Case study

45 years old male who has shortness of breathing
Patient lying on his bed
Patient has been watching Tv all the morning 15 minutes ago shortness of breathing started and it`s getting worse he took Ventolin puffer but it does not relief the pain he can just say single words. His wife called the ambulance
Past medical history; asthma
Social history: he lives with his wife, drink only in the weekend.
Medication; Ventolin puffer
Allergies; non
When paramedic arrived:
HR= 120
PULSE= STRONG AND REGULAR
RHYTHM= SINUS
BP=120\80
BREATHING= SHORT AND SHALLOW
SKIN=PALE AND COOL
BGL=5.4
TEMPRTURE=37.1
Diagnosed;
Bronchospasm
• Treatments paramedic did in the ambulance
– oxygenation, adrenaline IM nebulised salbutamol and ipratropium post-adrenaline administration

1) Define intuitive and analytical (hypothetico-deductive) reasoning and discuss how you believe they relate to the diagnosis and clinical decisions made in your case?
• Describe how you think analytical (hypothetico-deductive) and intuitive reasoning may have influenced the diagnosis, the elimination of differential diagnoses and the way treatment (care) was provided
• Think about the idea of the Duel Process Theory!!
Support your discussion using literature.
(500 words – provide at least two (2) references to literature on intuitive & analytical reasoning)
(20 marks)

2) What influence would knowledge and clinical experience (scope of practice and education) have on the diagnostic process?
• Include reference to the different types of bias and how they influence the decision making process
• Consider how information is gathered, valued and incorporated in decision making.
• Choose the biases that are most relevant to your case.
Support your answers using literature and reference to the case.
(300 words – provide at least two (2) references to literature regrading bias in clinical reasoning)
(20 marks)

3) Current literature points to a debate surrounding the reliability and safety of intuitive clinical reasoning in comparison to analytical (hypothetico-deductive) reasoning. Discuss the benefits and limitations of both forms of reasoning in relation to your case.
Support your answers using literature and reference to the case.
(300 words – provide at least two (2) references to literature regarding the benefits and limitations of both forms of reasoning)
(20 marks)

4) Describe two (2) key factors which might have influenced the clinical decisions and diagnosis made in your case. Discuss briefly why and how these factors influenced the clinical reasoning in your case.
The following are suggested areas for consideration.
a) Level of knowledge and experience of the clinician
b) Patient presentation (clinical signs & symptoms)
c) Risk & Safety– Clinical Outcomes
d) Psychological / Social Factors
e) Environmental Factors
f) Operational & Logistical Factors (system factors)
Support why these factors ‘bound’ or constrain the decision making in your case with reference to literature
(300 words – provide at least two (2) references to literature regrading factors that influence clinical reasoning)
QUESTION 1
Define intuitive and analytical (hypothetico-deductive) reasoning and discuss how you believe they relate to the diagnosis and clinical decisions made in your case? • Describe how you think analytical (hypothetico-deductive) and intuitive reasoning may have influenced the diagnosis, the elimination of differential diagnoses and the way treatment (care) was provided. • Think about the idea of the Duel Process Theory!! Support your discussion using literature. (500 words – provide at least two (2) references to literature on intuitive & analytical reasoning) • Note: make sure in your response you describe both intuitive and analytical reasoning (their key feature and Include the idea of heuristics i.e. mental short cuts). • Link to how they were used to develop potential diagnoses and treatment pathways

QUESTION 2
What influence would knowledge and clinical experience (scope of practice and education) have on the diagnostic process? • Include reference to the different types of bias and how they influence the decision making process. • Consider how information is gathered, valued and incorporated in decision making. • Choose the biases that are most relevant to your case. Support your answers using literature and reference to the case. (300 words – provide at least two (2) references to literature regrading bias in clinical reasoning) • Note: make sure you consider in your answer the difference between novice to expert clinician and how they are defined and the way education and knowledge influences clinical reasoning. • Consider in your answer how the way we think (cognitive bias) affects clinical reasoning.

QUESTION 3
Current literature points to a debate surrounding the reliability and safety of intuitive clinical reasoning in comparison to analytical (hypothetico-deductive) reasoning. Discuss the benefits and limitations of both forms of reasoning in relation to your case. Support your answers using literature and reference to the case. (300 words – provide at least two (2) references to literature regarding the benefits and limitations of both forms of reasoning) • Note: Include reference to the reliability of intuitive and analytical reasoning and why there are limitations to both forms of reasoning.

QUESTION 4
Describe two (2) key factors which might have influenced the clinical decisions and diagnosis made in your case. Discuss briefly why and how these factors influenced the clinical reasoning in your case. The following are suggested areas for consideration. a) Level of knowledge and experience of the clinician b) Patient presentation (clinical signs & symptoms) c) Safety & Harm – Clinical Outcomes d) Psychological / Social Factors e) Environmental Factors f) Operational & Logistical Factors (system factors) Support why these factors ‘bound’ or constrain the decision making in your case with reference to literature (300 words – provide at least two (2) references to literature regrading factors that influence clinical reasoning)

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