student’s name: institutional affiliation · factors are the environment and brain chemistry. the...
TRANSCRIPT
Running head: UNFOLDING CLINICAL REASONING
1
Unfolding Clinical Reasoning
Student’s Name:
Institutional Affiliation:
UNFOLDING CLINICAL REASONING 2
Unfolding Clinical Reasoning.
The case study is about Jeremy brown, a thirty-year-old Caucasian male. Today he is
brought to the emergency department. His present problem and personal social history are
presented to help in clinical diagnosis. These two data are relevant since each has a clinical
significance.
Important Data From Present Problem
Clinical Significance
Jeremy Brown is a 30 –year old Caucasian
male.
He is involved in an altercation at work.
He threw a large piece of metal at a coworker
and began yelling.
He is agitated, displaying pressured speech,
and repeating phrases he hears from police
and others in the ED.
He reports having stopped taking risperidone
and citalopram because he believes his
medication is poisoned (Forneris, Neal,
Tiffany, Kuehn, Meyer, Blazovich &
Smerillo, 2015).
The significance of this data is to enable the
physician to undertake the right diagnosis.
It allows the patient to be sent to the right
doctor for an accurate diagnosis.
Relevant Data From Social History Clinical Significance
UNFOLDING CLINICAL REASONING 3
The patient was a bright student of law and
with sound mental reasoning.
He experienced the first episode of mental
illness and diagnosed with schizophrenia.
He recently broke with his girlfriend
Both of his sisters are lawyers and his father
as well, and he feels disappointed
He has no close friends.
His mental health has been good until the last
three months
He has been paranoid in the past three months
The patient experienced a dramatic increase
in symptoms when he dropped medication
(Shellenbarger & Robb, 2015).
Patient history data is essential information
for effective clinical decision making.
It helps understand the medication the patient
had been taking.
The history data based on the medication
history help the clinician undertake the
correct diagnosis.
It also helps in making a change in
medication decisions or adopts a new
treatment strategy to the patient (Forneris,
Neal, Tiffany, Kuehn, Meyer, Blazovich &
Smerillo, 2015).
Patient Care Begins
What vital sign data important to be interpreted by nurse for clinical significance?
Relevant vital sign data Clinical significance
BP: 130/84
P-Q-R-S-T pain assessment:
P: regular
O2 sat:98% room air
These vital signs offer critical information on the patient's
states of health.
They are essential to the diagnosis of other related diseases
like heart disease, cardiac arrest, among others
UNFOLDING CLINICAL REASONING 4
(Shellenbarger & Robb, 2015).
It helps to narrow down the diagnostic process.
What assessment data important to be interpreted by nurse for clinical significance?
Important Assessment
Data
Clinical Significance
Overall appearance ,
Respiration,
Cardiac,
Neurology assessment
The general appearance informs the nurse on whether the patient is
relaxed, violent, and which help undertake mental assessment.
Respiration, cardiac, and neuron assessment is relevant to nurse.
Patients with mental illness and hot-tempered can develop related
health problems in the mentioned areas of evaluation (Forneris,
Neal, Tiffany, Kuehn, Meyer, Blazovich & Smerillo, 2015). A
nurse must interpret the information with a lot of care.
Relevant Mental
Exam Data
Clinical Significance
Appearance
Thought process
Thought content
Insight
Judgment
Cognition
The clinical significance of various mental assessment area is to
provide the nurses with critical information that help in making the
right diagnosis and determining the most appropriate treatment
(Shellenbarger & Robb, 2015).
UNFOLDING CLINICAL REASONING 5
Interaction
Mood
Suicidal/Homicidal
Clinical Reasoning Starts
Primary problem that that the patient is likely representing
Based on the physical examination conducted on the patient, the primary problem is
schizophrenia's, a mental disorder caused by a combination of different factors. Some of these
factors are the environment and brain chemistry. The identified factors cause hallucinations and
disorganized thinking. They also cause delusions and other negative symptoms (Forneris, Neal,
Tiffany, Kuehn, Meyer, Blazovich & Smerillo, 2015).
