Caring For An Elderly Patient With Arthritis And Macular Degeneration

Discuss about the Case Study of Amalie Jones.

Healthy aging can be defined as the development as well as maintenance of the optimal level of mental, physical as well as social well being and even functioning in the older adults. The healthcare professionals play a very important role by trying their best to keep the community safe and thereby promote their well-being (Smolen et al., 2016) . They also make sure that they advocate and conduct interventions in ways by which the old people become successful in getting access to healthcare services as well as different community programs for preventing as well as minimizing diseases. However, in order to identify the different social, physical and psychological determinants that are intricately associated with the disorders and health conditions of the patients, they should use the clinical reasoning cycle (Gossec et al., 2015). They should also use Miller’s Functional consequences theory as a framework by which they can provide care that suffice their expectations and requirements. This assignment will show how the use of both the theories effectively will help the nursing professionals to develop care priorities for the patient and maintain her dignity and social preferences at the same time.

The first step of the cycle is called considering the patient situation. Mrs. Amalie Jones is an 89 year old lady who is German by origin and had migrated to Australia after his marriage with an Australian sailor man named Henry Jones. The client’s son from her previous marriage named Dominik is well connected to her. Henry’s daughter Tracy and her family are also well connected with her and maintain regular conversation over phone. However, nowadays, she is affected with rheumatoid arthritis as well as osteoarthritis that had affected her mobility. As a result, she is gradually becoming socially disconnected that tend to have a negative impact on her health. Throughout her life, she has been very active in her social circles and therefore such separation from her active social life may have negative consequences on her emotional and mental health and result in poor quality physical health.

The second step of the cycle is called the collection of the cues that involves reviewing the current information, gathering new information and recalling knowledge of the occurrence of the disorder. The client has developed macular degeneration and her condition of rheumatoid arthritis and osteoarthritis had affected her mobility largely. The present symptoms that she is suffering from are joint stiffness, swollen foot as well as enlarged joints. She is also suffering from painful joints in her knee, hip, gingers as well as back. She also suffers from limited joint movement. All these had resulted in a poor quality social life where she is unable to interact with her social circles. Due to her disorders of the eye, she is also suffering from visual deficits. She is also suffering from constipation, as the diet she is taking is not containing any nutritious fibrous substances. Her weight loss is found to be non-significant. Although she adheres to taking medication but she also forgets them sometime when she is excessive pain. All these issues have the capability to degrade her quality of life that would not only affect her physical and social life but may also affect her psychologically. In order to ensure that she ages gracefully and healthily, the nursing professional need to process this information and develop care priorities for her.

Collection of Cues

The third step is called processing the information collected in the previous step and thereby link the information to the present condition of the patient to identify her care priorities. Arthritis is a joint disorder which results in inflammation of the joints that mainly functions to allow movement of the different parts of the body helping in locomotion. It often accompanies with pain in the joints called the arthralgia (Coates et al., 2016). The patient is seen to suffer from both osteoarthritis that mainly takes place from the wear and tear of the cartilage that occurs over a large period of time due to repeated activity of the bones and the cartilage. Another form of arthritis which she also suffers form is called the rheumatoid arthritis which mainly occurs in individuals due to over activation of the immune system. It is an autoimmune disorder where the immune system of the body attacks the tissues of the body. It affects the synovium that is a soft tissue in the joints. This is responsible for the production of a fluid that nourishes cartilage and helps in lubrication of joints.  Several of the risk factors can be identified in case of Amelia that might have resulted her in occurrence of osteoarthritis as well as rheumatoid arthritis (Ramiro et al., 2015). Researchers are of the opinion that lead people are at a higher risk of developing arthritis and Amelia’s age has made her vulnerable to the development of the disorder. Moreover, as she is a female, she is more vulnerable to the development of the disorder as researchers have found out women are more prone to develop this disorders in comparison to men. The third risk factor that remains intricately associated with condition of the client is her extensive travelling activities after her retirement. Researchers state that occupations of people that involve repetitive movements can expose individuals to development of osteoarthritis and muscoskeletal conditions. She had travelled a lot with her husband after their retirement that might have resulted in the present situation of wearing and tearing of the cartilages. Moreover, it is also seen that age is one of the most important risk factor for macular degeneration, which causes blurred as well as reduced vision occurring mainly due to thinning of the macula (Maguire et al., 2016). Macula is the region of the retina that is responsible for clear vision in the direct line of sight. This disorder is giving Amelia a hard situation for reading and writing which may worsen to situation where she may not recognize faces. Moreover, researchers have stated that constipation as one of the result for poor diet and inactive lifestyle along with lack of exercise and eating of junk food. Due to loss of mobility and poor diet, Amelia is also suffering from constipation that may give her poor quality life. Therefore, all these factors need to be attended by nursing professionals.

