NRSG370 – Clinical Integration - Speciality Practice

Running head: ESSAY
NRSG370 – Clinical Integration - Speciality Practice
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ESSAY1
Introduction- Person-centred care refers to the process of thinking and performing
things that considers individuals who seek health and social care services as equal partners in
formulation, development, and monitoring of care. Clinical reasoning cycle encompasses the
process where nursing professionals and allied medical practitioners gather indications,
conduct data processing, and comprehend the issues that are faced by their patients (Levett-
Jones et al., 2010). This essay will be based on the eight stages of clinical reasoning cycle for
evaluating a case study that involves a 20 year old woman, Bianca Lane.
Situation- Bianca Lane had been admitted to the Emergency department based on her
presenting complaints of lower quadrant abdominal pain. A thorough and comprehensive
physical examination revealed a perforated appendix in ultrasound diagnosis and necessitated
immediate laproscopic surgical intervention. 36 hours after the operation, her vital signs are
blood pressure of 94/45 mm Hg, heart rate 136, body temperature of 38.5° C, and respiratory
rate of 24 breaths/minute. Some of her presenting complaints include nausea, feelings of
bloated, and centralised abdominal pain that increases with movement (pain score 7/10).
Moreover, a distended right abdomen has also been identified from the physical examination,
with no bowel sounds.
Process information- Peritonitis refers to inflammation of the peritoneum tissue that
lines the inner abdominal wall, thus providing covering and support to the internal organs.
Some common signs and symptoms of peritonitis are namely, fever, feeling of distention or
fullness in abdomen, tenderness, diarrhoea, vomiting and nausea, and low urine output
(Ndayizeye et al., 2016). According to Wang et al. (2018) if left untreated, inflamed appendix
subsequently perforates or bursts, thus leading to the spillage of infectious substances in the
abdominal cavity, and causing peritonitis. A perforation in the appendix might result in entry
of bacteria in the peritoneum through pores in the gastrointestinal tract, thus explaining her
health status. An analysis of her vital signs suggest that Bianca is hypotensive, tachycardic,

ESSAY2
and febrile. Moreover, her respiratory rate also demonstrated signs of tachypnoea. Bianca
reports a history of depression and asthma. Tachypnoea can be attributed to her asthmatic
condition since asthma leads to narrowing of the airways located in the lungs, thereby leading
to imbalance in ventilation perfusion, and increasing the work of breathing (Radhakrishnan &
Almaddah, 2017). This might have eventually resulted in fatigue of the ventilator muscles.
Bianca’s current medications comprise of sertraline, seretide, and salbutamol. While
sertraline is a selective serotonic reuptake inhibitor and used for the management of
depression, anxiety, panic or obsessive compulsive disorder, seretide is administered for the
treatment of asthma and is a combination of inhaled corticosteroid and long- acting β2
agonist (Fann et al., 2017; Bender et al., 2016). Likewise, salbutamol is also used for opening
up the large and medium airways, particularly for the treatment of asthma (Bennett et al.,
2019). An analysis of Bianca’s pathological examination revealed elevated WBC count and
CRP. While high WBC count indicates functioning of the immune system for destroying an
infection, elevated CRP level acts as a marker of inflammation, thus increasing the risk of
heart attack.
Prioritisation- On thoroughly analysing the case study, the three major problems
identified were namely, (i) increased CRP as a result of bacterial infection, (ii) abnormalities
in vital signs as a result of peritonitis, and (iii) abdominal pain as a result of laparoscopic
surgery.
Often it has been found that CRP levels demonstrate an increase during the initial
week after a significant surgery, nonetheless to a larger extent amid infected patients, when
compared to their non-infected counterparts (Shrivastava et al., 2015). Persistently increased
CRP following a surgery demonstrates the onset and progress of postoperative infection, and
damage of tissues. It has also been found by researchers that people with increased CRP
levels demonstrate a greater likelihood of having a heart attack, than those with decreased