Clinical Judgement and Reasoning: A Case Study on Asthma Patient Lucy

Running head: CLINICAL JUDGEMENT AND REASONING
Assessment Task 2
Name of the Student
Name of the University
Author Note

1CLINICAL JUDGEMENT AND REASONING
Clinical reasoning refers to the process by which healthcare professionals and nurses are
involved in collecting cues, processing patient information, and gaining a deeper understanding
of the situation or patient condition. This is generally followed by formulating an effective care
plan and implementing the decided interventions (Delany & Golding 2014, p.20). An evaluation
of the outcomes and reflection from the entire process helps in enhancing patient safety. This
assignment will discuss a clinical reasoning cycle, in relation to a case study of Lucy, a 32 year
old patient suffering from asthma.
Sequence of proposed assessment
The patient Lucy has been suffering from asthma since her childhood, and recently works
as a cleaner at a private aged care facility. Although daily inhalation of beclomethasone has
helped in reducing severity of her asthma conditions, she is currently facing several problems
that have led to the occurrence of respiratory distress and dyspnoea. With the aim of collecting
information about the patient and formulating an appropriate care plan, her context and situation
will be initially considered, followed by collecting information about all the vital cues, which in
turn will facilitate patient assessment. Gaining a deeper understanding about her social
background and the community in which she lives, is integral to the process of clinical
reasoning, as it will provide exhaustive information on the risk factors that might have increased
her susceptibility to the disease (Shaban 2015, p.5). Moreover, there is a need to record
appropriate information about the medical history of Lucy, and the crucial role that her social
and cultural life might have played on the onset of asthmatic symptoms (Chawla & Davis 2013,
p.661). Conducting an exhaustive review of her family history is essential, due to the fact that the
patient suffers from asthma since her childhood. Assessment of family history is also needed
because her father also suffered from asthma, and died at 40 years of age. Moreover, asthma has

2CLINICAL JUDGEMENT AND REASONING
also been recognised as one of the diseases that are common in higher social classes ( Stephens &
Townsend 2013, p.129). This can be correlated with a need to investigate her social background.
Initially, a vital signs assessment will be conducted to note abnormalities in the temperature,
respiration rate, pulse rate, and blood pressure.
Any deviation from the normal ranges would indicate the state of Lucy's essential body
functions (Storm‐Versloot et al. 2014, p.41). This can be directly be correlated with her
presenting symptoms of dyspnoea, tightness in the chest and wheezing cough. Hence, conduction
of an assessment of the major vital signs, will act as an evidence for presence of any respiratory
difficulties. This assessment will also help in gaining a deeper understanding of the underlined
pathophysiology that might have led to obstruction and inflammation of the airways, and
subsequent development of asthma. This will also be followed by conducting a respiratory
assessment that will involve counting the breathing rate of the patient, followed by auscultation,
where sounds from the lungs and heart will be heard by a stethoscope.
Questions that inform the proposed assessment
Most medical encounters often combine health promotion and problem oriented
approaches, in order to extract answers from the patients that display their hidden concerns,
about specific health abnormalities or symptoms. At times, it is necessary for noting down
exactly what the patient intends to mean by particular statements. Hence, formulating appropriate
questions, while maintaining the privacy and dignity of the patients, is imperative in clinical
assessment (Lin, Watson & Tsai 2013, p.169). All forms of data related to the patient history
form a crucial aspect of health assessment, since they facilitate the process of obtaining
information about previous allergy, illness or any surgeries that have been conducted on the

3CLINICAL JUDGEMENT AND REASONING
patients. This is turn facilitates nurses and other healthcare professionals to understand about
probable risk factors that might have contributed to development of certain symptoms in the
patient. Hence, identification of the patient history is considered of utmost importance, and a
major priority while delivering optimal health care services (Frank, Basch & Selby 2014,
p.1513). With the aim of collecting relevant information that pertain to patient history,
developing appropriate communication skills is necessary. These skills initiate a patient centred
communication that provides assistance to understand and illicit the perspectives of the patient,
which includes their ideas, expectations, concerns, feelings, needs, and functioning (White &
Danis 2013, p.2325). Patient centred communication also helps to understand the unique cultural
and psychosocial aspects of the patients, and also facilitates the process of reaching a shared
understanding of the problems and treatment practices that will confirm with the values and
beliefs.
An initial establishment of rapport is followed by asking questions that relate to the
patient history, such as, “have you been diagnosed with any other illness since childhood, apart
from asthma?”, or, “did you undergo any major surgery ever?”, or “do you have allergies
towards any medication, food or external agents?”. Questions that relate to presence of pets or
close contact with pet dander and hair will also be formulated. This can be correlated to the fact
that exposure to pet dander have often been found to increase risks of asthma. Other questions
will focus on past medications such as, “do you remember the medicines that you used to take in
childhood for asthma?”, or “what medicines are you currently on?”. Questions related to social
background and family history will also be asked for obtaining a positive diagnosis of asthmatic
symptoms. Responses to these questions will facilitate the formation of a close association