The Cycle of Clinical Reasoning and Its Role in Problem-Solving Process

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Clinical reasoning is an approach which plays a vital role in solving problems and that involves the collection of information from the patient and proper interpretation of that information; it is followed by taking appropriate actions, evaluation of the results and reflection on the process (Jones et al., 2010). There are various steps of clinical reasoning cycle which consist of consideration of the patient situation, a collection of clues, processing information, and identifying problems, establishing goals, taking actions and evaluating results and reflecting on the process (Hoffman et al., 2011).

Patient Situation: (Describe or list facts, context, objects or people): Mr Marcel is 70 years old retired man with the Type 2 Diabetes Mellitus and he had been experiencing more fatigue.

Collect cues/ information: Marcel is suffering from Type 2 diabetes, lab findings show that he is hyperglycemic and he is also obese with a BMI of 35.6. Patient has a history of hypertension and was a heavy smoker. Patient has been initially ordered the combination of Metformin and Glibenclamide. Marcel complained that he had experienced continued diarrhoea and continued hyperglycemic after been changes in lifestyle and medication. Therefore, health care added insulin (Lantus 10 units) for his treatment and continue on Metformin 50mg BD. Marcel had a sedentary lifestyle and has gained 14kg in 9 months. He also experienced decreased sensation around his (L) little toe. His body is not able to produce the required amount of insulin which affects the cell and tissue function; therefore, chronic hyperglycemia leads to ineffective tissue perfusion (American Diabetes Association, 2010). He has limited knowledge regarding the cause and effects of the Type 2 DM.

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Process information: He is experiencing more fatigue while getting to the toilet in the night; fatigue is the common complication of Diabetes. His BGl can be high especially for the people the Hyperglycemia. There are the chances of high BP as he has a history of Hypertension. A condition such as hypertension and diabetes can co-occur because they have almost identical risk factors, such as obesity, following an unhealthy diet, and living an inactive lifestyle (Martín-Timon et al, 2014). Diabetes lowers the capacity of blood vessels to expand. Due to diabetes there is change is the way the body manages insulin and it also increases the amount of fluid in the body. Therefore, the chances of hypertension increase with diabetes. He is experiencing decreased sensation around the foot, which is the potential risk of Peripheral neuropathy. Control on BGL is necessary by a balanced diet, exercise and medication.

Identify problem / issue: He is diabetic and has a history of hypertension; his condition is worsened because of his deficient knowledge regarding his condition. Additionally, he also complained about the fatigue, numbness on his L (FOOT) and diarrhoea due to the adverse effect of the medication.

Establish goals: Patient should be encouraged for the diet which is high in fibre, have low-fat content and lower the consumption of alcohol, sweets and meat products. (Salas-Salvado et al., 2011). Educate of the patient about the home glucose monitoring is also important. It is important for the patient to understand how his diabetic medication works and rotation of the injection site periodically. Regular appointments with the health care professional: Regular pathology of HBA1C, GP visits, podiatry review, eye test, blood test. The patient needs to be educated about his foot care (Mcinnes et al., 2011).

Take action: Patient can be referred to the Dietitian and Diabetic Educator for the review. Discuss with a patient how he could monitor his BGL and how he can identify his limits at home. Educate the client about the functions of all his medications and their side effects. Focus on the checking of expiry dates of medications and checking insulin for cloudiness. Follow guidelines for appropriate storage and preparing insulin. Highlight the importance of rotating sites because absorption of insulin is less in liphypertrophic tissues. Review the client’s usual circumstances that lead to glucose imbalance because there are various elements such as improper diet intake, infection, or other health conditions can also be responsible. Educate the patient about the daily inspection and washing of feet also the wearing of appropriate footwear is important to prevent further complications. Refer him to a Social worker to review.

Evaluation: Mr. Marcel started walking for 45 minutes every day and stopped smoking. It is necessary to evaluate the level of blood glucose and patient knowledge on the factors that lead to the unstable blood glucose level. Interview the patient for the knowledge related to diet, physical activity and also evaluate the patient’s knowledge for appropriate foot care. Evaluate tools such as blood glucose monitors, pathology. It may also need to accommodate the needs and limitations of individual patient and re-education may also be required. Maintain skin integrity and demonstrate appropriate foot care by inspecting feet. Verbalize the need for a more frequent eye examination.


To conclude, clinical reasoning cycle have a beneficial influence on patient outcomes and, nurses play an important role while caring patient by utilizing clinical reasoning cycle to identify health-related problems in order to limit health complications. Clinical reasoning skills need well-built persistence and energetic engagement in daily practice and, nurses must acquire the clinical reasoning skills to emerge as a reflective health care professional. Hence, in this case study, I have effectively used my ideal clinical reasoning skills to construct a suitable clinical decision to solve the patient’s problem.

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