DETERIORATING PATIENT: Clinical Reasoning Cycle and Nursing Interventions for Osteoarthritis and Diabetic Neuropathy

Running Head: DETERIORATING PATIENT
DETERIORATING PATIENT
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1DETERIORATING PATIENT
Question 1
Clinical reasoning cycle:
It is a process by which the health care staff such as nurses and other medical staffs
collect information, process them and then evaluate the condition of the patient. The clinical
reasoning cycle is evaluated by Levett-jones (Dalton, Gee & Levett-Jones, 2015). Based on
the outcomes of the evaluation, they design intervention, collect the results and then reflect
upon the whole practice. This cycle helps in getting effective result with the help of treatment
provided to the patient (Koivisto, 2016).
Patient situation consideration:
This step the situation of the patient is considered based on the background and
medical information (Gummesson, Sundén & Fex, 2018). Mary Smith is an 82-year-old
patient, who was admitted to hospital a few days ago. She had osteoarthritis and hence
underwent an operation for total knee replacement six hours ago. Before operating she has
been given anaesthesia. After that, several test such as, BP, RR, RP, SpO2 and FiO2 were
conducted in 60 minutes’ interval to understand her health condition. Isotonic solution is
provided to her at 80ml/hour via a pump. Her past medical history is also analysed to proceed
further. She feels woozy and nauseated by anaesthesia and de not want to eat anything and
has taken only few sips of water.
Collect cues:
Cues are collected based on the patient medical history and treatment plan of the
patient. Information such as, BP, PR, RR and BGl are collected (Gummesson, Sundén & Fex,
2018). Mary Smith underwent a knee replacement surgery six hours ago. Both of her knees
were affected by osteoarthritis, because of which she can move very little and also feels pain
on weight bearing. She was also diagnosed with type 2 Diabetes mellitus three years ago for

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which she is taking Metformin 1000 mg and Empagliflozin 10 mg twice and once a day
respectively. In addition, she has hypertension for which she is taking Metrolol 25 mg and
Karvezide 300/12.5 twice and once a day respectively. For hypertension, she also takes fish
oil 5000mg once daily. Her BP was 123/70. She has fatty liver diseases with enlargement for
which she is taking Atorvastatin. In both the feet she has diabetic neuropathy and her GCS is
15/15. She has 18G 1V catheter in her right hand. Her radial pulse and respiratory rate is 55
and 18 respectively. Her weigh is 100 kilograms. Her body glucose level is 11.5mmol/l. Spo2
and Fio2 of the patient is 96% and 0.21 respectively. Spo2 is reduced after 60 minutes and
came to 93%. Tympanic temperature is T36.2 60 minutes ago and now it is T36.4. 60 minutes
ago the peripheral capillary refill is 2 seconds and warm digit is observed, but after 60
minutes the digits are cooled and the peripheral capillary refill is 3 seconds.
Process information:
The information and cues collected from the reports are then processed. This is the
core of clinical reasoning cycle and is a critical stage (Gummesson, Sundén & Fex, 2018).
Her BP was initially high for a patient suffering from hypertension but after 60 minutes it
decreased. Her GC is 15/15 which states that she is no neurological complication. She has
obesity as her weight is 100 kilograms. She feels nauseated because of anaesthesia. She has
been given PCA, which reduced her pain to 7/10 and she feels dizziness. Her radial pulse and
respiratory rate is normal. Her body glucose level is more (normal- 3.9 to 7.1 mmol/L).
Identify the problem:
Based on the information the problem is identified, which help in determining the
patient’s current state (Gummesson, Sundén & Fex, 2018). She has osteoarthritis on both of
her knees because of which her movement is limited. She is of 82 years’ old which can be
one of the cause of osteoarthritis. She feels pain on giving weight in her left knee and to this

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she has underwent total knee replacement of her left knee. She has diabetes and also
overweighed, which is considered as one of the risk factor for her diabetic neuropathy and
osteoarthritis (Tsonga, 2016).
Establish goals:
After identifying the problem the goals are established to treat the disease. Treatment
goals are developed (Gummesson, Sundén & Fex, 2018). She had osteoarthritis which was
treated by total knee replacement surgery, but along with that she has other health
complication also which needs urgent care. She has type 2 diabetes which should be treated
properly, otherwise it can worsen the symptoms of diabetic neuropathy. Her weight and
blood pressure should be reduced. Her knee pain also should be minimised (Tsonga, 2016).
Take action:
Implement action are taken. Action plan is developed based on the issue of the patient
with the help of physician and registered nurses (Gummesson, Sundén & Fex, 2018). Her
pain should be reduced by providing medication and exercise. She is also overweighed which
should be reduced by suggesting specific diet and exercise. She has hypertension which can
be reduced by medication such as beta blockers and calcium blockers and by changing the
life style. Her pain should be reduced by administrating epidurals (Maniquis-Smigel, 2017).
To treat type 2 diabetes also healthy diet, exercise and loss of weight is necessary (Lirk,
2014).. Her catheter dose should be increased if needed to reduce the pain.
Evaluate:
The effectiveness of action a plan is evaluated in this step. It allows to determine
whether the action plan is effective or not (Gummesson, Sundén & Fex, 2018). BP, pulse rate
and respiratory rate is normal for now, but we have to keep an eye on it to proceed further.
Her pain is also reduced from before. She did not feel like eating anything and feels woozy.