Question

Clinical Reasoning Report

This assessment task aims to develop your ability to apply the first three phases of the clinical reasoning process, at an introductory level, to the patient scenario below.

Patient Scenario - Jessie Lin

You are a student nurse working with a school nurse (registered nurse) in a secondary school. You and your mentor are supervising a bubble soccer match this afternoon (26^th March) which commenced at 1400 hrs. The match goes for 40 minutes with a 5 minute break in between the two halves. It is a hot and sunny day, the air temperature is 32 ^oC and the humidity is 45%.

After the match, your mentor asks you to perform a range of health assessments to make sure the students are fit to go home.

Jessie Lin is 16 years old and in Year 11.

It is now 1450 hours. You assess Jessie's vital signs and record the following results:

• Temperature (tympanic) 38.5 ^oC
• Pulse rate 140 beats/min
• Respiratory rate (RR) 29 breaths/min
• Blood pressure (BP) 130/70 mmHg

Jessie has flushed skin and her t-shirt is soaked. Her past medical history has not yet been documented in the school record as she is a new student and only enrolled in the school last week after moving from another state. She informs you that her mother is waiting for her in the car park, but she feels very hot and that her heart feels like it is beating very fast. She asks you for a bottle of cold water and a chair.

Jessie's previous observation records (on a clinical chart) are:

Date	BP	Pulse	RR	Temp
23rd March 2020	110/60	70	14	36.8
24th March 2020	112/60	74	12	36.6

What you need to do in your clinical reasoning report

• Provide a concise summary of Jessie's situation as an introduction to your report (approximately 50 words) - what pertinent information would someone reading your report need to know about who Jessie is and the context of this scenario?
• List the objective and subjective data (cues) that you have gathered from reviewing the information provided above (approx. 50 words)
• Analyse and interpret the identified cues and explain the assessment findings in relation to Jessie's context (approx. 450 words)
  
  To do this successfully, you should:
  • categorise the cues and identify what elements are normal or abnormal, and
  • compare the current situation and vital signs with previous health information known about Jessie, and
  • recall and apply knowledge of anatomy and principles of physiology (including concepts of homeostasis and the body's responses to physical activity) to explain her vital signs and other cues.
• Then propose what further cues you want to collect and explain why these are relevant and important to the situation (approx. 450 words)
  
  To do this successfully, you will need to form a logical opinion about what the further cues should be, when you would undertake the assessments to collect these cues (e.g. after some immediate actions for Jessie) and why these cues should be assessed. Relate your justification to Jessie's situation AND to the principles of anatomy and normal physiology (focusing on homeostasis).

Assessment criteria and marking rubric. Your clinical reasoning report will be assessed against the following criteria:

1. Apply a beginner's level of clinical reasoning to assess and interpret health information in relation to the patient's context.
2. Question 2. Apply knowledge of anatomy and principles of physiology to explain assessment findings in relation to the patient's context.  (including concepts of homeostasis and the body's responses to physical activity) to explain her vital signs and other cues.
3. Question 3. Apply a beginner's level of clinical reasoning to propose and justify further cues that are to be collected in relation to the patient's context

(Though these questions has been answered, please help me with quest 2 & 3 in Assessment criteria section . I basically joined this forum for these questions, as i have already done the rest. Thank you in advance).

Answer 1

Answer 2

Pulserate and Respiratory rate is abnormal..
Pulse rate is higher than 100 bpm
Respiratory
rate is more than 20 per min... So these are abnormal.
As above it has been described that she was playing bubble soccer for 40minutes each half with interval
of 5mins...

Core temperature decreasd

Sweating increased

Senstivity increased

Skin temperature reduced

Skin blood flow increase

Rate of blood flow increase

Thirst increase

Electrolyte loss decrease.

Plasma water level deCrease

Cardiovascular stability Improved
Heart rate – lowered
Stroke volume – increased
Cardiac output – better sustained
Blood pressure – better defended
Rate – increase
Myocardial compliance – increased
Myocardial efficiency – increased
Cardioprotection – improved
Skeletal muscle metabolism Improved
Muscle glycogen – spared
Lactate threshold – increased
Muscle and plasma lactate – lowered
Muscle force production – increase
Whole-body metabolic rate Lowered
thermal tolerance Increased
Heat shock proteins expression – increase

Answer 3
As playing conditions are very hot and humid and playing in afternoon...
It is physiological to have Flushed skin because of playing in hot humid temprature Of body increases this cause blood to flow toward skin and cause sweating which decrease temperature so skin of girl flushed,which is apparently more seen in white girl and also body maintain homeostasis in lots of other ways, such as by controlling your blood pressure.