Clinical Reasoning Case Study

This case study examines the clinical reasoning cycle applied to a 59-year-old Maori woman with hypertension and hypercholesterolemia. It details her symptoms, medical history, and the importance of effective clinical reasoning in managing her condition. The report emphasizes the need for regular monitoring and the implications of her health status, including family history and lifestyle factors. The study also includes clinical terminologies and patient assessment data, providing a comprehensive overview of the patient's situation and necessary interventions.

Running Head: CLINICAL REASONING 1
THE CLINICAL REASONING CYCLE
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The clinical reasoning cycle
Setting of the scene
The scenario focuses on care of a 59 years old New Zealand Maori woman admitted to the
emergency department with hypertension and hypercholesterolemia. The report covers
extensively the first three stages of the clinical cycle namely consideration of the patient
situation, a collection of patient cues and information and information processing. Mrs. Maori
has reported alterations in body temperature, blood pressure, pulse and the respiratory rate but
with a sustained blood sugar level which are fatal conditions in hypertension attacks for older
people which are the patient's case. The conditions manifest rapidly and may potentially cause
deadly consequences. Maintaining an electrolyte equilibrium and a standard fluid condition is
integral in her care. The imbalances in the fluid have potential to cause morbidity and even
mortality (Sharman, 2017). Effectual clinical reasoning abilities will help in recognition and
management of the patient deterioration at an earlier time and hence prevent adverse client
outcomes.
Considering the patient situation
We have Mrs. Amari in the stroke ward in bed 10. She is 59 years old and has hypertension and
hypercholesterolemia. She has been in the ward for 24 hours with numbness on the right side of
her face and her right arm. Her speech is slurred and the right face having a slight facial
drooping, the conditions changing occasionally. She moved from the New Zealand, Auckland, to
Australia where she has lived with her son for the past three years since the death of her husband.
The client computed tomography (CT) showed normal intracranial and the magnetic resonance
imagery (MRI) conditions. The patient has a steady gait and can swallow without many
difficulties. Mrs. Amari can move her extremities and can follow commands. The eye pupils

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were round, equal and had a typical response to light (4mm to 2mm) (Owens, 2017). The
situations were followed by a transfer from the original emergency unit to the stroke ward with a
mini stroke diagnosis, a transient ischaemic attack (TIA), under a neurologist care. Currently, she
has no facial asymmetry, and her numbness complaint has since subsided. The patient has also
reported having tobacco use for 25 years having quitted during the recent ten years. Her family
has a history of heart diseases, and she has a definite article with the concern. She only has
random walks, and she has not been in regular exercise (Vetoshkin, 2017).
The client's positive family history of heart diseases and prolonged tobacco use are the probable
cause of the current condition. The other thing that intensifies the situation is the lack of regular
exercise and lack of a personal care giver (Zabadi, 2017).
Abbreviations
The report makes use of some clinical terminologies as defined below. The abbreviations will
help to provide information faster but can cause tragic consequences if not understood so their
meanings must be got clearly (Zhu, 2016).
TIA- Transient Ischaemic Attack
GCS- Glasgow Coma Scale
CT- Computer Tomography
RMI- Magnetic Resonance Imagery
mm- Millimeters
Collection of patient cues and information
The emergency department

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- Temperature 36.7 C
- Blood pressure 148/97
- Pulse 81
- Respiratory rate 14
- SpO2 94%
- Glasgow Coma Rate (GCR) 15
- Blood sugar level 6.6mmol/L
- Computed tomography (CT) shows no acute intracranial change
- Magnetic Resonance Imagery (MRI) is within reasonable limits
- Numbness to the right side of the face and the right arm
- A slight facial droop when smiling
- Mouth diverted to the right side
- Slightly slurred speech but it could be understood
- Straight gait
- Able to swallow without difficulty
- Able to move and follow commands
- No nystagmus noted
- Round equal pupils reactive to light ranging from 4mm to 2mm
- No headache
- No nausea
- No vomiting
- No chest pain
- No diaphoresis

