Identifying Physical Health Issues of the Patient

The use of clinical reasoning cycle as developed by Levett Jones has been found to be extremely effective in dealing successfully with the complicated clinical scenarios in a convenient manner (Levett-Jones, 2013). The clinical reasoning cycle primarily based upon evaluating the condition of the patient based upon the collection of information, identification of the risk areas, undertaking decision about the interventions, setting goals, developing a care plan, evaluating the efficacy of the nursing goal based on the factors of evaluation and finally reflecting upon the clinical experience. The provided case study deals with the clinical scenario of 83 year old client, Mr. Dinh Nguyen and discusses about the intervention strategies based upon the practical use of the clinical reasoning cycle. The further sections of the paper would deal with identification of the physical health issues of Mr. Nguyen and critically proceed with designing an effective intervention with respect to all the steps that are followed in the clinical reasoning cycle. It is expected that this paper would successfully access the client and yield positive patient outcome.

The client Mr. Dinh Nguyen is 83 years old and immigrant from Vietnam. The client history reveals that Mr. Nguyen developed multiple sclerosis six years ago. The patient also reported to be affected with Osteoarthritis. However the condition of Osteoarthritis has been controlled to a considerable extent with the use of regular medication. The case study states that Mr. Nguyen lives alone and has been widowed twelve months ago on account of the death of his beloved wife Ngoc. It has also been reported in the case study that Mr. Nguyen does not have any children and although his brother and his family lives close by, he does not like seeking help from them. This is because the client does not want to bother his brother and his family with his physiological complications. The death of Mr. Nguyen’s wife has taken a toll on him and as a result he is finding it extremely difficult to manage the activities of daily living such as cooking, tying his shoe laces, showering and dressing up quite difficult for him. In addition Mr. Nguyen has also stated sensing a blurred vision, a sensation of a shock or tremor while he tries to move his head and neck. He also states that he is facing difficulty with urinary incontinence and a numbness in his face. 

Designing an Effective Intervention

On critically evaluating the medical history of the client and the medications that have been administered to the client, it can be said that the client has been administered medications which include the following:

• Panadol Osteo 6/24 Oral prn (with a maximum limit of 6 dose per day)
• Teriflunomide 14mg to be consumed orally daily
• Prednisolone 25mg Oral BD (to be consumed orally in case of an exacerbation)

In addition to the above stated medications, no other medications have been prescribed to the client. On critically evaluating the information provided by the patient, it can be said that the patient is likely to need assistance with activities of daily living. It can also be said that on account of living in isolation, the client can be a potential victim of depression and age related emotional stress and trauma (Gallo et al., 2013).

On the basis of the information that has been collected from the case study, it can be said that the issues that Mr. Nguyen is facing with movement is primarily because of the effect of multiple sclerosis and old age related degenerative changes of the muscular tissues. Scientific evidences have revealed that with the onset of Senescence, negative consequences such as loss of muscular elasticity and degeneration are common (Rantakokko et al., 2013). The numbness in the face can also be related to as a symptom of multiple sclerosis (Galea et al., 2015). The blurred vision can also be related to as an age-related disorder. Evidences have revealed that after the age of 45, blurred vision due to development of cataract is extremely common in men and women (Zhang et al., 2013). The feeling of insecurity and fear can be related to the initial symptoms of depression associated with the negative impact of old age (Weiss Wiesel et al., 2015). The medications that are administered are primarily to help with pain relief and treat the relapsing symptoms of multiple sclerosis (Filippi et al., 2016).

The primary issue that has been identified on the basis of the present physical condition of the client is, assisting the client with activities of daily living. The case study characteristically mentions that the client is experiencing tremors at the back and in his legs that is making it difficult to manage activities such as cooking, dressing up or taking a shower. Scientific studies reveal that with advancing age the ability to manage activities of daily living independently gets impaired (Kalyani et al., 2014). 

The second issue that has been identified is the persistent stage of psychological disturbance that the client is subjected to. It has been stated in literatures that old age marks the onset of depression associated with the negative effect of fear and insecurities in life and arrival of death (Gao et al., 2013). It has also been mentioned in the case study, that the client does not have any children to look after him and is widowed so it makes it extremely essential to address the psychological insecurities of the client.

Addressing Mr. Dinh Nguyen’s Needs for Activities of Daily Living

The third issue that has been identified ion close association to the case study, is to help the patient with problems of blurred vision and managing the symptoms of recurring multiple sclerosis. Blurred vision or vision impairment is often linked to advancing age that leads to the development of cataract or deterioration of the retina (Zhang et al., 2013).

In relation to the three nursing issues that has been identified, the goals would comprise of addressing the needs of the client with activities of daily living, catering to the emotional imbalance that might lead to severe depression if not addressed spontaneously and devising an intervention to assist the client with the problem of his blurred vision. It would also comprise of managing the advanced and recurring symptoms of multiple sclerosis (Landi et al., 2013). In order to address the three goals individually a nursing care plan would be chalked out that would ensure that the status of the patient is improved to an extent that the client is being able to sustain himself with minimal stress or agitation.

