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Levitt- Jones Clinical Reasoning Cycle

Table of Contents

Introduction.

Overview of Patient’s condition.

Pathophysiology as per collected cues.

Addressing problems.

Care priorities.

Planning health education.

Outcome Evaluation.

Reflective conclusion.

References.

Introduction to Levitt- Jones Clinical Reasoning Cycle

Effective nursing intervention is necessary for clinical governance which is leading to patient’s wellbeing. Understanding the actual need of patients and providing both short and long term wellness is the main aim of conducting such interventions. The current case study analysis is determining the clinical intervention by nursing staffs for a mental health issue. With the help of clinical reasoning cycle, the symptoms and effects on the patient have been determined and a systematic analysis has been conducted. At the end, a reflective account has been developed that is showing self-evaluation and knowledge level after conducting the clinical reasoning cycle.

Overview of Patient’s Condition

Identifying and notifying the complete medical condition is the primary phase of Clinical Reasoning Cycle (Levett-Jones et al. 2010). The case is about Mr. X who is 20 years old and suffering from Depression and Anxiety. He has a medical history of surgery of appendectomy and tonsillectomy. He is showing continuous suicidal tendency and self-harm. This issue has been identified in his maternal group and he is also suffering from stress and sleeplessness. Along with this, the reason of his depression is regarding job and for this reason, he is becoming suicidal, stressed and anxious. However, he does not have any kind of addiction towards smoking, drug use, gambling and drinking.

Pathophysiology as Per Collected Cues

The patient is depressed and anxious due to job insecurity. Along with this, he has a family history from maternal side about depression and anxiousness which has led two people to suicide. He is also becoming suicidal for this depression and anxiousness. The main issue is the patient is suffering from high depression and stress. However, any kinds of history and practice of drug or alcohol abuse is not noticed. Drug use can stimulate the issue of stress, anxiety and suicidal issue (Davis & Lockhart, 2017). apart from this, based on his medical condition, there medicines have been prescribed to him which are Risperidone, Effexor-XR Venlafaxine and Diazepam Valium. Along with this, it has been noticed, he is suffering from depression and anxiety for about 4 years. The pharmacokinetics are stated in below:

Medicine 1: Risperidone

Pharmacokinetics of this medicine is showing that Risperidone is a typical antipsychotic drug use to treat stress, anxiety, depression and other related issues. This is used to cure depressive tendency and it might cause insomnia, hypotension, headache, agitation, loss of appetite, blunt vision, GI upset and others. The direction of the medication is to take regularly as per the strict guidance without interruptive intake, and the patient must not stop taking until the advice of doctors. Within this period, alcohol, machine operation ad driving is strictly prohibited(drugs.com, 2020).

Medicine 2: Effexor-XR Venlafaxine

This is an appropriate antidepressant which is essential for boosting norepinephrine and serotonin in brain and improves concentration and mood. This drug can be applied on Mr. X for his generalised disorder (GAD). Along with this, in other cases like social anxiety disorder, post-traumatic stress disorder (PTSD), panic disorder, as well as obsessive-compulsive disorder (OCD)(drugs.com, 2020). The precautionary measure is same as the above. Additionally, it can cause several side effects such as GI upset, insomnia, fatigue, drowsiness, tiredness, blurred vision, headache, nausea and dry mouth.

Medicine 3: Diazepam Valium

The primary aim of this medicine is to control anxiety of the patient and lower the stress related to his job. Along with this, in order to relief skeletal muscle spasm, this is applied to patients. The main instruction for using the drug is as mentioned above (drugs.com, 2020). However, some side effects can be identified about this drug application such a fatigue, drowsiness, GI upset, headache, dizziness, tremor, hypotension, muscle weakness and others.

