Clinical Reasoning Cycle: Selecting a Potential Health Complication

The presentation discusses the clinical reasoning cycle and focuses on selecting a potential health complication from a case study. It explores the risk factors and treatment strategies for the identified complication. The case study involves a 56-year-old mechanical engineer with a history of hypertension, AMI, and obstructive sleep apnea.

Clinical reasoning cycle
Name of the Student
Name of the University
The purpose of the presentation is to select a potential health complication
from the case study and discuss it following the clinical reasoning cycle

Consider the patient situation
 Mr. Tomasi Joni is aged 56 years, a mechanical
engineer, and lives with his wife and children
 He belongs to the Fijian ethnic background
 He resides in Inner West City, Melbourne
 He has been referred for an annual health examination
by his GP
 On assessment, the practice nurse was able to identify
several health complications
Figure 1- Stages of clinical
reasoning cycle
Source- (Levett-Jones et al.,
2010)

Collect cues/information
 Currently he works for more than 50 hours each week
 He tries to perform physical activity during leisure
 He smokes and consumes alcohol and consumes takeaway food
regularly
 Medical history- hypertension, AMI in 2016, obstructive sleep apnea
(OSA) and CPAP for sleep
 Family history- Hyperlipidemia (father) and breast cancer (mother)
 Currently under three medications: metoprolol, aspirin and allopurinol

Process information
 BP 142/96 mm Hg provides indication for hypertension (Bloom, Kemp &
Lubel, 2015)
 Heart rate was 96 bpm that was within the normal limit of 60-100 bpm,
thus indicating normal functioning of the heart
 Respiratory rate of 22 breaths/min indicated a slight elevation from
normal condition, thus indicating shortness of breath (Anzueto &
Miravitlles, 2017)
 SpO2 was 96% on RA and normal
 Body temperature of 36.7°C indicated hypothermia or loss of heat at a
rapid rate from the body (Nassal et al., 2017)

Process information (2)
 Excess abdominal fat, indicating obesity
 Waist circumference of 104 cm
 Elevated level of blood cholesterol 9.2mmol/L (much higher than optimal
2.59-3.34 mmol/L) (Cahill et al., 2019)

Identify problems/issues
 Mr. Joni is at a risk of developing coronary
artery disease (CAD)
 This can be related to his history of
hypertension and AMI
 Also referred to as ischemic disease, the
condition involves a reduction in flow of blood
to the cardiac muscles (Arbab-Zadeh & Fuster,
2015)
 This limited blood flow is related to the
accumulation of plaque in the cardiac arteries
Figure 2- Coronary artery
disease
Source- (Torborg, 2018)

Establish goals
S Restoring balance between
oxygen demand and supply
M Measuring blood pressure and
cardiac output
A Administering medications
R Oxygen balance can be
restored
T 48 hours
S Reducing risk for coronary
artery disease
M Conducting stress
echocardiography
A Administering antiplatelet
drugs and nitro-glycerine
R Blood flow can be restored
T 48 hours
Restoring balance between oxygen
demand and supply Reducing risk for coronary artery
disease

Take action
 Administration of nitroglycerine
 Administration of calcium channel
blockers
Figure 3- Comparison of
normal heart and CAD heart
Source- (UChicago Medicine,
2018)

Take action
 Anti-platelet therapy
 External warming
Figure 4- Treatment plan
Source- (Skelly et al., 2016)

Conclusion
Hence, the case study suggested that the patient was at a risk of developing CAD.
The following outcomes will determine success of the nursing care plan discussed
previously:
 Reduction in blood pressure
 Reduction in respiratory rate
 No reports of angina episode
 Initiation of lifestyle changes
The clinical reasoning helped in gaining an understanding of risk factors for CAD
It helped in understanding pathophysiology of the health abnormalities manifested by
Mr. Joni. However, the nursing care plan could have been done differently, by placing
due focus on other treatment strategies such as, antiplatelet drugs, angioplasty, and
coronary artery bypass grafting.

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