Clinical Reasoning Report

This clinical reasoning report presents a case study of a 63-year-old widow and discusses the interpretation of vital signs and other cues. It explores the possible diagnosis based on the observed symptoms and suggests further requirements of cues for a complete diagnosis.

CLINICAL REASONING REPORT
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Table of Contents
1. Concise Summary..................................................................................................................2
2. Objective and Subjective data cues........................................................................................2
3. Interpretation of identified cues.............................................................................................3
a. Categorisation of cues............................................................................................................3
b. Comparison of the current situation to previous medical history..........................................3
c. Explanation of vital signs and other cues...............................................................................3
4. Further requirement of cues..................................................................................................4
References..................................................................................................................................6
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1. Concise Summary
The rehabilitation centre had organised a recreational class of swimming in an ocean pool on
5th April. It was considered to be a cherished outing for the care users as they would be able to
enjoy and relax. The weather was a bit chilly as the temperature was recorded to be 19°C and
the wind was blowing at a speed of 30km/hr. The water temperature was noted to be 17°C
and was considered to not be too cold and the care users from the centre would be
comfortable. Swimming and other activities continued for a quarter of an hour. Afterwards,
the vitals of all care users were measured. This study presents the case study of Roseanne
Chivers, a 63-year-old widow.
2. Objective and Subjective data cues
a. Objective Cues
Vital name Measure
Body temperature 35.0 °C
Pulse Rate 102 beats/min
Respiratory rate 24 breath/min
Blood pressure 150/84 mmHg
b. Subjective Cues
Feature Remarks
Shivering Normal reaction
Cold hands Normal reaction
Numb and blue fingers Heightened reaction
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3. Interpretation of identified cues
a. Categorisation of cues
Temperature
The body temperature of Roseanne was recorded to be 35°C which is slightly lower than the
normal body temperature of 37°C. This decrease in 2°C can be accounted for by her activity
in the cool weather and water.
Blood pressure
Her blood pressure was measured to be 150/84 mmHg which higher than the normal blood
pressure of 120/80 mm/Hg. It has been seen that the normal value of blood pressure is only
possible when the individual has been resting (Chen et al. 2015). As Roseanne was involved
in strenuous activity like swimming, her blood pressure may be elevated. It is only a need for
concern if the elevated blood pressure persists for a longer period of time.
Pulse and breathing rate
Pulse was recorded to be 102 beats/min and her breathing rate was 24 breaths in a minute.
Heartbeat and breathing rate could have increased as her body was trying to keep with an
increased need for oxygen (Foley 2017).
Body reaction
Roseanne felt a bit cold and was shivering. Shivering is a body’s reaction towards cold.
Geneva et al. (2019) satted that through the tremors, the body generates heat and warms up. It
was noticed that she was struggling to wear her jacket as well.
b. Comparison of the current situation to previous medical history
Her previous medical history showcase that her body vitals are all within the normal range.
The elevated values measured on 5th April could be because she indulged in some strenuous
activities.
c. Explanation of vital signs and other cues
Her objective vitals that could be measured were normal and did not refer to the presence of
any disorder. However, from the subjective cues that were noticed on the spot such as
shivering, cold and numb hands could hint towards a disorder (Priyadharshini et al. 2018). As
pointed out earlier, shivering is a natural body process to generate heat. However, Roseanne’s
body temperature had only dipped by 2°C. It could be said that her body was overreacting
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towards cold. Similarly, her difficulty in being able to don the jacket could be because her
hands were numb. It was observed that her fingertips appeared to be blue while other parts of
palm flushed red. These observations hint towards Raynaud’s disease but a diagnosis could
not be provided as her prior medical history was inaccessible.
4. Further requirement of cues
Roseanne’s older medical history was compared with the ones collected on 5th April. After
performing a review, it can be concluded that her homeostasis level appears to be normal.
The heightened vitals measured on the day of the ocean swimming class was also within a
range that is passable. Sherwood (2015) stated that when hen an individual engages in
strenuous activity, the body requires more oxygen for oxidising fuel and provide energy to
the cells. For this reason, the heart pumps more oxygenated blood to the organs to fuel them.
