Clinical Reasoning Cycle in Nursing: Managing Patient Hypovolemia Case

This essay discusses the application of the clinical reasoning cycle (CRC) in managing a 67-year-old female patient, Mrs. X, who was admitted post-operatively with hypovolemia, dehydration, and hypotension. The essay outlines the eight steps of the CRC, starting with considering the patient and collecting relevant clues such as vital signs, medical history, and handover reports. The data is then processed to identify problems like tachycardia, oliguria, and dry oral mucosa, leading to a diagnosis of fluid volume insufficiency. Goals are established to manage hypovolemia and prevent hypovolemic shock. Actions taken include informing the doctor, administering intravenous fluids, and closely monitoring vital signs. The essay concludes with an evaluation of the interventions, noting improvements in the patient's condition and urine output, demonstrating the effectiveness of the clinical reasoning cycle in nursing practice.

Running Header: CLINICAL REASONING CYCLE. 1
CLINICAL REASONING CYCLE.
STUDENT’S NAME
INSTITUTIONAL AFFILIATION
COURSE NAME
DATE.

CLINICAL REASONING CYCLE 2
Introduction
Clinical reasoning cycle in the healthcare setting is of importance as it facilitates
provision of quality and safe care. The reasoning cycle is helpful in making decisions in the
clinical areas as it facilitates positive outcomes. It has eight steps, that aims at guiding and
facilitating the both the student nurse and nurses in formulating the most appropriate and positive
decision in the clinical area. This essay will identify the steps of CRC and the clinical decision
made in regards to the patient’s/client’s hypovolemia, dehydration and hypotension condition.
Consider the Patient
The first step in the reasoning cycle, is assessing the patient holistically so as to come up
with the most beneficial outcome. Mrs. X a 67 years old female client was admitted to medical-
surgical ward on day one post operatively following partial colectomy. Her condition was stable
during the surgery, vital signs were normal but after transfers to medical ward she experienced
light headache, dry mouth and her condition deteriorated.
Collect clues/information
The second stage of CRC is collecting the most relevant information about the patient’s
condition. The information that is currently available; handover report, clinical documentation,
patient’s medical and social history are reviewed. The nurse then identifies the additional
information through assessing the vital signs and other health assessment. Mrs. X have a history
of hypertension and she is on medication, beta blocker. The handover sheets indicated that her
blood pressure (BP) was 140/80mmHg an hour ago before my shift.

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On assessment her temperature is 37.8c, heart rate (HR) 118, respiratory rate (RR) 20, BP
112/58mmHg and specific gravity 1.022. Currently, he is on Beta blockers and has an
intravenous (IV) running at a rate of 86ml/hr. She has an indwelling catheter with a urine output
rate of 20-25ml/hr. Her oxygen saturation (O2 sat) and blood sugar level (BSL) are in normal
range.
During surgery she had epidural anaesthesia during surgery as she has a history of
hypertension. Her recent hypotension could be related to the epidural anaesthesia as it lowers the
HR which impacts on the BP. In addition to this, the hypotension can be as a result of the patient
being nil per oral and also blood loss during the surgery. Despite this her oxygen saturation is
normal and blood sugar level is normal.
Process data
In this stage of CRC, the nurse interprets the clues collected and identify significant
aberration from normal. At this stage nurse call upon their wide repertoire of previous clinical
experience matching the features of the patient’s presentation with similar situation. Firstly, as it
has been mentioned previously both her oxygen saturation and the blood sugars are within
normal ranges. Secondly, she is afebrile as her temperatures indicates low grade fevers. Thirdly,
she has oliguria (20-25mls/hr of urine) and her oral mucosa are dry. The normal urine output is
50ml/hr to 60ml/hr (Hinkle & Cheever, 2013). Lastly, she has tachycardia (118 beats/minute) as
the normal heart rate is 60-100 beats/minute. This indicates that she may be experiencing
hypovolemia (fluid volume insufficiency) and the circulatory and the renal system are
compensating (Guyton,2015). In addition to this, she could further develop more complications
such as hypovolemic shock and acute kidney injury (McMahon 2016).