Principle Causes of the Primary Problem.
The patient condition is caused by a group of heterogeneous disorders that are not well
known. The alteration of dopamine neurotransmission causes imbalances. The environmental
factors of work subject the patient to conditions that eventually bring out schizophrenia
(Forneris, Neal, Tiffany, Kuehn, Meyer, Blazovich & Smerillo, 2015). The patient is always
disappointed that her two sisters are lawyers and his father as well. He became easily agitated,
and trigger work relationship problem with others
UNFOLDING CLINICAL REASONING 6
Collaborative Care Nursing
Nursing Priorities That Will Guide the Treatment Care Plan
(1)Lorazepam 1mg, (2) Citalopram 20mg, (3) Haloperidol 5mg, (4) Risperidone 2mg, (5) Admit
to inpatient mental health unit
What Interventions to Induct Centered on the Significance?
Treatment
Interventions
Justification Anticipated result
Administering
Lorazepam
1mg for every
6 hours
Lorazepam will help in reducing
anxiety or agitation.
The patient expected to react
positively, become relaxed and
comforted.
Citalopram
20mg
It will help to treat depression, and
it’s the right antidepressant. It works
Patients improve energy levels and
feelings of their well-being.
UNFOLDING CLINICAL REASONING 7
to restore the balance of a natural
chemical in the brain
Haloperidol
5mg in every
four hours
It is useful in severe agitation. It is
effective in the treatment of
schizophrenia disorders to help
control motor movement.
It decreases the excitement in the
patient brain.
Risperidone
2mg PO BID
Help to treat bipolar disorder, control
agitation.
Help the patient to think clearly and
take part in everyday activity.
Admit to
inpatient
mental health
unit
Inpatient admission will help monitor
patient behavior. Have close
observation of patient actions.
Resuming reasonable condition after
the admission period.
Body System to Assess Thoroughly based on the Primary Concerns
The primary diagnosed problem was detected as schizophrenia; this condition affects the
nervous system, the endocrine system, as well as the neurological system. Schizophrenia is a
UNFOLDING CLINICAL REASONING 8
mental disorder; therefore, conducting a thorough assessment of the mentioned system is very
important (Shellenbarger & Robb, 2015).
Worst Possible/most likely Complication to Anticipate
The most likely complication to anticipate include social isolation, health and medical
problems, inability to work or attend school, and madness. Other complications include
aggressive behavior, legal and financial problems.
Nursing Assessment that will recognize the Problem first if it develops rapidly
Some of the nursing valuation to help identify complications is behavior monitoring. Also,
a study of the patient's cognitive action will allow a nurse to identify this complication early
enough. Close monitoring will help learn as soon enough when difficulty begins.
Nursing Interventions to Initiate when Complication Begins
As mentioned above, the worst complexity is the patient to become mad. In such a case,
admitting him for inpatient in a mental hospital would be the most appropriate nursing
intervention. At the mental hospital, the patient will be under the care of a psychiatrist to help
him in managing the conditions (Shellenbarger & Robb, 2015).
Psychosocial Needs that Patients and Families will Likely Need to be addressed
UNFOLDING CLINICAL REASONING 9
Having diagnosed patients with schizophrenia, it is essential to address his psychosocial
needs that of the family as well. Most of them are stress management and stigmatization.
Communicating and showing a lot of empathy will help significantly (Shellenbarger & Robb,
2015). Nursing can help address these needs by offering professional counseling to patients and
family members.
Evaluation: Six Hours Later
What clinical data are essential and should be considered clinically relevant?
Significant vital sign Clinical importance
Temperature:97.4
Pressure: 78 (regular)
Respiration: 16 regular
Blood pressure: 118/70
O2 sat: 99% room air
The information becomes critical to nurses as
it helps if the treatment plan is useful to the
patient
Relevant assessment data Clinical importance
Appearance These are fundamental areas to asses so as to
UNFOLDING CLINICAL REASONING 10
Motor behavior
Thought process
Perception
Judgment
Cognition
Interactions
evaluate the patient's response to the
treatment plan.
