Case Study: Analysis of Patricia Finch's Nursing Needs

This assignment presents a detailed nursing case study analysis of Patricia Finch, a 58-year-old Indigenous Australian woman who underwent a left below knee amputation due to complications from peripheral vascular disease secondary to Type II Diabetes. The paper applies the clinical reasoning cycle to assess the patient's situation, collect and process health information, identify and prioritize nursing problems, establish care goals, and recommend appropriate interventions. The analysis considers the patient's medical history, current condition, and psychosocial factors, including her independent living situation, employment, and family dynamics. The assignment emphasizes the importance of a holistic, patient-centered care plan that addresses the patient's physical, mental, and emotional needs, including diabetes management, wound healing, rehabilitation, and psychosocial support. The paper also highlights the ethical and legal standards of nursing practice, including cultural sensitivity and adherence to quality and professional conduct guidelines. Overall, the assignment demonstrates the application of the clinical reasoning cycle to develop a comprehensive and effective nursing care plan for Patricia Finch, aiming to improve her quality of life and facilitate her recovery.

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

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Introduction:
The clinical reasoning cycle was developed by Levett Jones et al. in the year 2019. The
reflective model enables nursing students to reflect upon a clinical experience and accordingly
adapt measure to foster improvement in terms of recovery and positive patient health outcome
(Hunter & Arthur, 2016; Garneau, 2016). Research studies mention that the clinical reasoning
model helps to improve and strengthen the decision making ability of the nursing students to
effectively address critical clinical situations in the further course of their practice (Hunter &
Arthur, 2016; Levett-Jones et al., 2010; Miraglia & Asselin, 2015). The clinical reasoning cycle
broadly comprises of eight steps that include, consideration of the patient’s situation, collection
of patient information, processing retrieved information, identification of problem priorities,
establishing care goals, adapting treatment measures, evaluation of adapted intervention
measures and reflection on clinical experience (Levett-Jones et al., 2010). This paper intends to
apply the clinical reasoning model in order to analyze the case study of the patient Patricia Finch
who recently underwent below knee amputation of the left leg. The paper would assess the
existing physical health condition of the patient and identify care priorities by virtue of which an
holistic, patient-centred and effective care plan for the patient would be devised that would be
compliant with the ethical and legal standards.
Considering the patient’s situation:
The provided information about the patient suggests that the patient is 58 years old and is
Indigenous in origin that has a medical history of Peripheral Diabetes. The condition of
Peripheral Diabetes is managed with a Diabetic controlled diet and oral hypoglycaemic
medication. The patient works at a full time local newspaper house and resides within a rural

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town. It is further worth noting that the patient lives independently and has two sons who work at
the mine. The patient is divorced and developed a large vascular ulcer on her left calf region after
she experienced a fall. The injury caused her bruising and she sustained a large gaze. The wound
had since then turned infectious and did not respond to antibiotic treatment and dressings for a
period of 6 months. On account of continuous infection, the patient had to undergo left below
knee amputation which was performed under spinal anaesthesia electively within a regional
hospital. Post the surgery the patient has not experienced any post-operative complications but
has sustained nerve pain for which she has been prescribed Pregabalin. The wound appears to be
improving and it has been five days post her operation. At present, she has been referred to the
inpatient rehabilitation facility where she is learning the use of prosthesis to mobilize safely and
being imparted health literacy in relation to Diabetes symptom management. The current
medication of the patient includes Metformin 1g TDS and Pregabalin 75 mg BD.
Collection, Processing and Presentation of health information:
Upon critically analyzing the case information, it can be stated that the patient has a
prolong medical history of Diabetes which is characterized by poorly regulated blood glucose
level. On account of the same, the infection can be said to have sustained which had progressed
the stage of ulceration. Research studies mention that poor regulation of the blood glucose level
interferes with the normal production of the insulin which makes it difficult for the body to cope
with antigens or manifestation of infectious reactions (Park et al., 2015). A number of research
studies further suggests that improper regulation of blood glucose level triggers the problem of
neurological problems such as nerve pain and experiencing numbness of the nerves (Bunner et
al., 2015). As stated by Jahromi et al. (2015), poor regulation of blood glucose level down
regulates the immune system which leads to poor response to pathogens or antibiotics

