ATHC 1 Assessment: Clinical Reasoning Cycle for Patient Cyril Smith

This case study thoroughly examines the application of the clinical reasoning cycle to the care of Mr. Cyril Smith, a 72-year-old patient diagnosed with bowel cancer and scheduled for bowel resection surgery. The analysis includes a review of Mr. Smith's medical history, current symptoms such as dehydration and osteoarthritis pain, and potential complications related to his medications. Critical thinking questions address factors compromising safe medication practices, emphasizing the importance of therapeutic communication in nursing. The assessment reflects on lessons learned, particularly the need for careful monitoring of vital signs, consideration of medication history, and the implementation of therapeutic communication strategies to improve patient outcomes. The study highlights the necessity for rehydration therapies, pain management, and holistic care approaches in managing complex patient conditions. The document provides a comprehensive overview of patient assessment, diagnosis, and care planning, using evidence-based practices and therapeutic communication techniques.

ATHC 1 Assessment Three (3) template
Student Name:
Student Number:
Tutor Name:
Patient Name:
Complete the following table using information from Mr Cyril Smith’s story
Clinical Reasoning Cycle
Consider the patient situation
In this section, provide a
relevant and concise
description of your
observation of the context
and patient situation.
The current assignment takes into consideration the case study of Mr.
Cyril Smith. Mr. Smith is a 72 years old man detected with bowel
cancer. He has been scheduled for bowel resection surgery.
In this respect, some of the past case history of the patient has been
taken into consideration where Mr. Smith was a 72 year old man
living with his wife and three children, Dorren, Beth and Nelson
whom he lost in an accident six months ago. Mr. Smith had also
reported weight loss, decreased apetite.
The patient had a history of chronic obstructive pulmonary disease,
osteoarthritis and type II diabetes. Mr. Smith also had a past history
of smoking but has restrained from smoking since the last 10 years.
Mr. Smith had also reported that he had been overtly negligent with
taking his type 2 diabetes medications.
Collect cues and/or information
Review / Gather / Recall
Record current
information, new
information, knowledge
A-H diagnosis: A patent airway was found for the patient ensuring
that the patient could breathe normally without any hazard. The
patient recorded 20 breaths per minute which was again at par with
the normal standards. The patient recorded slightly high pulse rate
which was 110 signifying that the heart of the patient was beating at
an increased rate depicting signs of physical trauma present within
the body of the patient. The patient recorded normal on the PEARL
Score and reported that he felt slightly weak in his left leg and
complained of osteoarthritis pain recording 3 on a scale of 10.
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The patient recorded a bowel not open (BNO) syndrome which
means that the patient had difficulty in passing stools.
Process Information
Interpret
Analyse data and come to
understanding of
signs/symptoms
The patient depicted difficulty in passing stools and complained of
dry mouth. This could be attributed to the presence of bowel cancer
in the patient along with dehydration. The development of cancer
cells often affects the normal passage of the faecal matter out though
the rectum. Additionally, the patient was drinking less water.
Therefore, rehydration therapy should have been initiated with the
patient.
Discriminate
Distinguish relevant from
irrelevant information
However, some of the questions were only asked as part of routine
test. For example, some of the information like Mr. Smith was to be
visited by his daughter that day was extracted as part of a normal
patient enquiry process and was not clinically significant.
Relate & Infer
Cluster cues, make
deductions or form
opinions
Therefore, based upon the above observations, it was concluded that
the patient currently suffered from dehydration issues which made the
condition of his bowel cancer worrisome. Hence, there was an urgent
need for rehydration therapies to be implemented.
Match
Match current situation to
past situations
Therefore, based upon the current situations presented by the patient
it could be tallied with some of the past history and records. For
example, the patient reported of pain from osteoarthritis and had an
ankle fracture 15 years ago. Therefore, physiotherapy and effective
pain management was required for the patient.
Predict
Predict an outcome
The plausible outcome would be to reduce the leg pain in the patient
along with reduces the symptoms of dehydration by oral rehydration
therapies and safe medication practices.
Identify problems / issues
Synthesise facts and
interferences and make a
definitive nursing
diagnosis
From the facts and the details, it could be ascertained that the patient
had relatively low intake of fluid, which increased the dehydration
within the patient.
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Critical thinking questions
Identify and discuss two factors that could potentially compromise safe medication practices
(provide references) 100 words:
1 In this regard, a record was made of the medicines being suggested to the patient. Some of
these were Metformin 500mg BD, ibuprofen 400 mg BD and salbutamol 4 puffs PRN. The
salbutamol was provided to the patient due to his long history of chronic obstructive
pulmonary disease whereas the rest were pain management medications. However, the pain
in the patient was well controlled excepting the osteoarthritis pain. Therefore, overdose of the
pain medications could make the situation of bowel cancer worse in the patient by triggering
constipation (Shen et al. 2015).
2 Additionally, overdose of the salbutamol could trigger respiratory distress in the patient by
affecting the air pathway. The overdose of salbutamol has been seen to cause headache,
tremor, dry mouth, uneven heart rate, nausea, dizziness and seizures (Mallappa et al. 2015).
