ASPECTS OF CLINICAL REASONING

Introduction

The case on John Ryan, is developed in the context of the eight stages of clinical reasoning. These stages are: describing the patient, collecting the cues, processing information, determining the problems, establishing the goals, action taking, evaluating the outcomes and reflecting on the process as well as new learning (Levett-Jones & Bourgeois 2011). The stages are used by the nurses to enable them collect data, make a decision and evaluate the outcome. The initial stages are the one that help in correcting of data. The assignment will look at these stages and analyze two priorities in the case.
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Initial stages

  1. Describing The Patient

As a registered nurse the first thing I will is to describe my patient. The information that will be important to me at this stage is the age of the patient, the medical history of the patient, their lifestyle, family life. The age is important in order to determine the functional changes of the patients that are dictated by their age. The medical history will on their other hand, will determine if the patient has past medical complications and how long they have been experiencing them.  Their lifestyle can be a precursor on determining the risk factors that might lead to the occurrence of the health complications. Family background may also have something to do with the health of the patient, especially if they are not receiving enough support. Collecting of cues

I will ensure that at this stage I have all the relevant information regarding the patient. I will then review the information from the documented history and specialist handover report to develop conclusive results.  I will also ensure that I have collected new, but relevant, information on the health and lifestyle of the patients as well as those who are related to him, including friends. In short, I will ensure that all relevant cues about John that can help me in building up  his case are captured in my data. This includes carrying out a new set of medical extermination for blood pressure, determining the BPM and also the BMI.

  1. Information processing

After collecting all the relevant clues, I will analyze it quite critically to determine it shifts from what was available before my collection.  The analysis will also include determination of whether the cues indicate any aberration from what is said to be normal. The cues that I have collected must be grouped in certain classes and each of them is used to develop a particular pattern.  I will then develop the right theory support the cues and anticipate what the outcome could be when a certain action is undertaken. This will ensure that I am planning of what could happen in the near future of the patient.

  1. Determine the problem of the patient

After I have gathered all relevant information from the historical data and collected cues and the effective analysis, I will use it to determine the problems that more dire to the patient. In this case, the most pressing issue is chronic back pains and the degeneration of his hip. The two problems have even made John fed up of even thinking of them since he cannot carry out some of his favorite activities.

 

Setting out the goals

With the data at hand and the problems of the patient, determined I will determine what needs to be done immediately and what can wait a bit longer. The priority of the problems to be solved will be allocated as per the urgency.  The general rule in this is that objectives should be specific, measurable, attainable, be real and done timely, in a way that Levett-Jones & Bourgeois (2011) explains as being SMART.

PRIORITIES IN THE CASE:

PAIN ASSESSMENT AND MANAGEMENT OF CHRONIC BACK PAINS

Goals

Mr. John immediate problems are increased chronic back pains which he has been experiencing for quite some time. As a registered nurse, my first goal in this will be to ensure that the pain is relived. Secondly, I would be ensure that the patient can enjoy mobility and be in position to sit for long. I would also be objective on letting the patient know the importance of observing medication adherence. My other goal will be to let the patient understand what they need to do other than taking medication to help in pain management.  Exercises are the other thing I will be concerned with. Undertaking exercises helps people to build on their muscles and patients of chronic back pain should always undertake exercises for their functions as well as keeping fit (Hooten, Timming, Belgrade, Gaul, Goertz, Haake, et al. 2013).

Action taken

I will assess the patient’s historical data and determine how frequently the pain reoccurs.  I will invite the patient to express his issues with pain as this an important exercise as per many studies (Benjamin, Jane, Jon, Robert, & Karen, 2013). Historical assessment of the chronic back pain for the patients shows that he has had a spinal stenoisis in his forties. I will also educate the patient on the importance of taking medication as per the specification of the doctor.  I will assess the expectation of the patient in regard to pain treatment and get information of what they expect from the treatment.  I will also educate them on the importance of exercises in pain management and he can do it easily. I will ensure that their families are involved in helping them overcome the trying times

Outcome

The outcome that I expect from the interventions that I have made is, first and foremost, that the Mr. John’s chronic pain is reduced. Secondly, I would expect that he has improvement on the daily activities that he undertakes during my next follow up.  I would also expect that the John is taking his medication as per prescribed by the doctors. Medication adherence is an important aspect in the recovery of the patient. If the patients fail to take their medication as prescribed by their doctor and ensure that it is the medication (Jimmy & Jose 2011).   I would also expect that he is sleeping easy. In addition, my expectation is that he will be exercising without feeling over engaged since he likes it. Family intervention in the treatment of chronic pains goes a long way because they can help in the absence of a medical practitioner (Lorraine, Randel,Leon, Fredrick, David, 2014).

