CNA155: Clinical Reasoning Report on John Wells' Emergency Case

This clinical reasoning report examines the case of John Wells, an 82-year-old dairy farmer admitted to the emergency department following a fall from a stationary bike, resulting in a head injury and concussion. The report follows the clinical reasoning cycle, beginning with considering the patient's profile, including his age, medical history, and presenting symptoms such as nausea, headache, and confusion. It then details the collection of cues and information, including vital signs and the absence of prior head injury records. The information processing stage involves interpretation, discrimination, relating information, inference, matching, and prediction, analyzing the significance of the symptoms and potential outcomes. The report highlights the importance of recognizing potential complications like dementia and the need for immediate attention to the patient's condition. It emphasizes the impact of the fall and the potential for high blood pressure due to the concussion, referencing relevant literature to support the analysis.

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Clinical Reasoning

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Clinical Reasoning
Consider the patient
As indicated by (Alsalaheen et al., 2016), consideration of the patient is the initial phase
of the clinical reasoning cycle. In this stage, the patient is confronted by the nurse. The nurse
should immediately start to recognize the instant impression of the convalescent. The nurse may
experience the impression either from the handout report that he/ she was given or by observing
the convalescent’s behaviour (YAZDANI, HOSSEINZADEH, and HOSSEINI, 2017). As a
result, while examining the first impression of John, it is of most importance to put into
consideration that prior suppositions may have had an effect on some information in this phase.
With that information, now consider the case of John Wells, who is currently aged 82.
John Wells is a dairy farmer. He has a wife and a son. His wife is named Mavis, and his son’s
name is Sam. Additionally, John Wells is a dairy farmer. John Wells was brought by his son and
was admitted to the emergency section. This was after Sam was called by his mother Mavis who
was worried about John Well’s wellbeing. Mavis had observed that John had not taken his dinner
that night. She also noticed that John looked quieter than usual. John Wells informed Mavis that
he fell from a stationary bike after he became unbalanced. This was after he had ridden the bike
from the dairy and stopped when he reached home. Due to the fall, John hit his head on the hard
summer ground. As usual, John Wells was not wearing a helmet. Moreover, John Wells rarely
wears any protective devices while working and therefore, even during the incidence, he was not
wearing any protective equipment. Furthermore, due to the fall, John Wells incurred a slight skin
tear to his left arm (Stubbs, Brefka, and Denkinger, 2015). Besides, John Wells also suffered a
minor scratch to his left elbow. In relation to this, John Wells told Mavis that he was not

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experiencing any other pain or injuries. He also said that he was not experiencing any stiffness or
decreased range of motion to his limbs, chest and neck.
Collect cues and information
Gathering of cues and data is the second phase of the clinical reasoning cycle. In this
stage, the nurse is supposed to collect any information in regards to John Wells. Moreover, the
phase also requires the nurse to examine the convalescent’s data that is accessible either from his
nursing notes, handover report, history, or clinical documentation. Now, for the case of John
wells, there is no prior medical record of any reported concussion or head injury (Stevens,
Mahoney, and Ehrenreich, 2014).
During the nurse assessment, the nurse reported that John experienced nausea headache
and mild confusion from the fall. These three symptoms can signal a migraine or a concussion.
Additionally, John Wells suffers from mild hypertension, but he has not received any
antihypertensive treatment yet. Moreover, from nurse assessment, John stated that he was
currently feeling confused and had a headache of 4 out of 10 (Richardson, Bennett, and Kenny,
2014). The confusion could be caused by the fall or his age. Moreover, the headache could have
been caused by the concussion. Additionally, John stated that prior to feeling hazy, he
experienced dizziness. The dizziness feeling could be a sign of a concussion.
The results of the vital signs that were recorded from John’s assessment showed that he
had a body temperature of 36.7 degrees Celsius. The normal body temperature of an individual
should be around 36.1°C to 37.2°C. Although due to his age, the 36.7 degrees Celsius could be a
sign of a fever. John Well’s blood pressure was measured at 148/84 mmHg. The normal blood
pressure of an individual should be around 140/90mmHg for older persons. Therefore, even
though the diastolic level of John’s blood pressure was normal, the diastolic level was high,

