Clinical Reasoning Cycle - Ischemic Stroke

Clinical reasoning cycle – Ischemic stroke
Introduction
Clinical reasoning cycle is the process helps the nurse to execute the nursing care for better
outcomes. There are eight steps involved in the clinical reasoning cycle, The possibility
developing the complication, The complications that are related to the case scenario, The
complications that are related to the case scenario, Discussion on the Pathophysiology of
ischemic stroke, setting goals to reduce the risk of developing the complication, Evaluation
of the nursing care are implemented for the better outcome of the patient and for the learning
purpose. (Thampy,2019). This assignment assists in executing the nursing care using clinical
reasoning cycle. The case study of Mr. Tomasi Joni shows that he is suffering from ischemic
stroke. He has a history of hypertension, gout and had acute myocardial Infarction in2016.
The nurse was planning nursing care based on the clinical reasoning cycle. Clinical reasoning
is the essential nursing skill used in this case to critically analyse the patient’s condition. The
critical analysis helps to plan medical treatment and nursing interventions. Evaluation is the
final process of clinical reasoning cycle that helps the nurse to assess the outcome.
Consider the patient situation and collect information
The possibility of Mr. Joni developing the complication is due to various contributing factors.
(Levett-Jones et al., 2009). Critical analysis of the case study shows that the problem is
accompanied by several contributing factors. The factors that contribute to the problem are
age, work, stress, lack of adequate rest, not able to engage in social activities due to lack of
time, and smoking. Other contributing factors are hypertension, history of acute myocardial
infarction, and family history of hyperlipidemia He has a history of hypertension, gout and
had acute myocardial Infarction in 2016. On average he works 50hours/week. He drinks beer

once in a week and smokes one packet of cigarettes a week. He eats takeaway three times a
week. He also has the complaints of Obstructive Sleep Apnoea (OSA) and requires CPAP for
overnight sleep. His family history states that his father died of hyperlipidemia and stroke.
Joni’s Age, occupation, family history, past and present medical history are the major factors
that increase the possibility of joni developing the Ischemic stroke. According to his health
assessment findings, his weight is 93kgs and has excess abdominal fat. His cholesterol level
is 9.2mmol/L and fasting BGL is 9.6mmol/L. Albumin to creatinine ratio is 10mg/mmol.
Joni’s clinical findings during the time of admission are the evidence that confirms the
possibility of Ischemic stroke.
Process information and identify the issue
The complications that are related to the case scenario are an ischemic stroke. (Turpin, 2017).
Critical analysis with the support of literature and case scenario aids to conclude the
complication. Patient’s past and present medical history are the primary factors that prove the
possibility of developing the complication. Patient’s blood pressure is increased which is
related to ischemic heart disease. Uncontrolled increased blood pressure can cause the blood
vessels in the brain to burst which leads to ischemic stroke. Hyperlipidemia leads to coronary
atherosclerosis which is the major cause for the ischemic stroke. His saturation on assessment
is 96% on room air which indicates that there is less oxygen concentration in the blood. Less
oxygen in the blood can increase the complications of ischemic stroke. His vital signs are
slightly elevated. He has the family history of hyperlipidemia and he weighs 93 kgs which are
not appropriate for his height and excess abdominal fat and his waist circumference is 104cm
which may increase the chances of ischemic stroke. His Total cholesterol level is 9.2mmol/L
which shows that his cholesterol level is increased. He has excess abdominal fat evident.
Waist circumference 104cm also increases the possibility of developing

Pathophysiology
Discussion on the Pathophysiology of ischemic stroke aids to plan nursing care and
medication therapy. Ischemic stroke is the abrupt stoppage of blood supply to the specific
area in the brain. Sudden cessation of blood supply damages the neurons (Sommer, 2017).
One of the causes for the Cessation of blood supply to the brain cells is an acute cardiac
infraction. Patient past medical history shows that he had acute cardiac infraction in the year
of 2016. Complete cessation of blood supply occurs in the ischemic area. The ischemic area
is surrounded by penumbral area which also lacks blood supply that significantly affects the
function. The abnormal function may cause permanent damage to the cells. The function may
or may not restore once the blood flow return. Complication associated with ischemic stroke
is malignant cerebral oedema, venous thrombo embolism, and infection.
Cessation of blood
supply
Reduced blood supply
to the Ischemic area in
brain
Damages the cells and
functions affected
Ischemic Stroke