Mr. Jones Clinical Reasoning Cycle - Free Essay Example

Sample details Pages: 9 Words: 2623 Downloads: 4 Date added: 2019/10/10 Did you like this example? Introduction Nursing practitioners with effective reasoning skills always have a positive impact on the patient’s outcome. Conversely, nurses with poor clinical reasoning skills have a high potential of failing to detect the impending patient deterioration either from drug-body interactions or normal â€Å"failure to rescue.† These issues have resulted in increased number of escalating healthcare complaints in the ever expanding population of seniors (Levett-Jones Bourgeois, 2014). According to Alfaro-LeFevre (2009), there are three primary reasons for the adverse patient outcomes experienced in almost all health care provider institutions. Don’t waste time! Our writers will create an original "Mr. Jones Clinical Reasoning Cycle" essay for you Create order These reasons are: the failure to properly diagnose, the failure to institute appropriate medication and treatment and application of inappropriate management strategies of the presented complications (Alfaro-LeFevre, 2009). All these factors are directly related to the poor clinical reasoning skills. For that reason, Rubenfeld Scheffer (2006) suggests that education system must promote the recognition and management of deteriorating patients. Furthermore, nursing practitioners must be in a position to utilize different communication channels, a collaboration of inter-professional teams and escalation systems in order to achieve accurate and quality service delivery to patients (Rubenfeld Scheffer, 2006). One way of attaining this is by implementing the clinical Reasoning cycle (Levett-Jones Bourgeois, 2014). While putting this information in mind, this paper will utilize the Clinical Reasoning Cycle in reviewing and planning care for a patient named Mr. Jones.   Ã‚  Ã‚   Consider the Patient According to Levett-Jones et al. (2014), considering the patient is the stage of the Clinical reasoning cycle. In this stage, the nurse encounters the individual who is the recipient of the care and starts to gain an initial impression (Levett-Jones et al., 2014). According to Tanner (2006), this may happen as a result of hearing a report [handover] or by a notice when the patient is first observed (Tanner, 2006). Therefore, while conducting the first impression on Mr. Jones, it is critical noting that prior preconceptions and assumptions may have influenced some of the information in this stage. Furthermore, at this stage, the patient condition is viewed against the background of their historicity and within the institutions of care ability. Now, Mr. Jones 86 years of age was bought to the hospital after he was found wandering up and down his streets by a close neighbor. Furthermore, his limping and has a favoring in his left side. Blood strains are evident in his socks and paints. A skin tear is also visible in his left shin. Following this, he has been placed on bed rest for later assessment using X-ray to ascertain whether he has any fractures because he thinks that he fell over, but he is not certain about that. In relation to this, the patient complained of pain of pain originating from his left hip spreading down to the leg where he has a laceration following the fall.   Ã‚  Ã‚   Collect Cues and Information This stage involves collecting relevant information regarding Mr. Jones. Furthermore, it will involve reviewing patient’s information that is available in his documented history, nursing notes, clinical documentations and handover reports. From the reports, Mr. Jones is under medications such as Irbesartan 150mg PO daily. According to Drugs.com (2017), Irbesartan is mostly used in the treatment of high blood pressure (Ace Inhibitors) (hypertension). With this medication, it is clear that Mr. Jones has a history of hypertension. Additionally, he came in with Metformin 1000mg PO Daily. This drug is used in improving blood sugars and mostly in individuals having type 2 diabetes. For that reason, there are increased chances that Mr. Jones has type 2 diabetes. Also, he had Salbutamol metered dose inhaler 1-2 puffs every 4-6 hours and which is mostly used in preventing and treating bronchospasm in patients with bronchitis, lung related diseases, emphysema, and asthma. Based on the presence of these drugs more scrutiny is needed to define whether he actually suffers from any of that disease. Additionally, Mr. Jones had Symbicort Turbuhaler 160/4.5mcg 2 inhalations BD, a drug that is mostly used in preventing bronchospasm in patients with chronic obstructive