Report about What is Nursing? 2022

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Introduction
Clinical reasoning is an important skill in nursing that facilitates nurses to provide
safe and effective care. It is implemented in all phases of the nursing process. It includes the
step of recognizing cues from a clinical situation, elaborating judgment and reasoning to
select appropriate interventions and evaluate the outcomes achieved (Carvalho et al., 2017).
The clinical reasoning cycle is an important framework that gives guidance regarding the
stepwise process to be implemented to assess patient and develop care plan (see appendix 1).
The main purpose of this report is to analyze the case study of Mrs. Jane Austin using the
Clinical Reasoning Cycle and discuss about the provision of ethical, legal and holistic patient
centred care for patient. The paper will explore the health assessment data of patient to
understand three nursing problems, establish goal of priority and evaluate the nursing care
strategies to implement the intervention.
Consider the person’s situation:
The case study is about Mrs. Jane Austin, a 59 year old woman admitted to the theatre
for a laparoscopic cholecystectomy following severe right upper quadrant abdominal pain.
She had symptoms of uncontrolled nausea and vomiting. She has been diagnosed with
cholelithiasis and cholecystitis. Cholelithiasis is a condition associated with formation of
gallstones and cholecystitis is the inflammation of the gall bladders leading to severe pain in
the abdomen (Mohammed, Behan & Ahmed).
Collect, process and present related health information
Mrs. Jane has a body mass index (BMI) of 28 and has past medical history of
hyperlipidaemia, hypertension and smoking. Currently, she is taking her regular medications
like Lipitor and Perindopril. The review of the emergency department assessment data

2NURSING
revealed she was tachcardic and febrile. The subjective data of Jane revealed upper quadrant
tenderness on palpation and intolerance to fatty foods. The preoperative chest x ray is clear.
From the above data, the key diagnosis and health problem for patient is identified.
Post-anaesthetic recovery room (PACU) assessment data gave results regarding votal
signs, pain, level of consciousness, blood culture results and operation site assessment. She
was awake and alert and had 4 incision dressings with nil ooze. Her pain score was 6/10. The
vital signs of the patient included RR 28 (normal rate 12 to 20 bpm), HR 115 (90 to 100
bpm), BP 125/70 (120/80), SpO2 89% (96 to 99%) and temp 37.5 degree Celsius (within
normal range). Fluctuation in vital signs post operatively was seen. No bowel sound on
auscultation. However, mild abdominal distension was found on abdomen palpation. The
nursing assessment implemented are relevant with current evidence based practices as
assessment of skin, operation sites and gastrointestinal assessment is critical for post
operative patients with cholecystitis.
Identify and prioritise three (3) nursing problems/issues:
From the analysis of health assessment data for Mrs. Jane, the pain score is a concern
for patient as his current pain score in 6/10. Laparoscopic cholecystectomy leads to parietal
pain and this is a source of marked discomfort and surgical stress for patient. It may be due to
the effect of the surgical procedure as the procedure was slightly longer for Jane as the
surgeon had difficulty in identifying the common bile duct (Barazanchi et al., 2017). Hence,
the first priority problem is pain and addressing this is important to provide relief to patient.
Pain management is also critical to improve post surgical outcome and promote recovery in
patient. Pain is associated with emotional distress and negative psychosocial outcomes in
patient (Svanberg et al., 2017). Hence, pain management should be prioritized to provide
holistic care to patient and improve both physical and mental health outcomes of patient.

3NURSING
The PACU assessment reveals abnormal findings for vital sign assessment. Most of
the vital sign parameter was found to be abnormal for Mrs. Jane. His respiratory rate was too
high and heart rate was abnormal too. Since, Mrs. Jane was tachycardic even during
preoperative assessment, restoring normal heart rate is critical. In addition, SpO2 value was
also abnormal which can increase risk of respiratory distress for patient (Jaber et al., 2016).
Hence, the second priority problem identified is abnormal vital signs and identifying
appropriate interventions to maintain vital sign is critical to early identify clinical
deteriorating and take proper response regarding the same. Frequent monitoring and
management of vital sign is important to avoid adverse events. This can save medical team
from unanticipated adverse events and take proper response to clinical deteriorations too
(Kyriacos, Jelsma & Jordan, 2014). Hence, vital signs needs to be prioritized based on current
diagnosis and health condition of Jane.
The third negative vital heath concern identified for John is elevated C-reactive
protein. Elevation of this protein is generally a sign of inflammation and it is the most
common marker to diagnose patients with cholecystitis. The CRP level is high after surgery
and peak is obtained after 48 hours. The value is significantly higher in patients with major
complications compared to those with minor complications (Straatman et al., 2018). Having
elevated levels of the protein even after the surgery is an indication that inflammation is still
present and most important post operative goal is reduce the level of C-reactive protein
(CRP). CRP is an inflammatory protein that plays an important role in inflammatory
processes and host response to infection such as phagocytosis, releases of nitric oxides and
production of cytokines. CRP levels can increase because of age, smoking status, weight and
blood pressure too (Sproston & Ashworth, 2018). Mrs. Jane’s BMI was 28 which indicate she
is overweight. Her medical history shows includes history of smoking and hypertension.