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Identify problems/issues
The fourth stage of CRC is synthesizing all the important information that has been
collected and processed so as to identify the most appropriate nursing diagnose. Mrs. X
manifestations (tachycardia, hypotension. oliguria and dry oral mucosa) clearly indicates reduced
fluid volume. The causes behind these manifestations are; limited oral intake evidenced by the
dry mouth and thirst, inadequate fluid intake and surgical losses (Millers & Nicholas 2013).
Establish goal
At this stage, nurse prioritizes and clarifies the goals set based on their urgencies. These
goal must be specific, measurable, achievable, realistic and timely (SMART) and designed to
address the nursing diagnosis. The major nursing diagnosis for Mrs. X is fluid volume
insufficiency related to blood loss and reduced intake. Therefore, the therapeutic goal aims at
managing the hypovolemia (Odelle et al. 2014) to avoid her condition deteriorating to
hypovolemic shock which is fatal. Is managed through infusion of volume expanders. Her
condition is expected to normalize in the next four hours after starting her on fluid therapy.
Take action
This is the fifth stage in which the nurse selects the most suitable course of action so as to
achieve the goals set to address the specific nursing diagnosis mentioned above. In addition to
this, clinical knowledge, clinical skills, and effective communication skills are required so as to
achieve positive outcomes. As stated above, the patient has hypovolemia as a result of reduced
fluid intake and surgery blood loss (Vincent &Ferreira, 2016). Therefore, the treatment aims at
reverting this, so as to normalize the patient by restoring the fluid volume, electrolytes balance
and normalizing urine output (Kreimeier, 2016). The following are the actions I took; firstly, I

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informed the doctor about her condition. He prescribed intravenous fluids for her which I and my
friend administered at the rate of 125ml/her after checking her IV line for blockages. I also
continued to monitor her vitals.
Evaluate
At this stage, the nurse re-examines both the subjective and objective data so as to
evaluate the effectives of nursing intervention. This is assessed through the patient’s condition.
After monitoring her closely, we noticed that her condition had improved, her vital signs
normalized and also her urine output improved as well. This shows that the nursing interventions
were effective (Copstead & Banasik 2013).
Conclusion
In conclusion, it is clear that the clinical reasoning cycle is imperative in the nursing
practice. It is used as a guide for the nurses in formulating clinical decision that are clear and has
rationales. In the clinical scenario above it has facilitates the formulation of a clinical decision
and also in the breakdown of the process which has enabled the learner in coming up with the
most effective solutions. Furthermore, it is also clear that the CRC is an effective tool for the
healthcare providers in providing quality and safe patient care.

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References.
Copstead, L. C., & Banasik, J. L (2013). Pathophysiology (5th ed.). St Louis, Missouri: Saunders
Elsevier.
Guyton, A. C. (2015). Textbook of Medical Physiology. (13th ed.). Philadelphia: W. B. Saunders,
4(2), 78-90
Hinkle, J.L, Cheever, K.H. (2013). Brunner and Saddarth’s Textbook of Medical and Surgical
Nursing, (13th ed) Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
Kreimeier, U. (2016). Pathophysiology of fluid imbalance. Critical Care, 4(2): S3–S7.
McMahon, R., (2016). ‘Therapeutic Nursing: Theory Issues and Practice’, in R. McMahon and
A. Pearson (eds) Nursing as Therapy. Cheltenham: Nelson Thornes.
Millers W., Nicholas S., (2013). Linear communication models. Journal of clinical nursing. 13,
707-713.
Odelle M., et al. (2014). Nurses’ role in detecting deterioration in ward patients: a systematic
literature review. Journal of advanced nursing. 65(10), 1992-2006.
Vincent, L., Ferreira, L., (2016). Evaluation of organ failure: We are making progress. Intensive
Care Medicine, 26(6), 1023– 1024