Clinical Reasoning for Acute Renal Failure- myassignmenthelp.com

Question: Discuss about theClinical Reasoning for Acute Renal Failure. Answer: Introduction The paper emphasizes on the case of an aged woman who was examined with acute renal failure and stroke. To be precise, previously the patient bore the history of respiratory tract problems and complications as well as an amputation performed on the right toe due to the detection of gangrene. Apart from this, she had a medical history of diabetes and hypertensive which she acquired in her teenage years, 15 years of age. I had the case of Ms. S and was charged for her care plan since the time she was admitted to the ward. I remember, I had to shift him to long term facility with the aid of clinical reasoning cycle. For this case study I had executed extensive research in order to support my information with the help of evidence and practice based studies. In this paper the scenario of the patient had been explained after a thorough collection of information, identifying the problem and considering the patients situation following which adequate action had been taken and the occurrence of adverse impact prevented with the usage of clinical reasoning. Care had been given for a proper managing and recognizing and prevention of further deterioration of the patient (Burbach, BarnasonThompson, 2015). Scene Setting Ms. S was a 77 years aged female examined with renal failure accompanied by cerebrovascular accident. As stated the woman was examined in the past with hypertensive and diabetes since 15 years. Ms. S was consequently admitted to the surgical ward where I had been held responsible to take care of her high blood sugar level and regular dressing of her amputated toes. She arrived being carried on a stretcher accompanied by a nurse of emergency ward. As per the nurse statements, she had pain in her amputated toe therefore wound clearing was performed with endian. Furthermore, Ms. S received regular insulin of 50 unit (0.5/hr), colistimethate of 3700000 unit, Chlorhexidine(10ml) and IV.inj and Darbepoetinalfa 50mcg.howeverto that, enoxaparin 30 mg subcutaneous, pantoprazole 40mg NG,and furosemide 10mg, inj, IV were also provided to her. Consider the Patient situation Ms. S was kept in room number 245, and we had received her endorsement there. On the next day at 08800 AM we were handed over her documents and patient history by her nurse. As it is with bed-ridden (quadriplegia) patients with pressure ulcer, the patient needed to be positioned q2hr and providing of suction via tracheotomy, proper and daily dressing of the toes and monitoring of the blood glucose, its intake and output. These fell under my supervision and she required my utmost attention since her handover from her previous nurse. Collection of Information Review of Current Information During the time of clinical reasoning cycle, I had to help my preceptor to superintend the signs for Ms. S. I had to carry the machine for measuring blood pressure level by wearing the PPE which is protective personnel equipment as the patient was categorized under contact precaution owing to acenetobacterbaumannii found in urine. The observations can be listed as Temperature Tympanic 36.8, Respiratory rate 19 breath/min, SPO2:93% (low)on 02 flow 6 L /min Trachea mask Fio at 35% , peripheral pulse rate: 88 bpm , blood pressure, 140/74 mmHg. Consequently I had o document the observation in the patient chart by my preceptor. Gather New Information One of the fundamental and critical steps of the process of clinical reasoning is the collection of pertinent information or cues regarding the patients scenario. I did the same with a complete assessment from head to toe. Ms. S was alerted about her Glasglow coma scale which was 12 due to verbal response (Smeltzer, Bare, Hinkle, Cheever, 2010). According to the protocol, I had to start from her physical appearance of head to toe. In terms of physical appearance, Ms. S was clean except for long nails. As she had sacral ulcer her Bradenn scale was 13, she never had skin pigmentation though. As I pinched under the clavicle I understood that she had bad skin turgor which can be a result of dehydration (HabichLetizia, 2015).She had sparse hair on her scalp. Following this I was asked to finish the assessment alone by my preceptor. I conducted eye examination, the PERRLA of pupils was in round, there was no unusual about her hair. She had nasogastric tube size of 12 French at the right n ostril and everything else was normal. As I moved to the neck, Mr. S had tracheostomy inner cannula of size 6, with intact and secured ties. On her neck examination it was found out that Mr. S was on tracheostomy inner cannula size 6 was in tact. Her chest there was presence of crackles on the right side of the lung because of cough. This is the reason why she required suctioning. The heart and abdomen were normal. As she had quadriplegia it was impossible to analyze the gait and posture as well as flexion of extremities. she had muscle and joint stiffness as a result of neuromascular assessment finding. Therefore, MORSE was used as fall risk scale and she scored 50 signifying a high risk (Huey-Ming, 2015). On the completion of assessment, I suggested that tracheostomy suction not to be performed with clean gloves which was common amongst the wards. I had article to support my claim (Schreiber, 2015). She finally agreed to the fact that it should be conducted with the usage of steri le gloves within a limited amount of time in order to avoid infection. Recal Knowledge The above part deals with collection and review of Ms. S condition and her physiology, pharmacology and pathophsiology. Furthermore, the culture and context of car, ethics and updated evidence based practice relating to the patients situation. Her acute renal failure occurred on the failure of kidney to get rid of waste and fluids from the blood. The kidneys become incapable of proper functioning resulting in accumulation of waste in blood. Lack