Clinical Reasoning Cycle Case Study (Doc)

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Case study
TABLE OF CONTENTINTRODUCTION...........................................................................................................................1DIAGNOSIS...................................................................................................................................1Case study overview and purpose of paper.................................................................................1Collecting cues to find deviations from normal readings...........................................................1Processing information...............................................................................................................1Problems identified.....................................................................................................................1INTERVENTIONS AND TREATMENT APPROACHES...........................................................2Goal establishment and actions...................................................................................................2Pharmacokinetics of medications and their indication................................................................2Nursing management for adverse impact of mediations.............................................................2Treatment and interventions.......................................................................................................3Patient education.........................................................................................................................3HEALTH OUTCOMES..................................................................................................................3EVALUATING OUTCOMES....................................................................................................3REFLECTION............................................................................................................................4CONCLUSION...............................................................................................................................4REFERENCES...............................................................................................................................5
INTRODUCTIONClinical reasoning cycle is defined as the systematic and sequential approach throughwhich nurses diagnoses health issues and perform clinical interventions. The process alsoincludes the evaluation of outcomes and interventions applied so that reflective learning can alsobe taken into account for improving future practices(Webster & et.al., 2017). The report willdiscuss the care plan for the case study of given patient by applying various stages of clinical lifecycle.DIAGNOSISCase study overview and purpose of paperA 51 year old man named George has been diagnosed with stage four chronic kidneydisease (CKD) and secondary albuminuria. The patient also suffers some abnormalities inphysiological parameters and also consumes medications without knowing their usage or need.Thus the purpose of this paper is to assess and diagnose the physiological issues experienced bythe patient and to develop a care plan. The paper also aims at applying various stages of clinicalpractice in preparing care plan for the patients and to enhance clinical learnings by incorporatingreflective and case analysis practices for learning.Collecting cues to find deviations from normal readingsGeorge is diagnosed with stage 4 CKD and increasing weight and cholesterol I diabeteshas also contributed in macro albuminuria. He has high blood pressure and haemoglobin levels.He was a former smoker but has quit the practice. However unhealthy life style has madediabetes, cholesterol and blood pressure worsen.Processing informationIn patients with CKD obesity and high blood pressure makes them vulnerable tocardiovascular diseases such as chronic heart failure or stroke(Kovesdy & et.al., 2017). Despiteliving with wife and children no care is provided to ensure that which medications are taken bypatient. Thus there is need of specific care to monitor the fluid, nutritions and administration ofmedicines.Problems identifiedThe first problem or care priority identified for the patient is management of bloodpressure (BP) and nutritional intake. The high BP and unhealthy food puts over burden onkidneys and thus their deterioration rate is increasing(Verberne & et.al., 2016). The1
management of higher level of HbA1C is also another care priority because it enhances the riskfactor of stroke and heart failure in CKD patients. Due to lack of knowledge and guidancepatient is also consuming some medications without knowing their usage and impact(Isakova &et.al., 2017). Thus it is also one of the issue to manage medications for patient so that theiradverse impact can be avoided.INTERVENTIONS AND TREATMENT APPROACHESGoal establishment and actionsThe primary goal for George is to maintain normal level of blood glucose, fluid balanceand blood pressure so that CKD is not progressed into cardiac and other complications. Thus thefirst action which must be taken for patients is regular monitoring of body vitals such as bloodpressure, sugar level, heart and lung sounds and rates, GFR. The psychological stress can alsoworsen the situation by causing stroke and heart failure. Thus input output of body, fluid flowmust be controlled and regulated(Davison & et.al., 2015). Since patient has abnormal readingsof blood pressure, albuminuria and HbA1C these must also be monitored and treated so that theycan be improved to lie in normal range.Pharmacokinetics of medications and their indicationThe existing drugs such as sodium bicarbonate, metformin are considered to be restrictedfor patients of CKD. Thus it is necessary to understand the pharmacokinetics of medicinesconsumed. Kidney diseases bring significant changes in pharmacokinetics. As a result of CKDthe drug clearance is decreased and thus the volume of distribution may increase(Kovesdy &et.al., 2017). Similarly the absorption of drug which is executed by gastrointestinal tract is alsoaffected by pathophysiological changes in patients with diabetes and CKD. This can be indicatedby delay in emptying gastric variables. The excretion function of drugs is performed by kidneyand thus it is also observed that George may react abnormally against consumption of somespecific drugs(Eckardt & et.al., 2015). The abnormal behaviour can be indicated by the meansof several side effects such as nausea, skin reactions or changes in renal outcomes or bloodpressure.Nursing management for adverse impact of mediationsNurses must assure that patient does not consume any medication without approval fromthe health care professional. Thus at first nurses must assess all the medications and their dosagetaken by George. The medications which contraindicated with patients of CKD, diabetes and2
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