Clinical Reasoning And Procedural Competency Essay

Question:

Write about the Clinical Reasoning and Procedural Competency.

Answer:

Introduction

Clinical reasoning tool has been used by medical practitioners far and wide for the assessment of patients through the collections of cues, processing of information , being in a position to understand the patient, coming up with interventions and implementing them, doing evaluations is paramount in critical thinking progress, for the patient situation, (Levett et al., 2010). Clinical reasoning is essential in health care in that it builds competences and approach by focussing on problem based learning, (Chapman et al., 2013). It is a research tool that utilizes the five constructs to solve a problem thus contributing to the broader concept of human cognition. In this case review, is patient named Katie McConnell, a patient of mild traumatic brain injury. The case management assessment follows the clinical reasoning cycle of patient assessment.

Patient Situation

The case description is a 23 year old woman on admission at the facility. The patient is a victim of road accident; she has subdural hematoma which has lasted 18 hours, obtained by hit from a car. She has been transferred from a different facility and brought to the neurosurgical trauma for further reassessment and evaluations for better prognosis and care. Currently the patient is experiencing some memory lapse in a mild state. Her vitals indicate that the heart beat rate is 89 pulses, blood pressure is 142/72 Sp O2 96% and the respiratory rate is at 13. From the general assessments the pressure of the blood is high on the systolic side. Her pulse rate is at the normal levels. The vital statistics presented by the patient are normal except the increased in temperature and loss of memory. The changes can be attributed to her medical condition.

Cues and Information

The condition the patient is suffering is subdural haematoma from injury, it is considered in the medical filed the deadliest disease state for humans, the internal bleeding often fills the brain of the victim; it results in brain damage which can advance to death. Severe head injuries causes’ severe bleeding causes subdural hematoma, which is characterized by losing consciousness and confusion as displayed by parent Kate. Subdural hematoma can appear with no symptoms for the first few days after head injury, but patients appears confused, which is characterised slower blood bleeding causing increase subdural hematoma diseases. For slow developing hematomas, there is no significant changes in the or symptoms observed for greater than two weeks after bleeding

The medical condition of the patient is heterogeneous in nature. The injury falls into a full spectrum. The information given shows that the patient Bp is 142/72, heart beat rate is 89, respiratory rate is 13 Glasgow comma score is 14.

Symptoms patient Katie might be facing include confusion which is evident, headache pains, changes in the behaviour, dizziness, nausea and vomiting, weakness of the general body, apathy of the body and recurrent seizures.

Other medical diagnoses which are essential for the patient are imaging tests aided with computer tomography or MRI images to observe and monitor the extent of disease for the purpose ot diagnosis, (Soltaninejad et al., 2014). It also uses magnetic resonance techniques to take pictures of the brain to determine the extent of subdural hematoma. These tests generate images of the inner skull, thus showing any haematosis present. In comparative nature of tests done using MRI and CT scan, MRI is superior however CT scan is faster in producing results, (Wintermark et al, 2015). Angiography tests are essential for this patient. It is another diagnosis method for haematosis. It uses the application of a catheter placed in the arterial vessel located in the groin deeply into neck and brain. Special agent compound is injected to it and images of blood flow are observed through the blood vessels. These test can help in diagnosing patient Katie effectively thus providing appropriate care.

Process Information

In mild traumatic brain injury observed characteristics such as confusion and loss of consciousness and related disorientation of the person for shorter duration of time characterises this window. From the case study what we know is that the patient is experiencing confusion and difficulty in remembering things but can recall later when probing is done. The confusion is largely due to occurrence of concussion, which temporarily affects the brain thus causing confusions, memory speech, and vision and balance problems. If the concussion is not treated it advances to second impact syndrome, which is more fatal condition. Concussion can be managed through healing of the brain, (MoC, 2009 ).

Early symptoms associated with mild traumatic disorder include mild appearances which it has significant impact on lifelong impairment and the ability to function well. Some of the known live long problems with this condition are persistent headache, pains, fatigue, mood changes, and sensory related issues with later taste preferences, persistent headache and confusion. CDC, acknowledges that the following characteristics can be defined with respect to mild trauma injury, pain syndromes,codnitive impairments, nerve dysfunction and vertigo resulting from injury to the brain, (Ciuffreda & Ludlam, 2001).

Expected assessments symptoms which are positive for mild injury trauma are presented in three broader ways; cognitive, physical symptoms and behaviour changes combined with post concussive symptoms , (Koski et al., 2015). Cognitive symptoms include attention related problems and challenges, difficulty in concentration, memory related problem and orientation problems. The physical symptom includes headaches, dizziness, insomnia issues, nausea, seizures, blurred vision and fatigue. The behavioural changes explicated include irritability, depression, anxiety, and loss of initiative, sleep disturbances, social problems like marriage, relationships or school management.

Confirmatory tests of confusion and disorganisation, consciousness loss of more than 30 minutes, neuron psychological related problems and Glasgow coma scale of 13 or higher are the confirmatory tests for mild trauma injury of the brain, (Skolnick et al., 2014).

