Clinical Reasoning Cycle for Hypovolemia, Dehydration and Hypotension

Running Header: CLINICAL REASONING CYCLE. 1
CLINICAL REASONING CYCLE.
STUDENT’S NAME
INSTITUTIONAL AFFILIATION
COURSE NAME
DATE.

CLINICAL REASONING CYCLE 2
Introduction
Clinical reasoning cycle in the healthcare setting is of importance as it facilitates
provision of quality and safe care. The reasoning cycle is helpful in making decisions in the
clinical areas as it facilitates positive outcomes. It has eight steps, that aims at guiding and
facilitating the both the student nurse and nurses in formulating the most appropriate and positive
decision in the clinical area. This essay will identify the steps of CRC and the clinical decision
made in regards to the patient’s/client’s hypovolemia, dehydration and hypotension condition.
Consider the Patient
The first step in the reasoning cycle, is assessing the patient holistically so as to come up
with the most beneficial outcome. Mrs. X a 67 years old female client was admitted to medical-
surgical ward on day one post operatively following partial colectomy. Her condition was stable
during the surgery, vital signs were normal but after transfers to medical ward she experienced
light headache, dry mouth and her condition deteriorated.
Collect clues/information
The second stage of CRC is collecting the most relevant information about the patient’s
condition. The information that is currently available; handover report, clinical documentation,
patient’s medical and social history are reviewed. The nurse then identifies the additional
information through assessing the vital signs and other health assessment. Mrs. X have a history
of hypertension and she is on medication, beta blocker. The handover sheets indicated that her
blood pressure (BP) was 140/80mmHg an hour ago before my shift.

CLINICAL REASONING CYCLE 3
On assessment her temperature is 37.8c, heart rate (HR) 118, respiratory rate (RR) 20, BP
112/58mmHg and specific gravity 1.022. Currently, he is on Beta blockers and has an
intravenous (IV) running at a rate of 86ml/hr. She has an indwelling catheter with a urine output
rate of 20-25ml/hr. Her oxygen saturation (O2 sat) and blood sugar level (BSL) are in normal
range.
During surgery she had epidural anaesthesia during surgery as she has a history of
hypertension. Her recent hypotension could be related to the epidural anaesthesia as it lowers the
HR which impacts on the BP. In addition to this, the hypotension can be as a result of the patient
being nil per oral and also blood loss during the surgery. Despite this her oxygen saturation is
normal and blood sugar level is normal.
Process data
In this stage of CRC, the nurse interprets the clues collected and identify significant
aberration from normal. At this stage nurse call upon their wide repertoire of previous clinical
experience matching the features of the patient’s presentation with similar situation. Firstly, as it
has been mentioned previously both her oxygen saturation and the blood sugars are within
normal ranges. Secondly, she is afebrile as her temperatures indicates low grade fevers. Thirdly,
she has oliguria (20-25mls/hr of urine) and her oral mucosa are dry. The normal urine output is
50ml/hr to 60ml/hr (Hinkle & Cheever, 2013). Lastly, she has tachycardia (118 beats/minute) as
the normal heart rate is 60-100 beats/minute. This indicates that she may be experiencing
hypovolemia (fluid volume insufficiency) and the circulatory and the renal system are
compensating (Guyton,2015). In addition to this, she could further develop more complications
such as hypovolemic shock and acute kidney injury (McMahon 2016).