Clincal reasoning vs critical thinking

[Grnbay]

0Hi,

I just started my nursing program a few weeks ago. During class, we had a discussion about clinical reasoning and critical thinking. I really thought they were the same. I have a hard time thinking of a scenario to pick out the two.

My example scenario: Your patient has a history of asthma. As you walk into the patient's room, you noticed her lips looked a bit blue. You administer oxygen and check her oxygen saturation.

So would my clinical reasoning be knowing patient's health history and critical thinking is administering oxygen?

If I am wrong, would anyone like to give me a few scenario to help explain it to me? Thank you

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[bgxyrnf, MSN, RN]

Critical thinking is a general term that describes the thought processes in most fields... observing a set of data and thinking about causes, correlations, and conclusions...

Clinical reasoning is critical thinking applied to a patient, their disease state, their response to their disease state, and the cause and effect of various actions that one might consider taking to enhance the patient's state of well-being.

Here's an example as I see it:

You hear an alarm coming from the patient's room... you walk in to find that the noninvasive blood pressure reads 70/40. Critical thinking would direct you to consider first whether that's a real BP... so the patient is mentating OK and laying on her side, with the BP cuff on the higher arm. So, you have her lie on her back, reposition the cuff, and perhaps change it out to a properly sized cuff then take it again. Now you get 77/45.

Now your clinical reasoning kicks in and you think about why she's there, what medicines she's received, what are her earlier BP readings, and even her baseline from other visits. You read through her chart and see that she takes metoprolol and lisinopril at home. You see that she was given these meds again despite the fact that she took them this morning. Well, you think, she probably could use some fluids. The you think about the swelling in her feet so you're mindful that additional fluid might be an issue for her. So, you call the doc and recommend some fluids... you suggest a 250 bolus because you're concerned about overloading her. Before you start the bolus, you listen to her lungs to get a baseline and then check on her frequently over the next 60 minutes to make sure that she's (a) responding to the fluids and (b) not starting to be short of breath or getting crackles in her lungs.