Clinical Reasoning Cycle for Managing Post-Operative Complications in a Caesarean Section Patient

This essay discusses the case study of Candace Evans, a caesarean section patient with post-operative complications. It explores three care priorities identified for her recovery: in-dwelling catheter with 100ml of rose coloured urine, vaginal blood loss, and blood clot. The essay justifies the identified priorities using the Levett-Jones clinical reasoning cycle and suggests interventions based on evidence-based practice. The essay also emphasizes the importance of involving the patient and midwifery in setting goals and objectives for the best possible outcomes.

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Assessment task 2
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Introduction
Nurses with active clinical reasoning have an affirmative influence on patient results; on
the contrary, those with destitute clinical reasoning will frequently flop to discover imminent
patient worsening. Faults in decision making and judgment are recognised to version for more
than half of unreceptive clinical actions (Schug, Palmer, Scott, Halliwell & Trinca, 2015).
Clinical reasoning is a learning skill requiring active engagement and determination in deliberate
practice as well as reflection, specifically on activities designed to advance performance. This
essay will concentrate on the given case study on Candace Evans, a 42 years old woman with an
elective lower uterine caesarean section under spinal anesthesia. The paper will then explore
through three care priorities identified in Candace’s scenario: her in-dwelling catheter with
100ml of rose coloured urine, vaginal blood loss and the blood clot. The identified three prime
priorities will be examined and justified using Levett-Jones clinical reasoning cycle through
executed inventions and to assist nurses to attain those objectives which lead to the finest
conceivable results of the patients.
Properly managed recovery steps can avert symptoms associated with the caesarian
section (Neal et al., 2010). Candace is presented to the recovery room with vaginal blood loss
and some clots as well as an in-dwelling catheter with 100ml of rose coloured urine. The past
history of the patient includes gestational diabetes with her first pregnancy five years down the
line, which resolved following the birth with no recurrence in this pregnancy, anxiety, depression
or post-natal depression. There is clear evidence that Candace suffered from complications as a
result of operations. It is normal for women to lose lochia after birth until the wombs renew its
lining. Following Candace’s caesarean operation, she is given intravenous therapy of oxytocin
in CSL running at 250m/L/hour. This will encourage the uterus to contract, assisting it to shrink

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back to its normal size and reduce blood loss (Baaqeel & Baaqeel, 2013). Blood normally flows
quickly and uninterrupted through veins. But, sometimes, the clot can form that either reduce the
blood flows or stops it completely. A deep vein thrombosis is a blood clot in vein usually pelvis
or leg, and its common cause is immobility during surgery (Stephens & Bruessel, 2012).
Candace shows vaginal blood loss and the patients also display vaginal pad soaked with franks
blood and some clots. Therefore, perioperative and recovery nurses can use their critical
reasoning capabilities in executing approaches in managing intricate care and take full advantage
of the aids for patients by lessening risks elements connected with multifaceted health concerns.
Perioperative caregivers use evidence-based practice to advance the physical wellbeing
and uphold the blood count for the Candace by affecting various tactics and setting desired goals
(Pant, Fong & Scavone, 2014). For me to realize those goals, I must work closely with her and
midwifery for the best promising results. Patient life can be upgraded by using patient learning
after an operation which will enable the patient and midwifery gain more knowledge and skills in
her compelling conditions. The anesthetic may make one feel sick. Thus, a drip going into her
veins will make sure enough fluid when she is not able to drink. While the patient is drinking
enough fluid and no longer feels sick, then, the drip will be removed and I will tell her to start
eating. After two to three days, if the patient will have problems with bowel, I can give medicine
to open her bowels. It will be helpful for the patient to drink a lot of fluid, eat a high fibre diet
such as fruit, wholemeal or granary bread, cereals and vegetables (Torloni et al., 2011). To
improve the blood circulation and prevent further blood clots from developing, I will encourage
the patients to walk with the compression boots to improve the circulation. However, the first
day, I will encourage sit out of bed in her chair, even if it is for short period. I will encourage
resting, however, it is crucial to start exercise as soon as possible. As a result of vagina bleeding,

