Considering the condition of the patient
Clinical reasoning cycle is an effective framework that is used by nursing professionals in order to critically examine the symptoms and signs of patients and thereby come to a conclusion about the care needs of the patient. This framework mainly helps the nursing professionals in collection of the cues from the patients, analyses the symptoms of the patients with underlying pathophysiology from their knowledge and thereby set up the care priorities (Gee, Dalton & Levitt-Jones, 2016). Following the setting of the goals, the nursing professionals then sets up interventions that they apply to the patients in order to develop the quality of life of the patient and help them overcome the different ill effects of the disorders. The nursing professionals need to evaluate the condition of the patient and following this, they need to reflect on the experience so that they can learn new insights from every of their experiences (Nightingale, 2016). This assignment would also show how clinical reasoning cycle can be utilized by nursing professionals to systematically handle a case study of the patients and apply each of the steps properly so that they can provide the best quality care to the patients helping the patient to get back into her normal life and live with a better quality life.
The patient of the name Melody King had been admitted to the emergency department with acute pain in the right lower quadrant in the abdominal region. The patient was advised to undertake a laparoscopic surgery in order to remove the ruptured appendix. She had also developed peritonitis that was increasing the pain in the patent. Her past medical history reveals that she had been also a sufferer of depression as well as asthma. She also takes up the medication like ventolin, sertaline as well as seretide.
The nursing professionals had taken the vital signs that had shown abnormal outcomes. The blood pressure of the patient was 94/45 mmhg. Her respiration rate was high for about 22 breaths per minute. Her temperature of the body was also found to be high for about 38.3 degree centigrade and her heart rate was found to be about 120. She had a score of about 7 to 8 out of a total pain score value of 10. She was constantly complaining of nausea while she was at the ward and she was having a terrible central abdominal pain. Her SpO2 was found to 95% on the room air. When the professionals did the blood test, it was found that she had increased levels of white blood count as well as CRP.
Collection of cues as well as information
Occurrence of any form of obstruction as well as blockage in the appendix of individuals might result in a situation when the appendix develop infection and might get inflamed. When such a situation occurs due to the blockage, it results in accumulation of huge amount of parasites, mucus and even substances like the fecal matter. Because of this, bacteria are seen to quickly undergo multiplication inside the appendix (Dalton, Gee & Levett et al., 2015). Therefore, appendicitis is the clinical condition that develops mainly because of the swelling and irritations of the appendix region. When a particular patient does not treat such condition within the right time, it might result in much severe situation like that of peritonitis. The appendix gets ruptured, and the fluid containing the infection spreads in the appendix resulting in severe pain and suffering of the patient. Similar situation had taken place in the case of the patient named Melody king that had made her to suffer extensively after rupturing of her appendix.
When the blood test was done, it showed that the count of the white blood cell was quite high. Studies have shown that increased white blood cell count is itself an indicator of infection and shows that inflammation had taken place in the individuals. Moreover, it was seen that the patient had low blood pressure and this could be one of the reason because of which the patients had been suffering from various symptoms like nauseas. Researchers have found studies where hypotension is often found to be associated with feelings of dizziness, fainting as well as nausea (Thomson et al., 2015). The patient also had a higher respiration rate for about 22 breaths per minute when the normal breathe of individuals should be 12 to 20 breaths per minute. Two main reasons can be contributed to the higher respiration rate of the patient. This might be due to the airway obstruction that might be due to poorly managed asthma conditions as well as due to infection. Researchers are of the opinion that presence of sepsis or severe infection of the body might also contribute to increase respiration rate in any individuals. The heart rate of the patient was also seen to be higher and this is because of the presence of infection within the body of the patient.