pulmonary disease or asthma. Therefore, while combining the presence of Symbicort Turbuhaler 160/4.5mcg 2 inhalations BD and Salbutamol metered dose inhaler 1-2 puffs every 4-6 hours there is higher likelihood that Mr. Jones has a respiratory related disease. Finally, he complained hip and leg pain and which gives the reason why there are Paracetamols in his drug list. Paracetamols are mostly used as pain and fever relievers; therefore, there are increased chances that Mr. Jones may be feeling some pain on different body parts. Apart from this data, new information gathered from observations of Mr. Jones shows that: He 177 cm tall and has a weight of 125 kgs translating to a BMI of 39.9, Blood Pressure 165/95 mmHg, T 37.9C, P 105 bpm and R 24 breathes per minute. Additionally, Mr. Jones has a Pain score of 7/10, location located at left hip and leg. Other than these, he has three skin tear, a Waterlow score of 16, High fall score risks of 17 and GCS 14 having normal power in the right leg, mild weaknesses in the left leg. Finally, his pupils are equal and reacting in a sluggish manner. However, he has not opened his bowels for the last two days (BNO x Day 2). According to Alfaro-LeFevre (2017), it is important for the nursing practitioner in a change to recall some knowledge from Law, therapeutic, cultural context, physiology, and pathology in relation to the patient (Mr. Jones case). First, Mr. Jones wife died two months ago. This may be related to depression and stress resulting in lack of the ability to eat hence lowered bowel movements. Blood Pressure and hypertension are linked to the fluid status in the patient’s body (Alfaro-LeFevre, 2017). Additionally, Mr. Jones lives in a single Story House and which has two steps at the entrance. Therefore, due to the pain in his hip and leg, it may be related to the event where he was found wandering up and down his street by the neighbor. In the ward where Mr. Jones is hosted before an X-ray is conducted, there are standing orders that must be followed by the patients and the relatives or any individual connected to the patient. Before anything is done on the patient’s body, his children must visit the hospital, listen to the consent files and accept whether they agree on the procedures that the nurses and doctors aim to use on their father. Additionally, the nurse must inform the patient on all the possible medical procedures that will be taken to ascertain the real cause of the challenges and problems he is facing. These standing laws are to be observed as they will save the hospital from any possible law suits originating from human rights or family members.   Ã‚   Process Information According to Levett-Jones et al. (2014), all the cues and patient data collected in the above phase are carefully analyzed. Any aberration from the normal is identified and highlighted. Furthermore, cues patterns and clustered are recognized, inferences created and hypotheses generated (Levett-Jones et al., 2014). Simply, the patient’s situation is compared with previous clinical presentations thereby giving the nursing practitioner an opportunity to anticipate possible outcomes with regard to the available course of action. According to Alfaro-Le Fevre (2009), thinking ahead or rather predicting outcomes helps in knowing possible results of understanding certain procedures. Analyze the cues/Data to come to a stable understanding of Mr. Jones Signs and Symptoms. [Comparing the normal vs. Abnormal] Interpretation Normal blood pressure should not go over 120/80 and 140/90. Therefore, it is clear that Mr. Jones has high blood pressure. Furthermore, his skin tear is placed under category three where the skin flap is completely absent. Therefore, while following this information, the blood stains on his leg and pants may have originated from this skin tear. Also, Mr. Jones score 16 in Waterlow and which places him under high risk of developing pressure sores. With a fall risk score of 17, it means that Mr. Jones is susceptible to falls and therefore there is need to check the x-rays for any potential fractures. Mr. Jones has a GCS 14 with normal power in his right leg and mild weakness in the left. His pupils are equal however they are reacting sluggishly. A score of 14 implies that he is a having a mild dysfunction. This implies that his conscious state as a person has mild dysfunction. Mr. Jones is 177 cm tall and Weighs 12kgs. This means that his BMI is actually 39.9. According to World Health Organization, individuals with a BMI of 30 and over are classified as observed obese. In most cases, senior individuals and who are obese