of filtration affect the blood chemical and disrupt balance (Schmidt, BeutelKielstein, 2015). As far as data is concerned it has been noted that renal failure is the 9th cause of death as reported in US (CDC, 2012). To conclude the section Ms. S was discriminated based on nurses previous assumptions due to patients age and other predominating discrimination. This can apparently make them to presume that providing the patient daily routine care is sufficient because of her old age (Gabel, 2012). Process Information Interpret Here interpretation of data will take place collected during my findings. Ms. S had (ARF) acute renal failure as a consequence her sodium level was 131mmol/L which is below normal. Her creatime level was as high as 274 mmol/L wen compared to the normal (95-107). Her urea result was 12.09 mmol/L which is on the higher side (3.6-7.1 mmol/L/day) because of waste accumulation in body resulting in acute dehydration within the patiemt. Additionally her albumen was low 22 g/L which is low comparing to the normal values (35-55 g/L) due to ART. She had moreover high white blood cell 12.7 (4.5-11) owing to acetobacterbaumannii growth in urine (Pagana, Pagana, 2011). Discriminate This portion of the paper concerns about discriminating on the important caring part of the patient through the physical assessment observation. On observation, it was found out that she had extremely low saturation owing to gathering of secretion in trachea. Also her poor skin turgor and decreased urine due to dehydration and positive intake output ratio because of ARF (Ashley Stamp, 2014). Relate This portion will put together all the collected information and comprehend the link between them. My patient had high blood pressure due to ARF (acute renal failure) due to which the kidney fails to filter the waste product. Additionally, her sacral pressure ulcer resulted from long period of hospitalization, quadriplegia and inadequate turning hours (Ellis Price, 2015). She had also suffered from tightness and while breathing because of secretion in trachea which required to be suctioned via tracheostomy. She also had low hemoglobin which led her to develop anemia. Another fact is Hypoalbumenia that might had caused edema via decreased oncotic pressure that refers to the nephritic syndrome consisted of proteinuria. She also suffered from excessive low sodium level as well as high urea and creatinime because of kidneys failure to remove the waste products from her body. Infer This section of clinical reasoning cycle includes my thoughts on the patients information and cues which were needed to arrive at a conclusion. These recollections are needed for making reflections upon her conditions. Her difficulty in breathing proves that she never had regular suctioning therefore interrupting the breathing process during her treatment. Predict In this section, I have analyzed and predicted the possible outcomes of the patient. The result of inadequate or no suctioning in case of Ms. S via tracheostomy led to extreme discomfiture within her and a decreased level of saturation. Furthermore, she developed a new pressure ulcer on her back and consequently deteriorated for the absence of medical attention or care like application of cream or spray on the affected regions. Additionally she was not made to position q2hr to help with her ulcer which had severed her conditions. Her NG (nasogastric tube) was also not made to check at regular intervals, which stopped her from consuming food and medication. This had naturally aggravated her conditions and delayed her process of wound healing (Curtis, 2013). This iwas aggravated more because the nurse needed to check her blood glucose to prevent hyperglycemia or hypoglycemia phases. Match In this portion I have tried to make a comparison of Ms. Ss case with that of my previous patients with acute kidney failure conditions. It is important here to mention that when I was in BN3 for the purpose of conducting medical surgical course I had clinical rotation in medical ward situated in almafraq. I was responsible for supervising a patient who was suffering from acute renal failure and slowly began to worsen. Additionally in case of Mr. S, her history of stroke coupled with quadriplegia resulted in steady deterioration more so because of her immobility. When I compared this with my previous patient who was under me, the person had ischemic stroke therefore chances of degeneration was lesser due to the stability of condition. Identify the problem/issue This portion of the paper dealt with the problem that the patient suffered from as well as examining the patient to make a proper and definite diagnosis. Primarily, ineffective airway clearance pertaining to the collection of secretion quadriplegia as seen in Mr. S on on 02 flow 6 L /min Trachea mask Fio at 35% , and as well the presence of cough. In my second diagnosis I have found non-functioning or impaired physical mobility (quadriplegia and stroke) concerning to disease process and inability to move within the surrounding physical environment, limited range of motion (ROM) and non-functioning coordination. In my third diagnosis I have found during my diagnosis fluid and electrolyte imbalance: more than the body requirement related to less fluid output increased by weight and development of petting edema in her during the period of hospitalization. Lastly, in the fourth part of my diagnosis I had diagnosed that: Risk for fall related to patient disease process. Additionally, I fo und that my preceptor had the misconception about ageism and ignorance of the needed care that elderly people require, including cleanliness and hygiene. Another important factor was to check the patients body while over-turning. One thing can be concluded that the reliability on patient and her family is required when they understand the need for suction. It is required for the preceptor to behave judiciously without being over-confident or judgmental which can be severely harmful for the patient.