Discuss about the Parkinson Disease Of Mr. Rathin Bhai.
Clinical reasoning cycle is a tool used by healthcare professionals in Australia. This tool helps the nurse in assisting their treatments of the patients by helping them in clinical reasoning, clinical judgement, problem solving as well as decision making and critical thinking (Dalton Gee and Levett-Jones 2015). By this process the nurse mainly follows sequential pattern of collecting cues about the patient, processing the information coming to an understanding of the patient. It also helps the patient to plan and implement interventions followed by evaluation of the outcomes and then reflecting on the procedure to develop skill and knowledge (Hnter and Arthur 2016). This assignment would thereby show a how a nurse can use the cycle effectively to handle a case of Parkinson diseases effectively and how a sequential procedure helped her to provide e better quality life to the patient.
This step mainly helps the nurse to describe as well as list different facts about the patient. Mr.Ratin Bhai is an 87 year old man who is a widower as his wife has passed away a year ago he has migrated from India to Australia before 1946 and is residing in a two storey house on the superannuation which he has self managed to this day. He has no children. However he has a brother named Niraj and his family lives close by. However he does not want them to bother due to the recent tremor he is facing in his regular life. This is creating issues for his daily activities like cooking food, making cup of tea, doing buttons and others. He has hypothyroids which affected him 4 years ago. However, it is well managed by proper medication.
Collection of cues
This step mainly helps the nurse to review his current information, gathering new information about the patient and then recalling knowledge in order to understand the patient’s information. Mr. Ratin Bhai is an old man who is performing all his activities by himself. At such age, old men are highly vulnerable to development of tremor like symptoms as this age often project them to the chance of developing Parkinson’s disease. The GP has asked the nurse to check that whether he is having the correct medication is because researchers have seen that when patients do not report hypoglycaemia properly with medication, it may lead to hand tremors. It is very essential to check out that whether he is taking the thyroid medication properly or whether his symptoms of hand tremors are the results of improper hypothyroid medication (Weerkamp et al. 2014)
This step mainly involves interpreting and analysing the data which is collected from the signs and symptoms discriminate and distinguish relevant information from the irrelevant information. This is then followed by relating, inferring from the opinions and then matching them with the patient situation and thereby predicting outcome (Kovisto et al. 2016). It is found that the patient is correctly maintaining his medication. His issues with the hand tremor is worsening day by day and this gradual worsening of the symptoms suggest that he is gradually affected by a different disorder and not by improper medication,. By relating the nursing knowledge, the nurse should try to match the knowledge of symptoms of different diseases and relate the present symptom of the patient with her knowledge (Safarpour et al. 2015). As people age, a large number of them face symptoms like slight tremor or shaking of their limbs, finger, thumb , hand and others, change of handwritings, loss of the sensation of smell, issues in sleeping procedures, issues in moving and walking, constipation, low or soft voice, dizziness and others. These are all the symptoms of Parkinson diseases. It is found by the nurse that the patient suffers from symptoms of los of mobility and hand tremor which are very similar to that of Parkinson’s diseases. Hence, it can be concluded that Mr. Bhai is suffering from the disorder of Parkinson.
Identification of problems
When a patient suffers from Parkinson disease, it is seen that certain nerve cells of the brain called neurons gradually undergo destruction and break down or may die (Liaou et al. 2016). Loss of these neurons result in the les production or abnormal production of an important chemical messenger called dopamine. Due to lowering down of the dopamine levels, it is seen that there is also occurrence of abnormal brain activity. These lead to different symptoms of Parkinson’s diseases. The main risk factors that lead to the occurrence of such a disorder is the age. It manly begins in middle age or late age and the risk increases with age. As the patient is quite aged in the case study, there is high possibility that he is affected by Parkinson disorder (Kuipr et al. 2016). Another important risk factor that matches with the patient condition is sex. Males are more prone to develop the disorder than females and therefore it is of high chance that the patient is suffering from this disorder only. In the present day, no specific test exists which would help in diagnosing the condition of patient on specifically. Here the healthcare professional needs to be trained in nervous system conditions to diagnose the medical history, a review of the different signs and symptoms as well as different neurological and physical symptoms to finalise on the occurrence of the disorder. Imaging tests such as MRI, ultrasound of the brain as well as PET and Scan can be conducted for differential diagnosis in order to cut out the chance of developing any other neurological disorders (Ahlskog, 2014). On diagnosis of this disorder, cabidopa-levodopa is given so that the patients getting relief from the symptoms confirm the presence of the Parkinson disorder in him.
