Reasoning Cycle

Scenario 1.
Mr. Brown is a 32-year-old male who has been suffering from Ulcerative Colitis for 10 years. Over the past
week he has been transfused with 4 units of whole blood for persistent bleeding from his large bowel. He has
been in a lot of pain requiring high doses of Codeine Phosphate 30 mg. He is taking 80 mg of Prednisolone
daily, 1000-2000 mg of Sulfasalazine 4 times a day and is not improving. He has lost 20k over the past few
weeks. He is married with 3 small children. His wife works in the health care system. He is a computer
specialist.
He presents with severe abdominal pain 9/10.
Bloody diarrhoea ++
T.38 P.128 & reg. BP100/60 R.32 O2 sats: 96% on room air.
Nausea & vomiting ++
Mr Brown is diagnosed with Fulminating Ulcerative Colitis & is taken to surgery for a total colectomy. His
surgery lasts 7 hours.
He returns to the ward & you are allocated as his primary nurse.
Mr Brown is screaming in pain for his wife.
LLQ sited Ileostomy, pink mucous membrane, long bag attached. Bloody drainage.
IV insitu: 6/24 Hartman’s
NGT insitu on free drainage
IDC insitu
T.38 P.120 & reg. R.26 BP.100/60 O2Sats. 98% on 8L O2 via face mask
Central abdominal suture line with dressing intact
Hb 9.0
ESR 40
Medications:
Hydrocortisione 100mg IV 4/24
Morphine 10mg IM 4/24
Maxalon 10mg IV 6/24
Vancomycin 500mg 6/24
Using the Clinical Reasoning Cycle:
 Consider the patient situation
 Collect the cues/information
 Process the information
 Formulate a care plan as instructed for 2 priority nursing diagnoses with 5 interventions with
rationales & the expected outcomes
6 days later, Mr. Brown’s pain is under control. His NGT has been removed & his ileostomy is starting to
work. He is having fluids as tolerated. IVT N/S 12/24.
 Formulate a care plan as instructed for 2 priority nursing diagnoses with 5 interventions with
rationales & the expected outcomes.
4 days later Mr Brown is going home. His weight is 65k & he is 182cm tall.
 Formulate a priority nursing diagnosis with 5 interventions with rationales & the expected outcome
relating to discharge management.