Clinical Reasoning Free-Samples for Students- Myassignmenthelp

Question: Explore Physical Assessment using Clinical Patient Scenario. Introduction Engaging effectively in clinical thinking help nurses to improve the outcome of a patient. Nurses with adequate clinical reasoning skills can detect the conditions of their patients and diagnose them correctly. Additionally, health care providers with critical clinical reasoning skills can administer the right medication and institute a system to manage any resulting complications. Clinical reasoning is an ongoing process where nurses collect cues from patients, process and analyze the information to gain an in-depth understanding of the patient condition, plan and initiate intervention and eventually evaluate and learn from the process (Levett-Jones et al., 2010). This assignment looks at Katie McConnell case study in which she has been brought to the hospital after been hit by a slow moving car. The patient is suffering from subdural hematoma and a mild traumatic brain injury. The study will use the elements of the clinical reasoning cycle to complete Katies admission assessment. Katie McConnell, a woman aged 23 years is admitted to the neurosurgical trauma unit. Katie suffered from subdural hematoma 18 hours ago after she was hit by a slow moving vehicle and was diagnosed with mild traumatic brain injury. A Subdural hematoma is a severe medical condition where the blood collects between the skull and the external brain surface. The condition is caused by serious or mild brain injury (Mulligan, Raore, Liu Olson, 2013). The condition destroys the space between the skull and the brain and is common among the older adults. According to Hanif, Abodunde, Ali Pidgeon (2009), incidences of subdural hematoma are rampant and almost double in number from the age of 65 to 75 years old. Additionally, the condition is more extensive in men than women. Men are more affected than females as the mean brain size of men is 9-12% larger in men; hence, men undergo a more rapid cerebral aging compared to women (Oh, Shim, Yoon Lee, 2014). Katie reported to hospital after 18 hours. Acute subdural manifest in less than 72 hours, the sub-acute level might take up to 1 week while chronic subdural hematoma takes weeks to show (Hugentobler, Vegh, Janiszewski Quatman?Yates, 2015). Therefore, subdural hematoma condition is more prominent to aged people above the age of 60 years. Additionally, men tend to suffer more from the condition compared to the women. Hence, Katies case is not a common complaint about a patient suffering from a mild traumatic brain injury. Katie McConnell had a blood pressure level of 142/78 and a heart rate of 89 in the last 18 hours. Additionally, Katie had Sp02 of 96% and a respiratory rate of 13 in the past eighteen hours. Katie recorded a Glasgow coma score of 14 upon admission. Moreover, the patient was noted to have some difficulties in recalling some of the recent information. Katie needed the aid of prompts to remember. On enquiring about his past medical history, Katie notes that she has all along had a painful ankle sustained from the years of her basketball. However, she adds that she does not like to use any painkillers. The patient information on any history of headaches is missing which is very crucial. Headaches are one of the main symptoms and complaints of chronic subdural hematoma (Chelse Epstein, 2015). The establishment whether the patients suffers from constant headaches would help determine the level of condition. Furthermore, Katies information on any instances of confusion or intracranial pressure would be helpful in the adequate diagnosis of the patient. 90% of subdural hematoma patient experience confusion (Joseph et al., 2015). Information about the patient feeling nausea and vomiting would help verify the condition. The availability of the information would aid in proper filling of the admission assessment. Katie McConnell recorded a Glasgow coma score of 14. A patient suffering from mild traumatic brain injury records the approximately similar Glasgow coma score. 50% of patients with head injuries and have a mild traumatic brain injury that requires immediately neurosurgical attention records a Glasgow coma score of 14-15 (Joseph et al., 2015). Thus, Katie with a coma score of 14 is in line with the expected score for a patient with mild traumatic brain injury. Katie is reported to experience difficulties in remembering recent information. Patients suffering from mild subdural hematoma experience loss of memories. About 40% of patient reported with mild traumatic brain injury have a high level of decreased consciousness, cognitive dysfunction leading to loss of memory and confusion (Roozenbeek, Maas Menon, 2013). Hence, Katie inability to recollect recent past information is in line with a patient suffering from mild traumatic brain injury. Katie recorded a BP of 142/78 upon admission. Mild traumatic brain injury causes hypertension to patients. Traumatic brain injury patients experience a systolic pressure of 120mmHg and above (Teale, Iliffe Young, 2014). Katies BP is in