Application of Clinical Reasoning Skills within a Clinical Patient Scenario

This report discusses the application of clinical reasoning skills in a clinical patient scenario. It covers topics such as the pathophysiology of acute pain, appropriate nursing assessments for patient deterioration, nursing interventions and their rationale, administration of morphine for pain relief, and the side effects of intravenous morphine. The case study revolves around Tran, a 33-year-old patient admitted to a surgical ward.

APPLICATION OF CLINICAL
REASONING SKILLS WITHIN
A CLINICAL PATIENT
SCENARIO

Table of Contents
INTRODUCTION ..........................................................................................................................3
MAIN BODY...................................................................................................................................3
1.1 Define the pathophysiology of acute pain and how it differ from chronic pain...................3
1.2 Discussion on three types of nursing assessments that are appropriate for Tran
deterioration................................................................................................................................3
1.3 Discussion on the three nursing intervention and provide rational as how this improves
physiological outcome................................................................................................................4
1.4 Discussion on administration of Morphine for Tran pain.....................................................5
Define the side effects of intravenous morphine to Tran case....................................................6
CONCLUSION................................................................................................................................7

INTRODUCTION
Clinical reasoning may be termed out as process of applying knowledge and expertise to
clinical situation that supports to develop one particular solution (McCullough, Peacock and de
Lemos, 2019). It is framework that supports to enhance the understanding in community nursing.
The present report is based on case study of Tran, who is 33-year-old and admitted to surgical
ward.
MAIN BODY
1.1 Define the pathophysiology of acute pain and how it differs from chronic pain.
The pathophysiology of acute pain is mainly occurring in response to tissue injury.
However, the acute pain is the sudden outset and this results of clearly defined cause such as an
injury. This is pain that can be resolves with healing of its underlying cause. It is the pain that
can be last for weeks or moths (Urits, Burshtein and Kaye, 2019). On the other hand, the chronic
pain relates with ongoing tissue injury that mainly caused by persistent activation of these fibres.
It is pain that last for more than 12 weeks.
In the above given case study of Tran, he was suffering from the acute pain. To cope up
with it he also has given narcotic analgesia so that he can get relief from acute pain. This has
been found out that Narcotic medication are mainly used for treating moderate to severe pain.
Hence, the most appropriate use of narcotic analgesic is to get relief from the intense, short-term
pain that occurs after the surgery or due to medical condition. It is medication that can also be
given in terms to get relief from the pain due to caner, palliative care and end of life care. From
the case study this has been found out that Tran is also on the Narcotic analgesia. This is
medication that has many side-effects. Although people with cancer or terminal illness taking
narcotics for long period of time that can be tolerant to some of these kind of side effects. Thus,
common effects of this medication are as Drowsiness, sleepiness, dizziness that is all common
with most narcotic analgesics (Hameed, 2019). It can affect the ability of person to operate
machinery and perform the other hazardous task. Hence, this is medication that support to reduce
anxiety, reduce tension and happiness among the individual.
1.2 Discussion on three types of nursing assessments that are appropriate for Tran deterioration.
In terms to effectively determine the diagnosis and treatment for a patient’s nurses needs
to make four assessments such as initial, focused, time lapsed and emergency. This is one of the

crucial part of the nursing education as well as to the health care industry. It is group routine
procedure and process that inclusive with the patient’s assessments and care. With the use of
these assessments the nurses and health care professionals are able to access and can be ready to
determine the best treatment for an ailing patients. Thus, nursing assessment are outlined as-:
Initial comprehensive assessment- This is called out as an admission assessment. It aids to
review the all medical history of Tran. From this assessment this has been identified that Tran
has past record of the crohn's disease (Stamer, Liguori and Rawal, 2020). This is inflammatory
bowl disease. This causes inflammation of the digestive tract that can lead to abnormal pain,
severe diarrhoea and weigh loose etc. Due to this illness, Tran has also reduce his weight to 55
kG. At this level, the nurse has identified the medical condition of Tran. It can assist to treat the
health of patients effectively. Thus, he has suffered from disease that needs to get relief from
conditions of acute pain.
Focused assessment- It is the stage that defined how the cause is been treated. To get relief
from the pain he is prescribed the several medication such as Prednisone, Metronidazole,
Balsalazide. Tran is also on Narcotic analgeisa infusion (Shaballout, Aloumar and Beissner,
2019). This also has been identified that prior to transfer his to the surgical ward he was
prescribes and administered the loading dose of intravenous morphine 5mg. From his family
history, this acknowledged that he has been partnered for 10 years. This is the stage that aids to
determine that where the cause of issue has changes or improved, worsened or resolved.
Emergency assessment- It is the stage that needs to be focused at the time of life threatening
situations in which preservation of the life is one of the top priority. From the conditions of Tran
this has been identified that he has given the high dose of medication and this is affecting his
health in the worsen manner. To get relief from the acute pain he is on the narcotic analgesia.
This has been monitored that Tran he is difficult to rouse and non-verbal. His eyes were closed.
Thus, the initial set of vital signs: Temp 35.8, Pulse irregular 110 bpm, BP 98/55, RR 6, SaO2
93%
1.3 Discussion on the three nursing intervention and provide rational as how this improves
physiological outcome.
Nursing intervention can be termed out as the actual treatment and action that are mainly
performed to assist the patients in order to reach the goals. Henceforth, the nurses uses their
knowledge, experience and critical thinking skills that aids to define that which kind of the

