HI6006 Competitive Strategy Editing Service
Delivery in day(s): 4
This assignment is aimed to identify and highlight the most important nursing care issues for a given case study of Mrs. Barbara Green. Basically, three nursing care priorities would be identified for the patient and the most important one would be discussed where the management of the issue and the care services required to be delivered by a nurse would be highlighted. In order to accomplish these assignment requirements, two theoretical frameworks would be used viz. Miller’s functional consequences theory to depict the age related influence on patient’s functioning abilities and overall condition and Levett Jones Clinical Reasoning Cycle to analyze the given information of the patient, identify her important nursing care issues, planning and implementing interventions and to learn from the process. These two frameworks are widely accepted models and are extensively used by nurses. The first one assists nurses effectively support and care for older adults by understanding age related changes, risk factors and functional consequences while the second one assists them in making effective judgments and decisions.
The given case study is about 89 years old woman Mrs. Barbara Green who has been assigned a registered nurse to support and care for her at her home. In order to assess her health condition and identify her nursing care issues, a theoretical model Levett-Jones Clinical reasoning cycle would be used having eight important steps of looking, collecting, processing, deciding, planning, acting, evaluating and reflecting that are in a form of cycle and repeats itself after completion (Levett-Jones, 2013). The cycle can be better understood through a diagram shown below:
First of all, the patient would be considered to know her present condition. As per given information, Mrs. Green is staying alone in her home and find it really difficult to walk or move due to joint stiffness, swollen feet and pain in knee, hip, fingers and back joints. Her vision has got deficit, so she has stopped driving as well. She is not eating properly and getting isolated day by day as she spends most of the time at her unkempt home. She even has very limited food items at her home. Further she is having constipation and feels dizzy occasionally. She is already taking analgesics, thyroxine and Hydroxychloroquine. As the patient is in her late 80s, a lot of age related changes has also taken place. On taking functional consequences theory under consideration, modifiable, non modifiable changes and their functional consequences on patient’s health can be identified (Hunter, 2016). With increasing age, bone mass and bone density is lost which is more extensive in females especially after menopause. The bones become brittle, joints get stiff due to decrease of intra-articular fluid and cartilage gets wear away(Ndosi, et al. 2011).. Hip, knee and finger joints start degenerating and loose cartilage. With age, changes also take place in eyes and vision. Eye muscles become weak and even deposits start occurring on retina diminishing overall vision(Zhang, et al. 2011). As a result of these changes, Barbara’s ability to perform her day to day activities is decreasing. She is facing difficulty in walking or even moving, vision has reduced and she is getting socially isolated due to her inability to drive or walk out much.
The second stage of clinical reasoning cycle involves collection of cues where the gathered information would be reviewed and new information is collected through focused health assessment. It has been found that the client is staying alone in her home since last two years and her health conditions of decreased mobility and decreased vision has further limit her social interactions leaving her feel isolated. She had a very active social life in past years that can even make her depressed. She is also suffering from osteoarthritis, rheumatoid arthritis, dry macular degeneration and hypothyroidism. All these conditions along with her increasing age is deteriorating her condition and is making it difficult for her to perform activities of daily living(Delany & Golding, 2014).
Next step is to process the gathered information by interpreting, relating, inferring and matching the data and predicting the outcome. The client is a known patient of hypothyroidism that decreases metabolism and increases body weight. Thus, it seems that Mrs. Barbara is not eating properly and it is due to her hypothyroidism that her weight loss is non significant. The minimal amount of food items in her house also suggests that she is not taking proper diet. Further, arthritis has lead to the pain, swelling and stiffness in joint decreasing her mobility and dry macular degeneration has decreased her vision. Thus, the client hardly goes out of her home due to her walking and vision issues, stays alone, does not eat properly or take medicines on time and needs somebody immediately to take proper care of her(Frich, 2003)
Next is to identify the care issues for the client by using the inferences. After considering and assessing Mrs. Barbara’s present condition, it can be said that she needs immediate support and care to lead an active and managed life. Three top most nursing care priorities for Mrs. Barbara are as follows:
1. Manage her decreased mobility
2. Mange her deficit vision
3. Improve her appetite, extend support and help her overcome her isolation
These are the three most important nursing care issues that need to be considered and addressed by the registered nurse as priority. But on the top most priority must be the management of her decreased mobility. Her painful and swollen joints have limited her activities, movements and even isolated her. On looking at her past active life, her inability to walk and perform ADLs may even depress her (Hoffman, et al. 2011).
Thus SMART goals must be set to improve her movements and walking. The goals for managing her symptoms are:
Barbara’s swelling in feet and enlarged joints would be managed to reduce her discomfort in one week.
Barbara’s pain in joints would be reduced to an intensity that she can tolerate it and walk around without difficulty in two weeks.
Barbara would be able to go out to a distance to meet people with reduced pain and stiffness in her joints in one month(Shunway-Cook, et al. 2002).
