Effective Clinical Reasoning skills can make a difference to patient outcomes (Levett-Jones, 2018). Throughout NRSG138 Transition to Practice, the Levett- Jones Clinical Reasoning Cycle has been introduced and implemented to better understand two case studies, Tula and Jim.
Task: Using an essay format, discuss the processes of the first four steps of the Clinical Reasoning Cycle in relation to the provided case study. Process the following case study according to the first four steps of the Clinical Reasoning Cycle.
The essay will include the steps of
Case Study: Jim Laverty
Jim Laverty is a 65 year old farmer who owns and manages a remote sheepproperty, which is an hour’s drive southwest of Blackall in Central Queensland.Jim is the primary carer for his elderly mother who is 80 years old and has early onset dementia, but there is currently a neighbour caring for her and the farm, as well as a council worker who comes once per week.
After having a fall, Jim was transferred to Rockhampton hospital to have surgery for a right knee joint arthroscopy. This was successfully conducted 10 days ago. Jim is now completing 2 weeks in the Rehabilitation ward. He will be discharged home in 4 days with telehealth physiotherapy and community nursing care support for a further 3 weeks.
Jim’s assessment information is as follows
Case Study
•Weight: 88kgNRSG138_ Supplementary Written Assignment _ © Australian Catholic University 2022 _ Page 3 of 3
NRSG138: Transition to Nursing
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Height: 174cm
Past Medical History: osteoarthritis, hypertension
Current Meds: Irbesartan 150mg PO daily, Paracetamol 1g 6/24 PO,
Ibuprofen 400mg PO 8/24, Clexane 40mg IMI daily
Small wound dressings x 3 to his right knee.
Jim has been showering and toileting independently, using a wheelie
frame when needed to mobilise.
Current information:
It is now Day 10 of Jim’s stay in the Rehabilitation ward, it is planned that he willbe discharged on Day 14. You are the student nurse, undertaking a medication round with Nurse Jo this morning. Following the successful administration ofJim’s medications, Nurse Jo leaves the room to attend to another patient. As youbegin to assist Jim in getting his toiletries ready for a shower, Jim asks you if he will really need to continue to do all of these exercises once he returns home. He is also worried about missing phone calls from the phone calls of the physiotherapist. He states he has not been to the toilet for 3 days and asks if he can have something to help soften his bowel movements. Through theconversation, he states can’t wait to get back to the farm to start work again andto be with his mother. He is awaiting a physiotherapist and social work review prior to discharge. You take his observations:
Current observations (35 minutes post medication administration):
Jim is alert and orientated to time, place and person.
BP 139/85
Sp02 97% Room Air
HR 85 bpm
RR 17 rpm
Pain score 4/10 in right knee, 1/10 in right wrist
Physical examination:
Right knee wound dressing intact with nil ooze. Surrounding skin pink, warm and capillary refill is noted at 2 seconds. Distal foot and toes pink and warm with both dorsal and pedal pulses present and strong.
Right wrist not observed due to splint. Distal fingers pink and warm with full range of movement and sensation.
Consider the Patient situation,
Collect cues & information,
Process information
Identify the problem/issue.
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