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I will advise the patient to use sanitary towels instead of tampons as this may increase the risk of
infection. I will discuss with patients and midwifery on the issues she should check after
returning home. If the bleeding becomes heavy or once she notices a smelly discharge, she
should see the GP for a check. Therefore, health care providers can offer means related to diet
and education on diet regulation and workout. Realistic goals can be established for vaginal
bleeding. Exercise chart and diet plan could be implemented for the recovery of patients.
It is important to assess the efficacy of the approaches used and to ascertain whether the
probable result is realised or not. For this purposes, will use diverse tools and resources to
appraise patient’s improvement. In Candace’s case, the nurse can use diet controlling plan and
discuss it with midwifery and patient herself to see how changing the lifestyle will affect her
recovery position. Body mass index is important gears in measuring the body weight before and
after recovery to assess the effectiveness of the exercise and diet plan. Therefore, the above
evaluation will back Candace to preserve the dynamic lifestyle and support her to use the idea in
further managing of operation in future.
As earlier discussed, Candace was also diagnosed with the vaginal bleeding as a result of
the operation. Literature suggests that it is normal to lose lochia. However following the
caesarian one will be given a drug which is a synthetic version of the naturally occurring
oxytocin (Butwick, Coleman, Cohen, Riley & Carvalho, 2010). Therefore, lowering the blood
bleeding is a prime priority which ultimately improves the health of patient for quick recovery.
Reduced blood bleeding will assist the patient to do a light workout and allow her to execute
daily doings with a positive influence on her self-esteem and avert her historical postnatal
depression and anxiety symptoms.

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For the reduction in vaginal bleeding, nurses should implement an invention based on
evidence-based practice. Nurses can use pharmacological and non-pharmacological invention
after putting into deliberation the patient needs and maximization of benefit. Non-pharmacology
treatment involves using the sanitary towels. Also, management of hemorrhage should be a
multi-disciplinary effort. Major obstetric hemorrhage can become fatal very quickly and
experienced clinician should be involved as soon as possible (Lie & Mok, 2017). To prevent the
primary major of PPH, involving supportive therapy with airway control and supplemental
oxygen is important. Non-pharmacological may include mechanical maneuvers to raise the
bimanual compression, uterine tone and artery ligation. Pharmacological means predominantly
uterotonic drugs and correction of coagulation-deficient (Rosales-Ortiz et al., 2014).
The assessment of the used invention is important to recognize the effectiveness of the
applied approaches in the controlling of the complex state. The nurses can use a pulse oximeter
to measure the oxygen saturation in the Candace body. The data will enable the nurses to
identify the effectiveness of the breathing exercise (Mushambi et al., 2015).
Another priority is the rose colour urine in the patient, likely as a cause of the presence of
the haemoglobin in the urine. A simple examination can show if the rose colour is from
hematuria, the medical word for the blood in urine. “Urine can also turn rose if it contains
myoglobin, an oxygen-binding protein in muscle cells that is similar to the hemoglobin found in
the red blood cells” (Torloni et al., 2011). Due to the interference with the urinary system, it can
allow blood get into the urine. Therefore, one will be encouraged to drink plenty of fluids which
will dilute out the blood so that it does not clot off the catheter and which will encourage the
cessation of bleeding (Toth, 2014).

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Personal reflection
The life experience in the recovery room is crucial to my future career, as I was able to
acknowledge that potentials according to the nurses, comprises of recognising the relatives as a
resource in the practical nutritional care offered. Perceiving health education as prime from
nutritional problems and physical inactivity viewpoint was identified as a potential for the
healthcare to offer good nutrition and physical activity. I now understand that relatives or
midwifery are always the ones who influence the patients much as they spend quite long with
them; so it is important to involve them in any decision making. I also came to realise that my
work is also influenced by the style and manner of communication with other healthcare
providers. It is affected if the patient would not cooperate and where there were difficulties in
understanding each other. I now understand recovery is a time-consuming process, which can
leave patients feeling tired, emotionally tearful or low. This frequently happens during the early
days and is a normal reaction. Patient’s body needs time and energy to build new cells and repair
itself. I think I did a recommendable job but next time I should be prepared for the big task as the
complex scenario can happen in future.
Conclusion
Vaginal bleeding, clotting and rose coloured urine are three priorities to sustain
Candace’s multifaceted care help. Evidence-based practice permits the nurses to reason
critically by pinpointing the concerns and use of intervention according to the best possible
outcomes for the patient. Critically analysing the patient situation, an involvement of patient and
midwifery in setting up the goals and objective is of the essence for the victory of the
implemented strategies. Observing ethical in the service provider is also vital. Both verbal and