line with the normal systolic pressure for a mild traumatic brain injury patient. High blood pressure above 120mmHg in subdural hematoma patients reduces the mortality rate by 18 (Salottolo et al., 2014). Hence, Katies BP should not raise an alarm it is in line with the expected level to reduce the mortality chances. The patient recorded a heart rate of 89. Traumatic brain injury results in an increase in the heart rate. Griesbach, Tio, Nair Hovda (2013) claim that patients with mild and acute subdural hematoma experience an elevated heart rate. Hence, Katies heart rate is in line with the expected outcome of a patient suffering from mild heart rate. The patient respiratory rate is at a reasonable level at a rate of 13, hence, does not provide room for any worries. However, I would like to concentrate on his Blood pressure level that indicates the sign of Mild traumatic brain injury and an increase in his heart rate. Additionally, I would like to focus on his Glasgow coma score of 14 that falls right at the scale of a patient suffering from mild TBI. The patient inability to recall past information is aligned with the expected outcomes of this situation. Failure to give the patient adequate medication would deteriorate the condition and may lead to dire consequences such total cognitive dysfunct ion or even death. In Katie McConnel's case, I will use the neurological system in the focus health assessment. The neurological system entails neurological observations such as the Glasgow Coma scale modified to examine and interpret patients consciousness levels. Observing the Glasgow coma score will help establish whether the patient is suffering from the traumatic brain injury and the degree of the condition. The assessment will determine whether the patient is aware of the different things happening to her or around her when prompted. Additionally, the neurological observation will allow assessment of various directions and movements to detect any confusion in the patient. Confusion is one of the symptoms of subdural hematoma condition (Honda et al., 2015). Being able to identify whether the patient can carry out the task without any confusion will help in effective diagnosis. Moreover, neurological system entails fine gross motor skills. The use of this assessment will help determine the gait and the balance of the patient and ensure proper diagnosis. Patient suffering from subdural hematoma experience gait dysfunction. Thus, the use of this assessment will allow me to gauge the patient balance to ensure certainty in diagnosis. Consequently, a person with mild traumatic brain injury suffers from loss of consciousness marked by Glasgow coma score of 14-15. Additionally, the patient experience confusion and loss of balance contrary to someone who does not suffer from this condition. In undertaking Katies focus health assessment using neurological observations, I will ask her to close her eyes and only opens them once I tap her forehead. Through this, I will observe whether she recognizes when I touch her and whether she will open her two eyes simultaneously. Additionally, I will ask her specific questions targeting specific responses and establish her consciousness. Moreover, I will ask her to undertake some activities using her left and right hands and legs to assess whether she is cognizant of the differences between left and right. These observations will give me a clear indication on one of the strongest symptoms of subdural hematoma which is a reduced level of consciousness. Using the fine motor skills, I will test the balance of the patient. I will ask the patient to stand up and lift one foot up and observe the balance. Furthermore, I will request the patient to move around carrying different weights in their hands and observe her gait. I will ask her to seat at various locations and watch the posture. By use of these skills, I will establish the gait and balance and inform my diagnosis as it is one of the subdural hematoma symptoms. Conclusion Consequently, efficient use of clinical reasoning for the nurses help in the proper diagnosis of the patient and administering the right care. A nurse with clinical reasoning skills actively engages in the process to picking information from the patient, processing it and efficiently identifying the problem. In the case of Katie McConnell, she is suffering from mild traumatic brain injury. The symptoms point rightly to the situation at hand. References Chelse, A., Epstein, L. (2015). Blunt head trauma and headache. Pediatric neurology briefs, 29(4), 30. Griesbach, G. S., Tio, D. L., Nair, S., Hovda, D. A. (2013). Temperature and heart rate responses to exercise following mild traumatic brain injury. Journal of neurotrauma, 30(4), 281-291. Hanif, S., Abodunde, O., Ali, Z., Pidgeon, C. (2009). Age related outcome in acute subdural haematoma following traumatic head injury. Irish medical journal, 102(8), 255. Honda, Y., Sorimachi, T., Momose, H., Takizawa, K., Inokuchi, S., Matsumae, M. (2015). Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma. 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