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administered to treat antigens invading the body. It should further be noted in this context that
the patient has recently underwent a left below knee amputation and is under post operative care
but is susceptible to acquire infections with respect to the diminished immunity on account of the
poor symptom management of Diabetes. Further, it should be mentioned that the patient is
divorced, sustains independently and has also underwent left below knee amputation which
would directly impact her ability to manage work and activities of daily living. As a result the
patient might experience poor coping skills with the existing medical health condition which
might diminish her quality of life.
Identification and prioritization of three nursing problems based on health assessment:
On the basis of the identification of the nursing care needs, it can be stated that the patient
has recently underwent left below knee amputation and considering her previous medical history
of Peripheral Vascular Disease secondary to Diabetes Type II, it can be stated that she is
susceptible to develop recurrent infections. This accounts for the reason why she would referred
to a Diabetologist. The rationale for the referral can be mentioned as prescribing her an optimal
nutritious diet plan that can assist her to maintain the optimal calorie intake which is
recommended for Diabetic patient (Washington & Williams, 2016). In addition to this, the
Diabetologist would also assist her with self-management strategies that would include,
medication management as well as blood glucose monitoring with the help of glucometer strips
(Powers et al., 2017). Also, the expert would impart health literacy to her and disseminate
awareness in relation to the risk factors that can trigger poor management of blood glucose level
and promote recurrence of the infection (Powers et al., 2017).

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The second nursing priority would include referral to an occupational therapist. The
supporting rationale can be explained as assisting the patient with activities of daily living and
smoothly managing the use of prosthetics for mobilization (Dorsey & Bradshaw, 2017). The
patient has recently undergone a major surgery and has been reported to stay independently. The
case study further mentions that the patient has a full time profession and wishes to get back to
her active lifestyle. In order to assist the patient with the same, the occupational therapist would
help her get accustomed to the activities of daily living.
The third nursing care priority for the patient would include referral to a psychotherapist.
The rationale for the same can be explained as the stress and the poor coping skills post the
amputation surgery. Further, the provided patient data suggests that the patient lives
independently and has been divorced. Owing to the pre-op trauma and the lack of professional
engagement and personal care giving, the patient is entitled to experience mental health issues
such as anxiety and depression for which she would be referred to a psychotherapist (Bunner et
al., 2015).
At each step it would be critically ensured that the referrals are made according to the
cultural preferences of the patient so as to promote a culturally safe and effective nursing care
that is aligned to the ethical, legal and professional standards of nursing (Washington &
Williams, 2016). Further the caring professional would exhibit competence with the NSQHS
standards of quality and NMBA code of ethical and professional conduct to render positive
patient care delivery (Safetyandquality.gov.au; Nursingmidwiferyboard.gov.au).

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Establishment of nursing goals based on identified priorities:
Upon analyzing the above mentioned nursing care priorities, the specific recovery goals
for the patient would comprise of a total of five goals. The first goal would include the
independent ability of the patient to self-monitor her blood glucose level using glucometer strips
(Powers et al., 2017). Also, the patient would be able to effectively manage her diabetes
symptoms, manage her medications and individually report any physical health complications
(Watson & Dyck, 2015). The second nursing goal for the patient would include improved
knowledge and awareness in relation to the pathophysiology and risk factors that trigger poor
symptom management of Diabetes (Tellechea et al., 2016). The third nursing goal would
comprise of the patient being able to independently manage her activities of daily living such as
cooking, bathing and washing without external assistance (Dorsey & Bradshow, 2017). In
addition to this, the patient would also be able to mobilize independently and efficiently without
assistance (Dorsey & Bradshow, 2017). The nursing goal would also ensure that the patient is
able to reside within a safe home environment that is free from the risks of falls or accidents. The
fourth care priority for the patient would include, improved social engagement and improved
stress management skills (Jahromi et al., 2015). The fifth care priority for the patient would
include, improved ability to resume her profession and sustain her living independently (Jahromi
et al., 2015). The discussed care goals are aligned with the identified nursing priorities and it is
expected that the fulfillment of the nursing goals would help to assist the patient with positive
recovery and improve her quality of life.