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written information was given about the voluntary participation. The patient was also guaranteed
confidentiality (Broaddus & Chandrasekhar, 2011). For instance, I was able to pull the curtains
to inspect for the vaginal blood loss. The above illustrates ensuring the self-esteem of a patient is
upheld as well as considering the privacy of the patient is intact. Finally, evaluation and personal
reflection are essential to decide the success of the intervention and let the healthcare provider
use various treatment options for the best outcomes. Thus, by using the critical responsibilities
leant, health caregivers can give the best care to Candice.

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References
Baaqeel, H., & Baaqeel, R. (2013). Timing of administration of prophylactic antibiotics for
caesarean section: a systematic review and meta‐analysis. BJOG: An International
Journal of Obstetrics & Gynaecology, 120(6), 661-669.
Broaddus, B. M., & Chandrasekhar, S. (2011). Informed consent in obstetric
anesthesia. Anesthesia & Analgesia, 112(4), 912-915.
Butwick, A. J., Coleman, L., Cohen, S. E., Riley, E. T., & Carvalho, B. (2010). Minimum
effective bolus dose of oxytocin during elective Caesarean delivery. British journal of
anaesthesia, 104(3), 338-343.
Lie, S. A., & Mok, M. U. S. (2017). Peri-operative management of caesarean section for the
occasional obstetric anaesthetist–an aide memoire. Proceedings of Singapore
Healthcare, 26(3), 180-188.
Mushambi, M. C., Kinsella, S. M., Popat, M., Swales, H., Ramaswamy, K. K., Winton, A. L., &
Quinn, A. C. (2015). Obstetric Anaesthetists' Association and Difficult Airway Society
guidelines for the management of difficult and failed tracheal intubation in
obstetrics. Anaesthesia, 70(11), 1286-1306.
Neal, J. M., Bernards, C. M., Butterworth IV, J. F., Di Gregorio, G., Drasner, K., Hejtmanek, M.
R., ... & Weinberg, G. L. (2010). ASRA practice advisory on local anesthetic systemic
toxicity. Regional anesthesia and pain medicine, 35(2), 152-161.
Pant, M., Fong, R., & Scavone, B. (2014). Prevention of peri-induction hypertension in
preeclamptic patients: a focused review. Anesthesia & Analgesia, 119(6), 1350-1356.

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Rosales-Ortiz, S., Aguado, R. P., Hernandez, R. S., Castorena, M., Cristobal, F. L., González, M.
C., ... & Coomarasamy, A. (2014). Carbetocin versus oxytocin for prevention of
postpartum haemorrhage: a randomised controlled trial. The Lancet, 383, S51.
Schug, S. A., Palmer, G. M., Scott, D. A., Halliwell, R., & Trinca, J. (2015). Acute pain
management: scientific evidence. Acute Pain Management: Scientific Evidence, lxiv.pp.
647.
Stephens, L. C., & Bruessel, T. (2012). Systematic review of oxytocin dosing at caesarean
section. Anaesthesia and intensive care, 40(2), 247-252
Torloni, M. R., Betran, A. P., Souza, J. P., Widmer, M., Allen, T., Gulmezoglu, M., & Merialdi,
M. (2011). Classifications for cesarean section: a systematic review. PloS one, 6(1),
e14566.
Toth, C. (2014). Pregabalin: latest safety evidence and clinical implications for the
management of neuropathic pain. Therapeutic Advances in Drug Safety, 5(1), 38-56.
doi:10.1177/2042098613505614