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Clinical Reasoning Cycle

Consider the Patient

The patient to be considered in the provided case study is an 18-year-old male. The past history of the patient includes childhood asthma for which he has been treated till date and also has a sound immunization history. The patient had his last tetanus shot administered about 12 months ago. Apart from having a history of childhood asthma, the patient is having no other underlying condition nor he his taking any other prescribed medication. The turn of events started when patient went to a local bar and had few drinks with his friends. He was attacked by another male after coming out from the bar due to some misunderstanding. The other person in the picture confronted Zac and pushed him around a bit. This caused Zac to fall back and hit his back of the head on the pavement. The injury was cited at the occipital lobe region of the head and Zac experienced some bleeding from the injury site. However, even after hitting his head on the road side, Zac was able to get up on his own and was very much conscious and oriented to the time and place.

An onger then intimated the emergency care unit and narrated the whole incidence to the care staff on the site of accident. Even after the injury the patient was able to recall the turn of events and was having a normal GCS score (Osler 2016, pp. 1879-1885). The main area of concern in the given case scenario is the patient having head injury. On admission he was found to have mild concussion, which can be quite obvious in cases of head injury. The hit on the head beared by the patient is on the occipital lobe region. Occipital lobe is responsible for multiple vital functions of the brain and any injury to this part can hamper or reduce those functioning. Some of the functions include, provision of visual field to the patient, recognising visual signs and objects, recognizing places and so on (Toma 2020, pp. 175-182). Another concerning issue is the intoxicated status of the patient. on admission to the emergency care department, the patient was having presence of 0.06% of blood alcohol. This value of intoxication in patient can be deemed to be on the higher equivalent and thus, can be harmful for the patient’s well-being (Eby 2017, pp. 73-81). Another underlying concern with the case is that there is no one, next of kin from the patient’s family to support him emotionally in these times of stress. However, the patient is 18 years old and can consent for any intervention to be carried out, the family is to be reported as per nursing care standards and due to ethical considerations (Noome 2016, pp. 56-64). Therefore, the two main concerns in this case study is patient having acute head injury and him being in a toxicated state of mind.

Collect Cues

At the time of the incident the patient was having high alcohol intake. He was pushed and had strong hit at the back of his head which led to bleeding from the injury site as well. For the given case there are multiple assessments techniques which can be carried out. The primary focus can be on evaluating the GCS scale for the patient. At the injury site his GCS was intact with a value of 15 (Salottolo 2017, pp. 197-201). Secondly, the vitals of the patient were also reported to be normal at the site of incident. However, when examined in the emergency care unit, the patient was observed to have a comparatively high blood alcohol content of about 0.06%. This can be the primary cause for altering the patient’s decision-making capacity (Francis 2019, pp. 3477-3496). The other major concerning issue in the given scenario if the patient having high blood pressure, as reported in the emergency care ward. In cases of acute head injury, mechanism of autoregulation is found to be hampered. This leads to directly rise in increased blood pressure readings. This might have been a causative impact of the head injury in patient, leading him towards development of hypertension. This is also found to be directly associated with the development of increased cerebral edema and intracranial pressure in the head (Huang 2019, pp. 48-52). If a higher blood pressure reading is recorded in head injury patients for a prolonged time, they are at a greater risk of developing stroke of the hemorrhagic origin (Pistoia 2016, pp. 9-18). The second concern that can be noted, that the patient was not able to recall the incidences in right chronological order. The patient can be observed to be in an alert state of mind, but can still be observed to be struggling emotionally. The wound laceration is not deep, but still might require minor surgical intervention for correction and prevention of further blood loss and damage to the injury site. One of the most crucial concern is injury to the occipital lobe. The patient is at a higher risk of losing proper functioning of the occipital lobe. This has an underlying added risk of altering patient’s vision or decision-making capacity. These alterations can also cause hallucination in patients. Nurses can assess the patient in detail with the help of various diagnostic tests. This can include brain CT-scan to known the possible unknown extent of the internal injury to the soft tissue. Blood tests can be done for noting any hidden allergies and for collecting the exact intoxication value (Scantling 2017, pp. 741-746). Knowing the allergies beforehand, will help the nurse in preventing any adverse medication event. Reporting of the incident to the concerning authorities is another concern in the situation, as the family of the patient has to be notified for any intervention and management. This is crucial to prevent any negative medicolegal considerations pertaining to the case.