and hypertensive have a higher chance of having diabetes, eye problems and hear problems. Therefore, Mr. Jones BMI index opens a clearer path to securitizing some of the co-morbidities that he is currently suffering from. While still connecting Mr. Jones age of 86 with his BP 165/95 mmHg. Additionally, the patient had, T 37.9C, P 105 bpm, R 24 breathes per minute. Because the normal blood pressure is less than or equal to 120/80 mm Hg, then Mr. Jones is above the normal with 165/95 hence labeling him as hypertension. While looking at the textbook, the normal temperature is between 36 to 38, Mr. Jones’s temperature stands at 37.9 and which labeled as high temperature. On the other hand, the Pulse for adults should stand at an average of 70 (60-100). Mr. Jones pulse rate stands at 105. This implies that his pulse is way before normal. Finally, from the textbook, an older adult should have an average of 16 in his or her respiratory rate. While comparing his respiratory rate [24] and what is highlighted in the textbook, he may be suffering from tachypnea a condition where an individual suffers from faster respirations. Discriminate: This involves distinguishing relevant from the irrelevant information. Furthermore, it involves recognizing the inconsistences in the data in order to narrow down the information to levels where the gaps in the cues is collected. Based on Mr. Jones age, his temperature is up but, the nursing practitioner is not too worried about it. However, more concern is directed towards the Blood Pressure and the Pulse. For that reason, it’s good to check oxygen sats in the blood as well as the urine output. The text on the urine output will be to measure the glucose output.   This information will help in correlating the GCS 14 his individual level of consciousness. Relating the Cues At this sublevel, the nursing practitioner is expected to discover new relations within the information and cues. It also helps in identifying the relationships that exist between the data. For instance, Mr. Jones high respiratory rate, pulse and blood pressure may result in the experienced GCS 14. Furthermore, with a category three of the wound, the blood paints have a higher possibility of originating from this site. Also, all the medications that Mr. Jones came with to the hospital prove the fact that the mentioned co-morbidities of Asthma, Type 2 diabetes, Hypertension and Arthritis are evident. Finally, the fact that Mr. Jones bowels have not opened for 2 last days may be linked to two main factors. First, Mr. Jones wife died a few months ago, therefore, he may be suffering from loneliness and stress and which have a possibility of halting his digestion ability. Additionally, based on his current age, his digestion may be weak to digest the take away and frozen meals that he has been depending on. For those reasons, the bowel movements problems are more likely to be associated with these factors. Infer This involves making deductions while forming opinions that follow the logic by interpreting the subjective and objective cues. For instance, in Mr. Jones case, his pulse rate and respiratory rate could be higher based on the tension and stress that he has been exposed to in his old age. Furthermore, the wound may be breeding from lack of attendance. Finally, his blood pressure could be low due to the amount of blood lost through the wound. The fact is that his pants were wet with blood. Match Situations According to World Health Organization, elderly individuals are at risk of suffering from hypertension, diabetes and difficulties in bowel movement. For that reason, some of the challenges facing Mr. Jones are connected. Furthermore, as individuals get older, their body muscles become weaker and which exposes them to risks of fractures or falls. For that reason, the pain that Mr. Jones is experiencing in his hip may be originating from either a fall he experienced a few days ago. Following the fact that he’s old, there are increased chances of losing memory and which means that he has a potential of forgetting what happened in his life. Predicting the Outcomes Based on the nature of Mr. Jones, if he is not taken for X-ray scans, there is higher chance that the case of the pain in his hip may deteriorate. Furthermore, based on his condition, if he is not placed on fluids, there are increased chances that he may get a shock. To understand the nature of his bowel movements, Mr. Jones will be given some vegetable dish. The roughage will be focused on checking whether his bowels will open after getting exposed to fluids. Finally, due to his increased pulse rate and respiratory rate, Mr. Jones will be given behavioral therapy that will work in coming down his stress and depression levels. This is because, with hypertension and higher pulse rate, there are increased chances of facing challenges in breathing or even stroke. Cleaning the wound helps in lowering the bacteria and which works in reducing the pain originating from the wound.   