Case Study: Analyzing Ted's Post-Operative Care Using CRC Stages

This assignment presents a comprehensive case study analyzing the post-operative care of an 82-year-old male named Ted Williams, who underwent bowel resection and colostomy. The analysis employs the Clinical Reasoning Cycle (CRC) to evaluate the patient's situation, collect and process inform...Read More

Question 1: Use stage one of the clinical reasoning cycle (CRC) ‘Consider the patient
situation’ to identify the biopsychosocial, spiritual and cultural impacts of Ted’s
surgery for him and his family.
This particular section of the paper attempts to make use of the stage one of the clinical
reasoning cycle (CRC) with the view to identify the bio-psychosocial, spiritual and cultural
impacts of Ted’s surgery for him and his family. Clinical reasoning can be simply described as
the procedure through which nurses (along with other clinicians) gather cues; process
information; arrive to some constructive understanding regarding a patient’s situation or
problem; plan and execute interventions; examine outcomes and lastly, reflect upon as well as
learn from the procedure (Alfaro-LeFevre, 2009). The stage one of the Critical resonating
cycle (CRC) i.e. considering patient’s situation, requires nurses to properly highlight the
patient’s details (Alfaro-LeFevre, 2009). This would involve facts and several context or
situations of the patient. In the provided case, Edward (Ted) Williams is basically a 82 years
old male who is day 4 post-operative subsequent to a bowel resection as well as creation of a
temporary colostomy. Moreover, he before had a coloscopy along with biopsy, which
established a malignant mass. Ted also has a previous medical record of heart failure, obesity,
type II diabetes melilites and lastly, gout. His health statistics include BMI 37.6m2; Height
175cm; weight 115kgs. In order to better evaluate Ted’s present situation, RLT model could
be brought to use. The RLT model would serve like a guide for all-inclusive patient
evaluation as a basis for a care plan (Scheffer and Rubenfeld, 2000). As per the RLT model,
it can be stated that the Ted’s surgery could have various bio-psychosocial, spiritual and
cultural impacts upon him and his family. Firstly, the surgery can have an impact upon
biological factors like overall health and level of autonomy. Secondly, it could have an
impact upon psychological factors like emotions, spiritual beliefs and capability to
understand things. Thirdly, it could have an impact upon socio-cultural factors like
expectations, culture, beliefs, values and ability to carry out daily activities as well as
communicate.
Question 2: The information for stage two of the CRC collect cues and information has
been provided for you in the case study. Use this information to provide responses to
CRC stages three ‘Process the information’ and stage four ‘Identify Problems.’ Please

link to pathophysiology and provide evidence from the literature to support your
thinking.
In stage two i.e. collecting cues nurses review the information such as the history of the
patients, reports, any previous undertaken nursing evaluation and other information related to
the patient (Alfaro-LeFevre, 2015; Shulman, 2004). The information for stage two of the
CRC has been already provided in the given case study revolving around Ted. The provided
information about Ted would help the nurses and clinical staff to provide responses to CRC
stages three ‘Process the information’ and stage four ‘Identify Problems. In stage three, while
processing the available information related to Ted, the nurse requires interpreting,
discriminating, relating, inferring, matching conditions and lastly, predicting an outcome
(Tanner, 2006). In stage four, the nurses would require synthesizing facts and then make a
definitive diagnosis of the issues faced by Ted (Halpern, 2001). With a sound data processing
stage, one would be capable of determining the possible reason behind the Ted’s present condition.
After appropriately identifying Ted’s problem, it would require being diagnosed
appropriately. After evaluating the information provided related to Ted and his case history, it
can be stated that his current medication i.e. Metformin 500mg Mane, Captopril 12.5mg
mane, Frusemide 40mg mane, Allopurinol 100mg Daily and lastly, Paracetamol 1g QID
would continue to be the same. Ted is now day 4 post operation. He was basically Nil By
Mouth (NBM) for the first 48 hours after surgery. Then, the third day he commenced on a
full fluid diet and has upgraded to a light diet yesterday evening. Today, Ted was given his
regular metformin and ate breakfast. Since then Ted has vomited twice and feels nauseous.
He has been given ondansetron 4mg for nausea. This shows that Ted needs to be given full
fluid diet for now as even light diet would not be suitable for Ted considering his situation
and latest experience.
Ted has some abdominal pain that he says is at a scale of 4-5/10, he says the pain worsens on
palpation to 7/10 and you note that his abdomen is distended. This shows that Ted should be
given PCA morphine ahead also for pain relief. The colostomy bag is intact and the stoma
can be sighted through the bag. The stoma is warm, pink, moist and slightly raised above the
skin. Also, his BMI is 37.6m2; Height is 175cm and weight is 115kgs. This clearly implies
towards the fact that individuals having a BMI of 300 and above are grouped as being obese.
During majority of cases, senior people like Ted and who are obese have a greater likelihood
of suffering from diabetes, hearing issues and eye problems. As a result, Ted’s BMI index

