Clinical Reasoning in Nursing Practice Analysis 2022

Clinical reasoning in nursing practice
Introduction
Clinical reasoning is the practice by which the nurse performs the nursing care. It includes the
collection of signs and symptoms, analyse the condition of the patient, diagnoses the actual
clinical issue and implements the nursing interventions according to the need of the patient.
This process continues with the evaluation and learns from the nursing process. In this case,
Mrs. Carole Kennedy is admitted with hypertension, ischemic heart disease and beginning
peripheral vascular disease. Her vital signs were normal at the take over time. After 30
minutes Mrs. Kennedy was started sweating profusely. She has mild pressure sensation over
the chest. On assessment her vital signs were abnormal. She presented with shortness of
breath and her extremities are cold. This essay helps to implement the clinical reasoning
cycle using the case scenario (Schmidt, 2015). The factors involved in the clinical reasoning
cycle are the analysis of the changes, prioritization of nursing care, and psychosocial issues
(Thampy, 2019).
Analysis of pathophysiological changes
 Analysis of changes in clinical manifestation
Mrs. Kennedy’s is a 56 years old female admitted for the treatment of pneumonia.
Observations during the take over her vital signs were Normal. Her blood pressure was
165/90 which is normal for her. Her past medical history clarifies that she is suffering from
ischemic heart disease and hypertension. She is a smoker form 19 years of age and dropped it
at the age of 49. She is also diagnosed with coronary heart disease. Assessment after 30
minutes reveals that the patient is sweating and feeling disgusted. When questioned about that
she says that she does not feel well and she is presented with mild pressure sensation in her
chest which was started 10 minutes before when she was lying on her bed. Her chest pain is

rated as 4/10. She verbalizes that she had same sort of pain before. The slight ache in the
underside of the upper left arm is present with a nauseated feeling. She also developed slight
shortness of breath and her extremities are cold and clammy. Her heart rate was 116/mt, and
respiration was 26/mt. She had shallow breathing. Her blood pressure was 105/70mmHg and
her Spo2 without oxygen was 92%. The patient was conscious and verbally communicating
to the nurse (Raj, 2015).
 Pathophysiological changes
The patient is diagnosed with Ischemic heart disease and related surgical procedures are done
to maintain her heart health. She is also diagnosed with coronary heart disease at the age of
49. A common complication of ischemic heart disease is heart failure. Heart failure occurs
when the heart is incapable to pump sufficient blood to meet the metabolic needs of the vital
organs. Mrs. Kennedy is presented with increased heart rate, which is one of the signs of
heart failure. When the heart loses its capacity to pump the needed blood, it tries to
compensate the lose by pumping faster than normal which leads to increased heart rate. In
spite of rapid pumping of heart, the cardiac output is will be less than normal. Thus the
amount of blood in the arteries will also be less than normal. This may lead to low blood
pressure ((Health care education services,2015). Due to less blood supply to the lungs from
the heart, it increases the respiration to meet the oxygen need of the cells which increases the
respiratory rate. Due to less cardiac output and less blood supply to lungs will lead to less
oxygen concentration in the blood. Less oxygen concentration in the blood is reflected in the
saturation (Haider, 2019). Due to less cardiac output, only the vital organs will receive the
blood and oxygen, and the extremities are ignored results in cold and clammy extremities.
Increased pumping of heart causes more strain to heart and leads to chest pain which may

radiate to the left arm. Medical history shows that the patient had sudden onset of clinical
manifestation. Sudden onset of symptoms confirms that it is Acute heart failure.
Priorities of nursing care
Ensure normal breathing and gas exchange
The patient is admitted with pneumonia. Pneumonia is the collection of fluid in the lungs
which may manifest with infection. Patient’s past medical history states that she ischemic
heart disease which is associated with the history of surgical procedures in the heart.
Breathing difficulty is of sudden onset and severe. Priority nursing care for patient with
multiple heart and lung disease is the maintenance of normal breathing and gas exchange
(Chertcoff, 2019). Ignoring the patient's condition may lead to clinical deterioration.
Maintenance of normal breathing will improve the condition of the patient.
Rationale
Increased heart rate and breathing are due the patient’s present and past medical conditions.
The patient is admitted with Pneumonia. Pneumonia is the collection of fluid in the lungs
which may strain the lungs in the process of breathing. She also has a history of ischemic
heart disease. Pneumonia and ischemic heart disease will manifest with less blood flow and
less oxygen supply to the vital organs. Lungs deprive oxygen and increase its rate which
leads to breathlessness (Cooper, 2016). Due to less blood supply to the lungs from the heart,
it increases the respiration to meet the oxygen need of the cells which increases the
respiratory rate.
Maintain normal blood flow