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Clinical Reasoning Cycle: Elaboration Using A Real Medical Case Study


Task: Provide a detailed account of the clinical reasoning cycle by relying on a medical case study.


If observed the medical context on a global scenario, it could be observed that the term of clinical reasoning cycle is being represented by various terminologies like decision making, clinical reasoning, critical thinking, and problem-solving. We have majorly used the term clinical reasoning cycle in this report to signify the process which is implied by the nurses to gather data, its analysis, arriving at a decision, diagnosing the problem of patients, determining required medical interventions, making am understanding from the occurred experience, etc (Hoffman,2007; Kraischsk & Anthony, 2001; Laurie et al., 2001). It is dependent on critical thinking at the personal level that the clinical reasoning cycle actually depends upon and hence could be influenced by the factors of individual perspective, personal attitude, preconception, and other thought processes. Though the process of Clinical reasoning cycle is dependent on a series of clinical encounters, it could not be stated as a linear process.

It is by the implementation of the clinical reasoning cycle that the clinical staff would collect and analyze the data collected relevant to the patient. It is based on this analysis that further medical interventions are made by the medical staff (Salminen et al. 2014). The process of clinical reasoning cycle was being developed by the specialist Levett Jones so that a proper systematic procedure should be introduced for the staff working as nurses in a medical organization. It has been observed that the clinical reasoning cycle displayed a lot of influence over the final results of the treatment on patients after its implication. We have taken the case of patients with the age of 20 years to elaborate on the context of the clinical reasoning cycle in this report.

Clinical Reasoning Cycle
Let us take the instance of Miss Lucy Wu, a patient who is of age 20 to describe this context much more elaborately. The patient is currently going through the medical condition of pneumonia. All the evident symptoms of pneumonia-like, tiredness, total fatigue, acute chest pain, heavy coughing, etc. are being displayed by the student. The patient has also displayed the aversion from consuming food or any sort of potable drinks. If looked at the medical measurements of the patient, it could be observed that they have the blood pressure of around 140/70 mmHg, and the pulse rate of 70 beats per minute, 16 inhalations per minute, the body temperature of around 37.5 degree Celsius. The profuse sweating has also been observed in the patient accompanied by occasional sweating at overnights. There were also some occasions where the patient has displayed a high occurrence of vomiting. In the vomit the presence of greenish-yellow fluid was detected and because of the symptoms, she was moved to the acute observation division of the medical institute.

Recorded data or indications: If checked the personal background of the patient, it could be ascertained that Miss Lucy Wu is a university student. It is at the University of Tasmania that she is pursuing the second year of her Bachelor of Business course. She is not a citizen of the nation and comes under the category of an overseas student. Her nationality roots back to China and her family reside in the city of Shanghai in China. Her current address of residence is in the Launceston of Tasmania. Her medical history reveals that she has suffered through Tuberculosis in her childhood. She has also been observed to be taking medication to cope with hypertension for around 2 years. The patient has revealed to the nursing staff that her body develops irritation and allergy against the medication of aspirin. Though the patient has no habit of smoking, she usually grabs a regular intake of 2 white wines every evening. It was after returning from Launceston that she has developed this medical situation.

Analysis of the collected data: It is clear from the recorded data by the nursing staff in the initial stage of diagnosis that Miss Lucy Wu has also some allergic symptoms and special care should be taken while prescribing her with the required medication. It is assumed that the visit of the patient to her home city Shanghai in China has developed the present biological situation of pneumonia. The normal presumption that the patient is a chronic smoker could not be taken on this context since the patient has no affinity towards smoking or nicotine products. Further analysis should be done to understand the major causative factor which led her to the present respiratory condition. The fact that she has some major allergic symptoms and medical history of Tuberculosis could be assumed as one of the contributing factors for the present condition of the patient. The previous and present medical conditions could have made the person susceptible and sensitive towards the attack of certain microbes (Marcum 2012). The condition of her stomach should also be taken into account since she has displayed a discharge of greenish-yellow fluid in her vomit. In medical intervention it has been reviewed that the medical condition has further worsened by the occurrence of high tiredness and fatigue because of the prolonged travel from her home town to the current residing town.

Recognizing the existing issues in the patient: The diagnosis of the 20-year-old patient taken in this context, Miss Lucy Wu, reveals that the major cause of symptoms is the biological condition of pneumonia. The conclusion has been derived from the evident symptoms like the regular occurrences of the shaking chills at night and vomiting. The other related symptoms like profuse sweating, tiredness, lack of appetite, heavy coughing accompanied with chest pain had confirmed the decision that the patient is suffering through the biological condition of pneumonia. The infection of the patient with the microbe of Streptococcal pneumonia had led to the present condition of her. In just six hours, her temperature has started rising with a very abnormal heart rate of 110 per minute. The temperature was observed to 39 degrees Celsius which is considered to be very high temperature as compared to the human body. After the appropriate medical interventions, the nursing staff was successful in bringing down the rate of the pulse to 70 heartbeats per minute, and temperature to the normal measure of 37.5 degree Celsius. The symptoms apart from chest pain, coughing, sweating, and fatigue were being subdued in the initial phase of the treatment.

