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Discuss about the Considering the Patient Barbara ?



Nursing care to the old is an initiative that has been less emphasized on in the nursing career. Recently it has become quite significant that as one age, one develops the propensity to illnesses. While taking care of these elderly patients, not all nurses can manage the task since not every nurse learnt these type skills in school. The duty requires a specialist nurse who has enough skills as well as compassion and understanding. The need for a specialist nurse is the fact that older adults suffer from depression, which acts as the platform for breeding other illnesses (Anderson, & Braun, 2009). Given the case of Barbara, who feels very connected to the community, and that she wants to stay in her home, the nurse taking care of her will have to deliver the services at her home. The paper will elaborate in depth, the nursing care priorities as well as the use of the clinical reasoning cycle. The paper will be structured in a way that it will first identify all the nursing care priorities and then from there, it will establish the most important priorities.

Clinical thinking and decision making by thinking critically and clinically, Is essential while considering a case of a given elderly patient. In nursing, caregivers follow the clinical reasoning cycle to collect information about the patient. Considering the patient Barbara, the information that a nurse ought to collect, includes her age, how she lives, who she live with, and the type of house does she live in. Barbara is 89 years old, lives in a single-storey house, and has a son who lives in Australia and a stepdaughter who is married in Germany. Both do visit often, and at one point, her son offered to take her with him to Australia though Barbara turned down the offer. Barbara is now twenty-four years since retiring as a teacher, due to the closeness she has developed with the neighbors, she feels much attached to the community and does not consider leaving her house. Off late, Barbara has been experiencing reduced levels of activity due to health deterioration that is mostly being contributed by the decreased cellular regeneration activity and muscle activity (Benner, 2017). However, the isolated way she is currently living in, may be the major risk factor for the development of illnesses; moreover, she rarely leaves the house due to altered mobility. The reduced physical contact with friends and German Association members has contributed to her depression. It is argued that older adults living alone at home without any social support are at the risk of developing depression, which results to deteriorated physical health as well as multiple chronic medical conditions (Carpenito-Moyet, 2012). 


Barbara has a dry macular degeneration, hypothyroidism, rheumatoid arthritis, and osteoarthritis according to her historical health records. Also, the GP has also noted joint stiffness, swollen feet, and enlarged joints, painful joint especially the knee, hip, fingers and back, limited joint movements, constipation, occasional dizziness, vision deficit, non-significant weight loss and occasional forgetfulness of medication when the patient is in pain. From this diagnosis the GP has also prescribed medication to the elderly patient as follows slow release paracetamol 665mg tab three times a day, ibuprofen 400 mg three times a day, thyroxin 150 mcg daily and hydroxyl-chloroquine 200mg daily to help manage the condition (Chellel, 2014).

Barbara’s house is usually untidy, has a food shortage such that the only food found at her house is tins of soup and baked beans meaning she is not eating healthy besides living in a dirty environment. Due to this, she is losing weight rapidly which combines with her medical history to worsen her illness state.

The dry macular degeneration has led to increased blurredness and reduced eye view, hindering her from driving. The inability to drive has increased the isolation, and this has increased the chances for depression (Daly, 2012).

Inadequate metabolism is also another condition contributing to her illness and immobility due to the Hypothyroidism condition. The condition involves inadequacy in thyroid hormone condition, a hormone that is responsible for metabolism in the body (Eliopoulos, 2010). 

 Barbara has also been diagnosed with Rheumatoid arthritis that is making her feel pain in her joints especially her knee, hip, fingers and back as well as limited joint movement. This kind of illness is being caused by a chronic inflammatory disorder that has attacked more than just the joints (Silveira Kempfer, 2012). This kind of disorder is mainly perpetuated when the body immune system attacks own body cells and tissues. The illness affects the joint linings in the body, leading to painful swelling, which results in joint deformation due to bone erosion. This limits the movement of joints and body locomotion (Flaherty, 2008).

Another condition that is further contributing to body deterioration is the Osteoarthritis. This particular kind of illness attack specific joints such as joints in the hands, knees, hips and spine. However, this kind of illness may be slowed down due to increased physical activity. Barbara Osteoarthritis condition has been slowed down over the years due to her engagement in activities with her husband. Consequently, after the husband passed away the condition has covered more ground due to increased inactivity (Hing, E.,2011).


According to the diagnosis performed by the GP, Barbara is also suffering from constipation dizziness and occasional forgetfulness. This kind of symptoms may be related to poor eating habits that deny the body the required minerals and energy. The lack energy leads to reduced brain functioning hence increasing forgetfulness, and the lack of the necessary minerals in the body reduces the rate of thyroid production hence reducing metabolism. Reduced metabolism coupled with reduced body energy is the cause behind occasional dizziness that she is experiencing (Hunter, 2016).

Constipation experienced by Barbara might be a culmination of all the illnesses that are currently attacking her body. Given her age condition and the medication, the treatment she is currently undergoing, constipation might result from any direction (Jasper, 2013). Some of the assumptions that can be made regarding the cause of constipation may involve;

Administration of anti-acid medicine that contain aluminum or calcium, Changing the usual diet and activities, eating disorders, reduced activity, lack of adequate water or fiber in her diet, problems with the nerves or muscles in the digestive system, stress, lack of enough sleep and use of strong pain medication or under reactive thyroid (Larsson Mauleon, 2015).

