Clinical Reasoning Cycle: Mental Health Nursing Case Study Analysis

This case study analyzes a 28-year-old single male named John Gray, admitted to the hospital after a suicide attempt, using the clinical reasoning cycle. The assessment involves collecting cues from the patient's history, medication, and vital signs, revealing prehypertension, potential malnutrition, and depression. The information is processed through interpretation, discrimination, relating cues, matching situations, and predicting outcomes, leading to the identification of problems like prehypertension, malnutrition risk, and potential for recurrent depressive episodes. Goals are established to normalize blood pressure, prevent malnutrition, and avert further depressive episodes. Interventions include thiazide diuretics, increased vitamin supplements, and cognitive behavioral therapy. Evaluation shows positive outcomes: blood pressure normalization, improved health status, reduced depressive episodes, and enhanced socialization. The reflection phase emphasizes the importance of family involvement in future cases. The study demonstrates the application of clinical reasoning skills to identify health issues and implement effective treatment strategies, ultimately improving patient outcomes.

Running head: CLINICAL REASONING CYCLE 1
Clinical Reasoning Cycle
Name of Author
Institution of Affiliation
Date of Submission

CLINICAL REASONING CYCLE 2
Introduction
Individuals pursuing a nursing course will, at most times, have a positive impact on the
convalescent’s health outcome if they have practical reasoning skills. Oppositely, nursing
practitioners with inferior clinical reasoning skills always have high chances of failing to
recognize the imminent deterioration of the patient’s health either due to drug-body interactions
or normal (Alfaro-LeFevre, 2015). These factors have led to an increase in the number of
accelerating healthcare complaints in the nursing category. Therefore, there was a suggestion to
incorporate the studies on how to manage patients in the nursing department. The studies were to
enhance nursing practitioners with the ability to use various communication channels in order to
deliver the best patient care (Blomdahl et al., 2016).
One of the ways of achieving this was by implementing the clinical reasoning cycle. With
this information in mind, this assessment will use the clinical reasoning cycle in understanding
and planning care for a convalescent named John Gray.
Consider the patient
Considering the case of John Gray, who is 28 years old and single. He was admitted to the
hospital one week earlier after he inflicted harm on himself intentionally. Moreover, John has a
rope burn mark around his neck that occurred after the rope broke when he tried to hang himself.
Besides, due to the fall from the attempted suicide, John Gray incurred some bruising and broken
skin on his legs and arms. Luckily the physical injuries were not that serious and therefore were
covered with a non-adherent dressing and tape.

CLINICAL REASONING CYCLE 3
Collect cues and information
This is another stage of the clinical reasoning cycle that involves gathering data in
consideration to John Gray. Additionally, it also involves analyzing the convalescent’s
information that is accessible from his history, handover reports, nursing notes, and clinical
documentation (Dalton, Gee, & Levett-Jones,2015). From the report, John Gray is under
medication such as Venlafaxine 75 mg bd. The drug (Venlafaxine 75 mg bd) is prescribed to
patients who have suffered from severe depressive episodes. The medication is to prevent the
events from reoccurring to the patient. Therefore, this medication shows that John is suffering
from depression (YAZDANI, HOSSEINZADEH, & HOSSEINI, 2017).
Moreover, John was prescribed with Multivitamin to prevent vitamin deficiency due to
the fact that the handover report suggested that John did not take his breakfast, and he ate almost
nothing at lunchtime. From this medication, we see that John Gray is suffering from vitamin
deficiency.
Additionally, John was also given a daily dosage of vitamin B. The medication is for
patients with depression and anxiety issues. Furthermore, the medication is for convalescents
with physical injuries. From this medication, it is obvious that John Gray has a record of
depression and also suffers from physical injuries.
Apart from this information, recent data collected from observations of John Gray
reflects that: John has a blood pressure of 125/75 mmHg, temperature of 36.3, and a pulse rate of
66. Besides, the information also showed that Gray’s respiratory rate was 18 breaths per minute.

CLINICAL REASONING CYCLE 4
According to (Delany, & Golding, 2014), it is crucial for individuals pursuing a nursing
career or is currently practicing to use the knowledge from therapeutic, physiology, law, and
pathology in matters related the convalescent, in this case, Mr. John Gray. First of all, John Gray
is single. This may be because he is not social or lacks interactive skills following the fact that
the occupational therapist report suggested that John did not take part in any activities, including
one-on-one activity or small group games. Additionally, he also grunted and turned his face to
avoid any contact from the nurse. This suggests that John Gray is not sociable. Additionally, Mr.
John is supposed to inherit the family’s farm, which in fact has been affected severely by the
lasting drought that has hit the community located in the north of Brisbane. This may be related
to depression and stress leading to the lack of appetite.
Process Information
As stated by (Forneris et al., 2015), every convalescent information and cues gathered in
the previous stage are cautiously examined. Any anomaly found is strictly identified and
highlighted. Moreover, every cue recognized is analyzed and concluded after any hypothesis
generated. To put it in simple terms, the patient’s current situation is compared to previous
clinical data presentations. This will enable the nurse to predict possible results in relation to the
available approaches. Therefore, in regards to this information, the nurse has to distinguish the
data of John Gray to normal and abnormal.