As a result, heart rate or pulse increases. However, for people age 60, pulse rate up to 160
beats/min is healthy during or after exercise (Shier et al. 2015). The dip of 2°C in her
temperature that was recorded was because she was swimming in cold water. Her
temperature recorded earlier on 1st April and 2nd April did not denote to any irregularities.
However, the subjective cues noticed and her hands hint towards a disorder. Numbness in
hands can be caused for causes like damage, irritation, compression, brain or spinal cord
injury and even injury to the nerves of the hand (Stahl et al. 2016). However, it is clear that
she did not meet any fall or damage which could cause her an injury.
Her symptoms recorded match with those displayed by people suffering from the Raynaud’s
disease as well. Raynaud’s disease is a rare disorder that arises due to an issue in the
peripheral blood vessels of fingers and toes. It causes the blood vessels to narrow down when
they are cold. This prevents the blood to reach the fingertips and toes as a result of which
they become numb and turn blue. When the temperature returns to normal or the affected area
is warmed, blood flow continues and the area flushes red. According to Thakur et al. (2018),
the primary cause of Raynaud’s disorder is not known. However, it has been seen to be more
common among women, especially those aged over 80 and sometimes runs in the family. An
immediate remedy can be achieved by dipping hands in warm water and covering them at all
times when going somewhere cold.
In order to provide a diagnosis, a complete medical history of Roseanne along with her
immediate family members are required. The diagnosis would be clearer if someone in her
family also has this disease or has showcased similar symptoms. A nail fold capillaroscopy
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can also be performed in order to test the capillaries in under the nail (Kotas and Medzhitov,
2015). Capillaries appear haemorrhaged or constricted in case she has Raynaud’s disease.
Figure 1: Normal capillaroscopic pattern
(Source: Scielo, 2015)
Figure 2: Patten with micro haemorrhages, dilated capillaries and constricted
capillaries
(Source: Scielo, 2015)
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References
Chen, Y., Lu, B., Chen, Y. and Feng, X., (2015). Breathable and stretchable temperature
sensors inspired by skin. Scientific reports, 5, p.11505.
Foley, R., (2017). Swimming as an accretive practice in healthy blue space. Emotion, Space
and Society, 22, pp.43-51.
Geneva, I.I., Cuzzo, B., Fazili, T. and Javaid, W., (2019), April. Normal Body Temperature:
A Systematic Review. In Open Forum Infectious Diseases (Vol. 6, No. 4, p. ofz032). US:
Oxford University Press.
Kotas, M.E. and Medzhitov, R., (2015). Homeostasis, inflammation, and disease
susceptibility. Cell, 160(5), pp.816-827.
Priyadharshini, S., Preetha, S. and Devi, R.G., (2018). Determination of pulse rate and blood
pressure just before the exam. Drug Invention Today, 10(11).
Scielo, (2015), Nailfold capillaroscopy: relevance to the practice of rheumatology [Online],
Available at:http://www.scielo.br/scielo.php?
pid=S048250042015000300264&script=sci_arttext&tlng=en [Accessed 4 May 2019]
Sherwood, L., (2015). Human physiology: from cells to systems. Ed 3rd, Boston: Cengage
learning.
Shier, D., Butler, J. and Lewis, R., (2015). Hole's essentials of human anatomy & physiology.
New York: McGraw-Hill Education.
Stahl, P., Macherey, O., Meunier, S. and Roman, S., (2016). Rate discrimination at low pulse
rates in normal-hearing and cochlear implant listeners: Influence of intracochlear stimulation
site. The Journal of the Acoustical Society of America, 139(4), pp.1578-1591.
Thakur, A., Aggarwal, P. and Siddiqui, U., (2018), April. Analysis of Pulmonary Diseases
Using Wireless Breathing Rate and Pulse Rate Monitoring System. In 2018 Second
International Conference on Inventive Communication and Computational Technologies
(ICICCT) (pp. 1041-1044). IEEE.
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