Clinical Reasoning Cycle, Case Study of Reggie

This paper scrutinizes the case of a 42 year old indigenous Australian by the name Reggie who lives in Blackall, central Queensland. Reggie is a family man with a wife and three children and the only breadwinner in the family. According to his medical history, Reggie had been diagnosed with rheumatic heart disease when young and since then has had a degree of compensated heart failure.

Running Head: CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 1
Clinical Reasoning Cycle, Case Study of Reggie
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CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 2
Clinical Reasoning Cycle, Case Study of Reggie
This paper scrutinizes the case of a 42 year old indigenous Australian by the name
Reggie who lives in Blackall, central Queensland. Reggie is a family man with a wife and three
children and the only breadwinner in the family. According to his medical history, Reggie had
been diagnosed with rheumatic heart disease when young and since then has had a degree of
compensated heart failure. The medical examination of Reggie at the Brisbane revealed some
unique body symptoms. First, the examination revealed that Reggie appeared fatigued and
complained of pain when breathing. He also had visible ascites. According to Reggie’s
explanation during the examination session, he had been adding approximately 10-15kg in the
last couple of months. The examination revealed that he had bilateral pitting oedema between her
legs and the knee. His respiratory rate proved to be very high, 28 breaths per minute while her
oxygen saturation on room air was 92%. Auscultation examination indicated that his chest had
some coarse crackles. His blood pressure, on the other hand, was very high 184/75 mmHg
compared to the normal pressure which is 120/80mmHg. Lastly, Reggie complained of a
persistent wound on his hand which had been sustained at work. This paper utilizes the clinical
reasoning cycle to assess the case of Reggie. In addition, the paper triggers various
pathophysiology hypotheses in relation to his overweight and high blood pressure signs and
symptoms.
Overweight is a medical condition characterized by an excessive accumulation of body
fat to the extent of affecting the normal functioning of body organs (Gersing, Solka, Joseph,
Schwaiger, Heilmeier, Feuerriegel & Link, 2016). People are considered to be obese their body
mass index (calculated as body weight divided by the square of a person’s height) exceeds
30kg/m2, while overweight people are those whose body mass index ranges between 25 to

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 3
30kg /m2. From the case study, it has been stated that the weight of Reggie was increasing at a
high rate, 10-15kg for the last three months which was a supernatural weight increase. Research
has linked obesity with various diseases like cancer, depression, cardiovascular disease, and
Type 2 diabetes. Type 2 diabetes is worth considering in this scenario because of some of its
symptoms which have come out clearly in the case study (Gersing et al, 2016). Specifically,
Reggie has been associated with a persistent wound on his hand which had been sustained at
work. The fact that this wound is persistent gives a clue that the obesity condition of Reggie
might have gone to the extent of causing Type 2 diabetes which is closely associated with
persistent wounds.
Commonly, overweight is caused by a combination of factors which must be put into
consideration in order to get an intervention. Among them, it’s excessive food consumption and
lack of physical exercises. Although there are some cases of overweight which have been linked
with genetic susceptibility, they are very few (Tan, Alén, Wiklund, Partinen & Cheng, 2016).
Some research studies have argued that overweight people eat little food and that the weight gain
is as a result of slow metabolism, however, this has not been fully supported because overweight
people are believed to have greater energy expenditure than normal people due to their high
demand for energy to maintain their body mass.
To mitigate the risks of overweight, a combination of personal choices and social changes
are adopted. For instance, dietary changes to avoid foods with high calories and routine
exercising are the main approaches. Foods with high calories are energy-dense foods such as
those with a high level of sugars and fats. Increasing consumption of foods rich in fiber is
advisable to help fight against overweight (Tan et al, 2016). Medications are also advisable along
with diet, especially drugs which reduce the appetite and absorption of fats into the body. In

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 4
cases where exercising, medication and dietary approaches don’t work, surgery or a gastric
balloon is also advisable to reduce the volume of the stomach and the length of the intestines.
This approach makes the victim reduce food intake and the ability of nutrients absorption into
the body.
Another sign and symptom of overweight presented in the case study is the bilateral
pitting oedema on Reggie’s legs. Being overweight reduces the effectiveness of the body
circulation system (Tan et al, 2016). As a result, leg swelling which is as a result of fluid
retention in the leg tissues or oedema is evident. Mainly, the buildup of the fluid in the legs
tissues is as a result of overweight.
There are different nursing interventions which can be put in place to control the
problem of overweight in the case study. Among the main interventions are; Physical activity
intervention, health education intervention, and dietary intervention (Patel, Asch, Rosin, Small,
Bellamy, Heuer & Wesby, 2016). Physical activity intervention draws from the fact that people
become overweight as a result of energy imbalance in their bodies. Mainly this condition results
from the high levels of calories but with too few of them being burned in the body (Al‐Khudairy,
Loveman, Colquitt, Mead, Johnson, Fraser & Azevedo, 2017). Among the determining factors
for the number of calories burned in the body is the activities people engage in every day.
Keeping active helps people lose weight and stay healthy. According to the world health
organization (WHO), adults are supposed to engage in a moderate to vigorous physical activity
for at least two to three hours in a week to reduce the chances of becoming overweight. This is
an independent intervention because it will mainly entail my efforts alone in the implementation.