CLINICAL REASONING CYCLE 5
Process information has five steps:
1. Interpretation
Normal blood pressure should not be above 120/80. Therefore, due to the systolic reading
which is 125, it is clear that John Gray has prehypertension even though his diastolic reading is
75 which is normal at his age (Hunter, & Arthur, 2016). Additionally, Gray’s temperature was
recorded at 36.3, which is in the range of normal body temperature. Besides, the normal pulse
rate is between 60 to 100 beats per minute. Judging from this statistic, John gray has a normal
pulse rate since his recorded information showed that his pulse rate was 66 beats per minute.
Moreover, his respiration rate was recorded at 18, which is good for an adult of his age.
Furthermore, Gray’s injuries from the fall were covered with non-adherent tape suggesting that
the physical injuries to the legs and arms were not major.
2. Discriminate
This stage requires differentiating the relevant information from irrelevant information
(Forsberg et al., 2015). Moreover, it requires identifying the inconsistencies in the information so
as to reduce the data to areas where the difference in cues is gathered. In regards to John Gray’s
age, his pulse rate, respiration rate, and temperature all appear to be at a normal rate. However,
more priority is put to his blood pressure rate. Therefore, the nursing practitioner should ensure
that Mr. Gray takes regular blood pressure tests.
3. Relating the cues
At this stage, the nurse is supposed to find how the information is related to each other.
For example, John Gray’s blood pressure rate was recorded at 125/75, which suggested

CLINICAL REASONING CYCLE 6
prehypertension. The prehypertension may be due to the fact that Gray refused to take his meals.
Additionally, the medications that John was prescribed with suggested that he was suffering from
depression, vitamin deficiency, and physical injuries. Moreover, the fact that John Gray refused
to take his breakfast and ate a small lunch may be due to three factors. First, John is to take over
his family’s farm, which is currently under bad conditions and therefore causes his stress.
Secondly, John is single, which at his age may cause loneliness. Lastly, John’s physical injuries
may be too painful. These factors may lead to a lack of appetite (Ironside, McNelis, & Ebright,
2014).
4. Match situations
According to the World Health Organization, people experiencing a lot of stress are
highly likely to get depressions, prehypertension, vitamin deficiency, and self-inflicted injuries
(Koivisto et al., 2016). For that reason, some of the issues facing John Gray are related.
Additionally, loneliness is another factor that can make an individual suffer from the various
illnesses mentioned. Therefore, loneliness due to the fact that Mr. Gray is single may be the key
reason behind the struggles he is facing.
5. Predicting the outcomes
Based on the nature of Gray, if the depression is not attended to immediate the depressive
episodes may increase and can ultimately lead him to commit suicide. Furthermore, the physical
injuries that Gray incurred during the suicidal attempt should be well treated to prevent
infections that may lead to a serious issue (Lee et al., 2016).

CLINICAL REASONING CYCLE 7
Identifying the problem
The three problems that John Gray is experiencing are:
1. The lack of participation in exercises caused the prehypertension and it is highly likely
that John Gray experiences high blood pressure.
2. John is likely to experience malnutrition as indicated with his lack of eating.
3. John is highly likely to experience other depressive episodes because of his prior suicidal
attempts.
Establish Goals
The first goal would be to reduce John’s blood pressure back to the normal range.
The second goal would be to prevent John from experiencing malnutrition.
The third goal would be to prevent other depressive episodes from reoccurring.
Take action
The lack of participation in exercises caused the prehypertension. Therefore, the nurse
should find a way to reduce John Gray’s blood pressure. Therefore, the nurse should administer
the medication of thiazide diuretics. This is because the medication is effective in decreasing the
blood pressure level. The medication acts directly on the kidneys and improves diuresis by
preventing the chloride cotransporter found in the functional unit of the kidney therefore,
reducing blood volume and consequently the blood pressure (Egan & Stevens-Fabry, 2015).
Moreover, the medication is mostly the first medication therapy for prehypertensive patients and
since John Gray has no prior records of hypertension, the medication would best suit him.

CLINICAL REASONING CYCLE 8
To reduce the risk of John Gray from experiencing malnutrition, the nurse should
increase the dosage of Multivitamin and Vitamin B. This is because John Gray is not eating and
therefore, the nurse should increase the dosage level of the Multivitamin and Vitamin B so as to
supplement the nutrition in John’s body that may be lacking as a result of not eating (Esper,
2015).
To reduce the risk of John Gray experiencing other depressive episodes, the nurse should
advice John to join a cognitive behavioral therapy (Young et al., 2014). This is because the
venlafaxine medication that John Gray was prescribed to seemed not to be working as indicated
by the suicidal attempts. Therefore, the cognitive behavioral therapy would be the best approach
to help John understand his thoughts and feelings that may have influenced his behavior.
Evaluation
Through the administration of the thiazide diuretics, the blood pressure of John Gray
reduced and came back to a normal range. Additionally, as John Gray went to the cognitive
behavioral therapy, his health status has improved. Moreover, the cognitive behavioral therapy
enabled John to learn how to express his feelings in other ways other than suicidal ways.
Furthermore, the therapy has helped John and he has shown signs of socialization, therefore,
with the continuation of the therapy, the risk of John experiencing depressive periods has
reduced (Lee et al., 2016). Additionally, with the supplements of the vitamins, John’s overall
wellbeing has improved.

CLINICAL REASONING CYCLE 9
Reflect on Process and New Learning
As stated by (Schmidt & Mamede, 2015), this phase is the last stage in the clinical
reasoning cycle. It is referred to as the reflection stage. This phase offers the nursing practitioner
to review how he/she has handled the case. Additionally, this stage offers the nurse the ability to
better the process, improve, or change the intervention techniques. Next time, while engaging
with a patient who has John Gray’s nature, the initial step will be to include his relatives in the
treatment procedure. This will help in ensuring that both the family members and the hospital in
collaborating to encounter potential issues that may arise in the future.
Conclusion
Through the utilization of the clinical reasoning skills, the nurse was able to identify the
health issues affecting John Gray and the treatment procedure for the convalescent. Moreover,
through the experience gained from the case study, the nurse had the opportunity to reflect on the
case and find ways to better the convalescent’s outcomes in case of another similar scenario.

CLINICAL REASONING CYCLE 10
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