Intriguing Scenarios Of Clinical Reasoning

Discuss about the Intriguing Scenarios of Clinical Reasoning.

Clinically, Mrs. Amari’s case presents one of the most intriguing scenarios of clinical reasoning. The case exposes faulty approaches by the medical staff in the diagnoses and treatment of the patient. In diagnosing this case, there is the need to collect facts from the patient situation; this includes her age, her social life, her lifestyle, and medical conditions. The nurses also ought to have collected cues from Mrs. Amari’s conditions, process the information, and analyze it,  before identifying the problems, and taking actions. Arguably, the nurses in charge did not do comprehensive evaluation of available options when dealing with Mrs. Amari’s case.  

Patient Situation

Cognitive perception of nurses is a key determinant of patient outcome and the foundation to correct treatment. Usually, nurses allow their judgment to be clouded by attitudes and hasty conclusions creating a deficiency in critical thinking that results in failure to notice vital warning signs in patients’ (Ericsson, Whyte & Ward, (2007). Mrs. Amari, a 59-year-old woman, was admitted to a hospital and diagnosed with a minor stroke on physical assessment which later gained the status of the Transient Ischemic Attack (TIA) since a subsequent check-up told of the disappearance of the symptoms. A TAI is not a heart attack nor can it be defined as a cerebral vascular accident; a TAI is caused by an unusual disruption of the blood supply to the brain due to presence of a blood clot, plaque or damaged arteries as a result of hypertension.

Don't use plagiarized sources. Get Your Custom Essay on
Intriguing Scenarios Of Clinical Reasoning
Just from $13/Page
Order Essay
Collecting Cues

A TIA is a form of stroke that is minor and subsides within a period of 24 hours a cerebral vascular accident, however, lasts longer and is riskier. When blood supply to the brain is disrupted, the blood components like oxygen and nutrients which are essential for the functioning of the brain are inhibited from reaching the brain. The brain cells, therefore, start to die, terminating the transmission of certain nerve impulses to parts of the body. This termination leads to paralysis and numbness of the affected areas which are usually on either the right or left part of the body depending on which part of the brain is affected by the blood disruption. Further blockage of the arteries serving the brain with blood may cause adverse effects or permanent stroke NSW Health (2006).

For the TAI the blood supply usually resumes, and the symptoms subside. Mrs. Amari being an elderly woman inflicted an ascertainment bias among the nurses who immediately associated her symptoms with stroke since the condition gets common with advancing age; this prevented them from realizing the bigger picture. According to Darmani (2010), ascertainment bias is said to be the lack of clinical reasoning by nurses due to assumptions based on age, stigma and stereotyping. Due to the prior ascertainment, there were no background checks on the patient’s history of medical assessment or analysis of previous patient charts. Instead, the nurses went ahead to gather new information basing their evaluation on the detection of signs associated with stroke. Their diagnosis followed the procedure of the stroke diagnosis that involves blood tests, computed tomography, MRI but failed to carry out a CAT scan which presents any bleeding in the brain. Coincidentally some of the signs and symptoms of a stroke were present and so once more there was a confirmation bias that led to a tilted processing and interpretation of patient information.

According to Warren (2011), some of the signs and symptoms of a typical TAI that a patient should possess include: having a weak, numb and paralyzed experience of the face, limbs or arms, delayed speech, and poor comprehensive ability, dizziness, blurred vision, headache and difficulty in swallowing. Out of all these symptoms, the conclusion was that she was having a minor stroke due to the numbness of the right arm and the slurring speech. What the nurses failed to see was that there were other symptoms indicating signs of a more complicated complication which may have led to the damage of the arteries in the brain causing the minor stroke signs. All the other symptoms were overlooked. According to Lasater (2007), this is a conformational bias and is described as when a nurse looks for evidence to support prior conclusions without considering the opposing signs. (Ericsson, Whyte, and Ward, 2007) state the slurred speech and paralysis as the main misguiding factors in the diagnosis of a patient that may lead to the conclusion that the patient is suffering from a stroke which may not be the case.

