Clinical Reasoning Cycle – Health Promotion

Clinical Reasoning Cycle – Health Promotion Template (Workshop 1).
(Modified from Levett-Jones, 2013)
1. HEALTH PROMOTION PLAN
Stage
Response.
Determinants of Health
Initial.
Ruby Pascal is a 43 years old female admitted to the medical ward with the
complication of a severe anxiety attack. Other symptoms include nausea,
chest pain, and vomiting. Her height is 160 cms and a weight of 90 kg. Her
BMI is more than 35, which is abnormal. She has a past medical history of
general anxiety disorder. Along with this her another medical history states
that she has Type II diabetes that she manages by having Metformin SR, 2000mg.
However, she took professional treatment to cure her general anxiety disorder.
The treatment included non-pharmacological and pharmacological support.
Anxiety disorder induced by a medical condition involves signs of extreme anxiety
or distress triggered directly by a physical health problem. In her case, the anxiety
disorder intensified when her husband was diagnosed with bowel cancer for that she
has to move to Brisbane. In addition to this, in Brisbane, she developed unhealthy food
habits and did not prefer working out. She used to take valium 10mgs to reduce her

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stress, and she feels that diabetes tablets are making her anxiety condition worse.
Interview, documentation,
observation.
Ruby Pascal's medical history stated that she has Type II diabetes. And she
had a history of general anxiety disorder. At present, her anxiety symptoms
are increasing along with physical symptoms. She is admitted to the emergency
department with nausea, chest pain, and vomiting. For general anxiety disorder
in the past, she had undergone professional treatment which included
non-pharmacological support from a visiting psychologist along with short-term
psychological treatment by her GP. For the treatment of diabetes, she takes
Metformin SR, 200 mg. In addition to this, she takes valium 10mgs, which dulls her
thinking and puts her to sleep. Valium is a medication that manages anxiety disorder
and gives short term relief to the physical symptoms. She is dependent on the
psychologists to reduce her stress level.
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Identify health concerns.
Identify patterns or
connections.
Ruby Pascal has developed anxiety disorder along with chest pain, vomiting, and nausea. Pascal has been
diagnosed with Type II diabetes for which she takes Metformin, an anti-diabetic drug. Chest pain, vomiting,
and nausea can be potential side effects of these drugs. Research has also found that diabetes sufferers are
more likely to be nervous. Several studies have specifically related insulin resistance to hormonal
imbalances in the brain and, as a consequence, the development of habits and symptoms similar to
depression and anxiety. Her intensified condition may lead to having intense, excessive, and persistent fear
about every day. This might comprise a sudden feeling of intense anxiety that reaches to peak within
minutes, which is regarded as panic attacks.
In this condition, it's necessary to improve her health condition by managing her diabetes and enhancing her
mental condition so that she can take care of her family.