opens a clear chance of securitizing few among the co-morbidities, which he faced in the past
or is likely to face in the future.
Question 3: Using stage five of the CRC Establish goals outline and justify (5) nursing
care interventions/strategies the registered nurse would implement to provide care for
Ted. Justify your thinking with links to current peer reviewed evidence and literature.
The stage 5 of Critical resonating cycle (CRC) i.e. establishing goals requires nurses to
outline exactly what objectives they want to accomplish, in a provided time period (Levett-
Jones, 2013). At the time when the objective is clear, they could work towards it as well as
make it possible. In the provided case of Ted, there needs to be few nursing care strategies,
which the registered nurse should implement for providing care to Ted. The strategies in case
of Ted take in:
 Firstly, After evaluating the information provided related to Ted and his case history,
it can be stated that his current medication i.e. Metformin 500mg Mane, Captopril
12.5mg mane, Frusemide 40mg mane, Allopurinol 100mg Daily and lastly,
Paracetamol 1g QID would continue to be the same. The nurse needs to keep a serious
check on his health and make sure that the medicines are added and changed as per
the need and his condition. There are chances that after a certain recovery point he
might not need to consume some certain medications as advised just after being
operated.
 Secondly, Ted was given his regular metformin and ate breakfast. Since then Ted has
vomited twice and feels nauseous. He has been given ondansetron 4mg for nausea.
This shows that Ted needs to be given full fluid diet for now as even light diet would
not be suitable for Ted considering his situation and latest experience. The nurse
needs to properly monitor his health signs and ensure that his body is accepting the
type of food being consumed. Ted should be slowly shifted towards solid food.
 Thirdly, the nurse needs to make sure that Ted does not experience any health issues
that he has faced in the past and thus, proper monitoring of the same is also required
at all times. The nurse would ensure that he does not consumer any medicine or food
that can have a negative impact on his health considering his past health history.
 Fourthly, the nurse would ensure that he does not face much pain since he has also
complained about the same. Any undesirable health signs or condition needs to be
immediately reported to the clinical expert or the doctor concerned. The nurse would

also keep a close check on Ted’s recovery and ensure that he recovers positively
within the set timeframe.
 Fifth, taking into consideration the age of Ted, the nurse would also ensure that at no
time he feels low or anxious because of his ill health or operation. It is highly believed
that a positive outlook helps patients to recover more speedily than expected.
Question 4: Select two classes of drugs that would be used to manage Ted’s post
operative condition. Please provide a rationale for why that drug class would be suitable
for Ted. Provide a detailed description of the pharmaco-dynamics of each of the selected
class of drug as well as the potential side effects and the nursing implications for
administration.
Taking into consideration the present situation of Ted along with the prevailing health
statistics, it can be clearly stated that there prevails the need for him to take few specific
drugs post-operative condition. It is provided in the case study that Ted has past history of
heart failure, type II diabetes melilites, obesity and gout. Also, his BMI is 37.6m2; Height is
175cm and weight is 115kgs. This clearly implies towards the fact that individuals having a
BMI of 300 and above are grouped as being obese. During majority of cases, senior people
like Ted and who are obese have a greater likelihood of suffering from diabetes, hearing
issues and eye problems. As a result, Ted’s BMI index opens a clear chance of securitizing
few among the co-morbidities, which he faced in the past or is likely to face in the future. In
such a situation, it is highly recommended that Ted should first focus on drugs that help him
deal with his BMI, he should focus on weight loss drugs like Rimonabant and physical
exercises. Rimonabant is basically a selective antagonist belonging to the type 1 cannabinoid
receptors. It induces substantial weight loss among patients with type 2 diabetes along with
central obesity, whilst additionally enhancing glycemic, blood pressure control and lipid. The
side effects of Rimonabant for Ted include depressive disorders, mood alterations, anxiety,
upper respiratory tract infections and lastly, nausea. However, the weight loss drugs can also
have negative impact on Ted as it can result in blood pressure issues.
Secondly, Ted could also take drugs for avoiding heart diseases in future by taking heart
reviving drugs like Aspirin as prescribed by clinical expert. Aspirin is basically a NSAID
(non-steroidal anti-inflammatory drug), which comes from salicylate that could be obtained

in plants like myrtle and willow trees. However, these drugs could result in thinning of blood,
upset stomach, heartburn, drowsiness or mild headache in case of Ted. Apart from all this,
there also exists the need for Ted to keep a continuous check on his health statistics such as
blood pressure, BMI and weight.
References:
Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to
outcome-focused thinking. St Louis: Elsevier.
Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment
E-Book: A Practical Approach. Elsevier Health Sciences.
Halpern, J. (2001). Humanizing medical care. Oxford; Oxford University Press
Levett-Jones, T. (2013). Clinical reasoning: Learning to think like a nurse. Pearson
Australia.

Shulman, L. (2004). The wisdom of practice. San Francisco: Jossey-Bass; 2004
Scheffer, B. K. and Rubenfeld, M. G. (2000). A consensus statement on critical thinking in
nursing. J Nurs Educ., 39(8), 352–60.
Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgement in
nursing. Journal of Nursing Education, 45(6), 204-211