NRSG370: Clinical Integration Case Study - Mr. Brad Taylor's Scenario

This case study analyzes the case of Mr. Brad Taylor, a 28-year-old male admitted to the High Dependency Unit (HDU) with a history of Type 1 Diabetes Mellitus (T1DM) and a recent episode of Diabetic Ketoacidosis (DKA). The paper applies the Clinical Reasoning Cycle to assess Mr. Brad's conditio...Read More

Running head: NRSG370 CLINICAL INTEGRATION 1
Unit Title: NRSG370 – Clinical Integration
Specialty Practice
Student Name:
Student ID Number:
Specialty Area:
Scenario:
1700 Words

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Introduction
During the provision of healthcare services, health providers such as nurses and doctors
should always ensure that patients are given high quality and patient-centered care. This ensures
that the outcomes of medical services provided to patients suffering from chronic diseases are
realized. In so doing, significant tools have to be utilized in the analysis of patient’s conditions.
This paper anticipates Mr. Brad’s condition by utilizing the clinical reasoning cycle to come up
with appropriate nursing interventions in the management of his condition. The clinical
reasoning cycle by Tracy-Levette Jones is a step by step approach that aids in developing nursing
interventions in the management of patients outcome. The steps involved in the approach include
consideration of patient facts, information gathering, information processing, problem
identification, goal establishment, action taking and finally evaluation and reflection. Therefore,
this paper displays the application of the clinical reasoning cycle on Mr. Brad’s condition as a
typical clinical case study.
Consideration of facts from Mr. Brad’s situation
The case study involves Mr. Brad Taylor, a 28-year old man who is admitted to the High
Dependency Unit (HDU) of a huge metropolitan hospital. Mr. Brad Taylor is brought by the
girlfriend and mother through the Emergency Department. His arrival followed his 2 day history
of malaise, polydipsia, vomiting and unwell feelings. Furthermore, he is recovering from very
mild cold. Finally, he is currently under my care as a registered nurse within the HDU 24 hours
after hospital admission.
Collection of information
Based on the case study about Mr. Brad, the type of information, methods of collection,
and the reason for information collection are the main areas of consideration (Charlap, 2017).

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The type of information collected about Mr. Brad includes personal details, history, type of
medication prescribed, assessment results after admission on the High Dependency Unit
(Fleshman, et., al, 2016). The results of the investigation and the proper nursing interventions are
also among the type of patient information that should be collected. Relatives and close friends
have a significant role to play when it comes to the collection of useful patient information. The
main reason why the medical information concerning Mr. Brad is collected is to identify and
evaluate the risks for disorders and diseases that are hereditary (Lu, 2017).
Therefore, following Mr. Brad’s condition, diverse information can be obtained.
Following his recent medical history, Mr. Brad has been expressing signs such as malaise,
polydipsia, vomiting and unwell feelings. Mr. Brad has just recovered from very mild cold. Also,
Mr. Brad has experienced a five year ICU admission for DKA despite being well from the
condition currently. Mr. Brad experienced uneventful appendectomy five years ago. He went
through T1dm for 10 years. Furthermore, he is a social drinker, non-smoker, and NKDA. Finally,
he works full time and lives with the girlfriend.
Mr. Brad’s medications include lantis 28 u/s nocte and Humalog 8-16 u/s PC. On
admission in HDU, vital signs include SpO2 98% on RA, HR 125 bpm, pain (3/10), GCS 14/15
PEARL, BP 100/60, Temperature 37.3 and RR 35 (Kussmaul type with acetone smell). I also
conducted a physical assessment which revealed restlessness, clear chest, dry skin, lax Abdo, c/o
thirst and nausea with intermittent vomiting. Mr. Brad urine output is 25ml/hr.
Processing of gathered information concerning Mr. Brad
Following the physical examination and historical data provided regarding Mr. Brad, a
great correlation exists between the data and DKA symptoms. The primary symptoms of DKA
include frequent urination, extreme thirst, high blood sugar levels, vomiting and nausea,

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abdominal pain, confusion, rapid breathing, dry skin and mouth, and fruity smelling breath. Most
of Mr. Brad’s symptoms correlate with this signs (Cohen,et al., 2016). For instance, Mr. Brad
displays vomiting, history of five year infection by DKA, pain (3/10) at the central abdomen,
restlessness, nausea, frequent urination (25ml/hr), dry skin, and thirst. Also, Mr. Brad has an
abnormal respiratory rate of 35 (normal respiratory rate is 12-20 for adults who are at rest) (Philip
et al., 2015). This is an indication of rapid breathing which is a symptom of DKA. Furthermore,
the fact that the Mr. Brad’s respiratoion is kussmaul type with acetone smell displays the
presence of DKA.
There exist a great correlation between DKA and Mr. Brad’s lifestyle. For instance, Mr.
Brad is a social drinker. Alcohol consumption is greatly linked to the development of type one
diabetes (Durrance et al., 2019). Following the exposure of plenty symptoms that express the
presence of DKA, I realized it was fundamental to carry out a laboratory test for measuring the
level of ketones. This is significant because it is the underlying cause of DKA. A high level of
ketones on finger prick confirms correlation between the patient’s condition and DKA.
Furthermore, it was fundamental to measure the blood gas ph. This is because DKA is often
associated with acidic conditions hence we expect the blood gas ph to be below normal to
confirm the availability of the condition (Iovane et al., 2018). Following the lab results, the blood
gas ph was abnormal and acidic (7.15) unlike the normal blood gas ph which should range
between 7.35 and 7.45 (Wang, & Zeng, 2019).
Following the fact that most of the signs and symptoms of the condition relate to DKA, it
was fundamental for me to assess the mental alertness of the patient. DKA is always associated
with confussion. This was identified gap in the assessment process. It was fundamental to
conduct a mental assessment to the patient as find out is the patient is mentally confused. Mental

