Clinical Reasoning cycle assignment analyzing a clinical case to help outline possible treatment

Question

Task: how can medical professionals use Clinical Reasoning cycle assignment skills to determine the most suitable treatment parameters?

Answer

Introduction:
Clinical Reasoning cycle assignmentresearch shows Clinical reasoning cycle is an important procedure in nursing which enhances the treatment process by making timely diagnoses and speedytreatment plans. Also it helps in avoiding the unnecessary investigations which furthertends to reducethe medical cost for the patient furtherhelps in improving the health complaint of the patient (Yazdani, Hosseinzadeh& Hosseini, 2017). The Clinical Reasoning cycle assignmentaims the medical evaluation with the help of Clinical reasoning cycle of a patient named as Andrew Collins.In order to achieve the aim, Andrew situation will be analyzed, cues will be collected and processed. Further the issues will be analyzed and goals will be established following the action accordingly.

Andrew situation:
Mr Collins is suffering from the issue of vomiting and nausea along with increased shortness of breathing from the last 3 days and is admitted to the ED department. He is diagnosed with Cirrhosis of liver with gross ascites. Considering the situation, abdominal paracentesis has been performed which lead to 4 liters of ascitic fluid draining out. Considering the medical history of Andrew, 10 standard drinks per day for since last 10 years has been noted down along with more than 15 tobacco per day since last 20 years. Liver ultrasound confirmed a large and fibrotic liver. Also mild tachypnea and yellowing of the sclera followed mild bruising to both arms. Vital signs are pretty normal excluding BP.

Clinical Reasoning cycle assignmentCollect cues:
As the patient has been admitted for the complaint of nausea and vomiting, it is important to check the vitals first which indicate a drop in the blood pressure (110/50) and that might be one of the reason behind the feeling of nausea (Chang et al., 2020). Besides, the Clinical Reasoning cycleassignment case reports he has diagnosed with liver cirrhosis and has underwent abdominal paracentesis which also leads to nausea, vomiting, fatigue and weight loss. Further yellowing in the sclera is also noted which might be the symptoms of jaundice commonly detected in case of liver cirrhosis. However to ensure the same, a bilirubin test will be needed. Though the patient denied having itchy skin, but constantly scratching the chest denotes the same. Apart from that, mild bilateral lower leg edema is also noticed which is also one of the major symptoms of cirrhosis. According to Mansour and McPherson, (2018). In case of cirrhosis, the normal flow of blood through the liver is decreased, which further increases pressure in the vein bringing blood from the spleen and intestines to the liver causing swelling in the legs and abdomen which is also noted in case of Mr Collins. Further these augmented pressure in the portal vein has led to accumulation of fluid into the legs causing edema and in the abdomen causing gross ascites in case of the patient. Result of the cirrhosis, increase in the levels of the liver enzymes has also noticed (alanine transaminase (ALT), alkaline phosphatase (ALP) and aspartate transaminase (AST)).

Clinical Reasoning cycle assignmentProcess:
After collecting the cues related to the Andrew case study, it is important to process to understand the abnormality currently he is dealing with. Past medical history of the patient confirms long term consumption of alcohol and tobacco which according to Chan et al., (2020), is one of the major risk factor that either increases the risk of liver damage or liver cirrhosis or leads to the same. The Clinical Reasoning cycle assignmentliterature suggests that alcohol causes a variety of issues to different organs and liver is one of that. It tends to break down the chemicals that removes the scar tissues. Removal of such scar tissues from the liver tends to forms scars in the liver and also replaces the normal healthy living cells which further increases the chance of damage. Same is found in the case of smoking (Petrick et al., 2018). According to Brahmania et al., (2020), in case of smoking, three major adverse impact upon the liver is detected which include, indirect or indirect toxic effects, oncogenic effects and immunological effects. Coming to the current medical condition of the patient, the only abnormality that is found in the vitals is the decreased blood pressure. It is due to the fact that hormones that tends to dilate the systemic blood vessels and further also helps in lowering of the blood pressure are found in much elevated concentrations in case of people suffering with cirrhosis (National Jewish Health Organization, 2022). Another vitals are found to be normal. Apart from vitals there are other complications also noticed which include mild edema and gross ascites fir which is already drained out with the help of abdominal paracentesis. It is due to the decreased flow of blood through liver as already mentioned above. Apart from edema and ascites, another severe complication that has been noted on the Clinical Reasoning cycle assignment case is the yellowing of the sclera which might be the indication of jaundice as liver is unable to remove bilirubin in his case.