The action plan designed is aimed at improving the present physical health and mental health condition of the client. It is aimed to be followed for a time period of six months and on the basis of the stringent evaluation of the nursing plan after six months, further decision would be taken to proceed with the care plan or introduce amendments in order to ensure better effectiveness. The action plan developed in order to critically provide relief in accordance to the three identified nursing issues are as follows: 

Firstly, providing the patient with home based nursing care for a period of 24 weeks. The rationale behind the providence of home based nursing care is to assist the client with activities of daily living that would also help in reducing the possibility of a major accident or a fall (Hunter, 2016). Secondly providing the patient with a personal psychotherapist for a period of 24 weeks. The rationale behind the providence of a personal psychotherapist is to ensure that the client does not get over burdened with complications and depression related to ageing. At the same time, it would also ensure that the client is able to communicate effectively with the care giver so that the care giver is efficiently being able to manage all health related issues. The third intervention would include referring the patient to an eye-specialist. This would be carried out on the very first week of the nursing plan implementation. The rationale behind referring the client to the eye specialist is to get thoroughly checked about the presence of a possible cataract or retinal damage and accordingly assist the client with a surgery or providing glasses. It has been clearly mentioned in the case study that the client has recently been experiencing blurred vision but has not been prescribed eye medication or glasses to provide relief. Further, in order to assist the patient with his blurred vision, items of daily use would be kept in reach of the patient so that the patient does not have to struggle with finding out things and hurt himself. This would be ensured by the appointed nurse who would be in charge of ensuring home-based care.

Catering to His Emotional Imbalance

The success rate of the nursing plan would depend upon the positive feedback of the client in terms of satisfaction with the nursing care. It would also be analysed on the basis of several parameters such as the ability of the patient to communicate spontaneously with the care givers about the complications experienced by him. It would also depend on other factors such as the ability to manage the activities of daily living with the help of the appointed care giver. The evaluation of mental status would be done on the basis of the Mental State Examination score and comparing it with the previous score of the client. This would help in judging the efficacy of the designed nursing plan and at the same time if no significant improvement is witnessed then the nursing plan would be improved. This would be done by devising a new nursing care plan with better methods of intervention to provide relief to the client. 

According to Levett-Jones (2013), critical reflection helps in analysing the clinical scenario and at the same time develop a rational to significantly adapt measures to improve the decision making process. As mentioned by Hunter (2016), critical reflection helps in developing a better self-assessment. On critically reflecting over each steps that have been taken in order to design appropriate nursing interventions for the client, it can be said that the knowledge of clinical reasoning cycle has helped me in undertaking proper clinical decision. I can clearly state that the interventions that have been proposed by me and are enlisted in the action plan have been taken after drawing reference from scientific literatures and at the same time with close association to the steps of the clinical reasoning cycle.

Therefore to conclude, it can be said that the clinical reasoning style serves as an important tool that helps the nursing professionals in designing appropriate interventions by critically accessing the condition of the patient. It has also been reported that the efficient use of clinical reasoning helps in rendering better service delivery and at the same time ensures positive patient outcome. 

References:

Filippi, M., Rocca, M. A., Ciccarelli, O., De Stefano, N., Evangelou, N., Kappos, L., … & Gasperini, C. (2016). MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. The Lancet Neurology, 15(3), 292-303.

Galea, I., Ward-Abel, N., & Heesen, C. (2015). Relapse in multiple sclerosis. Bmj, 350, h1765.

Gallo, J. J., Morales, K. H., Bogner, H. R., Raue, P. J., Zee, J., Bruce, M. L., & Reynolds, C. F. (2013). Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. Bmj, 346, f2570.

Gao, Y., Huang, C., Zhao, K., Ma, L., Qiu, X., Zhang, L., … & Tang, Y. (2013). Retracted: Depression as a risk factor for dementia and mild cognitive impairment: a meta?analysis of longitudinal studies. International journal of geriatric psychiatry, 28(5), 441-449.

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, pp 115

Kalyani, R. R., Corriere, M., & Ferrucci, L. (2014). Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. The lancet Diabetes & endocrinology, 2(10), 819-829.

Landi, F., Cruz-Jentoft, A. J., Liperoti, R., Russo, A., Giovannini, S., Tosato, M., … & Onder, G. (2013). Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age and ageing, 42(2), 203-209.

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson,pp 75-117

Rantakokko, M., Mänty, M., & Rantanen, T. (2013). Mobility decline in old age. Exercise and sport sciences reviews, 41(1), 19-25.

Taylor, W. D. (2014). Depression in the elderly. New England journal of medicine, 371(13), 1228-1236.

Weiss Wiesel, T. R., Nelson, C. J., Tew, W. P., Hardt, M., Mohile, S. G., Owusu, C., … & Ramani, R. (2015). The relationship between age, anxiety, and depression in older adults with cancer. Psycho?Oncology, 24(6), 712-717.

Zhang, X., Bullard, K. M., Cotch, M. F., Wilson, M. R., Rovner, B. W., McGwin, G., … & Saaddine, J. B. (2013). Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005-2008. JAMA ophthalmology, 131(5), 573-581.