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assessment incorporates tools such as forward and backward pronunciation of the days of the
week.
Problem Identification
In this stage, the information gathered concerning the patient is used in the determination
of the reasons for the patient’s current state. Below are the reasons why Mr. Brad is experiencing
the critical signs and symptoms provided in the case study information:
 Vomiting is due to the buildup of ketones in the blood by diabetic patients, which affects
the stomach hence leading to nausea and vomiting (Dowsett, Humphreys & Krones,
2019).
 Polydipsia, which is also referred to as excessive thirst, is due to frequent urination,
which is experienced by diabetic patients like Mr. Brad as a result of loss of too much
fluid by the body.
 Malaise is due to changes in the levels of sugar in the blood, which causes fatigue.
 Restlessness is due to damage in the nerves located on the legs. This is as a result of
uncontrolled high blood sugar levels in diabetic patients.
 High blood glucose also contributes to itchy and dry skin in diabetic patients like Mr.
Brad.
Goals establishment
Slowing down complication development and symptom eradication is one of the main
goals for in caring for diabetic patients like Mr. Brad (Haugstvedt, et., al, 2016). During goals
establishment, the main problems and issues faced by diabetic patients should first be identified.
Furthermore, most prioritized issues should be identified and ranked for efficient and effective

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healthcare provision. Below are the health problems that Mr. Brad and other diabetic patients
face:
 Lack of appropriate glucose monitoring technique.
 Lack of adherence to procedures and guidelines that help in the management of diabetes.
 Improper medication management.
 Developmental level.
 Stress and mental illness.
Ranking and prioritization of the above nursing health problems for diabetic patients help
in the realization of better healthcare outcomes. Therefore, improper glucose monitoring
technique is the health problem that should be given the first priority since most diabetic patients
lack knowledge on the best and most appropriate technique to monitor glucose (Chen, et., al,
2017). Lack of adherence to procedures and guidelines that help in diabetes management is the
second most prioritized health problem since the patients are not well familiar with these
techniques. Lastly, stress and mental disorder is another health problem that mainly faces
diabetic patients like Mr. Brad since they can’t find peace as a result of diabetes symptoms.
Action Taken
After identifying and prioritizing healthcare problems, the Clinical Reasoning Cycle
states that healthcare providers should provide the best nursing interventions that will help solve
the problems (Hunter, 2016). For instance, in order to solve the problem of inappropriate glucose
monitoring techniques, I shall always ensure the use of Intensive Insulin Therapy approaches
such as Continuous Subcutaneous Insulin Infusion (Farrar, et., al, 2016). Multiple Daily Injection
is also another nursing strategy that I shall uphold in order to reduce the cases of Type 1 Diabetes
in patients like Mr. Brad.

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Moreover, poor diabetes management due to lack of adherence to diabetes management
guidelines and procedures is also another health problem that requires immediate nursing
intervention (Arnold, et., al, 2016). I shall promote the best nursing intervention for proper
diabetes management by educating patients like Mr. Brad about diabetes. Educating the patient
promotes self-centered care which is advocated under the ethics of operation for registered
nurses (Schiller et al., 2019). This will make them understand better how to manage diabetes. I
shall also provide routine care for the patient. Finally, I shall provide dietary education to the
patient to avoid cases deterioration.
Everyone is always affected by stress and other mental illness. However, for patients with
diabetes such as Mr. Brad, stress can worsen the condition. To manage stress, diabetic patients
need to always keep regular appointments with the doctor (Hilliard, et., al, 2016). Stress
management is a significant approach that applies the legal framework in promoting good
outcomes among patients with diabetes type 1 (Yacoub et al., 2015) As a registered nurse, I shall
provide counseling services to the patient and advise him to fully comply with stress
management programs (Chatterjee, et., al, 2018). I shall also advise the patient to engage in fun
activities such as cooking for they play a significant role in stress management. Medication
reminders also reduce stress in diabetic patients. To make this approach more effective, I shall
include the family members and relatives (mother and girlfriend in the case provided) in
educating them regarding the management of the patient condition. Family inclusion is a
fundamental legal framework in healthcare provision.
Evaluation and Reflection
After determining the best nursing interventions for patients such as Mr. Brad with
diabetes, it is also necessary for the healthcare providers to also re-assess and evaluate the

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nursing interventions to ensure that they are relevant and appropriate (Ma, 2016). In monitoring
Mr. Brad’s glucose level I shall employ Continuous Subcutaneous Insulin Infusion. However,
shall use the approach in combination with Multiple Daily Injection which promotes
effectiveness. Furthermore, I shall compare the realized results with the set objectives and goals.
In so doing, I will be able to check the gaps and incorporate corrective measure into the program.
On the other side, I shall emphasize on maintaining and promoting the strengths of the programs.
Monitoring shall take plays on a routine basis to promote the wellbeing of the patient.
Conclusion
In conclusion, healthcare providers, such as nurses should also ensure that they adhere to
the legal frameworks during the provision of quality healthcare services. Research and
innovation should also be upheld in order to come up with appropriate techniques to monitor and
manage chronic conditions such as diabetes. Lastly, medical practitioners should always apply
the most appropriated communication skills in order to obtain useful and relevant information
concerning the patient.

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