Cognition in Clinical Reasoning
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Cognition in Clinical Reasoning
Introduction
Clinical reasoning in patient care involves specific analytical activities undertaken by medical practitioners to diagnose or determine the conditions of a patient and decipher appropriate treatment or care management protocols. Usually, the practitioners rely on individual observation based on their physical examination and verbal engagement with the patients they serve. Additional sources of information which inform that process include available patient history from previous reviews by their colleagues s well as results obtained from related diagnostic tests. Unfortunately, accuracy in diagnosis and treatment recommendations is not guaranteed given that between 5% to 14% of medical cases in the country are often misdiagnosed or mistreated. The reason for occurrences of such errors are often due to intuitive reactions from practitioners in instances of extreme pressure of time, laxity or complications. Cognition however, provides the medical fraternity with an alternative logic-based approach to clinical reasoning. The case scenario presented herein seeks to build on nurse practitioner cognition in clinical reasoning to establish accuracy in the face of the aforementioned challenges.
Description Background
The scenario herein establishes immense pressure on the practitioner, owing to the popularity of the hospital in which they work due to its ranking as the fifth most preferred trauma center in a city of 3.7 million people. The implication of that statement is that the intern faces a 12-hour shift of pressure to operate efficiently and without mistake, given that the night of the case is their first independent day on the job. The patient on the other hand is a twenty-five-year-old male who is the victim of an accident and has been admitted to the ER. A nicotine addict, Ryan the patient, has suffered a fractured femur and ribs and multiple abrasions to his body. He is conscious and talks which means that he isn’t in any immediate danger or at risk of death or permanent damage from the accident. Also, he has been examined by a physician who has left various instructions on how to handle the patient. The pressure of time therefore, has been slightly reduced with guidelines given by the instructions on the way forward. Based on the available information, the intern is perfectly poised to cognitively develop a care plan with consideration to all prevailing factors and those that may occur later.
Client Care Activities for Trauma Patients
Physical trauma from accident injuries often cause immeasurable pain to patients and for that reason, pain management constitutes a focal point of patient care for accident victims. In addition to pain, trauma patients also loose a lot of blood, which affects other organs of the body and the manner of their functionality. Treating trauma patients therefore, entails observation of certain matrices of measuring changes in the body’s blood composition. Such observational aspects include heart rate, blood pressure, oxygen stat and blood gases. Abnormal results for tests on any of these attributes is likely indicative of physiological distress on certain body parts and therefore, is a call to action for the caregiver. In trauma incidences, nurse practitioners are also required to guarantee patient safety by preventing an aggravation of the injuries or protection from associated infections. Various activities are consequently undertaken by the caregiver to ensure optimal comfort of the patient and speed up their recovery processes while protecting them from infections to which the injury makes them vulnerable (Gruppen, 2017).
Prioritizing Care Activities
For Ryan, the intern has a responsibility to manage the pain by intermittently dosing the patient with painkillers ate appropriate doses depending on the level of the pain. On top of that, he/she needs to regularly monitor the vitals of the patient to determine any changes to heart rates, blood pressure and temperature, all of which are indicators of stress in the body’s physiological composition. Patient-centrism in contemporary caregiving also calls for practitioner attention on the patient, providing treatment in the most convenient, comfortable and effective way for the patient. The intern in this scenario therefore, has to care for the patient’s individual demands that do not interfere wit the treatment process. the requirement of family, satisfaction of cravings and general improvement of patient’s condiment to improve their treatment experience. Despite the importance of all these activities, there are prioritizations for consideration and as such, establishing a sequential order of carrying out those activities is important for patient treatment (Norman et al., 2017).
First, the intern has to administer 2mmg Morphine IV now for breathtaking pain. Given the patient’s pain level that’s recorded at 8 out of 10, the patient could be in excruciating pain which is torturing. To reduce it to manageable levels that is the goal of 5, administration of a dose of morphine could stabilize the pain. Secondly, apply anti-embolism stockings bilaterally. The importance of that action lies in the role of anti-embolism stocking in minimizing blood pooling and preventing clots on the blood vessels around the legs. To manage efficient patient respiration, the third best action entails decreasing the O2to 2L Nasal Cannula and continue SPO2 monitoring. The reduction manages shortness of breath and returns the rate of oxygen flow per liter to 2, which is the optimal level accepted for an adult human being. An increase in the Nasal Cannula composition indicates a shortness of breath which strains the functionality of the lungs, heart and brain. The fourth action involves the input of consult for pain management into the electronic order system. That way, any administration of pain medication is highly regulated and undertaken based on necessity to avoid the possibility of overdosing the patient.
Eliminating Incorrect Activities
While tetanus immunizations for open wounds is a medical necessity, urgency doesn’t define the action and therefore, it could be scheduled for later. However, that does not mean that it is eliminated from the list of recommended activities, it implies that immunization comes fifth and therefore, doesn’t fit the initial processes that have been discussed above. Calling the physician for a nicotine patch for the patient however, is incorrect and therefore, ought to be eliminated from the list. Reporting on the reduced amber urine is also incorrect given that the patient’s condition has no relationship with kidney malfunction nor does it have any factor for risk of the same. The impact of nicotine consumption for Ryan at this point, is guaranteed to cause more harm than good and therefore, fetching some for the patient is incorrect. As a stimulating drug, its side effects include increased heart rates and blood pressure and a reduction of oxygen concentration in the blood, interfering with the optimum readings required for vital organs at this point (Johnsen et al., 2016).
Conclusion
Cognitive analysis is important for clinical reasoning to eliminate the errors of intuitive thinking associated with diagnostic and treatment protocols for patients. Based on the scenario of interest today, any medical practitioner would appreciate the need for taking reflective time on any case and analytically viewing the facts of the patient’s condition vis-à-vis the medial knowledge that one possesses. Successfully matching said facts with the appropriate knowledge is a means of cutting down on physician-error given that it is mainly a manifestation of the absence of integration between the two, rather than a case of incompetence.
References
Gruppen, L. D. (2017). Clinical reasoning: defining it, teaching it, assessing it, studying it. Western Journal of Emergency Medicine, 18(1), 4.
Johnsen, H. M., Slettebø, Å., & Fossum, M. (2016). Registered nurses’ clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis. Nurse education today, 40, 95-100.
Norman, G. R., Monteiro, S. D., Sherbino, J., Ilgen, J. S., Schmidt, H. G., & Mamede, S. (2017). The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Academic Medicine, 92(1), 23-30.