Explain On Case Study Through Clinical Reasoning Cycle?
In the clinical literature, the term Clinical Reasoning Cycle (CRC) is termed as the process through which healthcare experts collect indications, determine a plan of action to implement chosen intervention (Dalton, Gee & Levett-Jones, 2015). Further they conduct an evaluation of the process outcomes and finally undergoes a reflective process to understand the process and critically analyses it. This clinical reasoning process is not a simple and linear concept but a spiral link of clinical processes conducted for the betterment of the patients (Kriewaldt & Turnidge, 2013). This concept is important for nursing professionals as Nurses with effecting clinical reasoning ability impacts the patients wellbeing positively, whereas, poor reasoning skills fail to determine the deteriorated patient condition (Hunter & Arthur, 2016). According to New South Wales Health Incident Management report (2018), the prime reasons for the increasing escalations related to healthcare are due to failure in proper detection of symptoms, failure to implement appropriate interventions and failure in managing adverse patient situations within the facility. This assignment will be discussing the use of CRC in sequential progress of the healthcare of Peter Mitchell (52 years) and help the patient to achieve complete wellbeing.
In the case study, Peter Mitchell (52 years) has been detected with type 2 diabetes and morbid obesity. He is a chain smoker since 30 years and smokes 20 cigarettes every day. He is suffering from sleep apnoea and diaphoresis. Socially isolated Peter is divorced and his sons do not visit him as there is no such close relationship between them. He is suffering from depression as he is unable to perform his activities of daily life. Further, peter also visited a dietician and nutritionist and he was currently on high protein and low carbohydrate diet so that he can lose his body fat and forwards to a speedy recovery. This is how the patient’s situation was assessed through clinical reasoning cycle.
Further, in case of Peter, the past medical history involves Diabetes type 2 since last 9 years, obesity (with 145 kg body weight and 50.2m2 BMI), hypertension and depression (diagnosed by a GP three months ago). Further, he is being suffering from sleep apnoea and gastrooesophageal disease reflux disease. On current evaluation through patient assessment it was observed that he is not aware about the consequences of his critical situation and does not focuses on health literacy. His obesity and diabetes are not under control due to his negligence towards the diet chart provided by the dietician that leads to increase his weight. Moreover, increased weight has led him develop obesity hyperventilation syndrome, diaphoresis, shakiness, high blood glucose level and increased hunger. His blood pressure readings 180/92 made him vulnerable to cardiac disorders in future. He was highly overweight and hence, the chances of gastro oesophageal disease reflux disease was diagnosed in critical stage in his body.
The first connection that is observed in the current and past medical condition of Peter was regarding his diabetes and moderate to high obesity, hence, weight management is the first priority. Peter was unaware of the ‘dos and don’ts’ of diabetes and obesity that lead his increase his weight and the severity of obesity also increased. As the body starts storing enough glucose within the cells as glycogen, however it fails to produce enough insulin to regulate the blood glucose, the individual develops type 2 diabetes (Cnop, Foufelle & Velloso, 2012). Furthermore, according to Esser et al., (2014), the fat cells around the abdomen releases a type of pro-inflammatory chemicals that has proven to inactivate the efficiency of insulin. Therefore, as in obese people, the level of pro-inflammatory chemicals are more than others, they tend to become affected with obesity. Hence, in case of Peter, poor management of obesity and diabetes is the prime reason for the development of obesity hyperventilation syndrome. Peter is currently facing difficulty in breathing that can affect his lungs in future as the concentration of oxygen in his is decreasing comparing to the increased carbon-dioxide concentration. Therefore, the nursing professionals should focus on the treatment of obesity to control the other emerging disorders.
The second intervention the nursing professional should implement about the social isolation condition of Peter that leads to high blood pressure associated hypertension and depression related symptoms. According to Matthews et al., (2016), social isolation is one of the prime reasons for loneliness, depression that leads to hypertension and stress in maximum of the individuals. The current blood pressure of peter is 180/92 which is much higher than the normal blood pressure 120/80mmHg. This high blood pressure can have deteriorated health consequences in future as the patient will become vulnerable to several cardiac disorders, strokes and several other physiological diseases. Further his habit of chain smoking including 20 cigarettes per day is also reason for his increasing blood pressure and depression. According to D’alessandro et al., (2012), nicotine present in cigarettes has the ability to narrow the blood veins and arteries that leads to vasoconstrictions and hardening of the wall of arteries. This condition can leads to blockage of veins and arteries leading to cardiac arrests, strikes and other cardiac conditions (Abboud, Harwani & Chapleau, 2012). Hence, the nursing professionals should also focus on these aspects of Peter so that a constructive intervention can be applied for the overall wellbeing.
Furthermore, according to the CRC, synthesizing interferences and facts to make a constructive diagnosis of Peter was important. In this case study of Peter, it can be determined that Peter is not being able to manage his diet and nutrition choices as his health literacy is very much restricted. This leads to poor management of diabetes as well as obesity that leads to the emergence of serious conditions such as sleep apnoea, breathing problems, hyperventilation syndrome, high blood glucose level and hypertension (Ley et al., 2014). Therefore, this interference can be developed that proper management of obesity and diabetes through proper interventions and diet can lead to improve the patient’s quality of life. Further, by maintaining the smoking issue can lead to regulate the high blood pressure and his breathing issues will also be managed through this step. For hypertension, Peter will be asked to socialize with his neighbors or same age so that watching their health complication, can ignite positive hopes within him and through his will power he maintains a positive approach for implemented interventions (Anton et al., 2013). Further, the current medication of peter such as insulin and Metformin 500 mg, to decrease his diabetic condition or reduction in the blood glucose, Nexium 20 mg for gastro oesophageal reflux, Metoprolol 50 mg for chest pain and effective blood flow will also help to improve the condition.