Ã‚  Ã‚   Evaluation According to Levett-Jones et al. (2014), this stage involves the nursing practitioner re-evaluating the patient’s cues and the current status so as to determine the most effective nursing interventions and whether the patient’s condition has been improved. First, to lower the patient’s pain originating from the wound, lowering the infection has proved to be an effective intervention for the patient. It has initiated the healing process as well as lowering the pain experienced by the patient. After administering narcotics and antibiotics to the patients, another measure of the pain level showed 3/10. This score confirms that the pain has completely reduced. Secondly, offering fluids and treating the wound has worked in lowering the pressure and the blood pressure the patient was initiated exposed. Addition, use of drugs to control hypertension, diabetes and pulse rates were very effective in stabilizing the condition of the patient helping help to adopt a smooth r oute to healing. The X-ray proved that the patient did not have any fracture; however, the hip bone was somehow dislocated. Therefore, the physicians placed the patient under therapy to return the bones to normal. All in all, the interventions adopted by the nursing practitioners with help from senior doctors, Mr. Jones health status has begun returning to normal   Ã‚  Ã‚   Reflect on Process and New Learning Levett-Jones et al. (2014) place this last stage as a reflection stage. It offers a suitable opportunity to review the practice. This step provides a chance to refine the processes, change or improve the interventions. In this case, Cognitive Behavior Therapy will be included to improve the healing process of Mr. Jones based on the fact that he is a senior and has a chance of suffering from mental disorders and eating disorders. Next time, while dealing with such a senior patient, the first step will be including their family members into play. This will ensure that the hospital and the senior’s family work in collaboration in dealing with potential challenges that have a possibility of affecting the patient in future. Finally, if I had the skills in Behavior Therapy and Cognitive Behavior therapy, I would have provided therapy to allow the patient to change attitude and emotions following the death of his wife. This would help in improving the healing process of the senior pa tient.

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Business and society free essay sample

Which of the political tactics discussed in this chapter are evident in this case? Information strategy which businesses seeking to provide government policymakers with information to influence their actions has been used, described as traditional political strategy (Lawrence Weber, 2014). Writing letter campaign, sending of e-mails, and making telephone calls, as well as black out can be considered as this strategy. The blacking out action was very effective in the end. Why were the political tactics used by the new media so effective in this case? Because on the censorship day of the U. S, which critics created, many of new media companies, like Wikipedia, blacking out their website to protest SOPA. This way many of their website users will get irritated since the websites are shut down, and they will start blaming the roots of the problem, which is SOPA. Would the effectiveness of these tactics vary, depending on the political issue at stake? Yes, it will vary; it depends on what political issue it is. We will write a custom essay sample on Business and society or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page For some bill, for example, if the government is trying to make a new law about preventing global warming, yet it does not matter even if some environmentally unfriendly company did strike, it is not going to change anything. What can traditional companies learn from the new form of political activity described in this case? They should learn that the times have changed. They are long past the point where selling stuffs that are downloadable online and trying to protect their own benefit which is old school, they already got left behind. So do not struggle so hard and try to adapt their company to the new era.

