Clinical Reasoning Cycle: A Case Study of Candace Evans

This article discusses the clinical reasoning cycle used by healthcare professionals to collect cues of the patients, work with the information, understand the situations or patient's problems, make and implement intervention plans, evaluate outcomes, reflect on the process as well as learn from the process. The case study of Candace Evans is based on the clinical reasoning cycle to understand the patient, condition and the effectiveness and outcome of clinical reasoning on the patient.

Introduction
Clinical reasoning is used byhealthcare professionals to collect cues of the patients,
work with the information, understand the situations or patient's problems, make and
implement intervention plans, evaluate outcomes, reflect on the process as well as
learn from the process. Clinical reasoning is most important in the healthcare setting,
especially for the critical patients who are suffering from complicated health issues.
The acute patients are more likely to become seriously ill during their stay in the
hospital (Hegde, 2016). Hence, the presence of effective clinical reasoning among
the healthcare practitioners is essential so that they can be able to provide effective
healthcare services in order toachieve positive patient outcomes. The clinical
reasoning process is largely reliant on the critical thinking characteristic of the
healthcare professionals. Furthermore, the clinical thinking is usually influenced by
an individual's attitude, philosophical point of views, and preconceptions (Bucknall et
al., 2010). The case study of Candace Evans is based on the clinical reasoningcycle
to understand the patient, condition and the effectiveness and outcome of clinical
reasoning on the patient.
Content
Consideration of the fact from the patient or situation
The case study is focussed on issues related to the birth of Candace Evans son born
via caesarean section at 38 weeks gestation. The pre-operative nursing assessment
shows Mrs Evans a 42 year old lady has a past history of gestational diabetes with
her first pregnancy 5 years ago, depression, anxiety and post-natal depression is
also identified (Brenes, Divers, Miller & Danhauer, 2018).The current situation of Mrs
Evans shows there has been no reoccurrence of gestational diabetes though
Candace has been diagnosed withplacenta previa in where the cervix is usually
partially or completely covered by the placenta of the baby (Mangoni & Ruxton,
2016).The admission to PACU (Post Anaesthetic Recovery Room) assessment of
intra-operative blood loss was found to be about 150ml. Candace was given a spinal
anaesthesia perioperatively which after assessment is identified to be about a T3
dermatome level, pain is found to be zero out of ten and the lower uterine dressing
found intact and dry. Apart from this, the in-dwelling catheter with about 100ml of
rose coloured urine is seen which is found and also the intravenous therapy of

oxytocin in CSL is depicted to be carried out at running 250mL/ hour (Jayadevappa,
2017). Apart from this, the inspection of the vaginal blood loss is assessed, blood
clots noted and pad were found to be soaked.
Collection of information
The gathering of the information of the patient is made by the help of the regular
check up data and the medication processes carried out by the healthcare
professionals. The problems and the identification of the needs of the patients are
made which are illustrated in the Facts Form of the patient Candace Evans (Hurni,
2017). The patient history is gathered from the medical records while the patient was
admitted to the emergency. Therefore, the record of the patient is being tracked for
the purpose of analysing the data.
Processing gathered information (Analysing and interpreting)
From the case study, it is understood that a 42-year woman has gone through an
elective lower uterine caesarean section (LUCS) for giving birth to her child at 38
weeks of gestation. The whole procedure has been carried out after giving spinal
anaesthesia to the women. As the women are in her middle age (42 years old)
normally she has faced difficulties. It is evident that after 35 years the women face
various difficulties during the pregnancy, baby birth and after delivery of the baby.
Hence, for Candace Evans, it is normal that she is suffering from severe issues like
Placenta Previa. The case study provides the information that the patient has
Placenta Previa in where the patient's cervix is usually partially or completely
covered by the placenta of the baby (Mangoni& Ruxton, 2016). Hence, the channel
for the delivery of the baby uses to be blocked and so the patient may experience
severe blood loss throughout her pregnancy and during her delivery. The patient of
the case study Candace Evans had Placenta Previa and for this particular reason,
she has loss approximated 150ml intraoperative blood which is a severe problem in
this case. Because the losses of the huge amount of blood may be harmful to the
patient and it may serious for her life (Gelderina, 2017).
Apart from this, from the past history of the patient, it is known that it is her second
baby birth and her first baby birth was before 5 years ago with the caesarean
process. That time she was suffering from gestational diabetes but presently she is
free from gestational diabetes. Hence, it is a positive sign for her. From her past

