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Critical Analysis And Justification Of The Care Priorities

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Question:

Present a Comprehensive Discussion and Justification Identifying two Care Priorities within a Clinical Scenario using the Levett- Jones’ Clinical Reasoning Cycle.

 

Answer:

Introduction

The care of patient with chronic disease is affected by many challenges in delivering care. Often a gap in current and optimal practice is seen when nurses fail to interpret patient’s data and integrate patients need in clinical care priorities (Lubkin & Larsen, 2013). As a primary health care nurse, it is necessary that nurses prioritize care needs of patient by identifying both clinical needs as well as patient’s needs. This process of care planning and delivering intervention can be successful by means of proper collaboration and clinical reflection to assess patients (Chang & Johnson, 2014). The purpose of the report is to analyze the case scenario of Diana Harrison, a 64 year old female who has been newly diagnosed with Parkinson’s disease and identify the main care needs of Diana. The goal is to discuss and justify two complex care priorities for the patient using the Levett-Jone’s Clinical Reasoning Cycle.

Care priority 1: Management of impaired physical mobility

Consider the patient situation- To identify the clinical care needs of Diana, the current presenting condition of Diana was observed. The 64-year old patient had been struggling with symptoms of shaking hands with tremor and unsteady gait. Her tremor worsened at night, she also was very fatigued and forgetful.

Collecting cues/ information- The discharge summary of Diana revealed she had been newly diagnosed with Idiopathic Parkinson’s disease. She was presented to the hospital with symptoms of pronounced tremor in left hand, global bradykinesia, increased fatigues and sleepy episodes. She also had  emotional outbursts and felt sad on and off for the past 12 months.

 


Process information- The analysis of patient situation revealed that she has been suffering from this symptoms because of Parkinson’s disease. It is a chronic and progressive movement disorder where symptoms worsen with time. Diana had tremors in left hand and bradykinesia because the disease leads to malfunction and death of vital nerve cells in the brain. Most of these neurons are involved in the production of dopamine that has the function of sending message to the brain part involved in movement and coordination (Benazzouz et al. 2014). Hence, Diana has been experiencing symptoms of tremor of hands, bradykinesia (slow movement) and impaired balance and coordination because her amount of dopamine has decreased with the progression diseases. This has contributed to the inability of the client to control her movement normally (Allen et al. 2013).

Identify problem/ issue- With the presenting condition of tremor, bradykinesia, rigidity, gait imbalance and emotional regulation in Diana Harrison, managing care of client will be difficult due to fall risk issue. As patient is already struggling with tremor and postural instability in her daily life, it is possible that patient will be prone to frequent falls and injure herself. The duration and severity of symptoms may also increase the risk of fall (van der Marck et al. 2014). Hence, it will be the role of the nurse to take action against this issue.

Take action- The goal of the nurse will be to establish care priorities for managing impaired physical mobility and prevent fall risk in Diana. As fall prevention will be an urgent priority for care of Diana, the first action for the nurse will be to identify the factors or areas that can intensify the risk of falling. Apart from motors symptoms of Parkinson’s disease, it may also occur due to non-motor symptoms of client (van der Marck 2014). Hence, the nurse will have to identify non-motor symptoms of fall risk such as low blood pressure, fatigue, exhaustion and constipation in patients.

The nurse will manage physical mobility in Diana by teaching her the technique to initiate movement. The nurse will make her walk erect and use wide gaits to offset the shuffling gait. Furthermore, physical immobility can be improved by means of daily exercise that strengthens the muscle of Diana. Use of certain medications is also associated with fall risk due to adverse side effects. Therefore, the nurse will have to review the medication of Diana and inform her about the precautions to taken after taking medications due to its side-effects (Tan, Williams, and Kelly, 2014).

Evaluate-The care priority of managing fall risk inpatient by identification of non-motor symptoms is important in patients because these are hidden risk factor common in patients. Fatigue may be due depression and emotional stress to life events, whereas stress might increase fear and anxiety in patient leading to fall. The care priority of engaging Diana in physical exercise is also important because it will lead to increased neuromuscular interaction and help initiate functional and morphological changes in the brain. As Parkinson’s disease is associated with decreased level of dopamine, exercise will help to raise the concentration level of dopamine by increasing the serum calcium levels (Canning, 2014). Medication review of patient is also an important part of nursing care plan as certain medications contribute to fall risk. If any medication is highly associated with dizziness, then nurse might have to change the medication to avoid fall related injury (Canning, 2015).

 
 
Reflect-Hence, the care priority of managing fall risk and physical immobility in patient is considered important to avoid further complication in patient and help them effectively cope with the symptoms of bradykinesis, tremor and rigidity. The above strategies and techniques regarding movement will help to reduce fall risk in patients and prevent the progression of disease to severe forms.

2.Care priority 2: Manage social isolation and emotional outburst in patient

Consider the patient situation- Diana Harrison has been diagnosed with Idiopathic Parkinson’s disease. In such case, no particular cause for the disease can be determined. The chronic and degenerative brain disorder is characterized by tremors, slowed movement and muscle rigidity.

Collecting cues/ information- As analyzed from handover report of Diana, apart from experience of unsteady gait, bradykinesia, fatigue and tremor in the client, she is also having emotional outburst. She is constantly becoming constantly emotional and tends to forget things at work and home.

