Nursing Assignment: Clinical Reasoning Cycle and Patient Interview

This nursing assignment discusses the process of clinical reasoning and the importance of patient interviews in healthcare. It focuses on a case study of a 71-year-old female and analyzes the data collected using the clinical reasoning cycle. The assignment also identifies care priorities for the patient and suggests interventions based on the findings.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
According to Hunter and Arthur (2016), the process of clinical reasoning facilitates
healthcare professionals to undertake clinical judgment. The process involves the steps of
collecting cues, processing information, developing an understanding about the patient’s
condition, devising interventions, analyzing outcomes and according learning from the process.
A patient-centred interview helps in addressing the first three steps of the clinical reasoning cycle
(Peabody, 2015). This paper would build on the patient interview of a 71 year old female and
discuss the case in relation to the clinical reasoning cycle.
Consider the patient situation:
The patient interview took place within the care unit of a residential care facility. The
care unit was basically a small room that had a desk and two chairs placed in the opposite
direction. There was no external disturbance and session only included me and the patient. A one
on one session was conducted with the patient, where I asked some questions to the patient about
her illness and documented her responses. The documentation was done by me manually on a
notepad. Apart from that, I also conducted a vital assessment and documented the observed data.
Collect cues and information:
I started the session by focusing on the general health of the patient. I asked her what
made her request an appointment. To that she replied she had been feeling unwell since the past
few days. I then asked her what was mainly her health problem and to that she explained that she
had Diabetes and hypertension. Next, I asked her to describe her present health condition and to
that she replied, poor. Upon asking her to explain, she mentioned she felt increasingly fatigued
and had lost appetite. Further, she explained she found it difficult to sleep and during the night

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experienced a burning sensation in her feet. I then asked her if she was already under medication
and she mentioned that her present medications included Metformin (500mg) twice a day for her
Diabetes and Thiazide 25 mg PO once a day for her hypertension. The patient was then asked if
she took any over the counter medication and to that she said Aspirin for the pain in her joints
occasionally. The patient reported no allergies. Further the patient mentioned that she lived alone
and her husband had passed away three months ago due to a cardiac arrest. She stated that she
had a daughter who was married and settled in China and visited once in a year. After the death
of her husband the patient reported to feel extremely lonely and found it difficult to cope alone at
home and that accounted for the reason why she chose to stay in the residential care facility. The
patient reported no history of smoking of drinking.
After documenting the patient information, the vital assessment was conducted. The vital
sign assessment data yielded the following information:
 Temperature: 38ᵒC
 Hear Rate: 20 breaths per minute
 Blood Pressure: 145/95 mmHg
 Respiratory Rate: 112 beats per minute
 Body weight: 52 kg
 Height: 161cm
The foot was assessed for the presence of any ulcers or burns, however, there was no sign
of any an ulcer, burn or any injury.
Process Information:

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On processing both the subjective patient data, it can be inferred that the patient is
susceptible to develop depression on account of detachment from her daughter and loneliness
because of the loss of her husband. Further, it can also be said that the patient has lost
tremendous weight and has been experiencing difficulty while sleeping because of a burning
sensation of her feet. Further, upon assessing the objective patient data it can be stated that the
patient’s temperature is slightly elevated. Also, the blood pressure and respiratory rate is
considerably elevated. In addition to this, the objective patient data also suggests that the patient
is considerably underweight.
The burning sensation of the feet can be directly linked to the symptom of Diabetes.
Studies suggest that the primary cause of burning feet in patients who are already diagnosed with
Diabetes is neuropathy (Volmer-Thole & Lobmann, 2016). The condition is characterized by the
nerve fibers becoming overactive and leading to misfire (Manary et al., 2013). As a result, the
damaged nerves send pain signals to the brain even when there is no actual wound. Research
studies indicate that the first nerves that get damaged include the leg nerves. The effect of the
damage leads to a numbness of the feet or a tingling sensation which patients invariably
complain as the burning feet sensation (Furqan et al., 2014; Manary et al., 2013).
Therefore, the care priorities for the patient would include weight gain, referral to a
psychotherapist and ordering for an electromyography test. Weight gain would be fostered by
referral to a nutritionist who would monitor the nutritional intake of the patient by creating a
customized diet plan. On the other hand, the psychotherapist would administer counseling so as
to help the patient recover from loneliness. Further, the patient would be educated about
maintaining foot hygiene and would be assessed for skin integrity and the risk of infection.

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Therefore, on the basis of the interview information collected from the patient, the
facilitators can be mentioned as the awareness of the patient about seeking assistance for her
problem. Further, the facilitator can also be explained as the presence of low risk factors that
could worsen the condition. The patient confirms no history of alcohol consumption or smoking
which could potentially deteriorate the condition. On the other hand, the barrier can be explained
as the lack of a supporting family member who could effectively partner in the care process.
Conclusion:
Therefore, to conclude, it can be mentioned that the patient documents was collected and
processed with the help of the clinical reasoning cycle. Further, the documented patient data was
analyzed and the barriers and facilitators were identified in order to devise an appropriate care
plan.

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References:
Furqan, S., Kamani, L., & Jabbar, A. (2014). Skin manifestations in diabetes mellitus. Journal of
Ayub Medical College Abbottabad, 26(1), 46-48. Retrieved from:
http://ayubmed.edu.pk/jamc/index.php/jamc/article/view/1629
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
https://doi.org/10.1016/j.nepr.2016.03.002
Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The patient experience and
health outcomes. New England Journal of Medicine, 368(3), 201-203. DOI:
10.1056/NEJMp1211775
Peabody, F. W. (2015). The care of the patient. Jama, 313(18), 1868-1868. Doi:
10.1001/jama.2014.11744
Volmer-Thole, M., & Lobmann, R. (2016). Neuropathy and diabetic foot
syndrome. International journal of molecular sciences, 17(6), 917. DOI:
https://doi.org/10.3390/ijms17060917