NURSING Case Study: Clinical Reasoning and Care Plan for Patient

This nursing case study presents the scenario of Miss Jane Green, a 30-year-old female admitted to the ward after being hit by a car, resulting in a left lower leg fracture and anxiety related to her mother's dementia. The case study involves collecting cues through patient assessment, interpreting abnormal findings such as elevated blood pressure and pulse rate, and relating these to underlying pathophysiology. It predicts potential complications if no action is taken, identifies key nursing problems like insufficient compensation and staffing shortages, and establishes goals with related actions to address these problems. The study evaluates the effectiveness of care provided by monitoring the patient's emotional and physical recovery and reflects on the importance of nurse-patient communication in improving health outcomes. The assignment solution also contains information on nursing standards of wages to unions and legislative various nursing committees with and reliable services during professions and assigned roles of professional practice through experience levels.

Nursing Assignment 1
NURSING ASSIGNMENT
By Name
Course
Instructor
Institution
Location
Date

Nursing Assignment 2
Scenario 1: Miss Jane Green
The patient
situation
Miss Jane Green is a 30-year-old female who was hit by a car that ran a red light whilst she was crossing at a pedestrian crossing.
The impact caused Jane to be thrown into the curb resulting in an obvious left lower leg fracture. She has just arrived on your ward
from the emergency department. You introduce yourself to the patient and ask how she is going. She winces visibly but answers that
she is worried about her mother who is in the early stages of dementia and for whom she is the sole carer. You also notice that she
has a bad graze on her left shoulder. The time is 0800.
Collect Cues Review:
Patient assessment or new information:
Upon undertaking a further assessment of Miss Green you obtain the following new information:
Vital signs
BP: 155/90
Pulse: 107bpm
RR: 22
Sa02: 97%

Nursing Assignment 3
Temp: 36.6
Other data
GCS: 15
Pain score: 9/10 on movement. 8/10 on rest
Patient becoming anxious in regards to her mother’s welfare.
Neurovascular assessment
Capillary refill rate of >3 seconds.
Complaining of tingling in the toes of the left leg
Increased pain at rest and upon passive movement of the affected limb
Left leg appears paler than right leg
Recall:

Nursing Assignment 4
Recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be
occurring before proceeding with the rest of the cycle (self-directed)
Process
Information
Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
Normal Abnormal
Temp: 36.6
Sa02: 97%
GCS: 15
BP: 155/90
RR: 22
Pulse: 107bpm
Pain score: 9/10 on movement. 8/10 on rest
Capillary refill rate of >3 seconds
Relate & Infer:
 Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered
abnormal in this context.
 Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify
your answer (400 words).
A blood pressure of 155/90 is normally considered a high blood pressure since forms the second stage of hypertension development.

Nursing Assignment 5
This prevailing blood pressure puts the life of Miss Jane at a very high risk since she can easily develop problems of stroke or heart
attack challenges. This blood pressure may be hardly noticed by the patient despite its possibilities of breaking the body tissues and
other body organs and blood vessels which may result into very serious blood circulation problems within the body (Mattingly, 2011).
The frequently affected body organs by this pressure are always the heart which might undergo a degree of enlargement resulting in
dangerous heart failure and simultaneous damages to the kidney which eventually might require dialysis. The high blood pressure
experienced by miss Jane is mostly as a result of stress originating from the worry the patient possess relating to her mother. Another
reason to be considered for this high blood pressure is due to fracture the patient obtained from the nock which was she experienced
from the vehicle.
A pulse rate of 107bpm is generally regarded as a high pulse rate. The increase in pulse rate experienced by miss Jane is most
probably as a result of pain which originates from the obtained fracture. This pain triggers the increase in the rate of the pulse. The
anxiety experienced by the patient relating to the patient being worried about her mother who is in the early stages of dementia also
forms a source of origin for the increased pulse rate.
The patient, miss Jane is consistently experiencing stress resulting from the anxiety or worry on the health conditions of her mother
who is in the early stages of dementia disease who she is the carer (Mattingly, 2013). This stress is the probable cause of her accident
where she is hit a moving car due to her lack of concentration on the road. Miss Jane’s breathing rate is slightly higher as a result of
the pain she is undergoing from the fracture she obtained on her left leg. This fracture has simultaneously led to the patients increased
capillary refill rate to 3 seconds which is slightly higher than the average of below 2 seconds. In general, this forms the primary reason
for miss Janes higher pain scores on both movement and rest.

Nursing Assignment 6
Predict:
What may happen to your patient if you take NO action and why? (100 words)
The patient may develop very serious health problems conditions when a counselling programme is not immediately conducted to
assure miss Jane that her mother is in good care so as to reduce her stress resulting from anxiety on her mother's conditions since she
was feeling that she was the only person that could take care of her mother as she ails the dementia disease. In addition, the patient
must be made to understand the implications of her emotions towards her health with an emphasis on her rising blood pressure,
breathing rate, pulse rate and the rate of capillary refill rate which had already been worsened by the fracture on her left lower leg
(Norman, 2015).
Identify the
Problem/s
List in order of priority at least three key nursing problems (not included in word count)
 Insufficient or low compensation
 Shortages in staffing
 Workplace violence

