Priority Hypothesis to Guide Clinical Reasoning

Clinical reasoning refers to an individual ability to integrate and apply knowledge, weigh information provided, think critically upon information presentation, and reflect the processes used to arrive at clinical diagnosis (Gruppen, 2017). According to the case scenario, Ruth showed cognitive and physical deprivation, which needs to be addressed. When she was asked if she knows why she is at the hospital, she responds by asking where her husband is because he is usually home by that time.

Empirical inquiry can be made based on information that can be verified. In the case scenario, Ruth is an 82-year-old woman who presents with labored breathing and confusion. She has been taking two packs of cigarettes every day for 58 years, and she has type 1 diabetes. Early in the week, she has nausea and vomiting, and while at the hospital, she vomited fresh blood. According to the assessment data, she has 84% oxygen saturation, and she has a right foot wound. Therefore, based on the provided information, the hypothesis is that the patient is suffering from chronic bronchitis as evidenced by reduced oxygen saturation and fresh blood vomiting.

Smoking is a risk factor for the development of chronic bronchitis. Bronchitis causes the airway to be inflamed, leading to rupturing of small blood capillaries, which caused vomiting of fresh blood. The presentation of labored breathing is due to decreased oxygen saturation (Kesimer et al., 2017). The desired outcome is increasing oxygen saturation to high levels and be maintained at 95%. Oxygen saturation should be monitored to determine its effectiveness in the patient. Decreased oxygen supply to the brain can cause mental confusion

Ethical inquiry is made based on the principles and morals of patient well-being. In the case scenario, Ruth smells cigarettes because she has been smoking for 58 years. The mode of patient data inquiry can violate her rights because she is smelling and she might even smoke in the emergency room, and the nurse might harshly tell her to stop smoking. Ethical dilemmas that can arise during this situation are financial instability and access to the best medical services (Sprod, 2020). According to the patient chart, she only has Medicaid, which shows that the patient has financial barriers, hence she might have problems paying for medical services. The ethical obligations and dilemmas of the healthcare professions can be relieved through working with a social worker to find the best ways of covering health services.

Socio-political inquiry considers political and social factors to formulate a clinical diagnosis. In this case scenario, Ruth came to the emergency room with only Medicaid as the only insurance cover. This shows that she has insufficient money available even while at home. Ruth has been experiencing the social impact that she is living alone at home since her husband has been admitted to a long-term dementia center. This shows that she has a reduced source of income which makes her not meet the essential services.

The nurse can get this information from her through the appearance and the conversations of Ruth. Based on the above information, the formulated hypothesis includes poor income as evidenced by Medicaid insurance cover only. Medicaid is a program that is supported by the government, which gathers for the poor individuals (Anderson et al., 2018). Ruth could benefit from government support programs that help the poor. It is significant to talk to the patient, how she is doing after the initiation of treatment and monitoring.

Aesthetic inquiry considers the most relevant information and interprets it to make a clinical judgment. The neighbor who brought Ruth to the hospital stated that she has not been eating well, vomiting blood, and feeling dizzy. Based on the above information, the most appropriate hypothesis that can be formulated is the provision of medical interventions that will improve the patient’s well-being. According to the information provided in the case scenario, the patient is suffering from chronic bronchitis, as evidence by blood vomiting, high blood pressure, labored breathing, history of smoking, and development of wound on the right foot due to peripheral neuropathy (Gulla, 2018) Interventions given include administering bronchodilators to alleviate the symptoms and increase oxygen supply, leading to increased oxygen saturation.

The outcomes of the hypotheses will be evaluated to determine their effectiveness. The nurse would evaluate oxygen and bronchodilator administration if it improved the patient respiratory status by monitoring the inflammation and oxygen saturation through a pulse oximeter and bronchoscope. The healthcare provider will assess blood glucose levels after the administration of insulin. The effectiveness of insulin will be determined through the use of cognitive status and blood glucose.

Peripheral neuropathy will be evaluated through the assessment of the lower leg sensation. The evaluation of the interventions of the wound to determine if they were effective signs of healing or infection will be seen at the sight of the wound. Modification of the plan of care is paramount whenever there are any signs of infection at the wound. Monitor and take all the vital signs to ensure that any deviation that will not lead to achieving the desired goals is determined early. The patient’s appearance shows that she has a self-care deficit, therefore a social worker should follow up to address the socio-economic needs of the patient.


Anderson, M. L., Riker, T., Gagne, K., Hakulin, S., Higgins, T., Meehan, J., & Wolf Craig, K. S. (2018). Deaf qualitative health research: Leveraging technology to conduct linguistically and sociopolitically appropriate methods of inquiry. Qualitative Health Research, 28(11), 1813-1824. Web.

Gruppen, L. D. (2017). Clinical reasoning: defining it, teaching it, assessing it, and studying it. Western Journal of Emergency Medicine, 18(1), 4-6. Web.

Gulla, A. N. (2018). Aesthetic inquiry: Teaching under the influence of Maxine Greene. High School Journal, 101(2), 108-115. Web.

Kesimer, M., Ford, A. A., Ceppe, A., Radicioni, G., Cao, R., Davis, C. W., & Boucher, R. C. (2017). Airway mucin concentration as a marker of chronic bronchitis. New England Journal of Medicine, 377(10), 911-922. Web.

Sprod, T. (2020). The direction in a community of ethical inquiry. Journal of Philosophy in Schools, 7(2), 60-75. Web.

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