Process Information

In the current situation, it is clear that Mrs. Mari was a victim of biased clinical reasoning that led to wrong treatment and thus the worsened condition. The physical assessment shows she has progressed from stage one hypertension to stage two. Her respiratory rates are normal, and her GCS shows signs of moderate brain damage where she can only open her eyes to voices. She can respond to pain but has a clear vision, the blood glucose levels, and the temperature is stable and normal, it is essential to acquire the patient background knowledge on the history of assessments and health records (Malinina, Zema, Sander & Serebruany, 2007). From the previous evaluation and which was correct, there is the presence of a carotid bruit which indicates signs of a narrowed artery. According to Cox (2008), a carotid bruit is a sound occurring in the neck area which is detected by a stethoscope and which indicates signs of narrow artery lumen. Then the next step will be the new diagnosis, the first alarming sign is hypertension, and so we need to perform ambulatory blood pressure check accompanied by a lipid test to determine if she has high cholesterol levels. There after we need to repeat the MRI and CT scan this time being objective and being on the lookout for any danger signs in the brain.

From the findings, Mrs. Amari is suffering from the condition of high blood pressure which has originated from a condition known as hypercholesterolemia which is the presence of too much cholesterol build up (Tarner, 2006).This is a cause for alarm as the cholesterol build up exists in the arteries, and this has led to the narrowing down of the arteries transporting the blood from the heart. As a result, the cholesterol on the walls of the arteries have led to the hardening of the walls, and this is causing the heart to pump harder which may occur at her age cause heart failure or a heart attack (Groopman, 2008). According to Qureshi, Clarke & Rudd (2012), the heart pumps harder and as the arteries narrow down the blood pressure goes up, and this is causing plaques in the brain that may lead to frequent TAIs due to disruption of blood supply, this explains the numbness and slurred speech. If the plaques continue to add, there may occur permanent brain damage or permanent stroke (Tarner, 2006).


Medication; therefore, needs to start right away to reduce the cholesterol so as to reduce the risks associated with hypertension and cholesterol levels. To improve her condition, Mrs. Amari needs to improve her lifestyle regarding eating a balanced diet and exercising more, reducing her salt intake and living a stress-free life, Apart from that she will receive drugs to lower her blood pressure, reduce her cholesterol and eliminate the blood clots and plaques. However, it will be impossible to fully remove all the cholesterol in the arteries and also regain the shape of the lumens. The measures if implemented correctly will reduce the risk factors. The brain functioning of Mrs. Mari was altered, and this was assessed by the CAT scan and the MRI performed. Due to the change in the neurology of Mrs. Amari, it is important that she emphasizes on dietary change and management of stress. Her condition creates a risk of brain damage, and so it is necessary also to supplement her with prescriptions of supplements and vitamins to boost her brain activity.


Cox, Bev,B.Sc, R.G.N. 2008, “Stroke and transient ischaemic attack”, Practice Nurse,vol. 36, no. 1, pp. 43-48.

Darmani, N.A. 2010. “Cannabinoid-Induced Hyperemesis: A Conundrum – From Clinical  Recognition to Basic Science Mechanisms.” Pharmaceuticals, vol.3. no.7.pp 2163-2177.

Ericsson, K., Whyte, A. and Ward. J. 2007. “Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach.”  Advances in Nursing Science. vol 30. no.1.pp 58-71.

Groopman, J. (2008). How Doctors Think. Boston: Houghton Mifflin.

Lasater, K. 2007. High-fidelity simulation and the development of clinical judgment: students’ experiences. Journal of Nursing Education. 6. pp 269-276.

Malinina, D., Zema, C., Sander, S. & Serebruany, V. 2007, “Cost-effectiveness of antiplatelet therapy for secondary stroke prevention”, Expert Review of Pharmacoeconomics &      Outcomes Research, vol. 7, no. 4, pp. 357-63.

NSW Health, 2006. Patient Safety and Clinical Quality Program: Third report on incident management in the NSW Public Health System 2005-2006. NSW Department of Health.           Sydney.

Qureshi, S., Clarke, A. & Rudd, A. 2012, “Transient ischaemic attack”, GP, , pp. 27-29.

Tanner, C. 2006. “Thinking like a nurse: A research-based model of clinical judgment in nursing.” Journal of Nursing Education, vol.45. no.6.pp 204-211

Warren, Ed,F.R.C.G.P., G.P. 2011, “A QOF perspective on… stroke and transient ischaemic attack”, Practice Nurse, vol. 41, no. 1, pp. 19-22.

What Will You Get?

We provide professional writing services to help you score straight A’s by submitting custom written assignments that mirror your guidelines.