In the given case study, it is quite evident that Peter is aware of his deteriorated condition and is willing to improve his state however, his knowledge regarding health is the prime hurdle that decreases his confidence while adapting different interventions to lose weight. The first goal, hence will be making Peter understand the necessity of healthy and nutritious diet to attain wellbeing and how his increasing obesity is becoming the prime reason of each emerging disorders in his body. For this purpose, a counselling session should be provided to the patient so that for the future interventions, the patient can be mentally prepared. He should be involved in physical exercises so that sedentary time can be reduced. Further, the nursing professional would taught him the usage of diabetes reader device and related medications so that he can follow the process in the absence of healthcare exerts. Moreover, for the excessive smoking disorders, sublingual nicotine tablets, nicotine inhalers should be implemented, which are nicotine replacements and helps to quit cigarettes. Therefore, utilization of these nicotine replacements will determine lowing of blood pressure in case of Peter.
The final patient assessment according to CRC was evaluating outcomes and reflecting upon it determines the positive and negative aspects of the care process. For this processes, the nursing professionals should conduct health assessment of Peter and check his obese condition, BGL status, blood pressure and the habit of smoking so that overall wellbeing can be tracked. Further, for the evaluation of Peter’s health literacy, nursing professions should make him fill a small and easy questionnaire regarding his knowledge about diet, nutrition, diabetes and obesity so that his literacy can be assessed. Furthermore, the nursing professionals will reflect on the entire process and determine the shortcomings the evaluated in the entire process. According to Bulman, Lathlean & Gobbi (2012), reflection is an important aspect of nursing as they are able to convey the loopholes of the process to others so that those people are aware of the mistakes. This determines the decrease in the reoccurrence of the mistakes again within the process. The nursing professionals can also use the experience gathered from the incident to other healthcare process without any mistake.
From this above discussion related to CRC and its eight steps, it is determined that the reasoning cycle is able to help clinical professionals starting from patient assessment up to critical reflection about the intervention they apply for patient improvement. Further, this helped to develop a sequential plan of action through which two health priorities for Peter were determined. Furthermore, a set of intervention for both the health priorities and associated problems were discussed in the assignment. Health counselling was also implemented so that the health literacy can be improved and the patient feels empowered and supported to achieve a better quality of life with the ability to perform activities of daily life on his own.
References
Abboud, F. M., Harwani, S. C., & Chapleau, M. W. (2012). Autonomic neural regulation of the immune system: implications for hypertension and cardiovascular disease. Hypertension, 59(4), 755-762.
Anton, S. D., Karabetian, C., Naugle, K., & Buford, T. W. (2013). Obesity and diabetes as accelerators of functional decline: can lifestyle interventions maintain functional status in high risk older adults?. Experimental gerontology, 48(9), 888-897. Retrieved from: https://doi.org/10.1016/j.exger.2013.06.007
Bulman, C., Lathlean, J., & Gobbi, M. (2012). The concept of reflection in nursing: Qualitative findings on student and teacher perspectives. Nurse education today, 32(5), e8-e13. DOI: https://doi.org/10.1016/j.nedt.2011.10.007
Cnop, M., Foufelle, F., & Velloso, L. A. (2012). Endoplasmic reticulum stress, obesity and diabetes. Trends in molecular medicine, 18(1), 59-68. DOI: https://doi.org/10.1016/j.molmed.2011.07.010
D’alessandro, A., Boeckelmann, I., Hammwhöner, M., & Goette, A. (2012). Nicotine, cigarette smoking and cardiac arrhythmia: an overview. European journal of preventive cardiology, 19(3), 297-305. DOI: https://doi.org/10.1177/1741826711411738
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to’flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29.
Esser, N., Legrand-Poels, S., Piette, J., Scheen, A. J., & Paquot, N. (2014). Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes research and clinical practice, 105(2), 141-150. DOI: https://doi.org/10.1016/j.diabres.2014.04.006
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse education in practice, 18, 73-79. DOI: https://doi.org/10.1016/j.nepr.2016.03.002
Kriewaldt, J., & Turnidge, D. (2013). Conceptualising an approach to clinical reasoning in the education profession. Australian Journal of Teacher Education, 38(6), 7.DOI:10.14221/ajte.2013v38n6.9
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007. DOI: https://doi.org/10.1016/S0140-6736(14)60613-9
Matthews, T., Danese, A., Wertz, J., Odgers, C. L., Ambler, A., Moffitt, T. E., & Arseneault, L. (2016). Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Social psychiatry and psychiatric epidemiology, 51(3), 339-348.
New South Wales Health Incident Management. (2018). Patient Safety and Clinical Quality Program. Www1.health.nsw.gov.au. Retrieved 20 March 2018, from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2005_608.pdf
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