The symptoms of the peritonitis usually begins with the dull ache and if not identified and treated within this time, it developed into a situations when it results in excessive pain in the abdominal region with the severity increasing over time. With any form of movement, the pain is seen to increase and the chance of the situation becoming worse increases. Therefore, the professional who is attending to the patient would be mainly providing interventions to the patient for curing her from pain and to reduce her suffering (Hartwich et al., 2016). Her respiration rate and heart rate were found to be higher. Her hear rate was 120 when the normal heart rate is 100. Her respiration rate was also found to be 22 breaths over minute when normal breathing rate was found to be 12 to 20 breaths per minute. Her blood pressure had gone down when the normal blood pressure would be 120/80 mmhg. Infection had mainly resulted in such situations and there was a high chance that she had developed sepsis. Therefore, all these arenas should be taken care of by the professionals.
Processing of the information
The patient had been suffering from intense pain due to the spilling of the infected fluid of the appendix to rest of the part of the abdomen. The ruptured appendix had already been removed but the infection might persist and might make the patient suffer from pain (Kubota et al., 2015). Therefore, the nursing professionals had to control the infection and provide intervention to overcome the infection. Secondly, the patient is suffering from intense pain and therefore pain interventions need to be given. The patient has also higher rates of respiration and well as higher heart rate. Therefore, the patient is also having lower blood pressure and this should be also taken care of in order to help the patient recover soon.
Often, it requires a large amount of time for patients to recover when they undergo surgery for the removal of appendix that had been associated with the development of complications,. The appendix had ruptured before it could be operated out and it might have leaked infectious fluid content to rest part of the abdomen making the region infected. Therefore, the patient needs to be taken care of in a well-planned manner to relieve her from such situation. Until the pus has stopped draining, it is very important for the professionals to maintain the drain in place. Different studies have revealed that antibiotic therapy is one of the best interventions that help to prevent the hematogenous and even the local spread of the intra-abdominal infection. Therefore, the nursing professional can follow the intravenous antibiotic therapy to help in mitigation of the infection (Bhangu et al., 2015). Many studies have also talked about the importance of the Single-agent, broad-spectrum therapy and combination therapies. However, the professionals need to get more evidence-based information in order to include them in their care plans.
For the effective management of the blood pressure, the professionals can introduce electrolytes or that of intravenous fluids that have the capability of maintaining the normal blood pressure of patients. About 500 ml/cc or normal saline can help in the maintenance of the blood pressure of the patient helping it rise higher and reach the normal or average blood pressure required for healthy living (Taguchi et al., 2016).
Increase in the respiration rate of the patient also needs to be effectively managed and hence proper medications and interventions are highly important. The increase in respiration rate might be due to airway obstruction or might be due to infection resulting in poor quality life. In such situation, the patient should be treated with oxygen therapy as well as with respiratory medication like that of the beta-adrenergic agonist medications. These medications would be mainly helping in relaxation of the smooth muscles and thereby cause broncho-dialations for opening up the passages.
Identification of the issues as well as problems
The heart rate of the patient is also seen to be quite higher and its suggest that the occurrence of infection or that of sepsis is the main reason that result in development of the disorder. The professionals need to bring the heart rate under control in order to ensure safety of the patient. In such situations, the professionals need to provide her with anti-arrhythmic medication. This would help in controlling of heart rate of the patient. Calcium channel blockers and beta-blockers would be extremely helpful and therefore these could be taken in combination with that of the anti-arrhythmic medications for effective treatment of the heart rate (Escolino et al., 2018).
Effective management of the pain is also one of the most important aspects that need to be cared of for the patient. The nursing professionals need to use medications like that of the non-steroidal anti-inflammatory drugs. These would be including medications like ibuprofen, naproxen, celecoxib or ketorolac (Alvarado et al., 2018). These would be helping in lessening of the inflammations that had taken place due to the symptoms of the peritonitis. Different types of Non-opioid pain relievers should be also used to help the patients get relieved from pain and these should include acetaminophen as well as ketamine (Michaolidou et al., 2015).