Following the establishment of goals for the client, it is the time to take action. Best suitable nursing interventions would be identified to achieve the set goals and would be implemented by the nurse(Miller & Rudolf, 2011). Firstly, Barbara would be ensured that the registered nurse is now available at her home to take proper care and would support her through quality and person centered services. The nurse would make sure that she is physically, emotionally and mentally safe and would work to improve her quality of life. The nurse would not make Barbara dependent rather; she would help her regain her independence and active life. Following this assurance, the nurse would focus on her physical health and symptoms. Mrs. Green is already on medications for her pain, swelling and joint stiffness. Thus, the first and foremost requirement is to ensure that she takes her prescribed dose on time without missing. She must also be referred to her GP to reconsider her medicines and dosages and if any changes are recommended, accordingly her drugs must be given. In addition to these medications, other therapeutic modes must also be considered. As per current research, arthritis process cannot be reversed but symptoms can be managed through a variety of ways including exercise, hot and cold packs, lifestyle changes, mechanical aids and devices and even surgery(Primdahl, et al. 2014). By consulting a physiotherapist, appropriate exercises would be asked for the client and would be supported to perform those moderate exercises regularly. Exercise greatly helps in reducing pain and disability, strengthens muscles, and improves joint stability along with overall health and wellness(Daley& Spinks 2000).Further, to improve patient’s mobility, her lifestyle would be considered where it would be ensured that she gets balanced and nutritious diet, take proper rest and her sleep would be promoted through adjusted pain medications. Complementary and alternative therapies like applying hot and cold packs on painful joints, acupressure, acupuncture or Tai Chi therapies would be considered as well. In addition to these therapies, mechanical aids may be used to improve her mobility like promoting use of walking sticks and wearing shock absorbing footwear with extra support to aid walking. Large number of assistive aids and devices are available that may extend help but they may at times be uncomfortable as well as expensive.
If all these above mentioned therapies and aids also don’t help, then the Barbara must be considered for other procedures by consulting her doctor like cortisone injections, lubrication injections or realigning bones(van Eijk-Hustings, et al.2012)..
Following these interventions, the outcomes would be evaluated by checking whether the set goals have been achieved or not. It would be identified whether the reported pain is controlled or relieved, activity intolerance has been increased, client is following prescribed pharmacologic regimen, is participating in ADLs, is able to do desired activities and is encouraged to do self care. Her walking abilities and mobility would be compared with her previous state and would be checked for improvement.
The final step of this cycle is to involve in self reflection process. This whole case was a great learning experience for me as I got to learn and read about osteoarthritis and rheumatoid arthritis a lot(Moon, 2013). . I came to know about various treatment modalities and therapies that can help in relieving arthritis symptoms. However, I was unaware of impact of person’s diminished mobility on his overall mental and emotional state and if I had this knowledge beforehand I could have supported Mrs. Green in an even better way. Further, this case gave a chance to improve my overall communication and interaction skills.
It can be concluded that Mrs. Barbara Green is presently having difficult time and her health conditions are deteriorating. Her increasing age has contributed majorly towards this condition and thus, to support her and improver her quality of life, various nursing care issues have been identified for her. These are her decreased mobility, decreased vision and getting socially isolated. Out of these issues, her decreased mobility have been found as the most important issue to be considered as it is leading to discomfort and contributing towards her isolation and depression. It is planned that Mrs. Green would be given all her prescribed medicine on time and other non pharmacological treatments would also be used to manage her symptoms. Exercise, heat and cold packs and mechanical aids would be used for her along with referring her to GP and physiotherapist to improve her mobility.
For identification of these nursing issues, clinical reasoning cycle has been used that was a great learning experience for the registered nurse. She gained knowledge about arthritis management and also got an opportunity to reflect her own practice.
Daley, M. J., & Spinks, W. L. (2000). Exercise, mobility and aging. Sports Medicine, 29(1), 1-12.
Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC medical education, 14(1), 20.
Frich, L. M. H. (2003). Nursing interventions for patients with chronic conditions. Journal of advanced nursing, 44(2), 137-153.
Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.
Hoffman, K., Dempsey, J., Levett-Jones, T., Noble, D., Hickey, N., Jeong, S., ... & Norton, C. (2011). The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills. Nurse Education Today, 31(6), 587-594.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson
Miller, T. E., & Rudolf, V. H. (2011). Thinking inside the box: community-level consequences of stage-structured populations. Trends in ecology & evolution, 26(9), 457-466.
Moon, J. A. (2013). Reflection in learning and professional development: Theory and practice. Routledge.
Ndosi, M., Vinall, K., Hale, C., Bird, H., & Hill, J. (2011). The effectiveness of nurse-led care in people with rheumatoid arthritis: a systematic review. International journal of nursing studies, 48(5), 642-654.
Primdahl, J., Sørensen, J., Horn, H. C., Petersen, R., & Hørslev-Petersen, K. (2014). Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity—patient outcomes from a 2-year, randomised controlled trial. Annals of the Rheumatic Diseases, 73(2), 357-364.
Shunway-Cook, A., Patla, A. E., Stewart, A., & Ferrucci, L. (2002). Environmental demands associated with community mobility in older adults with and without mobility disabilities. Physical Therapy, 82(7), 670.
van Eijk-Hustings, Y., van Tubergen, A., Boström, C., Braychenko, E., Buss, B., Felix, J., ... & Huzjak, M. (2012). EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Annals of the rheumatic diseases, 71(1), 13-19.
Zhang, K., Hopkins, J. J., Heier, J. S., Birch, D. G., Halperin, L. S., Albini, T. A., ... & Williams, G. A. (2011). Ciliary neurotrophic factor delivered by encapsulated cell intraocular implants for treatment of geographic atrophy in age-related macular degeneration. Proceedings of the National Academy of Sciences, 108(15), 6241-6245.