Besides, abdominal pain is also found to be prevalent in Andrew which is one of the most common symptoms of patient with cirrhosis following with vomiting, and nausea. Apart from that, according to one of the carer, the patient is also found to be not being himself lately and is drowsy sometimes, however as per Andrew he is Alert. Further, the case study also suggests increased level of liver enzymes in the body, which according to Chicco and Jurman (2021), is also one of the most severe symptoms associated with liver cirrhosis and if avoided for a longer term might prove to be fatal. Also, increased level of ALP, ALT and AST give rise to the above mentioned symptoms such as abdominal pain, nausea, vomiting, drowsy movement, not feeling well and others. Therefore if this can be treated, majority of the symptoms will be cured eventually.

Identify problems/issues:
The two major issues that can be considered under priority on this Clinical Reasoning cycle assignment based on its impact over the patient include the yellowing of the sclera and the increased level of liver enzyme.
Yellowing of the sclera: In case of Andrew, yellowing of the sclera indicates high risk of jaundice, which is one of the most common symptoms in case of patient suffering from Liver Cirrhosis. It is due to the fact that, liver tends to help in breaking down of the bilirubin (extra deposition of it leads to Jaundice) and removing it from the body in the form of stool, however in case of Cirrhosis liver is unable to perform the same leading to yellowing of the skin and eyes. It needs to be treated immediately, as according to Brandman (2021), higher the rate of bilirubin in the body, higher is the chance of liver damage and failure.
Increased Liver enzyme level: In case of Andrew, level of liver enzyme has found to be elevated, which is giving rise to other symptoms as well that include abdominal pain, fatigue, Nausea, vomiting, risk of jaundice, itching and improper bowel movement. Long term elevated level might increase the severity of the other symptoms and hence needs to be treated immediately. Besides, it might also increase the risk of anorexia, muscle damage, biliary disease, heart attack, diabetes and infections, hypothyroidism and other diseases which if not addressed immediately might impair liver function (Mandal et al., 2018).

Establish goals:
After analyzing the current, past medical history and social history of theClinical Reasoning cycle assignment case patient it has been noted that there are there are number of complication, issues, signs and symptoms that is harmful for the patient and might increase the risk. It includes increased level of BP, increased liver enzyme level, nausea, feeling drowsy, vomiting, and edema, yellowing on the sclera, chest scratching, living alone and others. However the above mentioned issue are on the priority considering its severity and hence to ensure the speedy recovery of the patient, the above two mentioned issues needs to be resolved immediately and to do the same, the following actions needs to be taken care of:

Evaluate:
Clinical Reasoning cycle assignmentfindings show if the above mentioned intervention will be implemented properly, Andrew is expected to get a proper recovery. Considering, the first priority issue, it is expected that if change in the diet is done at least a week, effective improvement can be noticed. It might include, less no drowsy, reduced nausea and vomiting, and most importantly reduced yellowing on the sclera. Further, coming to the intervention suggested for second issue, advocacy not might only help in reducing the ALT level but will also help to manage the disease and the symptoms further (Abbasinia, Ahmadi &Kazemnejad, 2020). Reduction of the ALT, AST and ALP is also considered as the risk factor for many other symptoms listed under the section identifying issue will also be managed.

Reflect:
To be an effective nurse, it is important to learn daily either theoretically or practically. Same with the help of this assessment, I did not only learned about the liver cirrhosis, its impact over the body, severe symptoms associated with it, treatment process and rationale behind the same, but also got to know about the effectiveness and necessity of using clinical reasoning cycle (CRC) in care of the patient. Though I had learned about CRC during the Clinical Reasoning cycle assignment research stage, analyzing it with the help of case study helped to enhance my learning with the help of which I will be able to analyze the patient’s situation in future practice. With the help of it, I will also be able to priorities the issue patient will be facing and can formulate the care plan accordingly. Besides, it also helps to analyze the cues initially, thereby reducing the risk of missing of any important information. Coming to the case study, after assessing Andrew’s case study, I got to know about the impact of alcohol and tobacco consumption upon liver at the pathophysiological level. I got to know about the treatment options as well as its effectiveness if implemented properly for a specificperiod of time which will help me to treat any patient with such condition in my future practice.

