Free Essay: A Case of Mr. P, a 61-Year-Old Male Patient

The case involved Mr. P, a 61-year-old male patient, 62 kg weight who had been admitted for Transurethral resection of the prostate (TURP), and a prostate biopsy. The Patient needed immediate surgery for his conditions. The surgery procedures were a success, and the patient was transferred to the recovery room. Unfortunately, a few hours in his recovery room, the patient accidentally removed his IV cannulas, prompting an alarm that notified the anesthetist. Immediately the anesthetist was informed, and another IV cannula inserted as the patient need it for postoperative analgesia. After 10 minutes of observation, Mr. P's blood pressure had dropped significantly (hypotensive) 90/45 mmHg, his heartbeat at rest increased (tachycardia) 120 b/m, and fell short of breath which resulted into high breathe rate than normal (tachypnea)26 b/m. The patient also complained of feeling cold as his body temperature had reduced to (hypothermia) 35.9 C, 1.1 C below normal body temperature. The patient's Spo2 was at 93 %, and capillary refill > 3 Second. These complications made his skin color to look pale, and he eventually fainted.

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During the encounter, the two significant challenges causes identified after a thorough examination were; patient's fluid volume deficiency, which was thought to result from intraoperative fluid loss, and (postoperative) nothing by mouth status. The second challenge was Ineffective breathing patterns patient thought to have resulted from primary medical problems, increased work of breathing, and fatigue. These challenges were probably missed during the diagnosis since the patient's medical history did not provide much information. Besides, only vital tests were done before taking the patient to the surgery room, which provided a very narrow window to suspect any respiratory or fluid-based complications. The patient did not display any abnormal symptoms outside the Transurethral resection of the prostate (TURP) and a prostate biopsy.

These vulnerabilities were traced back to premature closure and unpacking principle clinical reasoning errors (Levett-Jones, 2018). Premature closure is a clinical reasoning error where a clinician tends to apply incomplete (thorough) reasoning, diagnosis before full verification, in-depth analysis of the situation, observations, and patient responses, which leads to an early conclusion to the decision-making process. The Unpacking principle, on the other hand, is a clinical reasoning error that involves failure to collect all relevant cues in establishing a differential diagnosis (Levett-Jones, 2018). As mentioned in the introduction, Mr. P's medical history did not provide much information outside his current diagnosis. He did not have any allergies, or respiratory, or cardiac-related issues. Besides, only vital tests were done before taking the patient to the surgery room because it was an emergency. This action provided a very narrow window to suspect any abnormal symptoms outside the Transurethral resection of the prostate (TURP) and a prostate biopsy.

Clinical errors are quite common in the emergency department (ED), with an estimated occurrence rate ranging from 1% to 13% of admitted patients (Croskerry, 2003). Despite the high prevalence rates, clinical errors are preventable. In diagnosis, errors are categorized into three principal categories; No-fault errors are mainly resulting from patient misleading or absent information. Systemic failures, which arise from the surroundings and workplace, predispose, and the third category is cognitive errors ranging from knowledge deficiency to cognitive disposition (Croskerry, 2003). Both unpacking principle reasoning errors and premature closure reasoning errors fall under cognitive clinical errors.

Unpacking Principle Reasoning Error

Considering the presented case, the patient was 60 years old and in the ED. While nurses are required to conduct a pre-analytical assessment detailing the patient's identity, signs and symptoms, and available medical history (WHO, 2005), incorrect information and errors made during this phase would have a massive effect on the preceding assessment phases. Several factors contributed to this reasoning error. The patient's age could have influenced the patient's cognitive ability (National Institute on Aging, 2017), and thus forgot to address one of the following signs, which play a significant role in the correct diagnosis for the patient. Chest issues, dizziness, fatigue, headaches, and difficulty in breathing are critical indicators of respiratory challenges and cardiac system complications (Amakali, 2015).

Secondly, the patient was in the ED, which limited communication. The case was so urgent that if a slight delay in carrying out the surgery would have resulted in heavy bleeding, which would then require the patient to undergo a blood transfusion (Mayo Clinic, 2017). In addition, the patient was at a very high risk of urinary retention, which leads to other complications, including kidney inflammation, infections, in the worse case failure (Mayo Clinic, 2017). With such possible risks ahead, the window to conduct a much-detailed diagnosis before the procedure was very narrow.

Premature Closure Reasoning Errors Fall

This error was primarily influenced by an unpacking principle reasoning error; that is, the medical team was hasty to take the patient to the emergency without in detail analyzing another possible diagnosis. The Patient's medical history was narrow and did not offer much information on the patient is another diagnosis. Limited or lack of information on the patient's medical history has been listed as one of the leading causes of cognitive errors, mainly contributing to the clinical information deficiency to make more practical and effective decisions (Croskerry, 2003). Besides, Transurethral resection of the prostate (TURP) and a prostate biopsy resulted in bleeding and loss of vital body fluids (Mayo Clinic, 2017). Proceeding with surgery further resulted in the loss of blood and could have been a possible explanation of why there was a drastic change in Mr. P's vital signs and his accidental removal of IV cannula from the discomfort after surgery (AHRQ, 2017).

Reflection and Process New Learning

The clinical encounter an unforgettable and fundamental experience, insight, and above an exposure that was not only informative but also challenged both my professional skills and cognitive skills. I learned valuable lessons regarding the critical management of the entire diagnosis of the recovery process. As a nurse, reasoning is a very fundamental practice in the profession, and any wrong decision could lead to fatal outcomes.

It was, however, unfortunate that during the encounter, while the goal was to save the patient's life, the reasoning and decisions made put his life at risk. I learn every very small detail plays a huge role in how the nurse or clinician will reason and the cause of actions they are likely to take. Nevertheless, I also learned that experience is such a valuable tool in nursing practice since different cases are interpreted differently. For instance, if the patient were a middle-aged man, the cause of reasoning would be different. Also, if Mr. P's medical history provided more information, the possibility of such an error would be minimal.

In that regard, therefore, I tend to be more alert, and cautious, and, most importantly, ensure I apply Premature closure is a clinical reasoning error where a clinician tends to apply thorough analysis after full diagnosis, observations, and patient responses before making a decision. I also intend to be collecting possible cues in every phase of diagnosis to establish any available differential diagnosis.

There is a great need to be prepared for such encounters in the future. And the best way to prepare is through education, practice, and consultation with more experienced experts within a particular field. Communication, education, and training also play a vital role in the overall preparedness.