Medical Surgical Nursing

Running head: MEDICAL SURGICAL NURSING
Medical Surgical Nursing
Name of the Student
Name of the University
Author’s Note:

1MEDICAL SURGICAL NURSING
Task 1: Consideration of the patient
‘Clinical Reasoning Cycle’ is a systematic structure which guides the nursing professionals to
develop care plans for the receiving patient so that utmost quality of health care service can be
provided to that respective patient as well as to meet the health care required by the patient
(Dalton, Gee & Levett-Jones, 2015). First step of this clinical reasoning cycle is to consider the
patient and collect visual, verbal and observable cue from the patient in order to understand
and consider the patient situation (Hunter & Arthur, 2016). This step also aids the nurses and
health care professionals to provide holistic care service to the patient. In this case study, I will
be discussing the condition and situation of Miss Violet Paterson and in this section the
patient’s situation will be considered according to the first step of the ‘Clinical Reasoning Cycle’.
Miss Violet Paterson is a 77 year old single woman who was admitted to the hospital ward with
AMI or Acute Myocardial Infarction. Present condition of Miss Paterson is now stable as her
Acute Myocardial Infarction is under control. From Miss Paterson’s medical history, it has been
observed that Miss Paterson is suffering from primary hypertension along with longstanding
osteoarthritis. At the time of admittance, she has reported that her arthritic pain has been
increased significantly over the last few months. In addition, her daily activities have been
hampered significantly due to her blood pressure problem as well as osteoarthritis. This
situation has been worsened further due to the fact that she lives in a third floor apartment and
Miss Paterson’s apartment building has no lift. Climbing up and down of the three flights of
stairs has also exacerbated the problem of arthritic pain. This condition has significantly
handicapped her situation to perform the activities needed for daily life and she had to perform
all the activities as she lives alone. She has also stated that she has no extended family and her
only companion is her cat named ‘Molly’. These condition might make Miss Paterson socially
excluded and may imbalance her mental stability.
Task 2: Nursing assessment
The next part of the holistic approach for Miss Paterson would be to identify and provide
nursing assessment (Koivisto et al., 2016). In order to do that, I need to go through the ‘Clinical
Reasoning Cycle’ for the provision of her care structure. From the information above, it can be

2MEDICAL SURGICAL NURSING
seen that Miss Paterson has admitted due to Acute Myocardial Infarction. Hence, the first
assessment for Miss Paterson would be to conduct an Electrocardiogram or ECG test as studies
have reported that ECG is able to detect the further damaged done to the myocardium. Recent
evidenced based researches have reported that an ECG test should be performed in every thirty
minutes for the initial four hours of the patient presented with Acute Myocardial Infarction
(Mythili & Malathi, 2015). ECG works by detecting the electric pulses generated by the muscles
and impaired heart muscle cannot generate electrical impulses and thus an ECG test is effective
in detection of the damage done by Myocardial Infarction. Hence, the conduction of an ECG
test is the first and foremost assessment for the patient with Acute Myocardial Infarction. In
addition to the ECG test, another test which can be performed is ‘Blood Test’ for Miss Paterson.
During the Myocardial Infarction protein and fat particles get released from the heart muscle
which can be detected through the blood test. Therefore, blood test is another indicator to
know the condition of the patient’s heart (Mythili & Malathi, 2015). In a nutshell, the first
nursing assessment for Miss Paterson would be to conduct an ECG test every 30 minutes for
the initial four hours along with blood test.
The patient, Miss Paterson is long suffering form the condition of osteoarthritis and her related
arthritic pain has increased for the last few months. Hence, by the aid of the ‘Clinical Reasoning
Cycle’ the next assessment for Miss Paterson would be to identify the pain level and provide
proper care plan to reduce her pain at the earnest as the arthritic pain can be a additional
burden for an 77 years old woman suffering from Acute Myocardial Infarction. For identification
of the pain, a pain assessment tool can be utilized. In this pain assessment tool the patient will
be asked to convey her pain in a scale of 0 to 10 where 0 denotes the absence of pain and 10
denotes extreme unbearable pain (Keane, 2013). According to her report, she is in considerable
pain as it is hampering her daily activities and this pain also increases her risk of fall while
performing daily necessities. Therefore, an additional assessment will be the patient’s fall risk
assessment. The FRAT tool can be implemented by the nurses for fall risk assessment of the
patient. This FRAT tool has three parts and they are fall risk status, risk factor check list and
action plan respectively (Nawaz et al., 2015). Hence, the second nursing assessment for Miss
Paterson would be identification and remission of pain as well as fall risk assessment.