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NRSG138 Transition into Nursing

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Question:

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

  1. Consider the Patient situation,
  2. Collect cues & information,
  3. Process information
  4. Identify the problem/issue.

Case Study: Tula Folau

Tula is a 38 year old Samoan woman who works at a textile factory in Dandenong, Melbourne. She is in a relationship with Paul who is 41 and works as a building labourer. She has one child, Lydia who is 10. Lydia’s father Tom has a good relationship with Tula and shares the care of Lydia.

Tula’s assessment information is as follows

  • Weight: 114kg
  • Height: 160cm
  • BMI: 44.5
  • Past Medical History: # L) ulna aged 6, Polycystic Ovary Syndrome (PCOS) diagnosed aged 17, hypertension
  • Current Meds: Irbesartan 150mg PO daily
  • Admission history: Admitted with a persistent dry cough, paroxysmal expiratory wheeze, Tula states that she developed acute dyspnoea towards the end of her 12 hour factory shift. Transported to local emergency department by ambulance, and following assessment was admitted to the respiratory unit for assessment and review of treatment.
  • During Tula’s eight day inpatient stay her care was coordinated by the unit nurses. She was reviewed by a respiratory consultant, a physiotherapist, a social worker and a respiratory CNC. Following clinical examination and respiratory function testing, she was diagnosed with adult onset asthma, and commenced on salbutamol (Ventolin) and salmetreol/fluticasone (Seretide) inhalers.

Current information:

It is now Day 8 of Tula’s admission, it is planned that she will be discharged tomorrow. You are the student nurse, undertaking a medication round with Nurse Kate this morning. Following the successful administration of Tula’s medications, Nurse Kate leaves the room to attend to another patient. Tula asks you if she will really need to use those inhalers when she goes home. She also requests a medical certificate as she is concerned that she might lose her job for having so many days off. She is awaiting a physiotherapist and social work review prior to discharge.

Current observations (prior to medications being administered):

  • BP 127/89
  • Sp02 96% Room Air
  • HR 92 bpm
  • RR 19 rpm
  • Chest auscultation:
  • Audible wheeze in central bronchi on auscultation, equal air entry to both lungs, symmetrical chest movements
  • Tula is alert and orientated to time, place and person
  • Tula has an IVC in her left cubital fossa
  • She has been showering and toileting independently and is looking forward to getting home to her daughter.

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