NRSG139 - Clinical Reasoning Cycle: Application to Patient Health

This essay details the application of the Clinical Reasoning Cycle (CRC) in assessing and planning care for a 61-year-old patient, Mr. Smith, awaiting AAA surgery. As a first-year nursing student, the author describes using the CRC to gather information about Mr. Smith's health history, including hypertension and previous beta-blocker use. The essay outlines the process of collecting cues through patient interviews and reviewing medical records, followed by interpreting and processing this information to identify potential risks like hypotension during and after surgery. Facilitators and barriers to Mr. Smith's health are considered, emphasizing the importance of fluid management post-operation. The author reflects on the experience, highlighting the CRC as a valuable tool for clinical decision-making in nursing practice.

Running head: CLINICAL REASONING CYCLE 1
Clinical Reasoning Cycle
Name
Institutional Affiliation

CLINICAL REASONING CYCLE 2
CLINICAL REASONING CYCLE
Introduction
My care situation involved caring for Mr. Smith who was a sixty-year-old patient waiting
for AAA surgery. I was tasked to assess his current health status. Because I was a nurse
professional nurse first year student, I went via daily interview period which entailed processes
of making decision. My assignment and instruction was to consider using a CRC3. Thus I will
show the steps I took to achieve my goals under the supervision of a nurse I worked in handy
with.
Consider the patient situation (CRC 1)
For the practical and precise decision on the present health condition, it is essential that I
considered all the necessary data about the condition. These include data on the effects, how the
condition appeared and other data. As a professional nurse first year student, I needed to make
some decisions taking into account my judgment and knowledge during several conditions that
can never be sorted with the textbook or research knowledge. The clinical reasoning session
which I went through entail moral reasoning sessions that ultimately helped me consider the
condition of the patient alongside health status before advancing with the process of decisions
making. I generated my clinical reasoning from a caring and concerned position which I
developed to take desired care of my patient alongside advancing my career (Forsberg, Ziegert,
Hult & Fors, 2016). To facilitate data collection, I first developed a rapport with Mr. Smith, and
we became friends. I empathized with his situation, and he got to be open with me and told me
all the things I wanted to know without a challenge. In the case where he could not talk to
explain, I provided him with a paper and a pen to write down. This helped me gather the required
information from the interviews when I realized he had difficulties explaining his conditions.

CLINICAL REASONING CYCLE 3
The 61-year-old man was in the ward waiting to undergo AAA (adnominal aortic aneurysm)
surgical treatment the following day.
Collect cues and information (CRC 2)
Mr. Smith was a 61-year-old patient who had a history of hypertension and under the
beta-blockers in his past life. He was an ordinarily hypertensive individual condition that
required strong consideration. In the course of my session with him, I was mandated to appraise
the collected information and data which included the medical history of Mr. Smith, handover
reports, past investigations reports as well as any previous medical or nursing assessment which
have been carried out. Mr. Smith had a history of hypertension. Mr. Smith also previously used
beta-blockers. His blood pressure (BP) was 141/181 thirty minutes ago.
I undertook a new patient assessment of my patient to gather potential changes which
could have taken place. The fresh data gathered through Mr. Smith’s evaluation showed a BP at
111/61 while his epidural streaming stood at 10ml per hour. The ultimate task within this specific
step was for me to recall knowledge that encompasses recalling past phases and steps my patient
had to go through (Hunter & Arthur, 2016). Here, I evoked knowledge like therapeutics, ethics,
culture, law, pharmacology, and pathophysiology because Mr. Smith’s BP is linked to his fluid
status. His epidurals could drop the blood pressure as they result in vasodilation. Within the
ward, I got standing instructions relevant to running epidural (Koivisto, Multisilta, Niemi,
Katajisto & Eriksson, 2016).
Process information (CRC 3)
In processing the information, I used several steps under the instruction and supervision
of nurse that entailed interpretation, discrimination, relation, a combination of inferring,
matching and prediction session. Under interpretation, I analyzed the information I had gathered

CLINICAL REASONING CYCLE 4
to understand the signs and symptoms of Mr. Smith and stimulated a comparison between the
abnormality and normality. Under discrimination, I refined the useful information from the
irrelevant ones, and recognized any possible inconsistencies and finally extracted the most
significant disparities within the cues I had gathered. Mr. Smith’s temperature was somewhat
high; however, I was never concerned in this regard. My main concern regarded Mr. Smith’s
pulse and blood pressure. I would check Mr. Smith’s oxygen sat alongside urine output. I then
related to and realized that hypertension and tachycardia could be imminent shock symptoms.
Mr. Smith’s blood pressure dropped following his epidural raising. Under relation, I discovered
the new association or patterns whereby I Mr. Smith’s blood pressure stayed down, for a person
who is especially usual hypertensive. Under the combination of inferring, I inferred that Mr.
Smith’s blood pressure might drop when taking to surgery the next day due to loss of blood
during the operation. I matched and predicted the information by making some deductions and
considering options or alternatives alongside consequences (Levett-Jones et al., 2010). Here, I
was aware that AAA often has hypotension after the operation, and thus I predicted that if Mr.
Smith were not given additional fluids after the surgery, he would get into shock (Daly, 2018).
Under the matching step, I compared past and present health condition of Mr. Smith. From this
step, I was able to note the possibility of Mr. Smith’s blood pressure to get down. Under predict
session, I went through the expert critical reasoning process to predict the likely outcomes. For
this part, I anticipated the need to ensure that Mr. Smith is given more fluids the following day in
the post operations (Wong, Chandra, VanDeBogart, Lu & Yee, 2015). This will help ensure the
safety of Mr. Smith because it is expected that he will lose much blood throughout his intended
surgery (Dalton Gee & Levett-Jones, 2015). In general, I realized some facilitators and barriers
to health for Mr. Smith’s relative lifespan phase. The facilitators included the existence of Mr.

CLINICAL REASONING CYCLE 5
Smith’s medical history which availed desired information which helped me know exactly what I
needed to support Mr. Smith.
Conclusion
As a first-year student professional nurse, I was presented with a 61-year-old patient who
had a history of hypertension and under the beta-blockers in his past life. He was a normally
hypertensive individual. I have used the CRC3 to demonstrate the steps I took to making clinical
decisions to help Mr. Smith deal with his condition.

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References
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,
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Daly, P. (2018). A concise guide to clinical reasoning. Journal of evaluation in clinical
practice, 24(5), 966-972.
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression of clinical
reasoning through virtual patients: An exploratory study. Nurse education in
practice, 16(1), 97-103.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Koivisto, J. M., Multisilta, J., Niemi, H., Katajisto, J., & Eriksson, E. (2016). Learning by
playing: A cross-sectional descriptive study of nursing students' experiences of learning
clinical reasoning. Nurse education today, 45, 22-28.
Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C., & Wink, J.
(2010). Learning to think like a nurse. HNE, 15 (1), 23-176.
Wong, J. M., Chandra, M., VanDeBogart, R., Lu, B., & Yee, A. H. (2015). Clinical Reasoning:
A 27-year-old man with rapidly progressive coma. Neurology, 85(9), e74-e78.