4/1602434.short

McCarthy, C. (Ed.). (2018). COPD: An update in pathogenesis and clinical management. BoD–Books on demand. https://books.google.com/books?hl=en&lr=&id=PCyQDwAAQBAJ&oi=fnd&pg=PP10&dq=COPD+management+and+pathogenesis&ots=ETv_b9v2oL&sig=6_BfyAPn2WGQL7GU5B0upvbKFPI

Ritchie, A. I., & Wedzicha, J. A. (2020). Definition, causes, pathogenesis, and consequences of Chronic Obstructive Pulmonary Disease (COPD) exacerbations. Clinics in Chest Medicine, 41(3), 421-438. https://www.chestmed.theclinics.com/article/S0272-5231(20)30040-X/abstract

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