Nursing Assignment 7
Establish Goals &
Take Action
From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and then list
related actions you would undertake, including detailing any relevant nursing considerations (350 words)
Problem 1 Goal Related Actions Rationale
Insufficient or low
compensation
To encourage and motivate
practicing nurses on the need
and reward for offering good
and reliable services during
professional practice through
the provision of better and
sustainable nursing wages
(Brailovsky et al, 2011). This
will increase the passion for
service delivery by the nurses.
 Establishment of
standards of wages to
various nursing
professions and
experience levels.
 Introduction of
subsidies and tax
exceptions to nurses at
various distinct or
harsh environmental
conditions (Schell &
Carvero, 2013).
 Introduction of laws
governing the
regulation and gradual
 Formation of nursing
unions and legislative
committees with
assigned roles of
controlling and
regulating wages of
nurses through
designing the approach
and system of
increasing nurse
wages.
 Generation of a clear
nursing profession
levels of experience
and its expected

Nursing Assignment 8
increment of salaries to
nurses after a given
duration of time.
 Establishment of
nursing saving
schemes, insurance
covers and loans
provisions to nurses
with an aim of
improving the living
standards of practicing
nurses.
rewards and wages.
This should also be
accompanied with a
specific outline of
allowances, insurance
coverage amounts, and
retirement benefits.
Problem 2 Goal Related Actions Rationale
Shortage in staffing
To increase the capacity of
staff so as to reduce challenges
resulting from challenges
witnessed through long
working durations by nurses
 Conduction of nursing
promotion programmes
at secondary
institutions aimed at
informing students of
 The continuous and
consistent hiring of
nursing graduates.
 Enabling good nursing
practice conditions so

Nursing Assignment 9
due to insufficient staff.
Improvement in staffing
capacity will also encourage
and motivate nurses to perform
their duties in the right time
and manner since they will be
practicing in a good and
healthy environment.
the importance of
nursing profession in
the society.
 Provision of bursaries
and aids to nursing
students so as to
encourage interested
students who may lack
funds to pursue the
nursing profession.
 Introduction of gradual
and consistent increase
in nursing wages and
tax exceptions with an
aim of improving
wages to nurses hence
eventually portraying
the nursing profession
as to maintain the
already available
nursing staff (Eva,
2015). This achieved
through equipping a
health care facility with
all relevant professions
such as guidance and
counseling officers so
as to facilitate nursing
service delivery
through eradication of
arrogance and lack of
understanding from
patients.
 Funding of nursing
institutions with an aim
of enhancing a

Nursing Assignment 10
as a lucrative career
which will eventually
lead to increased
demands and interest in
the profession (Barrows
& Feltovich, 2017).
 Establishment of more
nursing institutions
with reliable and
adequate facilities and
staff which offers
nursing training and
education to all
interested individuals.
sufficient and reliable
training for nurses.
Evaluate outcomes Briefly describe how you would evaluate the effectiveness of the care provided (i.e. what do you want to happen?) and reflect on how

Nursing Assignment 11
& Reflect on new
learning
this encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).
The effectiveness of the nursing care provided to miss Jane is determined by getting to know the patients prevailing health conditions
and its impacts on her emotional and mental being. Miss Jane is expected to soon recover from the anxiety which resulted from the
stress or worry involving her ill mother who she was taking care of. This should form her first nursing care which will eventually lead
to prevention of further increase of the patients’ blood pressure and pulse rate. In addition, the patient is expected to feel limited pain
amounts which originated from the hitting by the vehicle which led to a fracture on her legs as a result of good nursing care and
medication. The reduction in pain is expected to result in slower breathing rates from the patient (Norman et al, 2010).
My engagement with miss Jane has formed a boost in understanding the importance and need of a common understanding and
communication between a nurse and a patient in the delivery of better nursing care service purposefully aimed at improving the health
and emotional standards of a patient.

Nursing Assignment 12
References
Barrows, H.S., and Feltovich, P.J., 2017. The clinical reasoning process. Medical education, 21(2), pp.86-91.
Brailovsky, C., Charlie, B., Beausoleil, S., Cote, S. and Van der Vleuten, C., 2011. Measurement of clinical reflective capacity early in training as a predictor of
clinical reasoning performance at the end of residency: an experimental study on the script concordance test. Medical Education, 35(5), pp.430-436.
Eva, K.W., 2015. What every teacher needs to know about clinical reasoning. Medical education, 39(1), pp.98-106.
Mattingly, C., 2011. What is clinical reasoning? American Journal of Occupational Therapy, 45(11), pp.979-986.
Mattingly, C., 2013. The narrative nature of clinical reasoning. American Journal of Occupational Therapy, 45(11), pp.998-1005.
Norman, G., 2015. Research in clinical reasoning: past history and current trends. Medical education, 39(4), pp.418-427.
Norman, G.R., Brooks, L.R., Colle, C.L. and Hatala, R.M., 2010. The benefit of diagnostic hypotheses in clinical reasoning: an experimental study of an
instructional intervention for forwarding and backward reasoning. Cognition and instruction, 17(4), pp.433-448.

Nursing Assignment 13
Schell, B.A. and Cervero, R.M., 2013. Clinical reasoning in occupational therapy: An integrative review. American Journal of Occupational Therapy, 47(7),
pp.605-610.