It becomes important for the professional to undertake blood test of the patient for effective evaluation of the condition of the patient and in order to find out whether the interventions are helping the patient to recover. The normal count of the WBC in individuals should remain between the ranges of 3500 to 10500. It should be found that whether the total count of WBC had increased or not (Salminen et al., 2015). Increase WBS shows presence of infection within the body. If the WBC count is within the normal level, then the patient is responding to the interventions and otherwise interventions need to be changed. Another important factor that helps in the identification of the presence of inflammation is the CRP. This mainly helps in acting as the blood tests markers for finding out inflammations in the body when they are found out in the blood tests (Podda et al., 2017). It would not be detected in the blood test if the inflammation is not present. Pain score should be also taken to see if the pain of the patient is reduced or not. Moreover, physical examination of the abdomen would also help the nurses to realize nay abnormality still present or not.
Establishment of the goals
I have leant the different interventions that need to be provided to the patient after that person has undergone surgery for removal of ruptured appendix. I have learnt that antibiotic therapy is useful for infection reduction. I have also developed pharmacological knowledge required for treating such patient pots operation.
Conclusion:
From the above discussion, it is seen that clinical reasoning cycle is one of the best methods to take cues of the patients and accordingly plan interventions from them. Accordingly, it would help me in treating patients with the best evidence based care that is not only planned but also ensure safe quality care of the patients. This ensures best quality life of the patient.
References:
Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis.
Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J. H., & Drake, F. T. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet, 386(10000), 1278-1287.
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, The, 33(2), 29.
Escolino, M., Becmeur, F., Saxena, A., Till, H., Masieri, L., Cortese, G., … & Esposito, C. (2018). Infectious Complications After Laparoscopic Appendectomy in Pediatric Patients with Perforated Appendicitis: Is There a Difference in the Outcome Using Irrigation and Suction Versus Suction Only? Results of a Multicentric International Retrospective Study. Journal of Laparoendoscopic & Advanced Surgical Techniques.
Gee, T., Dalton, L., & Levitt-Jones, T. (2015). Using Clinical Reasoning and Simulation based education to flip the enrolled nursing curriculum. In Sustainable Healthcare Transformation: International Conference on Health System Innovation.
Hartwich, J., Luks, F. I., Watson-Smith, D., Kurkchubasche, A. G., Muratore, C. S., Wills, H. E., & Tracy Jr, T. F. (2016). Nonoperative treatment of acute appendicitis in children: a feasibility study. Journal of pediatric surgery, 51(1), 111-116.
Kubota, A., Goda, T., Tsuru, T., Yonekura, T., Yagi, M., Kawahara, H., … & Umeda, S. (2015). Efficacy and safety of strong acid electrolyzed water for peritoneal lavage to prevent surgical site infection in patients with perforated appendicitis. Surgery today, 45(7), 876-879.
Michailidou, M., Goldstein, S. D., Casamassima, M. G. S., Salazar, J. H., Elliott, R., Hundt, J., & Abdullah, F. (2015). Laparoscopic versus open appendectomy in children: the effect of surgical technique on healthcare costs. The American Journal of Surgery, 210(2), 270-275.
Nightingale, K. E. (2016). Embedding Simulation-Based learning in a Capstone Undergraduate Nursing Subject to Develop Clinical Reasoning Skills.
Podda, M., Cillara, N., Di Saverio, S., Lai, A., Feroci, F., Luridiana, G., … & Vettoretto, N. (2017). Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery.
Salminen, P., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., … & Sand, J. (2015). Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. Jama, 313(23), 2340-2348.
Taguchi, Y., Komatsu, S., Sakamoto, E., Norimizu, S., Shingu, Y., & Hasegawa, H. (2016). Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surgical endoscopy, 30(5), 1705-1712.
Thomson, J. E., Kruger, D., Jann-Kruger, C., Kiss, A., Omoshoro-Jones, J. A. O., Luvhengo, T., & Brand, M. (2015). Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety. Surgical endoscopy, 29(7), 2027-2032.
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