Identifying Problems and Issues

In symptomatic identification of issues there is need to know the underlying disease features. Patient Katie has had traumatic brain injury, clinically portraying induced disruption in the physiology path, disruption of brain function which can be manifest by; loss of conscious for more than 30 minutes however this is not the case for patient Katie, loss of memory which is characterised by not remembering events for short or long periods of time before or after an occurrence of an accident before diagnosis. Mental disorientation, which is portrayed by changes in the mental status during the periods of the accident.

In depth analysis of baseline lab investigations for patient Katie necessary, they include determination of FBC, serum electrolytes urea, serum glucose, coagulation status, blood alcohol level in the blood and urinalysis. Arterial blood gas determination is not a factor in traumatic brain injury, (Tootal, 2014). Securing of definitive way for breathing assistance is based on clinical findings from either lab or physical assessments. A patient diagnosed with GCS lower than 8 or a victim of trauma brain injury not breathing effectively and smoothly, thus not maintain the airway with assistive oxygen requires definitive pathway, (Kothari , Kothani & Gadhi, 2016).

In-depth assessments reveal that symptoms like headache, memory lapses and poor concentration are manifesting itself. In the general patients, symptoms persist for psychological problems. Further assessment need to be done for confirmation purposes. It includes modern technology usage like abnormalities or occurrence of concussion which in this case signifies loss of consciousness.

Other focussed health assessments to be done include physical examination attests, which include the papillary tests, head and neck assessments which involve fundoscopic examination procedure for the patient (Woo & Hirsch, 2016), palpation of the scalp for hematoma, auscultation for corneous disease, cervical evaluation for confirmation of tenderness. However further assessment can be conducted for patient Katie, they include conducting MRI and CT scan.

Health Assessments

Canadian CT head rule cam be done. CT scan diagnosis is suitable for people with minor head injury like Katie, the result of this test are presented in neurological examination and GCS score of 15 is assured. Those that portray high risk behaviour include headaches, vomiting, over 60 year’s alcohol dependent, seizure and amnesia.

Currently there are many components for analysing the criteria for traumatic brain injury. Commonly used is the Glasgow Coma Scale, which is utilised in assessment of, assessing patients. As way of conducting the assessments , there is need to start from non- invasive procedures with key approach focussing on the lab assessments then to those that offer specific tests and easier to interpret like CT scan and MRI however costly suits the case study for Katie for appropriative management .

The final assessment of the results obtain will be based on the following criteria; unconscious loss for up to 30 minutes, memory loss after accidents occurrence in the last 24 hours, changes in the mental state at accident time, measure of the deficits in the neurology that are not transient, conscious loss for more than 30 minutes, amnesia presence after accident exceeding 24 hours or the Glasgow scores scale for coma falling below 13 after half an hour, (Mrashall et al.,m 2012).

References

  1. Chapman, D. M., Calhoun, J. M., Van Mondfrans, A. P., & Davis, W. K. (2013). Assessing effectiveness of a problem-based learning curriculum in teaching clinical reasoning skills. Journal of Clinical Reasoning & Procedural Competency, 1(1), 17-28.
  2. Ciuffreda, K. J., & Ludlam, D. P. (2011). Conceptual model of optometric vision care in mild traumatic brain injury. The Journal of Behavioral Optometry, 22, 10-12
  3. Koski, L., Kolivakis, T., Yu, C., Chen, J. K., Delaney, S., & Ptito, A. (2015). Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury. Journal of neurotrauma, 32(1), 38-44
  4. Kothari, S., Kothari, N., & Gandhi, P. (2016). A Study Showing Correlation Between Glasgow Coma Scale And Brain Computed Tomography Scan Findings In Head Trauma Patients. International Journal of Scientific Research, 5(4).
  5. 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.#
  6. Management of Concussion/m TBI Working Group. (2009). VA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury. Journal of rehabilitation research and development, 46(6), CP1.
  7. Marshall, S., Bayley, M., McCullagh, S., Velikonja, D., & Berrigan, L. (2012). Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Canadian Family Physician, 58(3), 257–267.
  8. Skolnick, B. E., Maas, A. I., Narayan, R. K., van der Hoop, R. G., MacAllister, T., Ward, J. D., ... & Stocchetti, N. (2014). A clinical trial of progesterone for severe traumatic brain injury. New England Journal of Medicine, 371(26), 2467-2476.
  9. Soltaninejad, M., Lambrou, T., Qureshi, A., Allinson, N. M., & Ye, X. (2014). A Hybrid Method for Haemorrhage Segmentation in Trauma Brain CT. In MIUA (pp. 99-104).
  10. Tootal, D.A., (2014). Spectrin Breakdown Products in the Investigation of Blast Induced Traumatic Brain Injury (Doctoral dissertation, Durham University).
  11. Wintermark, M., Sanelli, P. C., Anzai, Y., Tsiouris, A. J., Whitlow, C. T., & Institute, A. H. I. (2015). Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. Journal of the American College of Radiology, 12(2), e1-e14.
  12. Woo, T., & Hirsch, C. H. (2016). Physical Examination. In On-Call Geriatric Psychiatry (pp. 17-30). Springer International Publishing.

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