Clinical Reasoning

Clinical reasoning is the process that clinicians and nurses use to consider patient situation, collect cues, process information, then to make plans and implement interventions, finally to evaluate outcomes and reflect on learning from this process (Hoffman, 2007). The framework that is used in clinical reasoning is the clinical reasoning cycle. This case study will discuss, clinical care provided to Julie Kenny, a 27 year old female, admitted to emergency department after an exacerbation of asthma using the clinical reasoning cycle as a framework using objective and subjective data (Please refer to Appendix 1) that has been provided following a comprehensive nursing assessment. Asthma, a condition of the airways, is associated with hyper

Co-existing psychological problems are particularly present in those with decreased control and poor adherence (Thomasa, Brutonb, Moffattc, & Clelandd, 2011). There are consistent evidence which suggests that health status relating asthma is impaired when anxiety is present (Cluley & Cochrane, 2001; Goldney, Ruffin, Fisher, & Wilson, 2003; Lavoie et al., 2006). A Canadian study found that the worst management of symptoms of asthma occurred in the patients with anxiety and depression. When shown in a regression model 29 % of the variance in asthma control questionnaire score was accounted by the presence of psychiatric co-morbidity (Lavoie et al., 2006). Some symptoms such as breathlessness is perceived to be more intense in patients with co-morbid anxiety even though the degree of bronchoconstriction is similar (Martínez-Moragón, Perpiñá, Belloch, de Diego, & Martínez-Francés, 2003). Therefore it can be concluded that psychological co-morbidity collates with worsening of asthma symptoms. It is normal for an individual with asthma to be anxious however if the severity is increased, the patient tends to adopt inappropriate behaviors such as poor self-management skills, poor relationships with clinicians, poor adherence to controlled therapy and indulgence in risk behaviors such as smoking and discontinuation of medications as prescribed (Bender, 2006). Anxiety causes hyperventilation, this can cause asthma like symptoms and in turn act as a trigger for asthma (Hibbert & Pilsbury, 1988). Psychological factors relating to asthma can influence biological effects on the function of the immunological, hormonal and autonomic systems contributing to the severity of asthma (Thomas & Griffiths, 2005). The short term goal is for the patient to demonstrate a reduction of anxiety