Processing the Information

The fourth step is called the identification of the problem and issues. This step thereby helps in definite diagnosis of the problems of the patients. From the entire discussion, there important care priorities have been identified by the restricted mobility of the patient due to both the types of arthritis. Therefore, her mobility needs to be developed (Schwartz et al., 2015). The second nursing priority is her impaired vision that is mainly due to occurrence of macular degeneration. Therefore, care should be taken so that she develops better quality life. The third care priority is her issues with constipation that often affects lives of individuals affecting their quality life. Therefore, care should be taken so that her issues of constipation can be handled effectively helping her overcome the symptoms effectively.

The fifth step is called the establishment of the goal stage that mainly involves the nursing professionals to set goals after analyzing the care priorities of the patient (Levett-Jones, 2013). From the first two care priorities, the most important intervention that needs to be taken for ensuring safe life of the patient is fall prevention strategies. As she is suffering from loss of mobility and impaired vision, it becomes very important for the professional to provide fall prevention strategies. From the third care priority, the nursing professional should involve diet management strategies as well as develop interventions by which she can engage in interactions with the society so that they can develop her quality of life and so that she can age gracefully (Nam et al., 2014).

The fifth step is called the taking action stage. In this stage, the professionals should introduce interventions for developing the health condition of patients. In this case, the nursing professionals need to apply another theory while developing care plan for the patient. They should follow Miller’s theory of functional consequences (Combe et al., 2017). The nurses should understand that every aged individual have to experience different functional consequences due to age modifications and additional risk factors. Therefore, without interventions functional consequences faced by the older people may have different negative effects on the individuals. Therefore, this theory instructs nurses to identify the factors that may have interfered with activities of the patients and help in developing interventions that enhance quality life of patients. She should mainly identify the age related changes that can be reversed and the risk factors which can be modified. Therefore, in their case study, the nursing professionals should identify the factors and then propose the interventions (Wasserman et al., 2018). In case of Amelia, the factors and care properties have been identified and the different interventions are proposed. The nurse should at first fix physiotherapy sessions where the physiotherapist would provide service to Amelie at fixed intervals in the week to help her relieve from pain. The nurse should also help her o learn free hand and light exercises with proper assistance so that she can develop her mobility in a gradual manner that would help her to gain self-esteem and self confidence. The nursing professionals should move the items of the patient in easy reach with the patient like those of call lights water, telephone, urinal and others. This is because items that are too far increase the risk of hazards by several times. The nursing professionals should respond as soon as summoned and also keep the beds at lowest possible position and patient’s sleeping surface can be placed adjacent to floor (Nikiphorou et al., 2017). Use of rails on beds, nonskid slippers and soles, keeping heavy furniture that will not tip, familiarizing the patient with the environment of the room and others also need to be done. Occupational therapy and physical therapy for development of gait can be ensured to develop her condition. The environment of the room should be brightly lit up so that the patient can see clearly see as she also has visual impairment (Matchman et al., 2015). She should be well familiarized of the different objects and layout of room so that she does not have issue and try hard to visualize any object. A proper diet plan should be given to her and she should be taught the importance of proper diet in her regular life so that she does not suffer from constipation.

Identification of Problems and Issues

The patient is German by origin and her English is not easily understandable by others. Therefore, the care that should be devised by the nursing professional should be culturally and ethically competent. The nursing professionals should develop cultural awareness and should provide culturally sensitive and culturally competent care to the patients. They should be aware of the German traditions, preferences and inhibitions and thereby follow such traditions while providing care to the patients. (Kavanaugh et al., 2014) The nurse should be careful that she does not ask the patient to repeat as that might affect the self-respect of the patient. In order to maintain her dignity and autonomy, the nursing professional should make sure that they ask for her informed consent so that she does not feel disrespected or low in self-esteem as because of her loss of functions in her old age (Hunter, 2016).

The next step is the evaluation of the outcomes and reflecting on the process. The nursing professionals should evaluate that the patient is able to move and locomote successfully on a gradual note. Risk assessment should be done so that she is free from any fall vulnerabilities. Her condition of constipation has resolved and she is gradually being accommodated with her condition of the eye that is a symptom of changes due to old age. A therapeutic relationship has to be developed between the professionals, the patient so that the client can disclose all her emotions, issues, and concerns and can communicate effectively with the patient (Singh et al., 2016). The professionals then need to reflect on their practices for enhancing their knowledge and skills successfully.

From the entire discussion above, it is seen that clinical reasoning cycle and Miller’s functional consequences theory have guided the nurse in planning proper intervention for the patient. The steps of the clinical reasoning cycle have properly guided the professionals to identify the care priorities of the patient after analyzing the requirements and needs of the patient’s conditions. All these had helped in correctly identifying the interventions required for the patient ensuring that she develops better quality life.

References:

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