Determined Targets: It should be according to the present medical condition and remaining symptoms that certain targets should be set by the medical team for the best possible delivery of nursing care for Miss Lucy Wu. We have enlisted a certain set of goals by keeping in mind the previous medical history and present condition of the patient. Let us have a detailed look at it.

  • Subjugate the pain experienced by the patient.
  • Conduct the periodical supervision of the patient's vital signs in thirty minutes.
  • Making the patient well aware of her biological situation and preventive measures (Marcum, 2012).
  • Encouraging the patient to take regular food and water though she is facing a very evident lack of appetite.

Required action: The nursing team should take into account the set of determining targets discussed in the above section of this clinical reasoning cycle. The decision like the frequent checking of the vital signs like blood pressure, RR, pulse rate, and temperature should be taken very seriously by the nursing staff. By using the auscultation of the lung field, the current rate of the depth of respiration should be enhanced (Blais, 2015). Special aids should be given to the patients to elevate the process of respiration like elevating the head position while lying on the bed. The patient should be made aware of various respiratory exercises so that the current difficulty should be subjugated to a certain level. Various measures like provide small massages or rubs, change in lying positions, music at a very subtle volume would help the patient in recovering at a very fast rate (Ishida et al. 2012). Though alleviating the chest pain is the primary motive, it should be taken care specially that the dose of aspirin should not be given to the patient since it would lead to the condition of allergy in her (Audetat et al. 2013). The risk of dehydration is also very eminent in the case of Lucy and hence she should be encouraged to consume at least 3000 ml/day. The food and fluids should be provided at regular intervals since she has a great aversion to food because of a lack of appetite. With the proper guidance from the attending doctor, nurses should provide the patient with fluid supplements (Herdman, 2011). The officials could also assemble a health promotion program for the patient so that the occurrence of pneumonia could be tackled with appropriate focus and systematic measures.

Analysis of the results: In the case of Lucy, it has been observed that the timely intervention by the nurses by relying on the core principles of the clinical reasoning cycle, has made a significant positive impact on the recovery from pneumonia and related symptoms. Hence it could be said that the implication of the clinical reasoning cycle would help the medical team to make a significant impact on the recovery of the patient (Alfaro- LeFevre 2012). The practical implication of the clinical reasoning cycle proves that the implication of the clinical reasoning cycle is the best approach towards the patient.

Reflection: It could be perceived by the person while implying the clinical reasoning cycle in the case of the critical patients that it is the most effective method existing in the current scenario. It is only after the implication of the clinical reasoning cycle that the actual effectiveness of the process could be understood. In the theoretical description, this method seems t be quite weak as compared to the other available methodologies. For the better implication of the clinical reasoning cycle, the nursing staff should possess the aptitude and skills to gather the vital information regarding the patient, analyzing the collected information, arriving at an accurate conclusion, etc. (White and Ewan 2013).

The effectiveness and the major ideology of the clinical reasoning cycle are being discussed in this report taking into account the case study of twenty-year-old person Miss Lucy Wu who belongs to the Chinese nationality. The clinical reasoning cycle is a very systematic approach in which the valid information regarding the patient is being collected by the health officials. In the later stage, the analysis regarding the collected information is conducted and a valid conclusion is derived out with the medical aid of physicians and doctors. It is based on this conclusion that the actual medical intervention is carried out by the medical team. This report would be helpful for nursing students who find it very difficult to understand the major principles behind the clinical reasoning cycle.

Reference List
Alfaro-LeFevre, R. 2012. Applying nursing process: the foundation for clinical reasoning. clinical reasoning cycle. Lippincott Williams & Wilkins

Audetat, M.C., Laurin, S., Sanche, G., Beique, C., Fon, N. C., Blais, J. G., and Charlin, B. 2013. Clinical reasoning difficulties: a taxonomy for clinical teachers. Medical teacher, 35(3), e984-e989.

Blais, K. 2015 Professional nursing practice: Concepts and perspectives. clinical reasoning cycle. Pearson

Herdman, T. H. (Ed.). 2011. Nursing diagnoses 2012-14: Definitions and classification. John Wiley & Sons.

Ishida, T., Tachibana, H., Ito, A., Yoshioka, H., Arita, M., and Hashimoto, T. 2012. Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Internal Medicine, 51(18), 2537-2544.

Marcum, J. A. 2012. An integrated model of clinical reasoning: dual?process theory of cognition and metacognition. Journal of evaluation in clinical practice,18(5), 954-961.

Salminen, H., Zary, N., Bjorklund, K., Toth-Pal, E., and Leanderson, C. 2014. Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning.& Journal of medical Internet research, 16(1)

White, R., and Ewan, C. E. 2013. Clinical teaching in nursing. clinical reasoning cycle. Springer

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