PAIN ASSESSMENT AND MANAGEMENT OF DEGENERATION OF THE LEFT HIP

Goals

When it comes to the management of degeneration of hip, my goal, firstly, will be to reduce or control leg weakness, bilateral muscle wasting and the reduced sensation in his both feet. My goal would also to prevent blisters as a result of pressure on the feet. I would also ensure that the patient sleep easy, look relaxed and be in a position to doe activities as per his ability. I would also want to see the patient following the therapy exercise to the end and get involved in the activities that they like the riding of the bicycle and hiking.
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Taking action

Degeneration of the hip is caused by the inflammation in the joints of the hip and can pain making patient to have difficulties in mobility (Ackerman, Buchbinder & Osborne, 2012). One of the actions that I will take when it comes to degeneration of the hip is to determine the intensity of the pain and the exact location of the pain.  I will put a scale of 0-10 on the pain and determine the factors accelerating the pain. I would then inform the patient on the importance of physiotherapy in the treatment of degeneration of the hip. Physical exercise is vital in the treatment of hip degeneration complications.  I will also determine how critical the blisters are, which he tries to ignore and determine the best way to stop them. This may include change of his footwear.

Outcome

The reduction of pain in the hip would be my first expectation when it comes to degeneration of hip. I would expect to see him seeking the services of a physiotherapist as he appreciates the outcome of the exercise. Exercise prescriptions are used in many ways to treat the inflammation in the hip as well as other joints of the body (Bennell &Hinman, 2011). My other expectation on the follow up is, Mr. John is able to move freely as a result of muscle built up which reduces bilateral leg weakness, muscle wasting and reduced sensation of the his feet. Reduction in blisters on his feet would also be my expectation on follow ups.

Reflection on the process and the new learning

Reflection on the various things that have happened in the clinical reasoning cycle is quite an important issue. I will critically analyze the process to its success, determine the things I did not do better, determine what should have been better or differently and stipulate the new learning.

Conclusion

Nurse intervention to health issues of the patient goes a long way in ensuring the problem of the patient is addressed in the shortest time possible. They need to ensure that every detail has been documented in order to capture every detail that can help in the next cause of action. In order to do so,  stages of clinical reasoning must be followed to the letter.

Reference

 

Ackerman, I.N., Buchbinder, R., Osborne, R.H. (2012). Challenges in evaluating an Arthritis Self Management Program for people with hip and knee osteoarthritis in real-world clinical settings. J Rheumatol,39(5),1047-55.

Benjamin, J.N., Jane, L.S, Jon H.R., Robert, L.A.& Karen, L. (2013). A Narrative Review of the Impact of Disbelief in Chronic Pain. Pain Manag Nurs., 14(3),161-171.

Bennell, K.L. & Hinman, R.S. (2011).A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport, 14, 4-9.

Hooten WM, Timming R, Belgrade M, Gaul J, Goertz M, Haake B, Myers C, Noonan MP, Owens J, Saeger L, Schweim K, Shteyman G, Walker N. Institute for Clinical Systems Improvement. Assessment and Management of Chronic Pain. Updated November 2013.

Jimmy B & Jose J (2011).Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal, 26(3), 155-159.

Levett-Jones T & Bourgeois S (2011).The placement: An essential guide for Nursing Students (2nd edn). Marrickville: Churchill Livingstone.

Lorraine,S.W., Randell,K.W., Leon, M., Fredrick, M.W. & David, H.J. ( 2014). Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain. Journal of Pain Research, 7, 291–299.

Mary, B.F.M., Sarah, A.M., Suzanne, B., Dinah, P. Carol, R. (2015).Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. CriticalCareNurse,33(2),28-43

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