Clinical Intervention

The clinical intervention is showing the anxious and depressed behavioural symptoms of the patient. Along with this, he is suffering from sleeping disorder which is a potential effect of his depression. Currently, he shows suicidal tendency in which the cause is his job tension as well as the suicidal and depression history of his maternal house. This clinical symptom is showing he requires medical support along with mental case intervention (Gleeson et al. 2019). There are two records can be obtained about suicides in his maternal side. On the other hand, lack of positive attitude can be noticed among his behavioural pattern which has negative impact on his mental health.

On the other hand, another significant aspect in his behavioural pattern is he is not socialised with people. The clinical intercession is indicating the on edge and discouraged social side effects of the patient. Alongside this, he is experiencing resting jumble which is a potential impact of his downturn. Right now, he shows self-destructive propensity in which the reason is his activity strain just as the self-destructive and wretchedness history of his maternal house. The genetic orientation and family history significantly matters in the depression and anxiety care especially for understanding the root cause of the issue (Gramaglia et al. 2016). There are two records can be gotten about suicides in his maternal side. Then again, absence of inspirational disposition can be seen among his conduct theme which has negative effect on his psychological wellness. Then again, another critical viewpoint in his personal conduct standard is he isn't associated with individuals.

The clinical reasoning cycle of Levett-Jones is followed and information has been collected and noted (Levett-Jones et al. 2010). Additionally, followed by this, the following assessment has been done. Based on these interpretation, the cues are generated and hypothetical assumptions have been done. Along with this, the signs and symptoms are interfering with the clinical understanding.

Interpretation: As the patient has a genetic history of mental disorder as well as suicidal history, alertness is required. He is having depression and stress mediated issues. This could create co-morbid issues or patient become suicidal (Hirsch et al. 2019). For this reason, the mental health issue is required to arrested in proper time.

Discriminate: This phase is indicating the elimination of improper details like his previous tonsillectomy and appendectomy (Lohman et al. 2016). Along with this, inclusion of notifiable details like previous history of psychiatric issues and current stressful events could be included.

Relating the cues: the patient is suffering with this mental health issue for about 4 years which has developed the issue deep rooted and it is necessary to eradicate the health issue.

Infer: The patient was not provided with regular medication and antidepressant treatment which has developed severity of the health issue. This could lead him to hypertensive and cardiac health issue (Zhong et al. 2017).

Match situations: As per WHO, 79% of the suicide is occurred due to mental disorder and depression. For this reason, providing drugs like Risperidone, Effexor-XR Venlafaxine and Diazepam Valium are provided to him for improving his sleeping disorder and depression related issues.

Predicting outcome: the outcome of this intervention can lead him to get over from this depression related suicidal tendency and improve his sleeping pattern (Gramaglia et al. 2016).

Care Priorities

The care priorities are:

  • To take action for providing care to the patient with suicidal tendency, knowledge of self-care approach is to be provided by providing training to family and friends that he does not feel isolation, worthlessness and helplessness
  • Encouraging him to express feelings of anger, guilt and sadness towards any people and providing him medication for sleep and anxiety control

Planning Health Education

Nursing Care Plan

Goal

Intervention

Rationale

Evaluation

Biological:

Client will have improved sleeping pattern

Improvement of sleep hygiene can enhance the outcome and trigger positive energy which needs to be done by medication and meditation before sleeping

Improve sleeping patterns and Promoting good sleep by facilitating and improve quality of sleep (Lohman et al. 2016)

At the end of this week, the patient will have improved sleeping condition

Psychological:

Self-positivity will be addressed by the client at the end of this week

Increase of the interaction can help the patient to express feelings like sadness, anger, distress, rage and others

Building trust and providing a supportive environment is necessary that can reinforce mental wellbeing and positivity (Gramaglia et al. 2016)

After completion of two weeks, positive attitudes will be addressed and socialisation with high self-esteem will be evaluated

Social:

Will be able to socialise in any group

Increase interaction with people, friends and family especially with brother that can motivate him and he would know his importance to the family and friends

Developing basic idea for socialisation, Responsive towards social responses, Preparation of mind to deal with the real word (Zhong et al. 2017)