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- No visual complaints
- Alert and oriented
Current situation
- Slurred speech
- Drooping on the right side of the mouth
- Temperature 36.8
- Blood pressure 175/105
- Pulse 90
- Respiratory rate 13
- SpO2 92%
- Blood glucose level 6.6mmol/L
Significant changes in client conditions
- Body temperature
- Respiratory rate
- Blood pressure
- Pulse
- SpO2
About these rapid changes, the patient should be checked for the conditions in every one hour.
Heart disease is assessed regarding fluid conditions and physical symmetry of external body
parts. Cardiovascular disease always lead to rapid changes because of failure in neural control of
the heart. The client, therefore, should be attended to within short hourly basis (Nabar, 2016).
Information processing (230)

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Interpretation
The standard patient conditions are identified below (Hill, 2017).
- Blood pressure 90/60 to 120/80
- Temperature 37C
- Respiratory rate 12 to 20
- Blood sugar 6.6mmol/L
- Pulse 60 to 100
Heart disease symptoms
- Fatigue
- Edema
- Short respiratory rate
- Rapid heart rate
- Loss of appetite
- Persistent cough
Some of the conditions for Mrs. Amari are like respiration, pulse, blood glucose levels are within
the normal and acceptable rates (Dong, 2017).
Discrimination
- Pulse
- Blood pressure
- Respiration rate

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The above conditions are critical for the heart failure client. They have to be monitored
regularly within 1 hour appropriated, and medication is given to maintain the conditions at
their acceptable levels (Bhatt, 2017).
Relation and inference
Relation
Mrs. Amari has high blood pressure from an uncoordinated nervous system.
Mrs. Amari has a short respiratory rate from high blood pressure
Mrs. Amari has rapidly fluctuating pulse from variations in hormone compositions
Inference
Change in Mrs. Amari conditions is as a result of lack of regular exercise, unmonitored
conditions, the previous tobacco use and depression. She should be given close attention every
time (Mitsutake, 2017).

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References
Bhatt, D., 2017. Predictors of Hypertension among Nonpregnant Females Attending Health
Promotion Clinic with Special Emphasis on Tobacco. Cross-Sectional Study, 1(1), pp. 93-127.
Dong, S.-S., 2017. Integrating regulatory features data for prediction of functional disease-
associated SNPs. Briefings in Bioinformatics, 4(9), pp. 23-26.
Hill, V., 2017. A Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy
Eating and Lifestyle after Stroke. Journal of Stroke and Cerebrovascular Diseases, 2(1), p. 13.
Mitsutake, T., 2017. Risk Factors after Reduction to Single Antiplatelet Therapy for
Postoperative Ischemia of Intracranial Stent-assisted Coil Embolization. Journal of
Neuroendovascular Therapy, 2(4), pp. 1-47.
Nabar, P., 2016. Professor of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh. The Journal of
the Association of Physicians of India, 8(64), p. 11.
Owens, S., 2017. New Study Identifies Features, Triggers, and Risk Factors for Post-Stroke
Recrudescence. Neurology Today, 2(11), p. 179.
Sharman, J., 2017. Targeted Lowering of Central Blood Pressure in patients with hypertension:
Baseline recruitment, rationale, and design of a randomized controlled trial. Contemporary
Clinical Trials, 3(3), p. 97.
Vetoshkin, A., 2017. Blood pressure variability disorder as a risk factor for atherosclerosis.
Atherosclerosis, 1(26), p. 175.
Zabadi, N., 2017. Risk perception of cardiovascular diseases among individuals with
hypertension in rural Malaysia. Hypertension, 2(9), pp. 108-164.

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Zhu, J., 2016. Glycemic Index, Glycemic Load, and Carbohydrate Intake in Association with
Risk of Renal Cell Carcinoma. Carcinogenesis, 2(19), pp. 1-18.