To demonstrate your knowledge and application of clinical reasoning with the best evidenced based nursing practice to the given nursing scenario

Applying Clinical Reasoning with Evidence Based Nursing Practice to Mrs. Jansen’s Scenario Name Institution Course and Code Professor Date Applying Clinical Reasoning with Evidence Based Nursing Practice to Mrs. Jansen’s Scenario Introduction The provision of the best care in healthcare settings hinges on the use of practical clinical reasoning which is a cyclic and systematic process that provides guidance for clinical decision-making in situations that are non-routine, emergent, and unpredictable. The processes will be guided by eight phases of the clinical reason cycle (CRC). “They include information processing, taking the right action, evaluating the health outcomes, identifying the health issue, gathering relevant cues, prioritizing the situation of the patient, establishing goals, and reflecting on the clinical processes (Maguire et al., 2022). The primary objective of this report is Mrs. Carol Jansen, a 72-year-old female who was admitted due to Chronic Obstructive Pulmonary Disease (COPD) exacerbation. Based on Mrs. Jansen medical history, she has been having COPD for the past half a decade. Other of her health problems include peripheral vascular illness and hypertension. Moreover, the case reveals that Mrs. Jansen is unsteady and likely to fall, especially when left to walk without assistance.” As such, the report discusses and examines the phases of the CRC as they relate to Mrs. Jansen’s scenario. Patient Situation Five days ago, Jansen was admitted due to an acute exacerbation of her COPD. Pre-admission, she was using several medications such as Salbutamol and Olmesartan for her condition. Furthermore, she was oxygen-dependent in the first four months. Post admission, however, she was put under different medication ranging from inhaled and intravenous corticosteroids, bronchodilators, oxygen-therapy and antibiotics to manage her situation. Her medical history consists of COPD for the last 5 years, and other conditions like hypertension and obesity. Her history also shows that four years ago she was a heavy smoker who smoked thirty cigarettes a day for three decades. Jansen’s objective data shows that her vitals are stable although she has fine crackles at bases. On the other side, her subjective data reveals that she has unsteadiness on her feet and she was recently involved in a near-fall incident. It also reveals that she is quite forgetful although a cognitive screen shows normalcy. As a result, she is really worried about her new medication. Currently, the admitting team has reviewed her and recommended that she be discharged. Collect Cues Several medications and strategies have been part of Jansens treatment since she got admitted. Previously she used medications like Salbutamol, Vitamin D3, Olmesartan, and Atorvastatin. However, after getting admitted, the medication team changed them to inhaled and intravenous corticosteroids, bronchodilators, antibiotics, and oxygen therapy that have helped in managing her situation. Jansen has been suffering with her condition for over five years and has to depend on oxygen for the previous four months. She has also endured comorbidities in the form of obesity, hypertension, peripheral vascular disease, and hyperlipidemia that worsened her condition further. Currently she is living alone but she has a son who lives nearby and supports her. The vitals of Jansen are as follows: a heart rate of 88 beats per minute, a 36.5 degrees Celsius body temperature, a 15/15 Glasgow Coma scale score and a blood sugar level of 6.3 mmol/l. She also has an oxygen saturation 96% on 2lpm of intranasal oxygen, blood pressure 135/85 mmHg, and a respiratory rate of 22 breaths per minute with good bilateral air entry and fine crackles at lung bases. Carol also reports having her bowel movements opened daily. Additionally, she sustained a near fall and is noted to be unsteady on her feet. She did not sustain any injuries during her fall, but she shows signs of fearfulness and gets tired quickly. While cognitive screen results show normal results, Carol displays signs of forgetfulness and admits that her new medication worries her. Jansen's worsening COPD likely comes from a combination of factors. One is her 30-year smoking history. As a result of her smoking, Jansen's airways have been chronically exposed to noxious particles and gases from cigarette smoke, leading to persistent inflammation and tissue damage (De Oliveira Rodrigues et al., 2021). Additionally, her dependance on oxygen in the last four months indicates that her condition is more likely advancing to a more severe stage most likely characterized by airflow limitation and chronic hypoxemia which can cause pulmonary hypertension (Mandras et al., 2020). The comorbid conditions that she has been grappling with may also have led to her worsening condition by causing cardiovascular strain and systematic inflammation. Lastly, her experiencing symptoms like fatigue and unsteadiness on her feet may be signs of skeletal muscle wasting. Process Interpretation of Abnormal Vital Signs Jansen’s temperature is within the normal temperature range but her 88 beats per minute heart rate may suggest mild tachycardia. This may be as a result of respiratory distress which may have increased the sympathetic tone. In addition, her 22 breaths per minute (bpm) heart rate, shows an increased breathing rate that is likely due to her lungs compensating for impaired gas exchange. The crucial signs above are consistent with the physiological response to COPD exacerbation, where increased work of breathing and hypoxemia stimulate respiratory drive and heart rate. Considering her hypertension history, her 135-mmHg blood pressure, although normal, may be relatively increased, signifying increased sympathetic activation or a compensatory response to hypoxemia. Clustering of Important Cues The health patterns associated with the exacerbation of Carol’s condition may be revealed by clustering essential cues. Firstly, the increased rate of respiration and the fine crackles in her bases may point to impaired gas exchanged in the lungs. It may also suggest a possibility of an inflamed airway. Secondly, her long history of smoking is consistent with the pathogenesis of her condition which displays airway inflammation and destruction of tissue when someone is exposed to cigarette smoke. Her depending on oxygen is also an indication that her condition is slowly progressing to a dangerous stage. A stage that has a significant restriction in airflow and chronic hypoxemia. Furthermore, the presence of comorbid conditions alongside his condition are further responsible in causing cardiovascular strain and aggravating her condition. Inferences/Hypotheses of Cause of Illness The worsening of Carol’s condition may have been as a result of several factors ranging from respiratory infections, environmental pollutants, to medication non-compliance. The crackles at her base most likely are the culprit of the respiratory distress she is experiencing. The increased rate of respiration and the dependency o...