Advanced Clinical Decision Making for Pneumonia Patient

Running head: ADVANCED CLINICAL DECISION MAKING
ADVANCED CLINICAL DECISION MAKING
Name of the Student
Name of the university
Author’s note

1ADVANCED CLINICAL DECISION MAKING
Introduction
Registered nurses needs to be flexible in the in the decision making approach and to
ensure a continuity of care. In order to provide a safe and a high quality of care, they should
possess the ability to judge, think and reason. Clinical reasoning is a complex process that
utilizes the formal and informal reasoning strategies for gathering and the analyzing the patient
reasoning. This process is reliant on the health care professionals and the individual client
circumstances. In this assignment, the Levett Jone's clinical reasoning cycle has been used as a
tool for the registered nurses to make appropriate decisions. Furthermore the recommendations
has been proposed in the light of the three competency standards for the registered nurses by the
Nursing and Midwifery Board of Australia (NMBA) .
Consider the patient situation
A 45 years old male patient named James had been admitted to the ED with the clinical
manifestations of Pneumonia. The patient had been admitted with productive cough and
shortening of breath. The patient has been suffering from the respiratory tract infections for the
last five days. A local General practitioner had been managing the respiratory illness was
referred to the emergency department on the exacerbation of the respiratory distress. After
admitting the patient in the emergency department, the patient was subjected to chest x-ray,
which displayed a consolidated lungs that indicated towards the occurrence of pneumococcal
infections. I was allocated as the nurses for taking care of this patient.

2ADVANCED CLINICAL DECISION MAKING
Collect cues/information
This is the second stage of the clinical reasoning cycle where nurses are accountable to
review the current information of the patient based upon the diagnostic tests. On arrival to the
emergency department vital signs of James were taken and recorded. The recorded temperature
was 38.8 degree Celsius. Heart rate was observed to 110beats per minute, respiratory rate 26 per
minutes, blood pressure was recorded to be 100/72 and oxygen saturation level was found to be
91 %. The doctored ordered for an hourly monitoring of the breathing, LOC and the neurological
status. James was initially admitted with an oxygen saturation level of 91 % which decreased
with time and was reduced to 87%, with increasing respiratory distress. Right after an hour of
admission the patient exhibited high fever with increasing respiratory problem. The current PaO2
level was observed to be 50mmHg. One of the main concern for James is the increasing
respiratory distress and the decreasing oxygen saturation level. The blood pH was recorded to be
7.45. I have recorded all the observations and reported the abnormal signs to the registered nurse,
who gave the order of reporting to a doctor.
Process information
Processing of the information is the third stage of the clinical reasoning cycle where all
the displayed signs and the symptoms are linked to the underlying pathophysiology,
pharmacology and the pharmacodynamics. The normal vital signs are compared with the
abnormal. Pneumonia is an acute form of respiratory tract infections that affect the lung
parenchyma and oxygenation of the lungs. The clinical manifestations are mainly monitored by a
chest x-ray (Singh, 2012).

3ADVANCED CLINICAL DECISION MAKING
The primary symptoms of Pneumonia involves coughing with a phlegm or a pus, difficult
breathing. High fever and symptoms of dehydration following the admission of the patient is an
important indication towards pneumococcal infections (Driver, 2012). Interpretation of the
arterial blood gases are extremely crucial in case of pneumonia patients. PaCO2 is low as the
standard range of the PaCO2 is 35-45 (Alwadhi, Dewan, Malhotra, Shah & Gupta, 2017). PaCO2
can be an effective marker in measuring the severity of community acquired pneumonia.
The PaO2 is also much low, whereas the normal value is between 80-100. PaO2 might be
low due to the mucous displacing the air in the alveoli affected by pneumonia. The pH is also on
the lower of the normal range that indicated towards a compensated respiratory acidosis (Singh,
Khatana & Gupta, 2013).Troubled breathing can be explained by the increased respiratory rate as
the heart has to pump more effectively to meet up the oxygen demand. Arterial hypoxemia is
mainly caused by the persistence of the pulmonary blood flow to the consolidated lungs causing
an interpulmonary shunt. Hypoxemia can be also be caused due to the intrapulmonary
consumption of oxygen by the lungs at the time of the acute phase. Respiratory failure in
pneumonia affects the lungs such that it cannot remove carbon-dioxide from the blood (Singh,
Khatana & Gupta, 2013). A low oxygen level and low carbon-dioxide level occurs at the same
time in the blood. Hypoxia is related to high respiratory rate as the an abnormally low content of
oxygen in the blood triggers troubled breathing to meet up the oxygen demand in the tissues and
the organs (Kushwah, Verma & Gaur, 2018). It has to be remembered that pneumonia is an
infection that is mainly caused when there is an inflammation in the airsacs of the lungs. Fever is
an autoimmune mechanism displayed by the body against any kind of infections. In a
retrospective study high rate of mortality was found in the elderly patients with pneumonia and
no fever in comparison to the ones with pneumonia and fever (Walter, Hanna-Jumma, Carraretto