The patient complained of dry mouth, which could be due to excess salbutamol. Hence, the
salbutamol dosage should be tightly regulated within the patient.
Outline the importance of effective therapeutic communication and how it relates to safe nursing
practice (provide references) (200 words)
The therapeutic communication practices play a pivotal role in nursing care practices. The
therapeutic communication approaches helps in understanding the mental state of the patient. For
example, here the patient Mr. Smith was undergoing through bowel cancer treatment. The
treatment methods were aggressive in nature which often developed fear and anxiety within the
patient. Additionally, the patient here Mr. Smith had depicted signs of withdrawal from the
treatment and had little hope left.
Therefore, adaptation of therapeutic communication approaches with the patient could have helped
in generation of motivation within the patient. As mentioned by Schwind et al. (2016), practising
therapeutic communication approaches could help resolving of ethical or mental dilemmas. Mr.
Smith loved going out and meeting with his friends. He also loved playing bowls. However, the
recent diagnosis of bowel cancer has prevented him from undertaking all these activities with
enthusiasm or vigour. The, the therapeutic communication approaches can help in restoring
positivity and faith in the patient which helps in providing an effective end of life care (LeMone et
al. 2015). Additionally, practising holistic care approaches along with effective communication
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aspects can help in reducing the obstacles in the care pathway (Sartore-Bianchi et al. 2016). The
therapeutric communication helps in implementation of the policy of informed decision making
and establishes a person centred approach.
What have you learned from this assessment? What actions will you take into clinical practice as a
result of what you have learned? (provide references) (200 words)
First and foremost, the rehydration therapies should have been initiated for the patient as the
patient complained of dizziness and dry mouth. Initially the oral mucous membrane of the patient
should have been checked for showing signs of dehydration. The urine output could be monitored
strictly, as urine output less than 30ml/ hr for two consecutive hours could be taken as a warning
sign (Mallappa et al. 2015). The fluid status in relation to dietary intake of the patient should be
checked.
The patient should be checked for presence of any serious heart disorder. Additionally, the
monitoring the patient at frequent intervals for reporting orthostatic changes or changes in plasma
concentration which affects blood pressure could be beneficial in this aspect (Freedman et al.
2017).
Based upon the last clinical practice, I will take into consideration the importance of monitoring
the vital signs in the patient before the beginning of any treatment. Additionally, I should ensure
that the past medications history of the patient should also be taken into consideration before the
delivery of an effective treatment. I should also put special emphasis upon therapeutic
communication approaches for connecting emotionally with the patient
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References
Freedman, S.B., Pasichnyk, D., Black, K.J., Fitzpatrick, E., Gouin, S., Milne, A., Hartling, L. &
Pediatric Emergency Research Canada Gastroenteritis Study Group, 2017, ‘Correction:
Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis’, PloS
one, vol. 12, no. 4, p.e0176741.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L. & Reid-Searl, K., 2015, Medical-
surgical nursing, Pearson Higher Education AU, pp. 145-165.
Mallappa, S., Gabe, S., Phillips, R., Robertson, M. & Clark, S. 2015, ‘Evaluation of the Efficacy of
Oral Rehydration Therapy in Restoring Water and Electrolyte Balance Post Colectomy-A Blinded
Placebo-controlled Randomised Cross-over Trial’, British Journal of Surgery, vol. 102, p.56.
Mallappa, S., Gabe, S., Phillips, R.K., Robertson, M.D. & Clark, S.K. 2015, PTH-260 Oral
rehydration therapy to restore the water and electrolyte balance post-colectomy: results from a
placebo-controlled randomised cross-over trial, pp.56-85
Sartore-Bianchi, A., Trusolino, L., Martino, C., Bencardino, K., Lonardi, S., Bergamo, F., Zagonel,
V., Leone, F., Depetris, I., Martinelli, E. & Troiani, T. 2016, ‘Dual-targeted therapy with trastuzumab
and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic
colorectal cancer (HERACLES): a proof-of-concept, multicentre, open-label, phase 2 trial’, The
Lancet Oncology, vol. 17, no. 6, pp.738-746.
Schwind, J.K., McCay, E., Metersky, K. & Martin, J. 2016, ‘Development and Implementation of an
Advanced Therapeutic Communication Course: An Interprofessional Collaboration’, Journal of
Nursing Education, vol. 55, no. 10, pp.592-597.
Shen, Y., Colloc, J., Jacquet-Andrieu, A. & Lei, K. 2015, ‘Emerging medical informatics with case-
based reasoning for aiding clinical decision in multi-agent system’, Journal of biomedical
informatics, vol. 56, pp.307-317.
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Venkatakrishnan, K., Friberg, L.E., Ouellet, D., Mettetal, J.T., Stein, A., Trocóniz, I.F., Bruno, R.,
Mehrotra, N., Gobburu, J. & Mould, D.R. 2015, ‘Optimizing oncology therapeutics through
quantitative translational and clinical pharmacology: challenges and opportunities’,Clinical
Pharmacology & Therapeutics, vol. 97, no.1, pp.37-54.
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