history, it is also recognized that before she was suffering from depression, anxiety,
post-natal depression etc. Hence, it is possible that in this time also she may be
affected by these issues and the healthcare service providers or nurse must take
care of these issues (Viswanath & Jose, 2014).
The examination of the post anaesthetic recovery room (PACU), it is observed that
the dermatome level of the patient is T3, which is abnormal and it is required to be
T4. Hence, it is a problem for the patient so the nurse must take care of the patient.
Besides this, the pain is 0/10, which is also excessive as 10 is the most severe pain
from that suffers the patient. Hence, the nurse has to take care of reducing the pain
of the patient (Tanimura, 2017).
Besides this, it is observed that indwelling catheter there is 10 ml of rose coloured
urine, it means she remains bleeds and the bleeding should be stopped immediately
as she has already lost the huge amount of blood. The Oxytocin has been
administrated to the patient for recovering the wound of the patient. Her other signs
are mostly normal and only heart rate 88 and Temperature of her body 36.9 0 Celsius
are abnormal and the nurse must take care of these. The body temperature is
normal as after baby birth the patient usually suffers from fever (Plewnia, Bengel &
Körner, 2016).
Lastly, the vaginal pad of the patient has been soaked with frank blood and blood
clots which indicate that the patient still bleeds and the blood clot is often dangerous
as it can affect the lungs of the patient. Hence, the nurse should take care of these.
Identify the problem
Firstly, the problem of bleeding is identified which is found from the blood clot
present in the soaking vaginal pads. Secondly, the urine is found to be Rose-
coloured which is indicating the reason for the development of the trauma of catheter
insertion. The monitoring of this problem is essential as it will create impact on the
patient (Tourigny, 2016). Thirdly, the degradation of the dermatome level is seen as
it is found to be creating impact on the breathing problem which is essential for being
reduced.
Establish goals
The goals that are established for the identified problems are depicted to be provided
in the following points:-

 To monitor the blood circulation as the blood is found to be coming out with
the urine and due to this reason, the removal of the bleeding problem is
essential.
 To remove the blood clot that is found at the vagina and for this reason, the
minor operation is essential (Peters, Lisy, Riitano, Jordan & Aromataris,
2015).
 To increase the dermatome level to T4 as it is found to be below the
determined level during the period of pregnancy.
Take action
The actions undertaken for the purpose of achieving the goals are depicted to be
provided in the following points:-
 The operation must be undertaken for the purpose of mitigating the issue of
blood circulation and blood clot. The integration of the operating activities
must be made with keeping the blood pressure at the normal level and also
the temperature of the body must be maintained at normal (Yorke, 2017).
 The monitoring of the blood circulation process is essential since the damage
of the catheter is seen. The symptom found is depicted to be rose coloured
urine which is indicating that the operation of the catheter is essential for the
purpose of removing this issue (Lao & Sahota, 2015).
 The increase in the dermatome level is essential as it will enable the
achievement of the goals in an appropriate way. The overall activities can be
easily made by which the appropriate achievement of the treatment process
can be easily made (Bucknall et al., 2010).
As per the case study is undertaken, the achievement of the goals are essentials as
per the determined actions. It will enable the patient to gain an appropriate life with
the removal of these problems.
Evaluation and reflection
According to my analysis, it is found to be reflecting the comprehensive functions
which are indicating the effectiveness of the nursing care and the interventions. The
implementation of the care processes accounted in this study is depicted to be
impacting the processes as it is creating the effectiveness of the research. The
unique contribution of the nursing processes reflected by me is found to be

illustrating the contribution of the real world practices. The appropriate discussions
provided by me are depicted to be reflecting the actions undertaken for the Candace
Evans for the purpose of carrying out the treatment processes (Rose, 2017). Thus, it
is being reflected by me as the study is undertaken.
Conclusion
The overall explanation is providing the in-depth case analysis of the Candace
Evans which is related to the perioperative process. The patient is appropriately
diagnosed with proper medications and the treatments for the problems identified in
this study. The proper explanation to the problems and the other necessary
processes such as action is undertaken and the evaluations of the problems are
analysed in this study. Thus, the study is providing an in-depth analysis of the case
facts as identified in this study. The characteristics and the development of the
analysis of the gathered facts are depicted to be provided in this study. The study is
also reflecting the steps that will be undertaken in this study and also it is found
reflecting the facts gathered from the medical records of Candace Evans. The
analysis is depicted to be focusing on the basis of the problem faced by the Candace
Evans which is indicating the processes for mitigating the problem of Placenta
Previa.

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