Clinical Reasoning Assignment

This Clinical Reasoning Assignment revolves around an 82-year-old patient named John, who was admitted to the hospital after having an accident. The assignment explains the process of clinical reasoning cycle and how it is used to evaluate the actual cause of the patient’s condition and helps in providing appropriate intervention.

Running Head: CLINICAL REASONING ASSIGNMENT
CLINICAL REASONING ASSIGNMENT
Name of the student;
Name of the university:
Author note:

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CLINICAL REASONING ASSIGNMENT
Consider the patient situation:
The assignment revolves around an 82-year-old patient named John, who was admitted to
the hospital after having an accident. John lives on the rural side of the country with his wife; he
was taken to the hospital by his son Sam. After having an accident, john behaviour has changed;
he becomes quiet from before and also has not completed his dinner. By interviewing the patient,
it can be understood that before accident, john became unbalanced and fell on the ground by
striking the left side of his head hard on the ground. John confirms that he has sustained a slight
skin tear and abrasion on the left elbow and left forearm respectively. Apart from that, he had not
received any other physical injury and also denied pain or stiffness.
The chief complaints observed in the case of john include loss of appetite, fatigue,
nausea and headache. By following the case study of the john, it is noted that there are two risk
factors that can be responsible for his current mental state, one is hypertension, and the other is
brain injury due to accident. As the patient has a previous clinical history of hypertension but
does not intake any hypertensive medication for its management, it can be responsible for the
primary complaints (Palagini et al. 2016). Another risk factor which can be accountable is brain
injury due to the accident. As in the case, headache, confusion, nausea, dizziness, loss of appetite
and fatigue is observed as symptoms.
Collect cues and information:
It is the subsequent step of clinical reasoning cycle, where all the significant information
regarding the patient is collected to formulate an effective care plan (Ryan et al. 2018). At first
the subjective and objective clinical data of the patient were collected (Hunter and Arthur 2016).

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CLINICAL REASONING ASSIGNMENT
The subject data is referred to as the data which were directly obtained from the patient as
symptoms and the objective evidence is collected by conducting a vital assessment of the patient
(Rosbach and Andersen 2017) The subjective data include, headache, confusion, nausea,
dizziness, loss of appetite and fatigue and the objective data includes, body temperature, pulse
rate, blood pressure, respiratory rate, oxygen saturation, pain score, level of consciousness.
The body temperature of the patient is recorded as 37 degree Celsius, which is the
average body temperature and hence should not be worried about. The standard pulse rate of a
healthy individual is between sixty to a hundred beats per minute, and the recorded pulse rate of
the patients is 81 beats per minute which is within the normal range. The respiratory rate of
patient is noted as 17 breaths per minute which is also in the normal range (standard pulse rate-
12 to 29 breaths per minute in healthy individual) (Cardona-Morrell et al. 2016). The average
oxygen saturation level is considered to be above 95%, and the oxygen saturation level of the
patient is 97% and hence is normal. The blood pressure of the patients is recorded as 148/84,
which is higher than that of the normal blood pressure range (120/80) (Lambe, Currey and
Considine 2016.). As the patient has sustained several injuries, pain assessment is also conducted
to deduce the pain score of the patient (Williams. and Craig 2016). From the pain assessment, it
is observed that the pain score of john is 4/10, which indicates the patient us suffering from a
moderate amount of pain.
Apart from this, other assessments are also conducted in case of john to evaluate the level
of additional injury. From the subjective data, it is observed that the patient is also feeling
confused and unconscious; hence glass coma scale assessment is conducted to determine the
level of consciousness of the patient (Reith et al. 2017). The glass coma scale is the most
common method used by the healthcare care staff to assess the level of consciousness of the

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CLINICAL REASONING ASSIGNMENT
patient suffering from any brain injury. The result is then categorised between 3 to 15, 3
determines poor motor response of the patients, and if the GSW score of the patient is 15, it
means the patient has high level of consciousness and along with that, have high verbal, eye and
other motor response. As the patient recently had an accident, hence the glass coma scale
assessment is necessary to evaluate the motor response of the patient.
During the accident, patient has received several injuries on his left forearm and shoulder.
According to the patient, apart from these, had not received any physics, but as during the
accident patient was not wearing helmet and had stroked his left side of the head hard on the
ground, which indicates that there is a possible chance any internal brain injury. To evaluate that,
the patient is performed with PERRLA test. The PERRLA test or pupillary response rest aids in
the evaluation of any internal cranial injury by observations the dilation of pupil (Vidyashree and
Rathi 2018).
The patient got hit on the left side of the brain during the accident and as the left
hemisphere of brain is responsible for the cognitive function of the body. Thus there are chances
of cognitive impairments in the patient which can be assessed by the aid of cognitive test. This
test helps to evaluate the balance, posture and coordination of the body. All the vital assessment
is conducted on a regular basis for the appropriate observation of the patient’s mental and
physical health condition (Duty et al. 2016).
Process the information:
This is the 3rd step of clinical reasoning cycle where all the gathered data is processed to
evaluate the actual cause of the patient’s condition and helps in providing appropriate
intervention (Thomas et al. 2016).

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CLINICAL REASONING ASSIGNMENT
The major problem observed after conducting the vital assessment of the patient is high
blood pressure. The blood pressure of the patient is recorded to 148/84, which is much better
than the normal range and instead of that patient does not take any hypertensive medication. In
the case of patient sufferings from high blood pressure, the artery becomes narrow which
decreases the flow of the blood to the arteries from the heart. Hence, the heart has to work hard
to pump the blood into the arteries, and as a result the heart requires more oxygen to perform the
work which was not provided to heart and give rise to fatigue (Mollan et al. 2016). It also
upsurges the risk of cardiovascular infection in the patient. As per the study conducted by Banks
et al. (2016), high blood pressure affects the blood-brain barrier which exerts an extra load on the
brain, giving rise to headache. Other chief complaints such as, loss of appetite, nausea and
dizziness of the patient are also due to the high blood pressure of the patient as suddenly
developed vomiting can lead to dizziness and loss of balance and coordination, which is also
considered as the risk factor of heart stroke (Heath 2016).
The patient is also observed to be in the moderate pain, which is due to the skin injury
and the abrasion which the patient has received during the accident. The patient is also
experiencing loss of consciousness which might be due to damage on left side of brain or due to
hypertension. Therefore, by processing the above information, it can be concluded that the
primary concern in the patient is hypertension.

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CLINICAL REASONING ASSIGNMENT
References:
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Palagini, L., Bruno, R.M., Cheng, P., Mauri, M., Taddei, S., Ghiadoni, L., Drake, C.L. and
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