case study - clinical reasoning cycle PDF

Preview

Summary

first year first sem case study of one of three person options creating a healthcare profile of the patient and a care plan as would be used in handover...

Description

1

Peter Demetriou The Clinical Reasoning Cycle is a process that assists healthcare workers and nurses in particular in comprehensively assessing a patient and their situation and create an effective care plan. In the case of Peter Demetriou, a beginning nurse forming a care plan must first refer to the first four steps of the Clinical Reasoning Cycle: Consider the patient situation, Collect cues/information, Process Information, and Identify problems/issues. (Levett-Jones, 2017)

Stage 1 - Consider the Patient Situation Peter Demetriou has presented at his local multidisciplinary Primary health clinic to receive an annual influenza injection. He is a 46-year-old male living in the suburbs of SouthEastern Sydney with his wife and three children. After the passing of his father who died of Colon Cancer, his mother began living with his family. Demetriou has been living in Australia since he was a small child, having been born in Greece. He has been struggling with bookwork for his building business (primary in home renovation) which he owns and runs. He has experienced a particularly stressful time as of late. While he has an active lifestyle, he has poor dietary habits, often eating fast food for lunches, and socially drinks on weekends.

Stage 2 - Collect Cues/Information Demetriou has a family history of Colon Cancer as stated by his father having and dying as a result of the disease. He has expressed a high level of stress recently, as well as regular poor dietary habits in daily life despite active lifestyle. To ensure that Demetriou is provided with quality holistic care, it is essential to ask wider health and lifestyle related questions and conduct a comprehensive health Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021

2

assessment. Regarding the administering of the influenza injection, a nurse must assess the patient’s eligibility to receive the vaccine by asking if they have an egg allergy or have previously experienced anaphylaxis in response to the vaccine. ("Influenza (flu) immunisation service", 2021) As Demetriou has not provided any information regarding allergies or past experiences with the Influenza injection, it is necessary to ask about these factors to ensure it is safe to provide him with the vaccine. As he has expressed poor diet, it is critical to assess the health factors which it may negatively impact, such as blood pressure, blood glucose levels and weight. As Demetriou has been experiencing a stressful period, it is also important to inquire about his mental wellbeing to assess its impact on his health, as stress can contribute to various health problems, such as difficulty sleeping, achieving restful sleep or deterioration of mental health. His family history of Colon Cancer presents an increased risk of developing the disease himself thus proving it crucial to conduct an inquiry into his current health status and whether he performs the necessary regular Colon Cancer screenings. ("Do the test", n.d.) The Roper-Logan-Tierney (RLT) model of nursing addresses each of the factors contributing to a patient’s health as well as each of the “Activities of Living” that must be assessed to determine health in order to provide holistic care. (Williams, 2017) Though in Demetriou’s case, information suggesting specific health concerns has been provided, it is essential that his overall health is assess holistically using the RLT model of nursing to ensure a high standard of quality care. Following the RLT model of nursing, Demetriou’s health can not only assess health risks but determine the source/s regarding the influencing factors. (Williams, 2017) For example, as he was born in Greece, the cultural and environmental shift may be sociocultural and environmental factors influencing activities of living such as communication. Further, this cultural distinction may entail differences in personal needs, boundaries and cultural customs that a nurse must be aware of and respect in their provision of care. Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021

3

Stage 3 - Process Information As minimal evidence of health determining signs or symptoms has been provided, it is difficult to analyse the current state of Demetriou’s health further than abnormal levels of work-related stress and poor diet possibly as a result of such stress. While Demetriou’s specific line of work is irrelevant to his health, the stress it has likely caused, in addition to his busy homelife, may impact his mental well-being. As poor diet is a factor in many health concerns, it is a critical piece of information to be further assessed in various areas of health. No information has been provided suggesting the impact of his diet on his health, such as weight or blood glucose levels. Addressing his family history of Colon Cancer is crucial in ensuring any risks are assessed and cared for as the disease can be fatal. Although Demetriou has provided information of family history, the healthcare workers assessing him have no knowledge of whether he regularly screens for the cancer or has experienced any symptoms. While Demetriou receiving his annual Influenza injection does not contribute to any major future health risks presented by his other stated health concerns or provide any new important information regarding his health or lifestyle, it may cause minor side effects. ("Influenza (flu) immunisation service", 2021) While it is not significant to his overall health, it must be addressed to ensure he is aware of the possible side effects and is provided with a plan to care for such outcomes. The patient has provided no information regarding allergies or past experiences with the vaccine that would determine his eligibility to receive it for his own safety. Demetriou’s family history and personal risk of colon cancer may be a contributing factor to existing stress caused by work related struggles. This build-up of stress is reflected in his poor diet as he may feel too overwhelmed to worry about maintaining a healthy diet or that he doesn’t have the time to do so as he is behind on his business’ bookwork. Poor diet Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021

