Clinical Reasoning Cycle: A Case Study of Candace Evans

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:-