The Great ha-jin Essay Example

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A Special Night It seemed like any other late spring night. I finished with work thinking only of how bad the rush hour traffic had become. Stuck in a stand still for nearly ten minutes, my nerves were on end. The last thing I needed was that phone call. With both hope, and fear in my heart I pressed the send button on my Motorola. With the simple greeting of hello, my fears were confirmed. My ex-husband had yet another asinine question, and an even more irritating favor to ask. He planned on taking our daughters swimming, but would not allow them to wear two piece swimming suits, which was all they owned. Much to my dismay he asked me to go and buy them new suits, with the empty promise that the money would be returned. Knowing that the money would never be seen again, but not wanting to punish my children, I reluctantly changed direction to the nearest Walmart. While rushing through the store in a very hostile mood, a rather pudgy woman with five children pushed along the aisle at a rather slow pace. In the nicest tone my voice could muster I politely said â€Å"Excuse me.† The woman looked at me and snapped back â€Å"Watch out kids we are moving to slow for some people.† Holding my tongue for fear of being sat on, I rushed up to the checkout aisle, when it finally happened. My phone rang again, and praying only that it was not my ex-husband, and answered again. This time however, the tone was different. It was a voice I was happy to hear, and could almost instantly change the nightmare of a day that I had already experienced. It was my boyfriend, and true love Tyler. His voice calm as always said lovingly â€Å"Hello sweetheart, how is my angel doing today?† With relief I replied about how awful I had been feeling and, hoping that he had something planned, hinted at what we were going to do tonight. Like so many times before he simply said that we were just going to dinner, and maybe to the park. At once a... Free Essays on Engagement Free Essays on Engagement A Special Night It seemed like any other late spring night. I finished with work thinking only of how bad the rush hour traffic had become. Stuck in a stand still for nearly ten minutes, my nerves were on end. The last thing I needed was that phone call. With both hope, and fear in my heart I pressed the send button on my Motorola. With the simple greeting of hello, my fears were confirmed. My ex-husband had yet another asinine question, and an even more irritating favor to ask. He planned on taking our daughters swimming, but would not allow them to wear two piece swimming suits, which was all they owned. Much to my dismay he asked me to go and buy them new suits, with the empty promise that the money would be returned. Knowing that the money would never be seen again, but not wanting to punish my children, I reluctantly changed direction to the nearest Walmart. While rushing through the store in a very hostile mood, a rather pudgy woman with five children pushed along the aisle at a rather slow pace. In the nicest tone my voice could muster I politely said â€Å"Excuse me.† The woman looked at me and snapped back â€Å"Watch out kids we are moving to slow for some people.† Holding my tongue for fear of being sat on, I rushed up to the checkout aisle, when it finally happened. My phone rang again, and praying only that it was not my ex-husband, and answered again. This time however, the tone was different. It was a voice I was happy to hear, and could almost instantly change the nightmare of a day that I had already experienced. It was my boyfriend, and true love Tyler. His voice calm as always said lovingly â€Å"Hello sweetheart, how is my angel doing today?† With relief I replied about how awful I had been feeling and, hoping that he had something planned, hinted at what we were going to do tonight. Like so many times before he simply said that we were just going to dinner, and maybe to the park. At once a...

The commonest form of contract law Essay Example | Topics and Well Written Essays - 750 words

The commonest form of contract law - Essay Example A court of law usually enforces the contract as long the offeree proves that he posted the letter. For the case of Bella, the letter he posted on 25th September 2006, but arrived on 30th September 2006, the contract to purchase the text book became binding immediately he sent the letter of acceptance. It does not matter that the letter was delayed by the post office. On the issue that since the recommended textbook for the course has changed, and Bella does not wish to buy the textbook, this would not apply. Acceptance one made, it cannot be revoked. The moment Bella expressed his acceptance of an offer, that very moment the contract is concluded, and it does not matter whether the acceptance is by word of mouth or even by writing. On the case of Chu who accepted Arun's offer by telephone, his contract became complete when the acceptance was heard by Arun on 30th September 2006. According to the law of contract, there is an exception to the communication of acceptance. A contact is complete only when acceptance is actually communicated to the offeror. But a contract made by telephone is complete only when the acceptance is heard by the offeror. For this case, Chu should not revoke the acceptance on the basis that the book will not be useful