intervention can assist to cope up with the threatening situation of patient. Henceforth, the
classification of nursing intervention is outlined in following context as are-:
 Independent- In this stage, there are action in which the nurse is able to initiate the
whole process independently (Finnerup 2019). From the case study, this has been
analysed that William has the past history of the Crohn disease. He is also on the narcotic
analgesia to get relief from the acute pain. Hence, the nurse intervenes by educating the
patients on the purpose of medication. Henceforth, the main side effects of the
medication such as narcotic is as Drowsiness, sleepiness, dizziness etc.
 Dependent- In this situation, Williams was not getting at the stable position. Due to this,
he was transferred to the surgical ward so that he can get treated from another health care
provider.
 Interdependent- It is situation in which participation of the multiple member of the
health care team is required.
In this situation, Tran has to adopts the following nursing intervention and these are termed out
as-:
 Health care system Nursing intervention- In this, the nurses take the action as part of
healthcare team to offer safe medical facility to all patients. In order to diagnose the Tran
situation this is crucial to undertake intervention and educate him about the prescribed
medication (Chua, Brummett and Waljee, 2019).
 Physiological nursing intervention- It is kind of intervention that relates with the
patient’s physical health. Thus, this is the in which medical condition of Tran needs to be
monitored at the several durations so that he can be provided appropriate treatment.
 Safety nursing intervention- It is inclusive of the intervention that allows to maintain
patient’s safety and also assist in order to prevent injuries. In the surgical ward, the Tran
needs to be educated about how to call for assistance if he is not able to move around on
his own.
1.4 Discussion on administration of Morphine for Tran pain.
Administration of Morphine-:
Morphine can be termed out as pain medication of the opiate family that has been found
naturally in number of animal including human (Chua, Brummett and Waljee, 2019).
Henceforth, administration of Morphine sulphate injection needs to be limited to use by those

familiar with management of the respiratory depression (Stone, Cooke and Mitchell, 2020). Also,
Morphine needs to be injected slowly and rapid intravenous administration may result in chest
will rigidity. In order to get relief from the harsh impact of medication as Morphine this impact
adverse effect on health status.
Contradiction-:
 Morphine sulphate is contraindicated in patients with known hypersensitivity to
morphine.
 Morphine sulphate is contraindicated in patients with respiratory depression in the
absence of resuscitative equipment.
 Morphine sulphate is contraindicated in patients with acute or severe bronchial asthma or
hypercalcaemia.
 Morphine sulphate is contraindicated in any patient who has or is suspected of having
paralytic ileum.
Risk of Morphine-:
 Risk of medication errors- Morphine sulphate injection is avail in fiver concentration
for the direct injection. This is crucial to prescribing and administering morphine sulphate
injection in order to avoid excessive dossing errors (Chua, Brummett and Waljee, 2019).
Thus, nurses must be educated about between the dose of mg and ml. This could result
into accidental overdose and death.
 Cardiovascular instability- Morphine has little effect on cardiovascular stability and
high doses are excitatory that resulting from sympathetic hyperactivity and increase in
circulatory catecholamine.
 Respiratory depression- It is primary risk of Morphine sulphate injection. However, the
Rapid intravenous administration may result in chest wall rigidity (Farooq, Tharani and
Parpio, 2020).
Benefit of Morphine-:
It is the medication that can be used to help and to relieve moderate to severe pain.
Morphine belongs to a class of drugs that called out as the narcotic analgesics (Gillis, Scott and
Glennie, 2020). It works in the brain to change how body feels and responds to pain (Chua,
Brummett and Waljee, 2019). Henceforth, this can be concluded that Tran is also on narcotic
analgesia. This is kind of Morphine injection that aids to get relief from acute pain.

Define the side effects of intravenous morphine to Tran case.
The medication such as intravenous morphine may cause some unwanted effects. It is
medication that uses to deal and treat server pain (Chua, Brummett and Waljee, 2019). This is
the medicine that cause some medicine may cause some unwanted effects. In addition to this, the
Moderate-to-severe pain is treated with intravenous administered opioids. Therefore, the
common side effective of Morphine is termed out as-:
 Difficulties and troubling in breathing.
 Patients may suffer from irregular, fast, slow and shallow breathing issues.
 Shortness of breath.
 The patient may suffer from very slow breathing.
Therefore, some of the incidence that are not known as-:
 Blurry vision
 Decrease in frequency of urination
 Fall in the amount of urine
 Difficulty in passing urine.
 dizziness, faintness, light-headedness while getting up suddenly from a lying or sitting
position
 This leads to painful urination
 It leads to issue such as sweating
 This may leads to unusual tiredness or weakness
CONCLUSION
Hereby, it can be concluded that clinical skills termed out as capability to perform
acceptably duties that directly relate to patient care. The present report has covered case study of
case study of Tran, who is 33 year old and admitted to surgical ward.

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