Sample Case Study On Cues From The Patient Presentation
Answer – Case 1:
In this study, the clinical decision has been impacted from the intuitive / pattern reasoning because the doctor is only capable to observe the patient’s presentation and only tangible aspects of the illness are found i.e. HR, BP, RR, Temperature and BGL. The clinical expert is linking the patient’s current condition with his medical history and due to the lack of equipment at present, the clinical expert has indicated the basal crackles in lungs and no symptoms are identified for the heart problem. The clinical expert is not able to conduct the in-depth diagnosis of the current position of illness and thus, wants to move the patient to the closest hospital. The intuitive factors ranked in accordance with their importance are as follows:
The clinical expert has made the observations based on the visual and tangible presentation of the patient i.e. Flushed Skin and the tangible presentation have been made by observing the heart rate and blood pressure. The patient has ‘moist cough’ with has given the clinical expert with the idea of the patient being diagnosed with the basal crackles in lungs.
Matches with illness scripts
The clinical expert has matched the illness of the patient with his medical history in which the patient had diagnosed with diabetes mellitus type 2, heart failure and arthritis, therefore, in the current analysis, the clinical expert has only indicated the lungs basal crackles based on the past diagnosis reports, however, nothing has been diagnosed related to previous heart failure history due to the lack of detailed checkup.
The clinical expert has fore taken the shortcut with respect to the observation of patient’s moist cough and dyspnea which was encountered by patient while he was talking.
It has been recommended for the patient he should be provided with clinical care at home as the patient does not want to move and the patient should be re-checked in the follow up checkup and if no improvement is being found then the patient should be transferred to the closest hospital that is 50kms away. The patient should be informed with this strategic decision so that he can prepare himself for the up-coming results (Rajkomar and Dhaliwal 2011).
However, the second part of the case indicates that the patient has gone in the cardiac arrest, therefore, it is highly recommended that the patient should be moved to the nearest major hospital because major hospitals has the tendency to operate the sever patients and the can be provided with the immediate care as prescribed by Anazodo et al. (2014).
Answer – Case 3:
It has been prioritized that the patient should be provided with the alternative source of oxygen as the patient is not able to breathe properly on his own. The patient should be transferred to the nearest hospital due to his severe unidentifiable condition as prescribed by Beuzekom (2010).
The pulse rate, heart rate and eyes sensitivity of the patient will be observed immediately to know his present condition so that the current state should be shared with the hospital staff to better understand his condition.
The observations with respect to HR and PR will be made to consider the current state of the patient in order know the severity of the case.
It will be said to the parents that they should remain calm because this is the time that their panic and over reaction towards the current situation can worsen the case as prescribed by Ferreira et al, (2010).
Rajkomar A and Dhaliwal G (2011). “Improving diagnostic reasoning to improve patient safety." Perm J 15(3): 68-73. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200103/
Anazodo, A., Murthi, S., Frank, K., Hua, P., Hartsky, L., Imle, C., Stephens, C., Menaker, J., Miller, C., Dinardo, T., Pasley, J., & Mackensie, C. (2014) Assessing trauma care provider judgement in the prediction of need for life-saving interventions. Injury http://dx.doi.org/10.1016/j.injury.2014.10.063
Van Beuzekom, M., Boer, F., Akerboom, S. & Hudson, P. (2010) Patient safety: latent risk factors. British Journal of Anaesthesia, 105, 52-59.http://bja.oxfordjournals.org/content/105/1/52.full.pdf+html.
Ferreira, A. P. R. B., Ferreira, R. F., Rajgor, D., Shah, J., Menezes, A., & Pietrobon, R. (2010). "Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines". PloS one, 5(4), e10265. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010265