Process Information

This one of the most important step of clinical reasoning cycle as it helps in collecting vital information for the patient, to formulate a customized care plan for the patient. Assessing and evaluating the patient in detail can help in highlighting and focusing on the primary clinical concerns for the patient. Detailed information for the patient can be carried out by the means of comprehensive nursing assessment for the patient. It can be best suitable choice of assessment for the patient given in our case study. In-dept evaluation of the patient can help in identifying the underlying risk factors the patient might be subjected to (McCrory 2019, pp. 20-26). It also provides an insight on the clinical conditions that need an undivided focus of the healthcare professionals. By having a detailed understanding of the clinical priorities of the patients, more methodical strategies can be adopted for the patient’s well-being. Some of the concerning issues in this case scenario can be increased blood pressure reading, head injury at the occipital region of brain and high level of blood alcohol intoxication in patient. the diagnostic as well as treatment interventions should be planned on this basis only. Setting clinical priorities for the patient can help in identifying the best possible healthcare solutions, assuring positive healthcare outcomes from the patients (Samadbeik 2017, pp. 377). Apart from physical concerns, emotional and psychological concerns of the patient should also be taken into due consideration. This will ensure a holistic care approach for the patient, covering each concerning aspect of promoting patient’s improved health status. Apart from planning and intervention, proper documentation of the clinical events is also crucial, to reflect back on the health deterioration of the patient. This will enable a sound and strategic management care plan for the patient to be devised as per his particular clinical needs and specifications.

References for Zac Smith Childhood Asthma Case Study

Eby, D.W., Molnar, L.J., Kostyniuk, L.P., Louis, R.M.S., Zanier, N., Lepkowski, J.M. and Bergen, G., 2017. Perceptions of alcohol-impaired driving and the blood alcohol concentration standard in the United States. Journal of Safety Research, vol. 63, pp.73-81. https://doi.org/10.1016/j.jsr.2017.08.013

Francis, K.B., Gummerum, M., Ganis, G., Howard, I.S. and Terbeck, S., 2019. Alcohol, empathy, and morality: Acute effects of alcohol consumption on affective empathy and moral decision-making. Psychopharmacology, vol. 236, Issue. 12, pp.3477-3496. https://doi.org/10.1007/s00213-019-05314-z

Huang, J.F., Tsai, Y.C., Rau, C.S., Hsu, S.Y., Chien, P.C., Hsieh, H.Y. and Hsieh, C.H., 2019. Systolic blood pressure lower than the heart rate indicates a poor outcome in patients with severe isolated traumatic brain injury: A cross-sectional study. International Journal of Surgery, vol. 61, pp.48-52. https://doi.org/10.1016/j.ijsu.2018.11.030

McCrory, V., 2019. An overview of the role of the district nurse caring for individuals with complex needs. British Journal of Community Nursing, vol. 24, no. 1, pp.20-26. https://doi.org/10.12968/bjcn.2019.24.1.20

Noome, M., Dijkstra, B.M., van Leeuwen, E. and Vloet, L.C., 2016. Exploring family experiences of nursing aspects of end-of-life care in the ICU: A qualitative study. Intensive and Critical Care Nursing, vol. 33, pp.56-64.

Osler, T., Cook, A., Glance, L.G., Lecky, F., Bouamra, O., Garrett, M., Buzas, J.S. and Hosmer, D.W., 2016. The differential mortality of Glasgow Coma Score in patients with and without head injury. Injury, vol. 47, no. 9, pp.1879-1885. https://doi.org/10.1016/j.injury.2016.04.016

Pistoia, F., Sacco, S., Degan, D., Tiseo, C., Ornello, R. and Carolei, A., 2016. Hypertension and stroke: Epidemiological aspects and clinical evaluation. High Blood Pressure & Cardiovascular Prevention, vol. 23, no. 1, pp.9-18. https://doi.org/10.1007/s40292-015-0115-2

Salottolo, K., Carrick, M., Levy, A.S., Morgan, B.C., Slone, D.S. and Bar-Or, D., 2017. The epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3. Journal of Critical Care, vol. 38, pp.197-201. https://doi.org/10.1016/j.jcrc.2016.11.034

Samadbeik, M., Shahrokhi, N., Saremian, M., Garavand, A. and Birjandi, M., 2017. Information processing in nursing information systems: An evaluation study from a developing country. Iranian Journal of Nursing and Midwifery Research, vol. 22, no. 5, p.377. https://dx.doi.org/10.4103%2Fijnmr.IJNMR_201_16

Scantling, D., Fischer, C., Gruner, R., Teichman, A., McCracken, B. and Eakins, J., 2017. The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy. European Journal of Trauma and Emergency Surgery, vol. 43, no. 6, pp.741-746. https://doi.org/10.1007/s00068-017-0793-7

Toma, M. and Nguyen, P.D., 2020. Coup-contrecoup brain injury: fluid–structure interaction simulations. International journal of crashworthiness, Vol. 25, no. 2, pp.175-182. https://doi.org/10.1080/13588265.2018.1550910

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