NSB303 Assessment 1: Ruby Pascal Health Promotion Plan

This case study presents a health promotion plan for Mrs. Ruby Pascal, a patient experiencing poorly managed Type 2 diabetes, generalized anxiety disorder, and obesity. The student, acting as a registered nurse, utilizes the Clinical Reasoning Cycle to assess Ruby's condition based on handover information and a simulation, identifying key health concerns such as uncontrolled diabetes, anxiety, and overweight status. The plan prioritizes problems and sets specific goals, including reducing anxiety, controlling blood sugar levels, and lowering BMI. Interventions are proposed, such as medication, patient education on diet and exercise, and relaxation techniques. The evaluation stage outlines measurable criteria, such as reduced chest pain, normalized blood glucose levels, and weight loss, to assess the effectiveness of the interventions. The student reflects on the learning experience, emphasizing the development of clinical reasoning and critical thinking skills through the analysis of the case study and relevant research.

Clinical Reasoning Cycle – Health Promotion Template (Workshop 1).
(Modified from Levett-Jones, 2013)
ASSESSMENT
Stage
Response.
Determinants of Health
Initial.
Mrs Ruby Pascal has been presented to a medical ward due to her poorly managed
Type 2 diabetes and general anxiety disorder. She has been admitted in the ED with
Nausea, chest pain and vomiting, which is probably due to the panic attack that has taken place.
Interview, documentation,
observation.
Medical history includes Metformin for managing diabetes. For her general anxiety disorder, she had been receiving
professional treatment. She has been vising psychologists and had been under short term treatment by her GP. Ruby’s
BMI>35.
Ruby’s anxiety have augmented highly after her husband’s diagnosis with cancer 3 months age, and her three children
are being looked after by her mother in Gin Gin.
Ruby also stated that she self-meditated valium 10 mgs at both day and night and sometimes even three times a day.
She stated that she knows about the dosages and does not takes much.
Ruby does not eat healthy food, as there is nobody to help her with cooking. She is not much in to physical exercises and
usually utilizes the taxi vouchers to get in to the hospital.
SW
our
text
her

Identify health concerns.
Identify patterns or
connections.
1. Uncontrolled diabetes
2. Generalized anxiety disorder
3. Overweight and obesity
People with mental health problems like depression or anxiety disorder are likely to develop anxiety disorders.
Diagnosis of Ruby’s husband with bowel cancer and her children living under the care of Ruby’s mother away from
Ruby also troubles can be the possible reasons for her anxiety. Biological changes induced by diabetes along with
the life style limitations and feelings associated with chronic illness can be linked with poor mental health.
Ruby is not a healthy eater as she has no domestic help to assist her in cooking and hence have to manage in take
away meals from nearby shops.

P
l
Stage Response
Identify and prioritize
problems. Number them.
1. Generalized anxiety disorder. Specifically , to reduce the feeling of chest pain, nausea and vomiting
2. Type 2 Diabetes level
3. Obesity
Select top 3 problems and
write goals for each
problem.
To reduce the anxiety level, evidenced by
reduced chest pain, nausea and vomiting To control her blood sugar level
To bring down her BMI to about 18.5–
24.9

Implement
Show the
actions/interventions to be
taken for the top 3 problems.
Number them clearly so that
they correspond.
1. Serotonin and norepinephrine
reuptake inhibitors (SNRI)
antidepressants, Prozac, Paxil needs
to be administered after the
admission of Ruby.
2. Ruby needs to be taught about the
signs and symptoms to escalate
anxiety, brisk walks and physical
exercises.
3. Encouraging the patient’s
participation in relaxation exercises
like deep breathing, guided imagery,
progressive relaxation of the muscles
and meditation.
1. The blood glucose level should
be assessed before meals and
at the bedtime
2. Ruby should be educated about
the daily monitoring of the
blood glucose level
3. The patient should be educated
about the type of food she
should consume.
1. To encourage the patient to maintain
a healthy diet, like preventing junk
foods or take away foods from
outside or sweetened beverages.
2. The patient should be encouraged
physical activities like yoga, aerobics
or brisk walking
E Stage
Show the criteria (changes in
cues) the you will use to
measure to show if each goal
was achieved.
1. The patient will be able to
verbalize less chest pain, nausea
and anxiety.
2. The heart rate and the respiratory
rate of the patient will decrease
3. The patient will respond to the
various relaxation approaches
with a reduced anxiety levels.
1. Ruby will show a blood
glucose level reading of less
than ,180mg/dL
2. The patient will be able to
perform blood glucose
monitoring at home.
1. Ruby will be able to identify
the inappropriate behavior
and the consequences that is
associated with obesity.
2. The patients will show a
change in the eating patterns
and participating in
individual programs
3. Ruby should display weight
loss with proper
maintenance of health.

v
This case study has helped me to understand about the prompt measures that should be taken for the emergency patients
admitted in the hospital. While learning about the interventions, I had to brainstorm through several journal articles for
strengthening the research base of each of the interventions. This has also helped me to develop my clinical reasoning and
critical thinking skills to understand the underlying pathophysiology of each of the clinical cues obtained from the case
study. I further intend to continue with lifelong learning for remaining updated with the nursing researches and evidences.