Clinical Reasoning Cycle to Identify The Fall And Health Risk

Question: Discuss about the Clinical Reasoning Cycle to Identify The Fall And Health Risk Factors. Answer: Introduction: Clinical reasoning cycle or clinical judgment is the process used by nurses to collect cues of patients, process the clinical information, interpret the problem or patients condition, plan intervention, evaluate and reflect on the learning process. This process is important as it helps to identify the disease and health risk factors of patients and has a positive impact on patient outcomes. This process facilitates planning of appropriate intervention with support from best practice assessment tools and patient centered approach to care (Dalton et al. 2015). The report utilizes the clinical reasoning cycle process to identify the fall and health risk factors present in Leonard, a 65 year old man admitted to the hospital after falling at local shop. Based on this analysis, it discusses the best practice assessment tool used to deal with Leonard. Finally, the report highlights ways to ways to persons centered approach while providing care to Leonard. Identify Leonards falls and health risk factors using the clinical reasoning cycle Leonard, a 65 year old man came to the hospital after falling at a local shop. To analyse factors and health risk factors that lead to fall in the patient, the following steps is followed- Consider the patient situation- The case study of Leonard reveals he is an old patient admitted to the emergency department due to fall.Initial observation shows he has not sustained any fracture however his face and hip has been severely bruised. Collect information of patients- The result of initial clinical investigation shows that Leonard mainly has decompensated liver disease which occurs mainly because of deterioration in liver function of patients with cirhossis (Moreau et al. 2013). His presenting symptoms included dyspnea, lethargy, ascites and anorexia. He tends to be confused and disoriented with little attention to personal care. The past medical history of Leonardo revealed that he had alcoholic liver disease as he was heavy drinker consuming about 180g alcohol/day for years and his consumption for last month was 40g/ day which is above the normal limit of 20-25 g/day. Due to his alcohol dependence, other health complication is also observed in patient such as mental and behavioural disorder, limb oedema, urinary continence and regular falls (Rehm et al. 2013). Other health risk factor in patient includes industrial deafness, hypotension, anemia, decubitus ulcer on left leg and arthritis in the lower back. Process information- The diagnosis of decompensated liver disease in Leonard suggest that he is a heavy drinker because decompensated liver disease occurs only because of long-term excessive alcohol use in an individual. This is associated with symptoms of ascites (fluid in the belly), jaundice and confusion in patients (Mankal et al. 2015). Hence, the presenting symptoms of jaundice and ascites was seen in Leonard due to decompensated liver disease. Identify problem/s issues- After analysing the presenting symptoms and health related risk factor in Leonardo, it is understood that decompensated liver disease is a major health issue for patient. This creates risk of fall in patients and he needs immediate support to manage his daily living. Secondly considering his age and his deteriorating health condition, continous family support was essential for him. However, his wife has died and he has no children. His two sisters cannot be present by him during night, hence community support is extremely essential to manage him at home. Another issue affecting the health and well being of Leonardo is that his personal car has declined due to disoriented symptoms in patients. This has mainly occurred because of increase alcohol dependence which ahs affected his mental and behavioural condition. Hence, nursing support is also needed in this area to provide relief to patients. Establish goals- Considering the health condition of Leonardo, the main nursing goal is to reduce his risk of fall and decrease the symptoms of alcohol related disease. Take action- The main action needed to improve health of Leonardo is- To treat his deteriorating symptoms caused due to decompensated liver disease. To assess fall risk in patient and provide necessary support To assess his behavioural and mental disorder and address them To enhance his motor skills and meet nutritional needs. To address his disorientation and problem in planning task. Evaluate outcomes- Positive outcome will be identified by means of improvement in his overall symptoms. Reflect on new learning- Based on complication and issues faced in the process of planning care, nurse can reflect and learn new ways to improve nursing practice. Best practice assessment tool in relation to the case Leonardo who has been diagnosed with decompensated liver disease due to excessive alcohol use is suffering from mental and behavioural disorder. Due to his confused behavior and disorientation, it will be necessary for nurse to assess his mental status. The best practice tool for the assessment of mental status is the Mini Mental state Examination tool. It is an effective, reliable and most wide used screening tool used to assess the cognitive impairment particularly in older adults. This is necessary for Leonardo as he is a 65 year old cognitively impaired adult with past alcohol history. It would help to predict cognitive changes in patient and plan interventions accordingly. It mainly evaluates and assess seven areas of cognitive functioning and accepted sensitivity of the tool is high. The score obtained from the test will help to identify the impairment in executive functioning, abstract reasoning and visual perception of Leonardo (Baek et al. 2016). Hence, based on this score, adequate interventions can be determined for Leonardo. Leonardo has motor planning difficulties and his disorientation is a risk factor for fall. Fall can have a severe effect on Leonardo at such age. As he also needs support during mobilisation, it is necessary for nurse