since it is not recommended text book in his course. An acceptance once made, it cannot be revoked. On the case of Dilma, who accepted the offer by email sent on 27th September 2006 but read by Arun on 28th September 2006, the contract became binding immediately the email of acceptance was sent. According to law of contract, there is an exception to the communication of acceptance as acceptance made by cable takes effect from the moment of posting is an exception to the general rule, that a contract is complete only when acceptance is actually communicated to the offeror. For this case, Dilma cannot be able to revoke the acceptance since an acceptance made cannot be revoked. Past Consideration is Sufficient Consideration Although consideration must not be past, there are three exceptions to this rule that past consideration is no consideration. The exceptions to this rule are applicable when:- The past consideration consists of services rendered at the express or on legally implied request of the promissor. A relevant case studied on this concept is that of:- Lampleigh vs. Braithwait In this case B, under death sentence, requested L to obtain King's pardon for him, which he did. B subsequently promised to pay 100 to L, which he failed to pay, and pleaded the defence that his promise was based on past consideration. It was held that as the plaintiff performed services as the express request of the defendant, a subsequent T promise to pay would be binding on him. When a debt, the payment of which is barred by statute of limitations, is revived by a fresh promise in writing for example if a creditor does not demand the repayment of the loan from his debtor within six years of the loan hence he cannot enforce his claim in the court in case the debtor refuses to pay. Lastly in the bill of exchange Act that provides that an antecedent debt or liability on the part of the promisor or drawer of the

Coursework Example | Topics and Well Written Essays - 1250 words - 2

Coursework Example The government also wants that the economy function at the full employment level, so that all the people who are capable and willing to work would be able to attain a job, however the natural rate of unemployment will never be zero due to seasonal, structural and other reasons. (McConnell & Brue, 1996) Zero inflation is considered bad for the economy; however, the inflation rate shouldn’t be too high or even too low in the economy and shouldn’t change rapidly. The government wants to sustain the inflation at a moderate and sustainable level. The prices and accordingly the demand of goods and services will vary according to the price level and therefore it is important that the general price level remain stable in the economy. Lastly, the government also aims at keeping their finances sound as well as the balance of payments account. (McConnell & Brue, 1996) However it is difficult to classify the objectives in order of their importance. And this makes the task of the go vernment difficult due to clashing objectives and a tradeoff needs to be made. Such as a policy that would perhaps stimulate overall demand or aggregate demand in the short run may reduce unemployment but that may increase inflation in the long run and go against the government’s objective of maintaining moderate inflation rate. This may also lead to a worsening of the balance of payment position and the government needs to make a choice as to what is more important. At the same time, growth and inflation are considered to be of utmost importance because growth is what improves the standard of living for people and controlling inflation also leads to general price levels being stable and thus attaining the goal of sustainable growth. Inflation is supposed to be the most important goal to achieve since it is believed that the other aims would be difficult to achieve in the long run if the sustainable inflation rate is missed. (McConnell & Brue, 1996) Governments can employ two policies in times of a recession, that is, a decline in GDP as well in times of expansion, that is, a rise in the GDP level. And these are: fiscal and monetary policies. Fiscal policies involve government expenditure and taxes to increase or decrease the economic activity. There are two types of fiscal policies: contractionary and expansionary fiscal policies. Contractionary fiscal policy is when the government spends less that the tax revenue, that is, the taxes are higher and government spends less on the economy to finance their debt. They also try to increase public sector borrowing requirement. An expansionary fiscal policy is used to expand the economy when it is in recession by the government spending increasing and a reduction in taxes. This leaves people with more disposable income and consumption and spending in the economy increases overall. The figure for an expansionary fiscal policy is shown below: A situation where G=T is one where the overall tax revenue funds the o verall government spending and this is called a neutral fiscal policy and is applied in an economy which is in equilibrium. Fiscal policies can help with the objectives of achieving a stable growth rate, full employment and price stability. However, government spending and borrowing can also lead to high interest rates, and when a debt is incurred, it may need to be facilitated from overseas, monetization or public borrowing. This can actually