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 5
To implement physical activity intervention, it will entail choosing the best and suitable
physical activity for Reggie. As an old man, Reggie may not be comfortable with extremely
vigorous activities offered in the gym and hence walking and joking is suitable for him (Wang,
Cadmus-Bertram, Natarajan, White, Madanat, Nichols & Pierce, 2015). The next step in the
implementation process will entail setting a suitable time for her to exercise. From the case
study, Reggie is a working class who may not get free time during working hours (Colquitt,
Loveman, O'Malley, Azevedo, Mead, Al‐Khudairy & Rees, 2016). Exercises will be scheduled
early in the morning before he leaves for a job or late in the evening after the job. Still,
combining the two would be an effective way of reducing his weight in a more efficient way.
Dietary intervention is the second intervention which will enable Reggie to control his
overweight condition. This is an approach which entails restriction on the intake of foods which
contain high levels of calories (Ruotsalainen, Kyngäs, Tammelin & Kääriäinen, 2015). Among
the diets which are advisable under this intervention include low-carbohydrate diet, high protein
diet, low-fat diets, and low glycemic index diets. This intervention will combine the efforts of
different professionals to be implemented. This is in consideration of the fact that the advice on a
diet can be effectively given by a professional in the field, who is a dietician (Ma, Strub, Xiao,
Lavori, Camargo Jr, Wilson & Lv, 2015). Adherence to the dietician advice on a diet may result
in health complications. This will require a nutritionist to handle the case hence must be included
in the implementation process.
The implementation of this intervention will entail a number of steps. First, Reggie will
be interrogated in order to determine his common diets (Samdal, Eide, Barth, Williams &
Meland, 2017). This will enable the team to determine the types of foods which must be avoided.
A dietician will oversee this process because he is a qualified person in the field. In case there

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 6
are diets with side effects on the patient, a nutritionist will advise the patient on the way forward
in dealing with the side effects or alternatives for the proposed diets (Mead, Brown, Rees,
Azevedo, Whittaker, Jones & Beardsmore, 2017).
The effectiveness of these two interventions will be based on weight increase value.
According to the case study, Reggie has been putting on weight on a rate of 10-15 kilograms.
The rate will be expected to decline in order for the two interventions to be marked effective
(Martin, Booth, Laird, Sproule, Reilly & Saunders, 2018).). However, if the rate continues to
increase or remain stagnant, the two interventions will be deemed ineffective. Also, the severity
of the other symptoms associated with overweight is expected to keep on declining. For instance,
the bilateral pitting oedema on his legs will be expected to deteriorate and the visible ascites to
gradually disappear (Cadmus-Bertram, Marcus, Patterson, Parker & Morey, 2015).
The second priority problem with Reggie is high blood pressure. Ideally, the normal
blood pressure for a healthy person should range between 120/80mmHg to 140/90mmHg. This is
the ideal blood pressure for people who have good health. At this level, the risk of heart diseases
or stroke is much lower. However, if the blood pressure goes beyond 120/80mmHg, then the
victim must start taking the necessary steps to bring it down. In simple terms, a person is said to
have high blood pressure or hypertension if the blood pressure is consistently 140/90mmHg or
higher (Anjum, Naveed uz Zafar, Noor, Iqbal, Hyder, Muhammad & Anwar, 2018). A person
may also suffer high blood pressure if one of the units of measurement is higher than it should
be. High blood pressure puts extra strain on the heart as well as vessels. Over time, the extra
strain increases the risks of heart attack or stroke. High blood pressure is also associated with
heart and kidney diseases as well as dementia.

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 7
Suffering from hypertension without frequent visits in the hospital is somehow dangerous
because the victim may not realize whether they are suffering from the condition. In fact,
research has indicated that one-third of hypertension victims don’t realize until they are
examined in the hospital. The only way for a person to know his blood pressure status is through
regular checkups. However, there are some symptoms which can reveal high chances of having
high blood pressure which includes chest pains, irregular heartbeat, severe headache, vision
problems, fatigue, and difficulties when breathing (Anjum et al, 2018)
Although the cause of hypertension has not been identified yet, statistics indicate that
around one in every twenty cases of hypertension is the effect of an underlying condition or
medication. Chronic kidney diseases have been identified as common causes of high blood
pressure because they limit kidney from filtering out fluids (Anjum et al, 2018). There is
however a number of risk factors which are known to increase the chances of hypertension.
Among them is the age, this is because old age makes arteries stiffer and narrower making the
blood pressure increase steadily. The size or body weight is another risk factor, this mainly
entails being obese or overweight. Alcohol and tobacco use is another risk factor. Existing health
conditions such as cardiovascular diseases, heart diseases, high cholesterol levels, chronic kidney
disease, and diabetes can also lead to hypertension, especially old people.
From Reggie’s case, there are several aspects which make him fit in the category of high
blood pressure victims. The first aspect is his blood pressure, 184/75mmHg, which is high above
the normal unit expected for a person with good health, 120/80mmHg. The case study has also
revealed that Reggie always appears fatigued, a symptom which has been listed among the main
symptoms of hypertension. Moving forward, the case study has indicated that Reggie complains
of pain on inspiration, compared to the pathophysiology on hypertension above, this can be

