Nursing Case Study: Cardiac Patient Clinical Reasoning Analysis

This essay presents a nursing case study focusing on a 65-year-old female patient in a cardiac ward. The study utilizes the clinical reasoning cycle to analyze information gathered during an interview. The essay details the interview setup, including the environment and techniques used to facilitate data collection. It outlines the process of cue collection, including the patient's reported symptoms of shortness of breath and swollen feet, as well as her medical history of congestive cardiac failure and bypass surgery. The essay then processes this information, identifying potential diagnoses such as edema, dyspnea on exertion, and hampered gas exchange. It also considers the patient's risk for sleep disturbance and depression, given her recent widowhood and chronic illness. The essay concludes by summarizing the key findings and emphasizing the importance of the clinical reasoning cycle in patient assessment and care. References are provided in APA 6th edition format.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student
Name of the University
Author’s Note:

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Introduction:
Collected information from patients which is processed through clinical reasoning
cycle aids health care professionals to make better clinical judgement. This clinical reasoning
cycle has different stages and they are cue collection, processing of information,
understanding of patients collected information, analyse of collected data and development of
intervention based on the analysis (Hunter & Arthur, 2016). Therefore, in this article,
collected information from a 65 year old female will analysed through clinical reasoning
cycle. The information was collected through an interview session.
Consideration of patient situation:
This interview with the patient was conducted in the cardiac department of the local
community hospital. This interview was the first point of contact for the patient before
through examination with the general practitioner. The interview was conducted by a
registered nurse. The interview process taken place in to an isolated in the cardiac ward in
which only the interviewer and interviewee was present. During the interview, both the
patient and nurse were in sitting position and it was conducted in face to face manner. The
room was devoid of any additional distraction and only the sitting arrangement and table was
situated in the room. The patient was first notified about the process and she was explained in
detailed manner about the interview procedure. The interview approach method was
qualitative approach and the patient was asked open ended question during this interview so,
that the patient will be explain about her condition better and more information can be
gathered as a result. The total interview process was documented and the documentation
process was performed through the recording device. Before the start of the recording, the
patient was explained that the interview will be recorded and consent was taken from her

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regarding this. The interview process was conducted for about 20 – 30 minutes duration and
it was followed by the vital assessment of the patient.
Cue and information collection:
As mentioned above, the interview process was started by explaining her about the total
process. Firstly, she was greeted and was asked about her health condition and reason behind
her visit to the hospital. In response, she stated that she has been suffering from shortness of
breath in the last few days. In addition, she also mentioned that her feet have swollen to the
degree that she cannot put her shoes on. This leads the nurse to query about her medical
history. In response to that she has stated that she has been diagnosed with left sided
congestive cardiac failure in 5 years back. After the diagnosis, she was had a bypass surgery.
In addition to that, she has mentioned that she is suffering from fluid problem in intermittent
manner for the past 2 to 3 years. In this aspect, the nurse asked her to whether it is three or
two. In response, the patient answered she is not sure and in might be between the two and
three years. In query of the nurse, the patient answered that she did smoked occasionally in
her youth. Then, the nurse asked her that did she come alone? In response, she replied that
she lives alone. She was married for 30 years but her husband passed away recently. From
then, she lives alone as she and her partner did not had any offspring. While recollecting her
family history, she mentioned that she has a history of cardiac disease in her family and in
response to query of the nurse, she stated that it was in her maternal side of the family.
During the interview, it has been observed that she was physical able, wearing proper attire
and seems to be maintain good hygiene. Instead of assumption, the nurse queried about her
hygiene practice and it has been found that the patient practises good hygiene practice.
During the interview, she sometimes lost her concentration and was absent minded
sometimes. She also stated that she is having trouble of sleeping. Next her vital assessment
was collected and it presented below:

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 Blood pressure: 97/52 mmHg
 Pulse: 80 (irregular)
 Temperature: 370 C
 Height: 155 cm
 Weight: 60 kg
 Respiratory Rate: 21 bpm
 SaO2 at room air: 92 percent
Processing of information:
By processing the above information, it can be deduced that the patient’s first
diagnosis will be edema or dyspnoea on exertion. This can be interpreted from her symptoms
of swollen feet and chronic fluid problem. The expected outcome of her will be imbalance of
fluid. Therefore, the patient should be monitored regularly for her fluid retention. In addition,
patient’s serum electrolyte level should also be monitored (Marenzi et al., 2014).
The next diagnosis will be the patient’s hampered gas exchange problem. This is
evident by the patient’s high respiratory rate and shortness of breath. The patient’s oxygen
saturation level is lower than the normal range. For the treatment of this, patient should be
administered with additional oxygen to maintain the blood oxygen level (Millar, Lutton &
O’Connor, 2014).
Another risk for the patient is the development of disturbance of sleep pattern. Due to
the congestive cardiac failure, patient might be experience disturbance in her sleep pattern. In
this scenario, the patients sleep pattern will be recorded and the patient should be encouraged
to establish a sleep pattern (Nasir, Shahid & Shabbir, 2015).
As mentioned by the patient, the patient lives alone and she has been widowed
recently. In addition with this, patient is also suffering from chronic disease like congestive

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failure. Therefore, patient has a high risk of developing depression. This is also evident by
her lapse of concentration during the interview (Steptoe et al., 2013).
Conclusion:
In a nutshell, it can be concluded that the qualitative interview approach was used for
the collection of the data and the collected data was processed through clinical reasoning
cycle. From the analysed data it can be stated that the patient has a risk of developing
depression, disturbance in sleep pattern in long term basis.

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References:
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79,
https://doi.org/10.1016/j.nepr.2016.03.002.
Marenzi, G., Muratori, M., Cosentino, E. R., Rinaldi, E. R., Donghi, V., Milazzo, V., ... &
Agostoni, P. (2014). Continuous ultrafiltration for congestive heart failure: the
CUORE trial. Journal of cardiac failure, 20(1), 9-17,
https://doi.org/10.1016/j.cardfail.2013.11.004.
Millar, J., Lutton, S., & O’Connor, P. (2014). The use of high-flow nasal oxygen therapy in
the management of hypercarbic respiratory failure. Therapeutic advances in
respiratory disease, 8(2), 63-64, https://doi.org/10.1177/1753465814521890.
Nasir, U., Shahid, H., & Shabbir, M. O. (2015). Sleep quality and depression in hospitalized
congestive heart failure patients. J Pak Med Assoc, 65(3), 264-9, Retrived from:
https://www.ncbi.nlm.nih.gov/pubmed/25933558.
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness,
and all-cause mortality in older men and women. Proceedings of the National
Academy of Sciences, 110(15), 5797-5801, https://doi.org/10.1073/pnas.1219686110.