Conclusion:
Concluding the discussion, it can be stated that liver cirrhosis is a pernicious disease which reduces the mortality by giving rise to many harmful issue such as gross ascites, edema, jaundice, vomiting and others which is also noticed in case of Andrew. However, out of all the issues that has been identified, with the help of clinical reasoning the issues are prioritized and goals are formulated accordingly. From the Clinical Reasoning cycleassignment finding, the increased level of liver enzyme and yellowing of the sclera is considered to be the priority issue and advocacy, monitoring, assessment and diet change is suggested as the intervention for the quick and safe recovery of the patient.

References:
Abbasinia, M., Ahmadi, F., &Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing ethics, Clinical Reasoning cycle assignment27(1), 141-151. . Retrieved on 12th September 2022, from: https://scholar.google.com/scholaroutput=instlink&q=info:zGhv_vuQrywJ:scholar.google.com/&hl=en&as_ sdt=0,5&as_ylo=2018&scillfp=6127487111043719912&oi=lle
Brahmania, M., Liu, S., Wahed, A. S., Yim, C., Hansen, B. E., Khalili, M., ... & Janssen, H. L. (2020). Alcohol, tobacco and coffee consumption and liver disease severity among individuals with Chronic Hepatitis B infection in North America. Annals of hepatology, 19(4), 437-445. Retrieved on 12th September 2022, from: https://www.sciencedirect.com/science/article/pii/S1665268120300090
Brandman, D. (2021). Jaundice in polycystic liver disease: more than meets the eye. Clinical Liver Disease, 17(3), 165. Retrieved on 12th September 2022, from: https://scholar.google.com/scholaroutput=instlink&q=info:KBGqrcQrW5QJ:scholar.google.com/&hl=en&as_ sdt=0,5&as_ylo=2018&scillfp=18375500680156609616&oi=lle
Chan, K. H., Bennett, D. A., Kurmi, O. P., Yang, L., Chen, Y., Lv, J., ... & China Kadoorie Biobank Study Group. (2020). Solid fuels for cooking and tobacco use and risk of major chronic liver disease mortality: a prospective cohort study of 0.5 million Chinese adults. International journal of epidemiology, Clinical Reasoning cycle assignment49(1), 45-55. Retrieved on 12th September 2022, from: https://academic.oup.com/ije/article/49/1/45/5607010 Chang, Y., Ryu, S., Kim, Y., Cho, Y. K., Sung, E., Kim, H. N., ... & Byrne, C. D. (2020). Low levels of alcohol consumption, obesity, and development of fatty liver with and without evidence of advanced fibrosis. Hepatology, 71(3), 861-873. Retrieved on 12th September 2022, from: https://www.research.ed.ac.uk/files/101801837/revised_Manuscript_clean20190702.docx

Chen, H. L., Wu, S. H., Hsu, S. H., Liou, B. Y., Chen, H. L., & Chang, M. H. (2018). Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases. Journal of biomedical science,Clinical Reasoning cycle assignment 25(1), 1-13. Retrieved on 12th September 2022, from: https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-018-0475-8
Chicco, D., &Jurman, G. (2021). An ensemble learning approach for enhanced classification of patients with hepatitis and cirrhosis. IEEE Access, 9, 24485-24498. Retrieved on 12th September 2022, from: https://ieeexplore.ieee.org/iel7/6287639/9312710/09347427.pdf
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Mandal, A., Bhattarai, B., Kafle, P., Khalid, M., Jonnadula, S. K., Lamicchane, J., ... &Gayam, V. (2018). Elevated liver enzymes in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease. Cureus, Clinical Reasoning cycle assignment10(11). Retrieved on 12th September 2022, from: https://www.cureus.com/articles/16144-elevated-liver-enzymes-in-patients-with-type-2-diabetes-mellitus-and-non-alcoholic-fatty-liver-disease Mansour, D., & McPherson, S. (2018). Management of decompensated cirrhosis. Clinical Medicine, 18(Suppl 2), s60. Retrieved on 12th September 2022, from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334027/
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Petrick, J. L., Campbell, P. T., Koshiol, J., Thistle, J. E., Andreotti, G., Beane-Freeman, L. E., ... & McGlynn, K. A. (2018). Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: The Liver Cancer Pooling Project. British journal of cancer, 118(7), 1005-1012. Retrieved on 12th September 2022, from: https://www.nature.com/articles/s41416-018-0007-z
Yazdani, S., Hosseinzadeh, M., & Hosseini, F. (2017). Models of clinical reasoning with a focus on general practice: a critical review. Journal of Advances in Medical Education & Professionalism, 5(4), 177. Retrieved on 12th September 2022, from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611427/Clinical Reasoning cycle assignment