The essay is focussed to describe the procedure of clinical reasoning cycle in the perspective of a particular patient. Clinical reasoning skill is an important aspect of patient care and it always has a positive impact on the health outcome of the patients (Smith Loftus & Levett-Jones, 2013). In this case, postpartum issues have been considered. In order to conduct the clinical reasoning cycle at first the data will be collected, processed and presented. In the next step, the issues or problems of nursing will be clearly identified. The paper will set goals to address the nursing issues identified and proper nursing care for the person. Finally the paper will conclude with the patient’s health outcome after the implementation of the nursing care plan and strategies into the treatment procedure.
Candace Evans is a 42 year old women and she was admitted to the operating theatre at 38 weeks gestation. She was admitted for the elective lower uterine caesarean section (LUCS) under spinal anaesthesia. She was diagnosed with PlacentraPrevia. It is a condition which generally happens during the pregnancy where the placentra partially or even completely blocks the neck of the uterus and that creates problem in the normal delivery of babies and the mother then needs to go under the caesarean delivery process. The main symptom of placentraprevia is bleeding at the 20th week of gestation (Borra, Iacovou&Sevilla, 2015). So, in order to prepare the nursing plan for her disease, background or history of her medical record should be collected and with the proper assessment of her previous as well as current clinical reports information will be gathered for the further treatment procedure
It was her second pregnancy and during her first pregnancy 5 years ago, she suffered from gestational diabetes but that resolved after the birth of the child and it did not recur the pregnancy too.But at that time she went under depression as well as anxiety as it was her first time of giving birth and she also undergone post-natal depression (Countouris et al., 2016). Currently she was having the main dealing with placentraprevia which causes very shocking and frustrating experience along with mental depression as well as dissatisfaction. After her anaesthetic recovery she has come for further assessment in the post anaesthetic recovery room (PACU). Candace has come to the PACU after the delivery of a male infant via lower uterine caesarean section (LUCS) and the APGARS of the baby was 8 at 1 minute and 10 at 5 minutes following the birth. APGARS stands for appearance, pulse, grimace, activity and respiration. The APGARS rate is checked at 1 minute after birth to know the condition of the baby in the womb and it is also checked after 5 minutes to know the babies condition outside the womb of mother. In this case, the APGARS of the baby was 8 at 1 minute and 10 at 5 minutes following the birth (Katz & Gagnon, 2016). The amount of intraoperative blood loss for the mother was 150ml. The amount of blood loss can vary as per the normal as well as caesarean delivery and according to the condition and health of the patients (Gummesson, Sundén&Fex, 2018).
Candace was diagnosed with placentraprevia before giving delivery of the baby and this was the reason caesarean delivery occurred. But, the condition of the baby was quite well as per the APGARS rate. According to medical science, if the APGARS rate lies between 7 to 10, then the health condition of the baby is absolutely fine but if the rate lies under 6 then that can be a matter of concern regarding the baby’s health (Putnam et al., 2015). In this case, the rate was in the good range. Apart from that, the assessment of PACU revealed that the pain of the patient was 0/10 which means there was no pain and the intraoperative blood loss was also in the normal range because it was 150 ml and within the range of 500ml the amount of blood loss is normal (Souweine et al., 2015). The dermatome level T3 of the mother was found to be stable in her assessment of PACU. Her lower uterine dressing was dry and intact but the in-dwelling catheter which was inserted in the bladder was containing 100 ml of rose coloured urine. The red urine can cause infection and in that case, the catheter should be changed and cleaned. Even, this red urine for long term can be a sign of bladder injury. Apart from that, her heart rate was 88 which were in the normal range, and temperature was 36.9 degree Celsius which was also perfect for human body.To improve the oxytocin function saline was provided as intravenous therapy at a rate of 250mL/hour. The reading of SpO2from 98-100 % range is normal and even if it is between 96 and 97 then also not a matter of issue (Tikkanen et al., 2014). In this case, the range was 97% and it was considered as normal.
From the analysis of her postpartum period which she has come for the assessment at PACU, the main problems have been identified. These problems require the medication attention first otherwise it can come out as a big deal for the patient’s health in long term. The identified problems are mentioned below.
