Clinical reasoning cycle Example PDF

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Clinical reasoning cycle Example...

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CRC EXAMPLE-NICK TUTORIAL 6 PROCESS

DESCRIPTION

CONSIDER THE PATIENT

Describe or list facts, context, objects or people

COLLECT CUES/INFORMATION

Review current information (e.g. handover reports, patient history, patient charts, results of investigations and nursing/medical assessments previously taken)

NURSING ACTION Nick is a fit 19-year-old, male, with history of 12 hours of acute abdominal pain, nausea and vomiting. Probable diagnosis of acute appendicitis  

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Gather new information (e.g. undertake nursing assessment)

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Recall knowledge (e.g. physiology, pathophysiology, pharmacology, epidemiology, therapeutics, culture, context of care, ethics, law etc) PROCESS INFORMATION

Interpret: analyse data to come to an understanding of signs or symptoms. Compare normal vs abnormal Discriminate: distinguish relevant from irrelevant information; recognise inconsistencies, narrow down the information to what is most important and recognise gaps in cues collected Relate: discover new relationships or patterns; cluster cues together to identify relationships between them Infer: make deductions or form opinions that follow logically by interpreting subjective and objective cues; consider alternatives and consequences Match: current situation to past situations or current patient to past patients (usually an expert thought

AFL player-injured on Saturday- low back pain Commenced oral anti-inflammatories (ibuprofen) and applying an anti-inflammatory gel (voltaren): last ibuprofen dose @ 0600 Monday 7:30am admitted to ED with 12 hours of acute abdominal pain, nausea and vomitingnot been able to eat or drink anything MO: has commenced IV fluids, analgesia and FBC/WCC. Ordered U/S

Vital signs-BP 110/65, HR 120, Temp 37.9, SaO2, U/A SG1035, tr ketones Pain Score/PQRST-8/10 WCC: elevated U/S-shows appendix swollen and oedematous Fluid balance chart-history Medication history & allergies

Pain right lower quadrant-agitated by activity, walking, coughing + localised rebound tenderness= suspected appendicitis Appendicitis > rupture > peritonitis

Vital signs/pain score Cues and test results-consistent with appendicitis WCC elevates-sign of infection U/A (ketones) metabolism of fat (has not been eating) Medication interactions (voltaren and ibuprofen)also empty stomach-contraindicated

IDENTIFY PROBLEMS

process) Predict: an outcome (usually an expert thought process) Synthesise the facts Acute pain related to obstructed appendix as evidenced by pain score 8/10 Risk for deficient fluid volume related to preoperative vomiting/ preoperative restrictions as evidenced by high SG in urinalysis/poor skin turgor/ patient saying they’re thirsty Risk for infection related to ruptured appendix/surgery (no evidence by as it has not occurred) Potential for anxiety related to unplanned hospital admission as evidenced by patient saying they’re nervous

ESTABISH GOALS

SMART 1. Relieving pain 2. Reducing anxiety-reduce anxiety before operation by providing reassurance, surgery education and family support 3. Eliminating infection due to the potential or actual disruption of GI tract 4. Preventing fluid volume deficit-rehydrate patient in the next 24hrs

Specific Measurable Attainable Relevant Timely

TAKE ACTION            EVALUATE

Ensure written informed consent is obtained Check OT-that Nick is on emergency list Prep Nick for OT-gown, no loose teeth/contact lens, fasting Check medication interactions and allergies Administer Pain relief as per medication chart with RN (and Nicks pain score) Assess pain after pain relief Monitor vital signs Fluid balance chart-IV therapy charted Ask Nick if he wants you to contact his parents Prep documents for OT Encourage fluids post-operation

Is patient rehydrated-Assess thirst, skin turgor and reassess U/A Do they still anxious-talk with patient about feelings? How is his pain? -assess pain with PQRST

REFLECT

What can be done better/differently next time? How did you feel?...