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indicating that he could be suffering from high blood pressure. Additionally, high blood pressure
could have been caused by a concussion. Moreover, the assessment report from the nurse showed
that John Well’s Pulse rate was recorded at 81 beats per minute. Normal pulse rate is between 60
to 100 beats per minute. Therefore, there was no concern in the pulse rate.
Besides, John Well’s respiratory rate was recorded at 17 breaths per minute. Normal
respiratory rate is between 12 to 18 breaths every minute. Therefore, John Well’s respiratory rate
was normal. In addition, the assessment from the nurse suggested that John well’s oxygen
saturation level was at 97%. The normal oxygen saturation rate is between 96 percent to 100
percent. Therefore, John Wells had a normal respiration rate (Koivisto et al., 2016).
Information Processing
According to (Alfaro-LeFevre, 2015), this is the most significant phase of the clinical
reason cycle. In information processing, the nurse is supposed to analyze all the data collected
from the previous stages (Khan et al., 2016). Moreover, he/she is required to differentiate all the
information from the relevant to irrelevant. Information processing is divided into six steps:
1. Interpretation
In this step, the nurse is supposed to examine the data and come to an understanding of
the signs and symptoms. Now consider the case of John Wells, due to the circumstances that led
to the fall, nausea, headache, and mild confusion that John Wells’ experienced showed that John
Well’s was suffering from a concussion (Hunter and Arthur, 2016). Additionally, the dizziness
that John Wells experienced was also caused by the concussion. Moreover, the mild headache
that John Wells was experienced was due to the concussion he incurred during the fall.
Additionally, the blood pressure level was high as a result of the concussion.

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2. Discrimination
In the discrimination stage, the nurse separates the relevant information from the
irrelevant. Now consider the case of John Wells, his temperature level was high, but it is not a
major concern due to his age (Fann et al., 2018). His blood pressure is high, but it is not a major
concern, especially for a person who has experienced a fall and due to his age. Additionally, high
blood pressure had already been noticed prior to the fall. Nevertheless, the nurse should
constantly check the blood pressure monitor.
3. Relating the information
In this stage, the nurse should find new links or patterns and see the relationship (Delany
and Golding, 2014). A concussion is highly experienced with older persons. Additionally, due to
his age, John experienced the concussion after riding the bike without a helmet which caused the
confusion leading to the imbalance and ultimately the fall.
4. Inference
In this stage, the nurse should create opinions that are logically seen from the cues and
data analyzed (Caprani et al., 2016). The blood pressure of John may have arisen due to the
concussion that he experienced after the fall. Moreover, his temperature level may have arisen
due to the trauma John may have experienced after the fall.
5. Matching
In this stage, the nurse discovers the relationship between the current case and past cases.
As stated by the World Health Organization, elderly persons are at a high possibility of suffering
from concussions. Therefore, some of the problems that John Well’s is experiencing are related
(Alsalaheen et al., 2016). Moreover, as individuals age, their muscle becomes weak, which

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exposes them to risk of falling. Moreover, due to his age, it is highly likely that John may have
forgotten what really happened that day.
6. Prediction
If John Well’s concussion is not attended to immediately, it may lead to major health
problems such as dementia and even ultimately cause his death (Alfaro-LeFevre, 2015).

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References
Alfaro-LeFevre, R., 2015. Critical Thinking, Clinical Reasoning, and Clinical Judgment E-
Book: A Practical Approach. Elsevier Health Sciences.
Alsalaheen, B.A., Whitney, S.L., Marchetti, G.F., Furman, J.M., Kontos, A.P., Collins, M.W.
and Sparto, P.J., 2016. Relationship between cognitive assessment and balance measures in
adolescents referred for vestibular physical therapy after concussion. Clinical journal of sport
medicine: official journal of the Canadian Academy of Sport Medicine, 26(1), p.46.
Caprani, N., Doyle, J., Komaba, Y. and Inomata, A., 2015, July. Exploring healthcare
professionals' preferences for visualising sensor data. In Proceedings of the 2015 British HCI
Conference (pp. 26-34). ACM.
Delany, C. and Golding, C., 2014. Teaching clinical reasoning by making thinking visible: an
action research project with allied health clinical educators. BMC medical education, 14(1), p.20.
Fann, J.R., Ribe, A.R., Pedersen, H.S., Fenger-Grøn, M., Christensen, J., Benros, M.E. and
Vestergaard, M., 2018. Long-term risk of dementia among people with traumatic brain injury in
Denmark: a population-based observational cohort study. The Lancet Psychiatry, 5(5), pp.424-
431.
Hunter, S. and Arthur, C., 2016. Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, pp.73-79.
Khan, A., Prince, M., Brayne, C. and Prina, A.M., 2015. Lifetime prevalence and factors
associated with head injury among older people in low and middle income countries: a 10/66
study. PLOS one, 10(7), p.e0132229.

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Koivisto, J.M., Multisilta, J., Niemi, H., Katajisto, J. and Eriksson, E., 2016. Learning by
playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical
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Richardson, K., Bennett, K. and Kenny, R.A., 2014. Polypharmacy including falls risk-
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Stevens, J.A., Mahoney, J.E. and Ehrenreich, H., 2014. Circumstances and outcomes of falls
among high risk community-dwelling older adults. Injury epidemiology, 1(1), p.5.
Stubbs, B., Brefka, S. and Denkinger, M.D., 2015. What works to prevent falls in community-
dwelling older adults? Umbrella review of meta-analyses of randomized controlled
trials. Physical therapy, 95(8), pp.1095-1110.
YAZDANI, S., HOSSEINZADEH, M. and HOSSEINI, F., 2017. Models of clinical reasoning
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Professionalism, 5(4), p.177.