Rose red blood in the catheter
Slightly lower BP
Dehydration after giving birth due to blood loss
In order to resolve her issues the primary task was to set some goals addressing the main problems. As per the problem of the patient, the nursing care strategies will be planned. Changing of catheter was necessary for the patient as it can be infectious if not changed. As she had a slightly lower blood pressure so there was no need of any specific medical care. Advising the patients for some home remedies and follow up was enough to bring it under normal range (Suri et al., 2017). Another issue was dehydration which is caused by blood loss and results in weakness and dry heaving (Yim, Stapleton, Guardino, Hahn-Holbrook &Schetter, 2015).Providing saline at a rate 250mL/hour was necessary for her in order to recover from it.
In order to address her three nursing issues and to investigate her vaginal blood loss it was important to check her vaginal pad and for this purpose she was kept behind a curtain and in the other side of the curtain her husband and new born baby was waiting. To maintain the privacy of the patient is always important and therefore it is ethical to make her husband wait outside the curtain. Her catheter was changed and saline was provided for an hour more. She was also instructed to have proper rest and intake proper healthy diet in order to overcome the issue regarding the low blood pressure range. As it was a mild issue, so self-care was best suited for this. Managing her for another round of saline was quite challenging but she was informed about the complications involved if she neglects and it worked as she agreed to take saline.
With the help of nursing care plan and the established goals of addressing the problem were taken into action which helped the patient to recover and improve her health function. Changing the catheter prevented the cause of further infection and giving saline for one hour was also helpful in her dehydration issue. She will also overcome the issue regarding the BP with some self-care at home. After her first pregnancy she suffered from post-partum depression and this time it is important for her to visit a psychiatrist if she suffers from depression. However, she needs some regular check up to avoid further issues.
Conclusion
The patient came with various kinds of postpartum issues. The proper analysis of her history and background about the problems, and investigation of medical records helped to determine the exact issues and appropriate nursing plan and actions were assistive enough to evaluate a positive health outcome of the patient. Although, she should stay under investigation for her blood urine in catheter as if it is not checked or maintained it can come out as serious health issues in future. However, the treatment plan was successful for this patient.
References
Borra, C., Iacovou, M., &Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Maternal and child health journal, 19(4), 897-907.
Countouris, M. E., Schwarz, E. B., Rossiter, B. C., Althouse, A. D., Berlacher, K. L., Jeyabalan, A., &Catov, J. M. (2016). Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia. American journal of obstetrics and gynecology, 215(2), 241-e1.
Gummesson, C., Sundén, A., &Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 1-6.
Katz, D., & Gagnon, A. J. (2016).Evidence of adequacy of postpartum care for immigrant women. Canadian Journal of Nursing Research Archive, 34(4), 71-81.
Koivisto, J. M., Haavisto, E., Niemi, H., Haho, P., Nylund, S., &Multisilta, J. (2018). Design principles for simulation games for learning clinical reasoning: A design-based research approach. Nurse education today, 60, 114-120.
Smith, M., Loftus, S., & Levett-Jones, T. (2013). Teaching clinical reasoning. In Educating Health Professionals (pp. 269-276). SensePublishers, Rotterdam.
Putnam, K., Robertson-Blackmore, E., Sharkey, K., Payne, J., Bergink, V., Munk-Olsen, T., …&Devouche, E. (2015). Heterogeneity of postpartum depression: a latent class analysis. The Lancet Psychiatry, 2(1), 59-67.
Souweine, B., Lautrette, A., Gruson, D., Canet, E., Klouche, K., Argaud, L., …&Cayot, S. (2015). Ethanol lock and risk of hemodialysis catheter infection in critically ill patients.A randomized controlled trial. American journal of respiratory and critical care medicine, 191(9), 1024-1032.
Suri, V., Jasuja, S., Suri, N., Saini, R., Naga, M. K. V., &Suri, K. (2017).Postpartum hypernatremic encephalopathy with “Wine Glass Sign” on magnetic resonance imaging.Apollo Medicine, 14(3), 188.
Tikkanen, I., Narko, K., Zeller, C., Green, A., Salsali, A., Broedl, U. C., &Woerle, H. J. (2014).Empagliflozin reduces blood pressure in patients with type 2 diabetes and hypertension. Diabetes care, DC_141096, 38(3).
Yim, I. S., Stapleton, L. R. T., Guardino, C. M., Hahn-Holbrook, J., &Schetter, C. D. (2015). Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annual review of clinical psychology, 11, 99-137.
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