4

and consumption of alcohol can risk further likelihood of developing Colon Cancer, an existing risk for Demetriou as is it present in his family history, especially as he approaches the most at-risk age group. ("Do the test", n.d.) From these cues and their respective connections, it can be deduced that Demetriou’s lifestyle has formed a potentially harmful cycle putting him at a high risk of mental health deterioration, of developing various nutritional diseases and conditions such as obesity, and of developing Colon Cancer. Lifestyle pattern alterations including following a healthier diet by cutting out fast food, reducing stress especially regarding his workload by seeking support from family and co-workers, and regularly screening for Colon Cancer as early detection is shown to contribute to higher survival rates. ("Do the test", n.d.) Though as a beginning nurse, it is difficult to relate Demetriou’s presenting issues to past situation and/or patients, in this case, one would be able to reference his father’s experience and death to assess similarities and predict possible outcomes. It can be predicted that if the appropriate interventions are not executed for the stated health risks, Demetriou’s mental and physical health will likely deteriorate as a result of increasing stress and poor diet. Further, without regular screenings to allow the early detection Colon Cancer, if Demetriou were to develop the disease, earlier detection can increase the chance of survival. (Araghi et al., 2019)

Stage 4 - Identify problems/issues Demetriou is at risk of Colon Cancer related to family history of the specific cancer. Both the risk of mental health deterioration and the risk of difficulty sleeping or achieving restful sleep related to the heightened stress he has been experiencing are present. He is also at risk of both high blood pressure and obesity related to poor diet. Without appropriate intervention, these risks are likely to be detrimental to Demetriou’s health.

Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021

5

Despite presenting for an Influenza injection, Peter Demetriou’s health history and current information provided regarding his physical and mental health have suggested various health risks that will require further health assessment and lifestyle inquiry in order to ensure holistic person-centred care is achieved and quality care is provided.

Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021

6

References

Araghi, M., Soerjomataram, I., Jenkins, M., Brierley, J., Morris, E., Bray, F., & Arnold, M. (2019). Global trends in colorectal cancer mortality: projections to the year 2035. International Journal Of Cancer, 144(12), 2992-3000. https://doi.org/10.1002/ijc.32055 Do the test. Cancer.nsw.gov.au. Retrieved 12 May 2021, from https://www.cancer.nsw.gov.au/dothetest/?gclid=CjwKCAjwe2EBhAhEiwAJI5jgyJqUEhFOBs1Jg6qya7TYCdQtNErzT_AmIo97dxu4e2Wjty5nHbOhoC4K8QAvD_BwE&gclsrc=aw.ds. Influenza (flu) immunisation service. Australian Government Department of Health. (2021). Retrieved 12 May 2021, from https://www.health.gov.au/healthtopics/immunisation/immunisation-services/influenza-flu-immunisation-service. Levett-Jones, T. (2017). Clinical Reasoning EBook : Learning to Think Like a Nurse [Ebook] (2nd ed., p. 4). Pearson Education Australia. Retrieved 12 May 2021, from https://ebookcentral.proquest.com/lib/acu/detail.action?docID=5220625. The health of Australia’s males, Diet - Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Retrieved 12 May 2021, from https://www.aihw.gov.au/reports/men-women/male-health/contents/lifestyle-and-riskfactors/diet. Williams, B. (2017). The Roper-Logan-Tierney model of nursing. Nursing Critical Care, 12(1), 17-20. https://doi.org/10.1097/01.ccn.0000508630.55033.1c

Ella McDougall_S00308003_ Assessment Task 3: Case Study_ NRSG138: Transition to Nursing_2021...