Clinical Reasoning and the Deteriorating Patient Value: 50% Due Date: 08-Apr-2019 Return Date: 02-May-2019 Length: 1800 words Submission method options: EASTS (online) Task back to topThis assessment...

Running Head: CLINICAL REASONING AND THE DETERIORATING PATIENT    1
CLINICAL REASONING AND THE DETERIORATING PATIENT    12
CLINICAL REASONING AND THE DETERIORATING PATIENT
Table of Contents
Introduction    3
Clinical Reasoning Cycle    3
Considering the patient situation    3
Collection of information    4
Processing gathered information    4
Identifying the problem    5
Establishing goals    5
Taking an action    6
Evaluation    6
Reflection    6
Moment of deterioration and nursing intervention    7
Deteriorating symptoms    7
Nursing intervention    7
ISBAR tool    8
Conclusion    10
References    11
Introduction
Nurses play a very crucial role in taking care of the patients. Delaying in treatment or careless monitoring of the patient becomes the reason for the worsening of their condition. Taking care of more than one patient in a general ward may lead to a poor quality care. Failure to rescue is one of the biggest causes of death in hospitals. Patients, who undergo surgery, often face this threat if poor quality care is given to them. Once the surgery is done, it is necessary to regular monitor the patient as they are very vulnerable and often failed to bear the pain. This can increase their anxiety and change their vitals. Hence, the present essay tries to determine the deteriorated condition of an 82-year-old female patient, who recently undergoes left knee surgery. Her conditions after admitting to general surgery ward become worse. Reason behind this condition will be examined in this essay.
Clinical Reasoning Cycle
Clinical reasoning cycle is a method of identification of the condition of the patient. As suggested by Hunter and Arthur (2016), clinical reasoning cycle can be defined as a process, using which nurses can collect cues about the condition of the patient. They can process the information and analyse the patient’s root problem or situation to plan and implement their interventions. As mentioned by Levett-Jones (2017), it enables the nurses to evaluate the outcomes of intervention, reflect on and learn from the entire process.
Considering the patient situation
    An 82-year old woman named Mary Smith is admitted to general surgical ward six hours after undergoing left knee replacement surgery under general anaesthesia. When approached to her bedside, she was fully alert; her Glasgow coma scale was 15/15. Her surgical wound dressing was dry; there was no sign of oozing. Her PCA has not been accessed in the past hour. She has 7/10 pain in her left knee and she feels lightheaded. She avoids eating and feels nauseated. Her vital signs are Blood Pressure 105/56, radial pulse 66 (regular), Respiratory Rate (RR) 20, SpO2 is 93%, FiO2 is 0.21, T36.4 tympanic, Blood sugar level is 11.5mmol/L, and peripheral capillary refill is 3 seconds, peripheral pale and cool digits.
Collection of information
    Mary had suffered from osteoarthritis of both knees. She had limited range of movement and pain on weight bearing in the left knee. She has Type-2 diabetes mellitus, which was diagnosed three years ago. She has hypertension and fatty liver disease that led to the moderate enlargement of liver. She suffered from diabetic neuropathy in both feet, which is responsible for intermittent mild neuropathic pain.
She does not have any neurological deficit. Her weigh is 100 kgs. She is administered with medications such as metformin 1000mg twice daily, empagliflozin 10mg once daily, metoprolol 25mg twice daily, atorvastatin 10 mg once daily, Karvezide 300/12.5 once daily, fish oil 5000mg daily and hypericum 1tablet daily. Her vital signs when admitted to the surgical general ward were blood pressure 123/70, radial pulse is 55, respiratory rate is 18, SpO2 96%, FiO2 is 0.21, T36.2, peripheral capillary refill at 2 seconds and warm digits.
    She has 18G IV catheter in her right hand and 200mL of isotonic saline remaining in the IV bag that runs at 80 mL per hour via pump. The PCA circuit is attached to this line.
You then analyse the findings using your established knowledge of physiology, pharmacology, pathology, culture, and ethics to establish cues and draw information.
Processing gathered information
Patient controlled analgesia (PCA) had not been monitored for past one hour, which is a sign of carelessness. As suggested by Freeman et al. (2015), PCA enables the patient to control their pain. After the surgery, pain is usually high at the affected area. Mary complained of having pain score of 7/10, which is relevant high. As suggested by Hatch et al. (2016), patient with neuropathic condition can undergo sepsis or deep venous thrombosis especially after post operation if pain is not controlled. Pain can lead to abnormal blood pressure. As noted by Asmat, Abad & Ismail (2016), empty stomach leads to light-headedness and increase in the blood sugar, which is relatively high Mary in comparison to the blood sugar when admitted to the ward.
As mentioned by Watt, Horgan and McMillan (2015), cytokines are released in the inflammatory region, post-surgery, leading to anxiety. It prevents patients from
eathing, then sepsis and later septic shock. Capillary refill is taking three second, which is sign of shock. All the vital signs and symptoms show that the condition of patient is deteriorating due to poor fluid intake, poor quality care post-surgery. The lack of monitoring of PCA is unable to detect the symptoms of sepsis. Lack of immediate nursing intervention would have worsened the situation.
Identifying the...