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 8
mapped under the symptom of breathing difficulties (Lurbe, Agabiti-Rosei, Cruickshank,
Dominiczak, Erdine, Hirth & Rascher, 2016). According to the case study description, Reggie’s
chest has coarse crackles which are also a symptom listed under the main symptoms of
hypertension. Heart diseases have been listed among the risk factors for people with
hypertension. This fact can also be used to affirm that Reggie might be suffering from high blood
pressure considering that he had rheumatic heart disease when young (Lurbe et al, 2016)
Two approaches will be implemented in this case to intervene in the case of Reggie. The
first approach will be an education intervention while the other one will be a medical
intervention. Under the education intervention aspect, Reggie’s condition will be managed
entirely by the primary care team which will include health professionals like pharmacists,
physicians and other allied professionals like physiotherapists, who work in cardiac rehabilitation
centers (Saleem, Hassali, Shafie, Ul Haq, Farooqui, Aljadhay & Ahmad, 2015). All the
professionals will play a potentially important role in controlling blood pressure. This is because
Reggie will be able to understand the benefits of managing his blood pressure right from the
experts who will tackle any questions he might have.
A study by Machado, Lima, Laureano, Silva, Tardin, Reis & D'Artibale (2016) revealed
that educational interventions promoted the level of understanding and knowledge of
hypertension for all the participants. It also had notable positive impacts on their beliefs about
hypertension medicines. In this case, the educational intervention will create an opportunity for
Reggie to understand his condition and the role of different therapies (Fletcher, Hartmann-
Boyce, Hinton & McManus, 2015). This intervention will also heighten his awareness about
disease complications as well as progression. Through this intervention, some of the
misconceptions which he might have about the treatment of hypertension will be clarified

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE 9
(Amutio, Martínez-Taboada, Delgado, Hermosilla & Mozaz, 2015). This will play a major role
in promoting his adherence on prescribed therapies and therefore lead to an improvement in his
blood pressure control measures.
The implementation of this intervention will entail some steps. First, the opinions of the
patient about the condition will be collected. This will help the team to understand any beliefs or
misconceptions he might have regarding the control measures of hypertension (Kaeppler,
Eastwood, Laud & Whittle, 2018). Also, the team will set an awareness program which will
entail enlightening the patient on control measures of the condition like the benefits of adopting a
healthy diet and medication approaches. Drinks like alcohol which might be worsening the
condition of the patient will be addressed as a control measure. Lastly, the change of the lifestyle
and its role in managing the condition will be addressed (Cappuccio & Miller, 2016).
Medical intervention will be used as the second intervention in the case of Reggie. Some
of the medications to be prescribed to lower and control the high blood pressure condition will
include thiazide diuretics, angiotensin-converting enzyme inhibitors (ACE), angiotensin ii
receptor blockers (ARBs) and calcium channel blockers (Conn, Ruppar, Chase, Enriquez &
Cooper, 2015). Thiazide diuretics which are sometimes called water pills will act on the kidneys
to help his body to eliminate sodium and water hence reducing the blood volume. The ACE
inhibitors will help relax the victim’s blood vessels by blocking the formation of natural
chemicals which narrow blood vessels (Hedegaard, Kjeldsen, Pottegård, Henriksen,
Lambrechtsen, Hangaard & Hallas, 2015). The ARBs, on the other hand, will help in relaxing the
blood vessels by blocking the actions of the natural chemicals which narrow blood vessels.
Lastly, the channel blockers will help relax blood vessel muscles and slow the heart rate
(Vrijens, Antoniou, Burnier, de la Sierra & Volpe, 2017).

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE
10
To evaluate the two interventions, data will be collected after every two weeks and then
compared with the original statistic. Reduced blood pressure will be an indication that the
interventions are working as expected whereas an increase in the original blood pressure.
Similarly, if there is no observable change in the blood pressure it will be an indication that the
interventions are ineffective (Conn, Enriquez, Ruppar & Chan, 2016). Also, the severity of other
symptoms like the respiratory rate, chest complications, and inspiration pains will be expected to
continue declining. In case they remain the same, the interventions will be deemed ineffective.
In summary, this paper has scrutinized the case of Reggie whose health status has
revealed several issues such as abnormal blood pressure, respiratory rates, abnormal weight
increase, and breathing difficulties. From these issues, two priority issues have been identified,
which are overweight and high blood pressure. As prove that Reggie is facing the two problems
identified, the pathophysiology of the two health conditions was mapped in reference to the
symptoms outlined in the case study. Nursing interventions to control the two problems have
also been proposed. For instance, to deal with the overweight problem, involvement in physical
activities and dietary interventions has been proposed. In consideration of high blood pressure,
patient education and medication interventions have been proposed.

CLINICAL REASONING CYCLE, CASE STUDY OF REGGIE
11
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