Health Assessment Report: Clinical Reasoning Cycle for Patient Care

This report focuses on the application of the clinical reasoning cycle in health assessment, using the case of John Wells, an 82-year-old dairy farmer who experienced a head injury after a motorbike accident. The paper details the initial assessment, including vital signs and the patient's complaints of dizziness, nausea, and headache, alongside memory issues. The report emphasizes the importance of gathering cues and processing information to determine the patient's condition, particularly considering potential concussion. The Glasgow Coma Scale (GCS) is highlighted as a crucial assessment tool. The report discusses the patient's symptoms, the potential impact of concussion on the patient's health, and the need for diagnostic tests. The report concludes by emphasizing the value of a priority-based nursing approach to help nursing professionals prioritize the health complications of patients and then provide them with accurate interventions to obtain positive outcomes. The paper aims to develop a patient management plan that facilitates systematic phases and supports accurate and appropriate decisions for holistic patient care.

Running head: HEALTH ASSESSMENT
CLINICAL REASONING CYCLE
Name of the student
Name of the university
Author note

1HEALTH ASSESSMENT
Consider the patient situation
In this paper, the case study of John Wells (82 years) would be considered as the
patient situation and while developing his priority based care, Levett-Jones clinical reasoning
cycle would be used for developing effective flow of interventions.
John Wells (82) is a dairy farmer who met with an accident on the day he was brought
to the emergency department of the healthcare facility by his son, Sam. While returning home
from his dairy farm, John fell from his motorbike as he became unstable. As per John, he fell
on his left side, due to which, the left side of his head hit the clear ground. As he was not
wearing any protective equipment at the time of accident, along with mild head injury, he
sustained skin tears in his elbows and forearm. After this incidence, he started feeling dizzy,
nauseated and headache. Further, Mavis, his wife also observed that he is unable to remember
the tasks he performed this morning and also felt lack of appetite, due to which she become
concerned about John. While discussing his medical history, no such head injury related
history was found as well as no risk of health complaints and critical conditions were
observed in the patient that could related to his current chief problems, associated with head
ache, nausea and dizziness. However, in criticism of the same, as per Wallace et al. (2017),
there are other risk factors that could be associated with his chief health concerns. Such risk
factors will comprise of adverse health consequences such as lack of energy, high or low
blood sugar level, sudden fall in the blood pressure and others. Furthermore, as per Rague
(2017), one of the primary risk factors of concussion includes chronic and fatal consequences
such as long term concussive damage that occurs due to direct accident or head injury.
Hence, from this discussion it is evident that concussion and associated head ache and injury
are the primary risk factors of John’s health complication due to which he is suffering from
head ache, nausea and dizziness. Therefore, it becomes important to collect the cues of his
health complication through application of health assessment and then determine the reason

2HEALTH ASSESSMENT
and interventions of his complications (Baxter and Udod 2019). One of the primary reasons
underlying the collection of cues associated with John’s complication includes an
understanding and subsequent development of a preferential order of healthcare processes
and interventions. Such a nursing process would be effective in developing a comprehensive,
holistic and efficient flow of interventions for Mr. Wells so as to instil critical awareness on
the need to include quality and holistic nursing care during healthcare health care intervention
implementation (Goodman et al. 2016).
Collecting cues and information
After Sam brought John Wells to the healthcare facility with his health complications,
vital signs were collected. As the patient complained about having dizziness, nausea, mild
confusion, vital signs were assessed for collection of cues regarding identification of
abnormalities in the patient’s baseline physiological processes. The body temperature of John
was optimum, whereas the blood pressure was slightly elevated as the reading was 148/84
mmHg. Besides this, the pulse rate and respiratory rate was found to be in optimum range.
The oxygen saturation level was also optimum hence no connection between his
complications and his vital signs were observed. However, he was facing difficulty in
remembering his day’s activities as well as due to loss of appetite and head injury, he was
feeling dizziness. Hence, in such condition, few other assessments should also be conducted
to understand the effectiveness of it. As per, Yue et al. (2017) Glasgow Coma Scale (GCS)
should be included in the diagnosis process as it helps to analyse the consciousness of
patients that are suffering from severe brain injury. Through the measurement of these
aspects such as eye opening, verbal responses, motor responses their level of consciousness
are assessed. As per Reith et al. (2016), if the patient obtains score less than 8, then he should
be considered as severely injured, whereas pain score between 9 to 12 is considered as
moderately injured. The normal range of GCS is 13 to 15. Hence, in case of John Wells, this

