Acute Care- Clinical Reasoning Assignment 2022

Running head: NURSING
Acute Care- Clinical Reasoning Assignment
Name of the Student
Name of the University
Author Note

NURSING1
Introduction- Clinical reasoning cycle refers to the procedure that is used by nursing
professionals for collecting cues, and coming to a shared understanding about the problem
that is being faced by a patient (Levett-Jones et al., 2010). This reasoning cycle also focuses
on the implementation of interventions for addressing the priority areas, followed by outcome
evaluation and reflecting on the process. This assignment is based on a 56 year old patient
Mrs Carole Kennedy who is being observed during the second rotation. The patient had been
admitted to the hospital for pneumonia treatment. She also reports a history of hypertension,
ischemic heart disease and initial stages of peripheral vascular disease. She has been an active
smoker, however, stopped cigarette smoking seven years ago, after being diagnosed with
coronary artery disease. On finding her to be diaphoretic, the vital signs were assessed that
demonstrated some abnormalities in several physiological parameters. The following sections
will analyse the changes in clinical presentation of the patient, and will also analyse the care
priorities, followed by discussing the current disease stage and psychological issues.
Clinical presentation- Pulse refers to the tactile arterial palpitation that is manifested
by the heartbeat and pulse usually remains palpated at places where the artery becomes
compressed near the body surface. The pulse for a healthy adult at resting stage is between
60-100 beats/minute. However, Mrs. Kennedy has a pulse of 116 beats/minute, thus
indicating the manifestation of tachycardia. Also known as tachyarrhythmia, the condition
occurred due to rapid beating of the heart that decreased its efficiency to pump blood to the
different body parts, thus lowering blood supply to the heart. Research evidences elaborate on
the fact that quick beating of the heart increases the demand for oxygen in the myocardium,
or the cardiac muscles (Sapp et al., 2016). In addition, tachycardia symptoms might have
occurred owing to rapid firing in micro re-entry or an ectopic focus circuit located in the
auricles. In several patients, multiple foci are present for tachycardia that eventually result in
variations in the morphologies of P-wave on the ECG, at the time of arrhythmia.
Furthermore, tachycardia might have also been triggered due to arrhythmia. According to
Kiedrowicz, Podd and O’Neill, M. (2016) this increase in pulse can also be accredited to
onset of automaticity that occurred due to abnormal mechanism due to a reduction in
membrane potential of the fibres located in the heart, which generally demonstrate an
increased amount of membrane potential. Under normal circumstances, the breathing rate of a
healthy adult is roughly 12 to 20 breaths/minute. However, on assessing the vital signs, Mrs.
Kennedy had a breathing rate of 26 breaths/minute, a condition commonly known as
tachypnoea.

NURSING2
Absence of sufficient amount of oxygen or an excess of carbon dioxide in the
bloodstream are common factors that might have resulted in this condition (Rauch et al.,
2016). This accumulation of carbon dioxide in the circulating bloodstream made the blood
more acidic, when compared to usual circumstances. An increase in acidity triggered the
brain, which in response sent a signal to the respiratory drive for increasing the breathing
pace. This shallow rapid breathing was initiated by the brain in an endeavour to restore the
imbalance between the respiratory gases. Hence, the primary reason for shallow breathing
symptoms was to return the blood pH to normal range, while reducing its acidity (Bunker &
Frieberg, 2017). Mrs. Kennedy was found to be diaphoretic that can be accredited to the
hyper functioning of sweat glands, in place of hypertrophy. The condition refers to excessive
sweating, devoid of any apparent reason and heart attack has often been considered a major
contributing factor. A blood pressure of 120/80 mmHg is considered normal for adults.
Owing to the fact that Mrs. Kennedy had a blood pressure of 105/70 mmHg, she reported
signs of hypotension. The renin-angiotensin-aldosterone system (RAAS) exerted a major
influence in the control of systemic vascular resistance and blood volume, which creates a
negative impact on arterial pressure and cardiac output of the patient. Renin that is
released principally from the kidneys, might have stimulated angiotensin development in the
blood and tissues. This stimulated aldosterone release from adrenal cortex. Due to a decrease
in pressure of the afferent arteriole, glomerular filtration reduced that decreased NaCl present
in distal tubule (te Riet et al., 2015). Hence, it caused renin release due to stenosis of renal
artery or systemic hypotension.
Priorities of care- With the aim of determining the care priorities in a critically ill or
deteriorating patient, it is imperative to conduct the ABCDE approach that focuses on
assessment of airway, breathing, circulation, disability, and exposure (Smith & Bowden,
2017). On conducting an analysis of the patient, no major deviations were observed in her
airways owing to the fact that she did not report any abnormalities in breathing sounds or
voice. The assessment of breathing is vital in order to diagnose and implement immediate
treatment to life-threatening health conditions. On counting the respiratory rate of the patient,
it was found to be 26 breaths/minute, thus confirming tachypnoea as a care priority. The
primary goal of this care priority is to help Mrs. Kennedy maintain an effective breathing
pattern, as confirmed by relaxed breathing that occurs at a normal rate, and no signs of
dyspnoea (Smith & Zolotorofe, 2018). The patient will be encouraged to sustain deep breath
by demonstrating slow inhalation and passive exhalation. These techniques of breathing