3807NRS Assessment 1: Clinical Reasoning Cycle Case Study Analysis

This case study analyzes a nursing scenario through the lens of the clinical reasoning cycle, focusing on a 30-year-old female patient experiencing heart complications, breathing difficulties, and edema. The assignment meticulously applies the seven stages of the clinical reasoning cycle, including information gathering, processing, analysis, problem identification, goal setting, intervention, and evaluation. The student nurse reflects on the decision-making process, highlighting the importance of effective communication, comprehensive patient assessment, and the formulation of appropriate care plans. The case study explores the challenges of managing congestive heart failure, the significance of recognizing vital signs, and the impact of missed information (such as the patient's diabetes history) on the overall treatment plan. The assignment demonstrates the application of the clinical reasoning cycle to improve patient outcomes and make informed decisions in clinical practice.

Running Head: CLINICAL REASONING CYCLE
CLINICAL REASONING CYCLE
Name of the student:
Name of the university:
Author note:

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To deliver appropriate carefulness to the patient it is important for the healthcare
professional to assess the patient carefully which is done by the help of several phases of the
clinical reasoning cycle (Dalton, Gee & Levett-Jones, 2015). The aim of this discussion is to
reflect the experience of the nurse in the treatment of the patient by the aid of the clinical
reasoning cycle. Clinical reasoning cycle supports in making decision making during the clinical
practice. Clinical reasoning cycle have seven phases which includes, patient information
gathering, processing, finding analysis, intervention, action plan and evaluation (Hunter &
Arthur, 2016). The chosen clinical decision for the assignment is the care planning of the patient
based on the present health status.
The first step of the clinical reasoning cycle that is the Levett-Jones et al., 2010, indicates
the collecting of the factual information regarding the present current health status of the patient
(Husebø, O'Regan, & Nestel, 2015). The patient involved here is 30 year old female who has been
suffering from heart complication. The patient also having breathing complication and swelling in
the legs and ankles. She is also experiencing weakness and irregular heartbeat.
The second step of the clinical reasoning cycle that is the Levett-Jones et al., 2010 is the
step which involves the evaluation of the therapeutic account of the patient. In this step all the
information regarding the previous and present clinical history is obtained. Based on the medical
history, findings are evaluated in order to establish the cues based on the patient condition ( Dalton,
Gee & Levett-Jones, 2015). In order to analyze the medical history and the current medical
condition, I tried to make a rapport with the patient. To make a rapport with the patient, I used
effective communication skill. After assessing the patient, I analyzed that the patient has been going
from dyspnea that is shortness of breathing and cough associated with the white tinged phlegm. After
evaluating the patient health, it is observed that the patient has lost excessive weight gain. Fluid

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retention is also observed in the patient. Swelling in the legs and the ankles as well as on the ascites.
Nausea and weakness is also observed. Frequent urination is also observed in the case of the patient.
After assessing the vital signs and symptoms of the patient, it is observed that breathing rate is 8
breaths per minute and the heart rate is 55 bpm which was evaluated with the help of Queensland
health protocol (Queensland Health, 2018). The patient stated that prior he had an issue regarding
the chest pain, but now there were no such issue. In order to collect more evidence regarding the
patient, an chest X-ray is performed.
After collecting the cues and information regarding the medical patient, the third step of the
clinical reasoning cycle that is the Levett-Jones et al., 2010, the information is administered and
based on that findings are analyzed. The information collected is distinguished and based on that
opinion are given (Dalton, Gee & Levett-Jones, 2015). After assessing the health condition of the
patient and by analyzing its signs and symptoms, it is stated that the client has been going through
cardiac issue. The breathing and the respiratory rate of the patient is also analyzed which state that
the breathing rate of the patient is 8 bpm which is less than that of the normal (12-20 bpm) and the
heart rate of the patient is also irregular that is 55 bpm which is less than that of the normal heart rate
(60 -100 bpm). Apart from that, fluid retention is also observed which causes Edema. Along with
that, other symptoms are also observed which includes coughing, nausea, weakness, lack of appetite
and weight gain which all indicates that the patient is suffering from cardiac complication. I only
collected the information associated with the present medical condition of the patient but missed the
previous medical history which is diabetes.
The fourth stage of the Levett-Jones et al., 2010, is identifying the actual problem based on
cues and information collected by the proper assessment of the patient. by identifying the problem of
the patient, the reason behind the current health state of the patient is estimated (Dalton, Gee &
Levett-Jones, 2015). In this case, by assessing the health state of the patient, it is evaluated that the

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patient has been suffering from congestive heart failure and the other issue that the patient has been
suffering from is the symptoms of the congestive heart failure. Diabetes is also one of the risk factor
for CHF which I missed during information gathering (Steinberger et al., 2016).
The fifth step of the clinical reasoning cycle is the establishment of the goals. In this step, the
care plan of the patient is formulated. Based on the physical and mental health wellbeing of the
patient, the care plan is formulated in order to get positive health outcome in limited period of time
(Dalton, Gee & Levett-Jones, 2015). In this condition the primary issue is the heart failure. The
severity of the heart failure is determined by the help of different diagnosis and then based on that
either medication or surgery is suggested to the patient. Shortness of breathing and the irregular heart
beat which should be drawn within the normal limit (Annest et al., 2015). The weight gain of the
patient should also be managed. Edema of the patient should also be treated to reduce the swelling in
the ankles and the legs.
The sixth stage of the Levett-Jones et al., 2010, is taking the action in order to provide proper
treatment to the patient (Dalton, Gee & Levett-Jones, 2015). I will formulate the care plan
according to the priority of the complication the patient is going through. If the congestive heart
failure cannot be treated with the help of medication such as betablockers, heart valve replacement or
repair will be conducted. Multiple specialist were involved in the treatment of the patient (Cohn &
Adams, 2017).
After the action, the seventh and the last step of the Levett-Jones et al., 2010 is explained
which is evaluation (Dalton, Gee & Levett-Jones, 2015). It is one of the most important step to
evaluate the effectiveness of the intervention applied. In order to evaluate, the vital signs of the
patient will be analyzed in regular interval (Wang et al., 2015). As I missed collecting the previous
medical history of the patient, the intervention took a little longer to provide positive health outcome.

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Reference:
Annest, L., Sheldon, M., Van Bladel, K., Heflin, E., Butler, W., Wechsler, A., ... & Arcia, R.
(2015). U.S. Patent No. 9,173,712. Washington, DC: U.S. Patent and Trademark Office.
Cohn, L. H., & Adams, D. H. (2017). Cardiac surgery in the adult. McGraw-Hill Education.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
The, 33(2), 29.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Husebø, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in
simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Queensland Health. (2018). Emergency Department Chest Pain Medical Assessment Pathway.
Retrieved from https://www.health.qld.gov.au/__data/assets/ pdf_file/0026/435833/
pathway_chstasses.pdf
Steinberger, J., Daniels, S. R., Hagberg, N., Isasi, C. R., Kelly, A. S., Lloyd-Jones, D., ... &
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Council. Cardiovascular health promotion in children: challenges and opportunities for

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2020 and beyond: a scientific statement from the American Heart Association [published
online ahead of print August .... Circulation, 134, e236-55.
Wang, Y., Luo, J., Hao, S., Xu, H., Shin, A. Y., Jin, B., ... & Zhao, Y. (2015). NLP based
congestive heart failure case finding: A prospective analysis on statewide electronic
medical records. International journal of medical informatics, 84(12), 1039-1047.