Premium Quality

Get result-oriented writing and never worry about grades anymore. We follow the highest quality standards to make sure that you get perfect assignments.

Experienced Writers

Our writers have experience in dealing with papers of every educational level. You can surely rely on the expertise of our qualified professionals.

On-Time Delivery

Your deadline is our threshold for success and we take it very seriously. We make sure you receive your papers before your predefined time.

24/7 Customer Support

Someone from our customer support team is always here to respond to your questions. So, hit us up if you have got any ambiguity or concern.

Complete Confidentiality

Sit back and relax while we help you out with writing your papers. We have an ultimate policy for keeping your personal and order-related details a secret.

Authentic Sources

We assure you that your document will be thoroughly checked for plagiarism and grammatical errors as we use highly authentic and licit sources.

Moneyback Guarantee

Still reluctant about placing an order? Our 100% Moneyback Guarantee backs you up on rare occasions where you aren’t satisfied with the writing.

Order Tracking

You don’t have to wait for an update for hours; you can track the progress of your order any time you want. We share the status after each step.


Areas of Expertise

Although you can leverage our expertise for any writing task, we have a knack for creating flawless papers for the following document types.

Areas of Expertise

Although you can leverage our expertise for any writing task, we have a knack for creating flawless papers for the following document types.


Trusted Partner of 9650+ Students for Writing

From brainstorming your paper's outline to perfecting its grammar, we perform every step carefully to make your paper worthy of A grade.

Preferred Writer

Hire your preferred writer anytime. Simply specify if you want your preferred expert to write your paper and we’ll make that happen.

Grammar Check Report

Get an elaborate and authentic grammar check report with your work to have the grammar goodness sealed in your document.

One Page Summary

You can purchase this feature if you want our writers to sum up your paper in the form of a concise and well-articulated summary.

Plagiarism Report

You don’t have to worry about plagiarism anymore. Get a plagiarism report to certify the uniqueness of your work.

Free Features $66FREE

  • Most Qualified Writer $10FREE
  • Plagiarism Scan Report $10FREE
  • Unlimited Revisions $08FREE
  • Paper Formatting $05FREE
  • Cover Page $05FREE
  • Referencing & Bibliography $10FREE
  • Dedicated User Area $08FREE
  • 24/7 Order Tracking $05FREE
  • Periodic Email Alerts $05FREE

Our Services

Join us for the best experience while seeking writing assistance in your college life. A good grade is all you need to boost up your academic excellence and we are all about it.

  • On-time Delivery
  • 24/7 Order Tracking
  • Access to Authentic Sources
Academic Writing

We create perfect papers according to the guidelines.

Professional Editing

We seamlessly edit out errors from your papers.

Thorough Proofreading

We thoroughly read your final draft to identify errors.


Delegate Your Challenging Writing Tasks to Experienced Professionals

Work with ultimate peace of mind because we ensure that your academic work is our responsibility and your grades are a top concern for us!

Check Out Our Sample Work

Dedication. Quality. Commitment. Punctuality

All samples
Essay (any type)
Essay (any type)
The Value of a Nursing Degree
Undergrad. (yrs 3-4)
View this sample

It May Not Be Much, but It’s Honest Work!

Here is what we have achieved so far. These numbers are evidence that we go the extra mile to make your college journey successful.


Happy Clients


Words Written This Week


Ongoing Orders


Customer Satisfaction Rate

Process as Fine as Brewed Coffee

We have the most intuitive and minimalistic process so that you can easily place an order. Just follow a few steps to unlock success.

See How We Helped 9000+ Students Achieve Success


We Analyze Your Problem and Offer Customized Writing

We understand your guidelines first before delivering any writing service. You can discuss your writing needs and we will have them evaluated by our dedicated team.

  • Clear elicitation of your requirements.
  • Customized writing as per your needs.

We Mirror Your Guidelines to Deliver Quality Services

We write your papers in a standardized way. We complete your work in such a way that it turns out to be a perfect description of your guidelines.

  • Proactive analysis of your writing.
  • Active communication to understand requirements.

We Handle Your Writing Tasks to Ensure Excellent Grades

We promise you excellent grades and academic excellence that you always longed for. Our writers stay in touch with you via email.

  • Thorough research and analysis for every order.
  • Deliverance of reliable writing service to improve your grades.
Place an Order Start Chat Now

Order your essay today and save 30% with the discount code Happy