to assess his risk of fall on a regular basis. This can be done by means of Heindrich II Fall Risk Model which is an efficient tool to determine the risk for fall based on gender, mental and emotional status, symptoms of dizziness, medication effect and other risk factors (Zhang et al. 2015). The fall risk assessment by means of this tool is important in older adults like Leonardo because fall among older adults can occur due to multifactorial etiology like chronic illness, medication and other effect. In Leonardos case, this is necessary due to his past history of alcohol use, his present condition of decompensatory lung disease, disorientation and poor motor planning. The validity and reliability of the tool has been shown from large case control study in acute care f acility. The tool has sensitivity of 74.9% and specificity of 73.9% (Hendrich 2017). By this means of assessment, treatment of Leonardo can be aligned to reduce present risk factors of fall. Leonardo has been found to be anorexic due to which he has also been referred to a dietician. Nurse can use the Subjective Global Assessment tool to evaluate the nutritional status in patients during the treatment process. This is done by gathering information about the food intake, gastrointesitinal symptoms, weight changes and physical examination in patients by analysing subcutaneous fat, edema, muscular atrophy and ascites. However this tool is not reliable for cirrhotic patients due to changes in ascites and edema. Hence, anthropometric measurement can be used to evaluate nutritional status. Tricep skinfold and mid-arm muscle circumference also helps to evaluate nutritional status (Romeiro and Augusti 2015). Person centred approach to support Leonards right and follow professional obligations In relation to the case scenario of Leonardo, an old adult with multiple chronic condition, it is necessary to provide holistic care by focusing on the immediate clinical needs of patient as well as his basic right and dignity in care. Patient-centred approach will be important in providing treatment to Leonardo because it is a provision for holistic care which involves the patient in the care process to get the best outcome (Kitson et al. 2013). Therefore, as part of professional obligation, the main priority of nurse will be to manage nutritional imbalance in patient, stabilize fluid volume and vital signs within the normal change and administer appropriate medication to control edema and ascites (Runyon 2013). Apart from pharmacological and nursing intervention, Leonardos care will be done by effective interaction with patients to know their issues or attitude towards treatment. Based on their consent, treatment should be planned. This will keep the patient motivated and promote their involvement in care process too. Patients preference should always be kept in mind and they should be motivated to changes their habit and lifestyle (Osborn et al. 2014). By this approach, Leonardo may pay attention to his personal care needs. As part of delivery of nursing care, nurse will respect the value of patient and take account of his needs. Secondly, good communication will be needed to educate patients regarding self-care and moving with assistive device. This will ensure continuity within the service and establishment of therapeutic relation with patients (Starfield 2017). Conclusion The essay summarized the importance of clinical reasoning cycle, best practice assessment tool and patient centred approach to care by means of the analysis of the case study of Leonardo. This gave practical example regarding how patients risk factors can be analysed and processed to plan nursing intervention. Secondly, explanation regarding the best assessment tool for Leonardo suggests the importance of appropriate tool in examining physical and mental status of patients. On the other hand, patient centred approach helps in practicing in accordance with professional obligation and patients right during the care process. References Baek, M.J., Kim, K., Park, Y.H. and Kim, S., 2016. The Validity and Reliability of the Mini-Mental State Examination-2 for Detecting Mild Cognitive Impairment and Alzheimers Disease in a Korean Population.PloS one,11(9), p.e0163792. Dalton, L., Gee, T. and Levett-Jones, T., 2015. Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum.Australian Journal of Advanced Nursing, The,33(2), p.29. Hendrich, A. 2017.Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model. [online] Available at: https://consultgeri.org/try-this/general-assessment/issue-8.pdf [Accessed 30 Apr. 2017]. Kitson, A., Marshall, A., Bassett, K. and Zeitz, K., 2013. What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing.Journal of advanced nursing,69(1), pp.4-15. Mankal, P.K., Abed, J., Aristy, J.D., Munot, K., Suneja, U., Engelson, E.S. and Kotler, D.P., 2015. Relative effects of heavy alcohol use and Hepatitis C in decompensated chronic liver disease in a hospital inpatient population.The American journal of drug and alcohol abuse,41(2), pp.177-182. Moreau, R., Jalan, R., Gines, P., Pavesi, M., Angeli, P., Cordoba, J., Durand, F., Gustot, T., Saliba, F., Domenicali, M. and Gerbes, A., 2013. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.Gastroenterology,144(7), pp.1426-1437. Osborn, R., Moulds, D., Squires, D., Doty, M.M. and Anderson, C., 2014. International survey of older adults finds shortcomings in access, coordination, and patient-centered care.Health Affairs,33(12), pp.2247-2255. Rehm, J., Samokhvalov, A.V. and Shield, K.D., 2013. Global burden of alcoholic liver diseases.Journal of hepatology,59(1), pp.160-168. Romeiro, F.G. and Augusti, L., 2015. Nutritional assessment in cirrhotic patients with hepatic encephalopathy.World journal of hepatology,7(30), p.2940. Runyon, B.A., 2013. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012.Hepatology,57(4), pp.1651-1653. Starfield, B., 2017. Is patient-centered care the same as person-focused care?.Issues,2016. Zhang, C., Wu, X., Lin, S., Jia, Z. and Cao, J., 2015. Evaluation of reliability and validity of the Hendrich II Fall Risk Model in a Chinese hospital population.PloS one,10(11), p.e0142395.