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Reflection on learning experience:
In this section, I would like to mention that the overall learning experience of working on
this assignment was an incredible one. The assignment helped me thoroughly learn the concept
of the clinical reasoning cycle and make use of the reflective model to analyze a patient scenario.
Further, it should be mentioned in this context that this assignment helped me to clearly identify
the patient problems and relate the identified problems with the aetiology and pathophysiology
of the existing chronic illness disorder. The assignment helped me to thoroughly make use of the
evidence base and retrieve relevant scholarly journals to provide rationale for the care
interventions that have been recommended for the patient in order to assist wellness and
recovery. Typically the clinical reasoning model helped me to analyze the case scenario across
multiple domains and accordingly devise holistic care interventions to promote positive health
outcome and help the patient across diverse healthcare domains. I believe the correct use of the
clinical reasoning cycle has improved my decision making skills and has helped to improve on
my analytical reasoning ability. Also, overall I believe that this assignment has helped me to
improve on my documentation and presentation skills and present logical arguments in favor of
the best interest of the patient.
Conclusion:
Therefore, to conclude it can be mentioned that the provided case scenario has been
analyzed thoroughly with the use of the clinical reasoning cycle. In addition to this, the
appropriate nursing care priorities for the patient have been identified under each step of the
clinical reasoning cycle. Further, the evidence base has been used appropriately to retrieve
relevant research papers that are aligned to the existing health condition and comorbidities of the

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patient and appropriately interventions have been discussed. Further, the proposed nursing
interventions have been backed with research evidence and supporting rationale have also been
appropriately discussed. Also, the nursing goals have been discussed which would focus on the
holistic recovery of the patient from the existing healthcare condition. Typically the discussed
nursing goals have covered the patient across the physical, mental and emotional life domain of
the patient. Hence, overall it can be stated that the paper presents an elaborate nursing
assessment and articulating of an appropriate care plan that is aligned to the multiple healthcare
needs of the patient.

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References:
Bunner, A. E., Wells, C. L., Gonzales, J., Agarwal, U., Bayat, E., & Barnard, N. D. (2015). A
dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot
study. Nutrition & diabetes, 5(5), e158.
Dorsey, J., & Bradshaw, M. (2017). Effectiveness of occupational therapy interventions for
lower-extremity musculoskeletal disorders: A systematic review. American Journal of
Occupational Therapy, 71(1), 7101180030p1-7101180030p11.
Garneau, A. B. (2016). Critical reflection in cultural competence development: A framework for
undergraduate nursing education. Journal of Nursing Education, 55(3), 125-132.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Jahromi, M. K., Ramezanli, S., & Taheri, L. (2015). Effectiveness of diabetes self-management
education on quality of life in diabetic elderly females. Global journal of health
science, 7(1), 10.
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... &
Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to
enhance nursing students’ ability to identify and manage clinically ‘at
risk’patients. Nurse education today, 30(6), 515-520.
Miraglia, R., & Asselin, M. E. (2015). Reflection as an educational strategy in nursing
professional development: An integrative review. Journal for nurses in professional
development, 31(2), 62-72.

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Nursingmidwiferyboard.gov.au (2019). Nursing and Midwifery Board of Australia -
Professional standards. [online] Nursingmidwiferyboard.gov.au. Available at:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 16 Sep. 2019].
Park, H., Park, C., Quinn, L., & Fritschi, C. (2015). Glucose control and fatigue in type 2
diabetes: the mediating roles of diabetes symptoms and distress. Journal of advanced
nursing, 71(7), 1650-1660.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... & Vivian,
E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint
position statement of the American Diabetes Association, the American Association of
Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes
Educator, 43(1), 40-53.
Safetyandquality.gov.au (2019). The NSQHS Standards | Australian Commission on Safety and
Quality in Health Care. [online] Safetyandquality.gov.au. Available at:
https://www.safetyandquality.gov.au/standards/nsqhs-standards [Accessed 16 Sep. 2019].
Tellechea, A., Leal, E. C., Kafanas, A., Auster, M. E., Kuchibhotla, S., Ostrovsky, Y., ... &
Zabolotny, J. M. (2016). Mast cells regulate wound healing in diabetes. Diabetes, 65(7),
2006-2019.
Washington, E. D., & Williams, A. E. (2016). An exploratory phenomenological study exploring
the experiences of people with systemic disease who have undergone lower limb
amputation and its impact on their psychological well-being. Prosthetics and orthotics
international, 40(1), 44-50.

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Watson, J. C., & Dyck, P. J. B. (2015, July). Peripheral neuropathy: a practical approach to
diagnosis and symptom management. In Mayo Clinic Proceedings (Vol. 90, No. 7, pp.
940-951). Elsevier.