Has Condition better or not as anticipated to this Point
The patient condition has been enhanced to the expectation. It is only after six hours, and
assessment indicates a positive response.
Whether Nursing Care Needs Modification in any Way after Six Hours of
Evaluation
I don’t think at this point, and there is a need for modifying the care plan. However, after
24 hours, evaluation, it can be adjusted accordingly.
SBAR report
UNFOLDING CLINICAL REASONING 11
Situation
Name/age: Jeromy Brown aged 24 years
A summary of the primary problem: according to the physical examination conducted on the
patient, the fundamental problem is schizophrenia's mental disorder caused by a combination
of different factors. Some of these factors are environment and brain chemistry which causes
hallucinations, disorganized thinking, delusions, and other negative symptoms
.
Background:
Primary difficult/finding: schizophrenia
significant historical health account: His mental health has been good until the last three
months
He has been paranoid in the past three months
The experienced a dramatic increase in symptoms when he dropped medication.
UNFOLDING CLINICAL REASONING 12
RELEVANT background data: Jeremy Brown, a 30 –year old Caucasian male.
He is involved in an altercation at work.
He threw a large piece of metal at a coworker and began yelling.
He is agitated, displaying pressured speech, and repeating phrases he hears from police and
others in the ED (Forneris, Neal, Tiffany, Kuehn, Meyer, Blazovich & Smerillo, 2015).
He reports having stopped taking risperidone and citalopram because he believes his
medication is poisoned.
ASSESSMENT
Most recent vital signs: T: 97.8 F/36.6 C (oral) P: 100 (regular) R: 16 (regular) R: 22
(regular) 130/84 Severity: O2 sat: 98% room air
RELEVANT body system nursing assessment data: Appearance
Motor behavior
Thought process
Perception
UNFOLDING CLINICAL REASONING 13
Judgment
Cognition
Interactions.
Relative lab values:
TREND of any abnormal clinical data (stable-increasing/decreasing): there is an increase in
temperature, respiratory rate, pressure
How have you advanced the plan of care? The care plan has not been advanced.
Patient response; patient responding well
INTERPRETATION of current clinical status (stable/unstable/worsening): the current
situation of the patient is adjusting well.
Recommendation:
UNFOLDING CLINICAL REASONING 14
The patient should be evaluated after another six hours. The cognitive process should be
assessed. If no further positive change recorded, counseling interventions will be advisable.
Education Priorities/ Discharge Planning
There is a need to develop a teaching plan for the patient and family. Offering
professional guidance will be most appropriate. The family needs to be taught how to relate to
the patient.
How can the Nurse Assess the Effectiveness of Patient and Family Teaching and
Discharge Instructions?
A nurse can assess the effectiveness of teaching to patient and family by first setting the
goal to be achieved and reviewing if they are met after some period.
Caring and the “Art” of Nursing
What is the Patient Likely Experiencing/Feeling Right now in this Situation?
In this situation, the patient is feeling under reasonable care, and he is thankful for
hospital efforts of helping him recover (Shellenbarger & Robb, 2015).
UNFOLDING CLINICAL REASONING 15
What can you do to Engage Yourself with this Patient’s Experience, and show that
he/she Matters to you as a Person?
As a nurse, I would establish a good and effective communication plan for the patient. I
would also engage him in conversation, and show him all the possibilities of him resuming his
average life.
UNFOLDING CLINICAL REASONING 16
References
Forneris, S. G., Neal, D. O., Tiffany, J., Kuehn, M. B., Meyer, H. M., Blazovich, L. M., &
Smerillo, M. (2015). Enhancing clinical reasoning through simulation debriefing: A
multisite study. Nursing Education Perspectives, 36(5), 304-310.
Shellenbarger, T., & Robb, M. (2015). Technology-based strategies for promoting clinical
reasoning skills in nursing education. Nurse Educator, 40(2), 79-82.