Improvement of group interaction and inclusion in family and friends will be noticed after the completion of 2nd week

Table 1: Plan

(Source: As per the case study)

Outcome Evaluation of Levitt- Jones Clinical Reasoning Cycle

After completion of the clinical intervention, Mr. X is expected to increase his sleeping pattern and time. Apart from this, the isolation, worthlessness and negative feelings will be eradicated after the completion of clinical session. The more inclusive approach with family and friends can improve the distress, depression and stress related suicidal tendency (Hirsch et al. 2019). With the help of nursing care of nursing care intervention as well as the patient care approach, the suicidal tendency will be mitigated and the sleeping pattern can be improved. It has been mentioned that the clinical intervention will provide medication that needs to be followed strictly and the person can have positive attitude.

Reflective Conclusion on Levitt- Jones Clinical Reasoning Cycle

Henceforth, with the help of clinical reasoning cycle, nursing care intervention and plan has been proposed. the main purpose of this study to understand the required intervention by referring with the clinical symptoms as well as case history, a holistic treatment could be provided. I have also understood the importance of nursing care strategy in the current case that can influence on the patient-centred outcome especially the case of Mr. X as he requires high level of mental health initiatives. Successful nursing intercession is essential for clinical administration which is prompting patient's prosperity. I am understanding the genuine need of licenses and giving both short and long haul health is the principle point of leading such intercessions. After fruition of about fourteen days, inspirational perspectives will be tended to and socialization with high confidence will be assessed. Toward the finish of this current week, the patient will have improved dozing condition.

References for Levitt- Jones Clinical Reasoning Cycle

Davis, C., & Lockhart, L. (2017). Not just feeling blue: Major depressive disorder. Nursing made Incredibly Easy, 15(5), 26-32. https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/09000/not_just_feeling_blue__major_depressive_disorder.7.aspx

drugs.com (2020) Find Drugs & Conditions, Retrieved on: 3 May, 2020, From: https://www.drugs.com/

Gleeson, H., Hafford-Letchfield, T., Quaife, M., Collins, D. A., & Flynn, A. (2019). Preventing and responding to depression, self-harm, and suicide in older people living in long term care settings: A systematic review. Aging & Mental Health, 23(11), 1467-1477. http://eprints.mdx.ac.uk/25526/1/Accepted_Systematic_review_older_people_suicide_and_self-harm_gleeson_etal..pdf

Gramaglia, C., Feggi, A., Bergamasco, P., Bert, F., Gattoni, E., Marangon, D., ... &Zeppegno, P. (2016). Clinical characteristics associated with suicide attempts in clinical settings: a comparison of suicidal and non-suicidal depressed inpatients. Frontiers In Psychiatry, 7, 109. https://www.frontiersin.org/articles/10.3389/fpsyt.2016.00109

Higgins, A., Downes, C., Carroll, M., Gill, A., & Monahan, M. (2018). There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care. Journal of clinical nursing, 27(3-4), e476-e487. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13986

Hirsch, J. K., Rabon, J. K., Reynolds, E. E., Barton, A. L., & Chang, E. C. (2019). Perceived stress and suicidal behaviors in college students: Conditional indirect effects of depressive symptoms and mental health stigma. Stigma and Health, 4(1), 98. 

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’patients. Nurse education today, 30(6), 515-520. https://www.sciencedirect.com/science/article/pii/S026069170900210X

Lohman, M. C., Raue, P. J., Greenberg, R. L., & Bruce, M. L. (2016). Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial. International journal of geriatric psychiatry, 31(7), 708-715. https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4381

Zhong, B. L., Li, S. H., Lv, S. Y., Tian, S. L., Liu, Z. D., Li, X. B., ... &Zhuo, C. J. (2017). Suicidal ideation among Chinese cancer inpatients of general hospitals: prevalence and correlates. Oncotarget, 8(15), 25141. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421916/

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