NRS82005 Case Study: Clinical Reasoning in Acute Nursing Management

This case study report details the clinical deterioration of a 68-year-old patient, Mr. X, admitted following a fall and fractured femur, leading to orthostatic hypotension. The report systematically applies the clinical reasoning process, including collecting cues, processing information, understanding the patient's problem, planning and implementing interventions, and evaluating outcomes. The patient's history of atrial fibrillation and recent medication changes (rivaroxaban to heparin) are key factors contributing to his condition. The report outlines nursing interventions such as physiological countermeasures and pharmacological interventions like fludrocortisone and midodrine to manage orthostatic hypotension and improve the patient's functional status before surgery. The evaluation of outcomes revealed positive responses to interventions like elevating the head of the bed and discontinuing heparin, leading to improved blood pressure and reduced fatigue. The report concludes with reflections on the importance of careful medication management, effective patient communication, and the role of preoperative rehabilitation in ensuring successful surgical outcomes.