Having identified all the above challenges and illnesses, the following goals have been formulated to help improve the health condition of the patient.

The first step is to ensure that the patient is on a proper diet by making sure that the patient's cupboards are well stocked with food. This will be followed by taking her medicine plus make sure that she is taken out twice a week to visit her children as well as to visit the German association members. Moreover, she will be going to local church on Sundays. This will ensure that she maintains her touch with the society as well as reduce depression. Also, her house will always be clean at all times, to ensure she stays in a clean environment. Finally, physical exercises will be made possible through some guidance to try to slow down the illness (Levett-Jones, 2013).

The nurse will ensure that the above set goals are achieved through proper discipline and strategies. The actualization of these goals will involve, taking Barbara to the clinic for medical checkups, applying knowledge and skills attained from nursing training to guide her during physical exercises. Ensure that the tidiness of her house will be taken care of by the house help who will conduct the house duties under supervision, and proper diet to be provided in line with a laid down schedule (Locsin, 2012).

The management of depression kept under control by ensuring that her social life is maintained by taking her around to see her children as well as the German Association members. Moreover, she will be visiting the local church every Sunday.

Finally, the medication prescription given by the GP will be strictly followed at all time under through proper supervision.



After implementing all these strategies aimed at improving Barbara's welfare, an evaluation will be conducted to ensure that there is some realization of progress.

After implementing these strategies, the patient’s weight will be measured and recorded weekly, to track the progress. The level of food intake will also be measured considered plus random questions to determine the memory of the patient. However food intake will be at top of the list, this is because most of the issues surrounding the patient usually have a direct effect on the food intake of the patient (Salminen et al., 2017). The other technique will be through observation where she will be observed whether her joints are healing and whether the inflammation is reducing (Marshall, 2010).


When I first enrolled in a nursing college I knew this is the career to take me to unimaginable levels of experience, as soon as I was through with my college, I had all the confidence since I thought everything to do with nursing was at my fingertips. Nevertheless, that would be short-lived once I was tasked with the responsibility of taking care of the old. However, it was such a tremendous learning experience.  I used to think that the old and retired people are the happiest as they had less to do. The only thing I thought they did was relaxing and reminisces on what they had achieved. That is far from the case. 

I now get to understand that loneliness, as well as inactivity, can lead to the eruption of diseases. Also, the fact that Barbara’s inability to remember her medication shows that there are a lot of patients out there suffering silently and Barbara is just one of them. Another lesson is that proper diet is very crucial and next time I happen to come across a patient suffering, the same conditions as Barbara I will be sure to take the necessary steps towards fighting the illness (Ramont, 2012).

Through the experience, I now believe that I can pass my knowledge to others through teaching and that, the suffering that the old go through should not take place with all this information around (Reed, 2009). 



Nurses are the backbone of the health system in any society. They can understand and deal with a patient regardless of the health challenge one is facing. Dedicating one's life to taking care of others health conditions is a tough decision as the patient expects the nurse to perform to his/her condition. However, the nursing career also needs one who is well equipped with health knowledge and experience. The case becomes even more demanding when one is dealing with the elderly, as one is required performing the nursing duties and still showing compassion. In away the nurse acts as if he/she is art of the patient’s family providing companionship for the patient.



Anderson, M., & Braun, J. (2009). Caring for the elderly client (1st ed.). Philadelphia: F.A. Davis.

Benner, P., & Hughes, R. (2017). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. Retrieved 26 March 2017, from

Carpenito-Moyet, L., & Carpenito, L. (2012). Nursing Care Plans & Documentation (1st ed.). Philadelphia: Wolters Kluwer Health.

Chellel, A. (2014). Critical Reflection in Health and Social CareCritical Reflection in Health and Social Care. Nursing Standard, 21(44), 30-30.

Daly, B. (2012). The acute care nurse practitioner (1st ed.). New York: Springer Pub. Co.

Eliopoulos, C. (2010). Gerontological nursing (1st ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Flaherty, M. (2008). The care of the elderly person (1st ed.). St. Louis: Mosby.

Hing, E., & Uddin, S. (2011). Physician assistant and advance practice nurse care in hospital outpatient departments (1st ed.). Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

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.

Jasper, M., & Rosser, M. (2013). Professional development, reflection and decision-making in nursing and health care (1st ed.). Chichester, West Sussex, U.K.: Wiley-Blackwell.

Larsson Mauleon, A. (2015). Care for the elderly (1st ed.). Stockholm.

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

Locsin, R. (2012). Quo Vadis? Advanced Practice Nursing or Advanced Nursing Practice?. Holistic Nursing Practice, 16(2), 1-4.

Marshall, L. (2010). Take charge of your nursing career (1st ed.). Indianapolis, IN: Sigma Theta Tau International.

Ramont, R., Niedringhaus, D., & Towle, M. (2012). Comprehensive nursing care (1st ed.). Upper Saddle River, N.J.: Pearson.

Reed, P., & Shearer, N. (2009). Perspectives on nursing theory (1st ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Salminen, H., Zary, N., & Björklund, K. (2017). Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning. Retrieved 26 March 2017, from

Silveira Kempfer, S. (2012). Nursing Care Centered on the Best Practices. Journal Of Nursing & Care, 01(04).


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