Process information- After reviewing the discharge report of Diana, it has become evident that Diana is experience intermittent bad mood and sadness for the past 12 months. This indicates that while planning care provision for Diana, mood changes will act as a significant barrier in her recovery. It will not only intensify the symptoms of disease, it will also pose problem for Diana in carrying out her home and work responsibilities. Normally, nurses pay attention only to the physical effects of disease while developing care priorities for people with Parkinson’s disease. However, as the disease is associated with disorder of the brain and nervous system, it can affect patient’s emotional state too (Kehagia, 2016). Hence, the nurse must also pay attention to factors leading to mood changes in Diana to promote her recovery and optimal care.

 


Identify problem/ issue- After analyzing Diana’s condition, it can be said that behavioral disorder (mood changes and anxiety) can lead to intense suffering for Diana apart from physical immobility and gait imbalance. If continued period of emotional disorder continue, the client may develop depression. Similarly symptoms of fatigue and anxiety will hamper the overall body functioning and quality of life of Diana. Hence, it is necessary for nurse to take action regarding the problem faced by patient in this area.

Take action- The main nursing priority for care of Diana will be to address behavioral changes in her apart from movement disorder. The important role of nurse in addressing this problem would be to identify whether the symptoms of mood disorder and anxiety is occurring in patient due to Parkinson related neuropathological changes or it occurs due to medication related hallucination. Medication related hallucination may occur if patient is treated with dopaminergic drugs (Duncan et al. 2014). To enhance the health related quality of life of Diana, nurse will have to communicate effectively with patients to identify predisposing and precipitating factor of the condition. To help patient cope with mood disorder symptoms, nurse will have to give non-pharmacological intervention to Diana (Miller et al., 2015).

Evaluate- Effective and compassionate communication with patients is an important care priority of nurse because by this means nurse can make Diana accept the illness and also educate her about how to maintain the quality of life despite illness. The nurse will support patient in self-care and coping with the disease (Eriksson et al., 2016). The proper assessment of patients regarding danger to self or other is necessary. Based on identification of risk factors, appropriate behavioral plan for Diana will help to manage the risk. The support through psychotherapy can also be provided. Nurse may also engage Diana in distraction or other technique to help her cope with anxiety. This is a form of talk therapy to help modify negative patterns of behavior in the patient (Iansek & Morris, 2013). 

Reflect- The care priority of behavioral disorder management is important for Diana because it will prevent further complication of the disease and help her cope with illness. The identification of the reason for disorder may help to take appropriate steps to manage the behavioral changes in patients. The non-pharmacological intervention will help to enhance the motivation of patient and encourage them to life with confidence. It will bring positive changes in both her personal and work life.

 

Conclusion

The report discussed the complex care needs of Diana Harrison based on analyzing, interpreting and evaluating patient’s condition by the use of clinical reasoning cycle. The use of clinical reasoning cycle helped to process patient’s vital information and determines the main problem that may cause problem to Diana in the long run. The two nursing care priority of managing physical immobility and behavioral changes in Diana has been selected because both movement disorder and behavioral disorder influenced the health related quality of life of this group of patients. Adequate nursing care plan detailing the course of action to address the two problems in patient will enhance her quality of living and promote recovery.

 

Reference

Allen, N. E., Schwarzel, A. K., & Canning, C. G. (2013). Recurrent falls in Parkinson’s disease: a systematic review. Parkinson’s Disease, 2013.

Benazzouz, A., Mamad, O., Abedi, P., Bouali-Benazzouz, R., & Chetrit, J. (2014). Involvement of dopamine loss in extrastriatal basal ganglia nuclei in the pathophysiology of Parkinson’s disease. Frontiers in aging neuroscience, 6, 87.

Canning, C.G., Sherrington, C., Lord, S.R., Close, J.C., Heritier, S., Heller, G.Z., Howard, K., Allen, N.E., Latt, M.D., Murray, S.M. and O'Rourke, S.D., 2015. Exercise for falls prevention in Parkinson disease A randomized controlled trial. Neurology, 84(3), pp.304-312.

Chang, E., & Johnson, A. (Eds.). (2014). Chronic illness and disability: Principles for nursing practice. Elsevier Health Sciences.

Duncan, G. W., Khoo, T. K., Yarnall, A. J., O'Brien, J. T., Coleman, S. Y., Brooks, D. J., ... & Burn, D. J. (2014). Health?related quality of life in early Parkinson's disease: The impact of nonmotor symptoms. Movement disorders, 29(2), 195-202.

Eriksson, K., Forsgren, E., Hartelius, L., & Saldert, C. (2016). Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease. Disability and rehabilitation, 38(12), 1187-1203.

Iansek, R., & Morris, M. E. (Eds.). (2013). Rehabilitation in movement disorders. Cambridge University Press.

Kehagia, A. A. (2016). neuropsychiatric Symptoms in parkinson’s Disease: Beyond Complications. Frontiers in Psychiatry, 7.

Lubkin, I., & Larsen, P. (Eds) (2013). Chronic illness: Impact and interventions (8th ed.). Burlington Ma.: Jones & Bartlett.

Miller, N., Noble, E., Jones, D., Deane, K. H., & Gibb, C. (2015). Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives. International journal of language & communication disorders, 1-10.

Tan, S.B., Williams, A.F. and Kelly, D., 2014. Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review. International journal of nursing studies, 51(1), pp.166-174.

van der Marck, M. A., Klok, M. P. C., Okun, M. S., Giladi, N., Munneke, M., Bloem, B. R., & Force, N. F. T. (2014). Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism & related disorders, 20(4), 360-369

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