CNA155 Clinical Research Reasoning Assignment Sample

Health Assessment

Introduction to Clinical Research Reasoning

In addition to nursing knowledge, one must learn analytical thinking to be a successful nurse. It is by logical thinking that he or she is going to make life-saving choices. Nurses who aspire to be critical thinkers must be logical, reasonable, clear, accurate, honest and fair; and all of these qualities must be articulated when they act, speak or write. Clinical reasoning is the process by which doctors obtain, analyse and interpret a patient's condition or problem so that therapies can be planned and implemented, and the calculation of outcomes. It is also a method of analytical thinking that can also be described as a sequence of actions taken. The Clinical Reasoning Cycle (CRC) is a structured decision-making method developed by Levett-Jones (2013) to enable nurses to make rational decisions through a comprehensive mechanism that takes several considerations into account.

Patient Situation

 Eighteen-year - old male, brought in by ambulance after an alleged altercation in which the patient's head struck the road at 2300 hrs. Patient refuses the lack of consciousness, but is unable to remember all events. Patient seems alert but tearful. 4 cm of laceration was noted while conducting inspection with slow oozing of blood from accident wound. Insitu dressing was provided. Vital signs and GCS were registered according to chart at 2325 hrs. No other visible injuries. Patient denies the use of drugs, states have had about 'five beers since 7pm.' Breath alcohol taken 0.06 per cent at 2330 hours. Patient estimates pain in occipital area to be 5/10, with no analgesia taken prior to presentation. Patients past medical history of childhood asthma, he was up to date with immunizations and his last tetanus shot was 12 months ago. Patient didn't report of any known allergies and was not on any medication.

Cues and Additional Information

From the report it can be observed that the patient suffered a laceration on the occipital area of the head and Laceration is an injury process in which blunt forces contribute to ripping of the skin and underlying tissues. Because of variations in anatomy and blood flow, scalp lacerations are distinct from lacerations in other areas of the face and body. The scalp rests on thin skin tissue, which sits on the bone, making it more vulnerable to laceration. Staples are usually the favoured form of closure of lacerations through the dermis in which bleeding is managed since they are quick, inexpensive and have little complications. While this process is relatively time-consuming compared with surgical staples, it is less painful and requires no staple removal, which typically results in successful cosmetic results with little complications. (Almulhim, A.M. & Madadin, M., 2019).When an individual has a suspected head trauma, the initial assessment begins with the primary survey, during which the ABCDEs are evaluated. A is for airways, and patients with traumatic brain injuries will not be able to shield their airways, leading to swelling and hypoxia, which may intensify the brain injury. These people can need intubation for the endotracheal and mechanical ventilation. B is for breathing, and if the intracranial pressure is increased, it can lead to an erratic breathing pattern-which is part of the Cushing triad. C is for circulation, and the two remaining traits of the Cushing triad are hypertension and bradycardia. Hypotension can also occur which can decrease brain perfusion. "D" is for disability, and can be measured using a Glasgow Coma Scale 15-point, or GCS, where the minimum score possible is 3.Finally, "E" is for exposure, where the individual is logged to expose the back, which can help identify other injuries such as spinal fractures.

Next is the secondary survey, which includes a physical examination with history and head-to-toe. Key elements are captured in the mnemonic "AMPLE" "A" for allergies, "M" for medicines such as anticoagulants and antiplatelet drugs which increase the risk of intracranial bleeding. "P" for the pregnancy and in this case past medical history, "L" for the last meal, and "E" for the events that caused the trauma, such as the injury mechanism and whether consciousness was lost. Getting information from eyewitnesses is helpful, because there may sometimes be post-traumatic memory loss or amnesia.The patient scored 4 in verbal response on Glasgow comma scale which indicates verbal confusion. Motor and eye opening responses were apt with scores of 6 and 4. The total Glasgow score was 15 for Mr Zac which suggests of mild traumatic brain injury. This could be due to the shock which patient sustained while he hit the curb. Patient stated of consuming five full strength beers before this accident and breath control taken at the spot was 0.06%, which could lead to a possibility of Intoxication of alcohol. At 0.06 percent BAC results in a dynamic multifaceted loss in human postural function. This decline in stability was mirrored in a causal association between elevated BAC and elevated body movements and a substantial reduction in stability. In addition, alcohol intoxication affected the movement pattern and decreased the ability to change sensorimotors in a lateral direction to such a degree that human postural regulation became increasingly less able to accommodate repetitive disruptions of the equilibrium (Modig, F et al., 2012).

Process Information

The process information in clinical reporting cycle, will be interpretation of the information which has been acquired by the nurse stationed there. The final step in process information will be assessing the outcome on the basis the age, gender, history. The patient had history of consuming 5 full strength beer before he met accident and he was unable to remember the whole incident and reported of GCS of 15, and decreased verbal abilities with score of 4. The GCS of 15 could be due the alcohol intoxication as the breath control was 0.06% which is suggestive of decreased motor abilities and the part where the patient was not able to recall the incidents .

 The nurse acquires data and explains it in the reasonable manner so for this case it suggests of Mild Traumatic Brain Injury (MTBI) which is also called as the intracranial injury, is generally caused by blunt-force trauma after a collision of head and a rigid object (e.g., concrete road) or a mobile object (e.g., moving car) (Roberts & Roberts, 2010) and this is also termed as ‘concussion’. TBIs can cause primary injuries that result directly from outside force.Can include injuries to the skulls such as fractures; injuries to the blood vessels such as an epidural or subdural hematoma, or subarachnoid or intracerebral hemorrhage; and brain parenchymal disorders such as contusions of the brain and acute axonal damage. Primary injuries may also lead to secondary injuries-such as cerebral herniation, seizures and increased intracranial pressure. A moderate TBI, also known as a concussion, usually has a 13 to 15 GCS, with less than 30 minutes of total lack of consciousness. The period of post-traumatic memory loss or amnesia, as well as a shift of consciousness level-such as feeling lethargic or confused-often lasts less than 1 day( Clinical reasoning,2020 ). According to Zollman (2016) most MTBI patients have a clear clinical presentation and relatively rapid spontaneous symptom resolution. Any patients also have an uncertain history of injuries and no clinical signs of damage, rendering MTBI diagnosis more difficult.

References for Clinical Research Reasoning

Almulhim, A.M. & Madadin, M., (2019) Scalp Laceration.

Clinical reasoning traumatic brain Injury. 2020, September 3. Retrieved from https://www.osmosis.org/learn/Clinical Reasoning: Traumatic brain injury.

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 29-34.

Harrigan, T. P., Roberts, J. C., Ward, E. E., & Merkle, A. C. (2010). Correlating tissue response with anatomical location of mTBI using a human head finite element model under simulated blast conditions. In 26th Southern Biomedical Engineering Conference SBEC 2010, April 30-May 2, 2010, College Park, Maryland, USA (pp. 18-21). Springer, Berlin, Heidelberg.

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’patients. Nurse education today, 30(6), 515-520.

Modig, F., Fransson, P. A., Magnusson, M., & Patel, M. (2012). Blood alcohol concentration at 0.06 and 0.10% causes a complex multifaceted deterioration of body movement control. Alcohol, 46(1), 75-88.

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