3HEALTH ASSESSMENT
GCS should be implemented in the assessment so that the level of consciousness could be
assessed. Moreover, to understand the level of his brain injury, neuroimaging diagnosis tests
such as MRI and CT scan should also be conducted to connect his health complications to his
health conditions that arise after his mild accident (Cesari et al. 2016).
Processing the information
As per Lavallee et al. (2016), majority of the patients inflicted with head injury, suffer
from dizziness. Such condition could be termed as concussion in which concerns are
associated with disturbances in balance, mobility, and improper speech with irregular
cognitive abilities are observed. Further, while analysing the risk factors that are associated
with post- concussion dizziness, it is mentioned by McNeal and Selekmen(2017) that stress,
anxiety, head movements, certain patterns due to which patients suffer from dizziness. In this
condition, it should be mentioned that due to the patient reported a pain score of 4/10 and did
not have any vital sign except slightly high blood pressure, conduction of GCS was important
to understand the reason of his health complications. It was estimated that if the patient
obtained GCS score less than 8, then he is suffering from severe brain injury and to ensure
that several diagnosis process was conducted with the patient such as CT scan and MRI so
that the patient and his severity of brain injury could be estimated. His vital signs did not
indicate towards any health complication, except his slightly elevated blood pressure, which
could have been developed due to stress or depression after his head injury. Further, as per
Lavallee et al. (2016) it was seen that due to concussion, patients develop dizziness, stress
and depression due to which their blood pressure increases. Further, due to the lack of
evidence from the vital sign assessment, this paper identifies GCS or Glasgow Coma Scale as
the primary assessment method to determine patient consciousness. Therefore, as per the
clinical reasoning cycle developed by the Dalton, Gee and Levett-Jones (2015), these are the

4HEALTH ASSESSMENT
information that were processed and analyzed for the effective care of Mr. Wells in his care
process.
Conclusion
In this paper, discussion about priority bases care has been done so that the patient
and his care priorities could be arranged in a way that his critical health complication could
be treated on priority basis. Priority based nursing approach is considered as an important
aspect in health care that helps nursing professionals to prioritize the health complications of
patients and then provide them with accurate interventions to obtain positive outcomes. This
paper used the first three steps of Levett-Jones clinical reasoning cycle and through the
application of this clinical reasoning cycle discussed about the case situation of John Wells
and in the process his health complication associated with concussion has been developed.
Hence, in this paper, all the aspects associated with this clinical reasoning cycle has been
included in the paper as it is easier to develop patient management plan and systematic
phases, accurate and appropriate decision could be made for the holistic care of the patient, in
their particular health complication.

5HEALTH ASSESSMENT
References
Baxter, P.E. and Udod, S., 2019. Priority Setting in Nursing Administration Research: A
Rapid Review of the Literature.
Cesari, M., Prince, M., Thiyagarajan, J.A., De Carvalho, I.A., Bernabei, R., Chan, P.,
Gutierrez-Robledo, L.M., Michel, J.P., Morley, J.E., Ong, P. and Manas, L.R., 2016. Frailty:
an emerging public health priority. Journal of the American Medical Directors
Association, 17(3), pp.188-192.
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.
Goodman, C., Dening, T., Gordon, A.L., Davies, S.L., Meyer, J., Martin, F.C., Gladman,
J.R., Bowman, C., Victor, C., Handley, M. and Gage, H., 2016. Effective health care for older
people living and dying in care homes: a realist review. BMC health services research, 16(1),
p.269.
Lavallee, J., Gray, T., Dumville, J. and Cullum, N., 2016. Preventing pressure ulcers in
nursing homes using a care bundle. European Health Psychologist, 18(S), p.976.
McNeal, L. and Selekmen, J., 2017. Guidance for return to learn after a concussion. NASN
school nurse, 32(5), pp.310-316.
Rague, J.M., 2017. Smaller Introducer Sheaths for REBOA May Be Associated With Fewer
Complications: Teeter WA, Junichi M, Idoguchi K, et al. J Trauma Acute Care Surg. 2016;
81: 1039-1045. Journal of Emergency Medicine, 52(3), p.388.
Reith, F.C., Van den Brande, R., Synnot, A., Gruen, R. and Maas, A.I., 2016. The reliability
of the Glasgow Coma Scale: a systematic review. Intensive care medicine, 42(1), pp.3-15.

6HEALTH ASSESSMENT
Wallace, J., Covassin, T., Nogle, S., Gould, D. and Kovan, J., 2017. Knowledge of
concussion and reporting behaviors in high school athletes with or without access to an
athletic trainer. Journal of athletic training, 52(3), pp.228-235.
Yue, J.K., Robinson, C.K., Winkler, E.A., Upadhyayula, P.S., Burke, J.F., Pirracchio, R.,
Suen, C.G., Deng, H., Ngwenya, L.B., Dhall, S.S. and Manley, G.T., 2017. Circadian
variability of the initial Glasgow Coma Scale score in traumatic brain injury
patients. Neurobiology of sleep and circadian rhythms, 2, pp.85-93.