Student’s Name: Institutional Affiliation · factors are the environment and brain chemistry. The identified factors cause hallucinations and disorganized thinking. They also cause

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


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



It helps to narrow down the diagnostic process.

What assessment data important to be interpreted by nurse for clinical significance?

Important Assessment

Data


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


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



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


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.


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


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


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


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


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.


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


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:


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).


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.


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.

Documents

Student’s Name: Institutional Affiliation · factors are the environment and brain chemistry. The identified factors cause hallucinations and disorganized thinking. They also cause