Setting of goals
The main symptom that are noticed in the patient which needs to be addressed by the nurse in order to provide care to the patient is the symptom of than tremor which is making him unable to perform different activities. Secondly, it is also important to maintain his movements and locomotion as his restricted mobility is interrupting his hobbies of tour and resulting in poor quality life (Skelly et al. 2015). Therefore the primary goal is to help him maintain the symptom of hand tremors so that his, life becomes easy and he can conduct different activities with as much independence as possible. The second goal would be to develop his mobility so that he can travel properly and conduct different activities which would help him to be free from restrictions and enjoy love independently without anyone’s help (Landi et al. 2014).
In order to provide the right interventions to the patient who is in the initial stage of Parkinson diseases, evidence based practices should be followed by the nurses so the best outcomes are observed in the patient. For developing the mobility of the person, the nurse should first instruct the patient with techniques that would initiate movement. This is because rocking form side to side would help him to start leg movement (Caning et al. 2015). The nurse should also instruct him to concentration his Walking with an erect position with the use of a wide based gait. A conscious effort must be made to develop the swinging of the arms, raising the felt while walking, using a heel toe placement of the feet with long strides. The patient should be also instructed to perform daily exercise which will in turn help in increasing the muscle strength as well as helping in walking, riding a stationary bike, gardening and also swimming. This will prevent any sort of contractures which may result when; muscles are not used extensively over a period of time. It will also help in coordination and dexterity. Moreover the patient should be also instructed to undertake exercise and walking programs which will ultimately help in delaying the progress of the disease (Martinex and Gonsalez 2014). The patient should be also taught to sit on chairs which have back rest and arm rest. This will help him in rising form a sitting position as well as prevention of falls. The other intervention would have to instruct the patient to raise the head out of the bed and making position changes slowly. The patient should be also taught to dangle the legs few times before standing. He should also avoid dehydration and thereby maintain adequate dietary salt. These will help to reduce orthostatic hypotension. The nurse may also instruct him to take warm baths and massages which would help in relaxing muscles spasm which accompany rigidity. He should also be referred to physical therapist.
For the development of hand tremors, the arms should be maintained as close as possible to the body as possible. The more the proximal stability and input which are provided to the affected arms of the patient, it would be more helpful for minimise of the tremors during different functional activities. The patients should be instructed to stabilise the arms on the surface when working. He should eliminate multi-working. Often standing and working creates difficulty and when such work is done in a sitting position, it enables the body to better manage the tremors (Shin and Haberman 2017). Besides, to control tremor as well as rigidity, pharmacologic management is very important but care should be taken that it does not lead to drug toxicity. Stresses should also be maintained.
Evaluation of outcomes
In order to develop an idea about how the patient is being benefitted from the interventions, it is very important for the nurse to evaluate the effects of the interventions. The patient would be given a time frame of a fortnight to undertake the interventions as educated by the nurse (Gage et al. 2014). Then the patient should be then asked for another visit where the nurse would come into the discussion of how effectively he could carry out the interventions and what were the problems faced by him. Moreover, he will also be diagnosed for the development of the symptoms. If no effective result is got, the nurse would modify her interventions accordingly to achieve the best health for the patient (Tan et al. 2014).
While handling the patient, I was effective in diagnosing the disorder of the patient. I was correctly able to link the symptoms with the disorder and also conducted differential diagnosis to rule out the symptoms of the disorders. Moreover the clinical reasoning cycle had made the entire procedure much easier as it helped in the sequential analyses of the cases and also helps in providing interventions successfully. However, my knowledge of the way of applying evidence based knowledge helped me to correctly find the right interventions which are in lieu with the modern day interventions and also helped the patient in developing the quality life of the patient. However, this experience would help me in further endeavours with patients of the same disorder and helped me to gather experiences that helped me to develop my modern skills.
Form he entire case scenario, it is seen that the patient is in the primary stage of Parkinson diseases. The patient also has hypoglycaemia, but the symptoms are well managed. The main issue faced by the patient is the occurrence of hand tremors and also his immobility which are affecting the quality of his life. After properly relating the patient’s symptoms with the knowledge acquired by the nurse in her practices, she first realised that he was suffering from Parkinson disorders. Following these, goals were set followed by appropriate interventions that helps him to overcome restrict td mobility and hand tremor symptoms. The nurse should also evaluate properly the outcomes and then reflect to gather knowledge from the practices and ensuring her skills. A nurse who follows the clinical reasoning cycle would be able to handle every adverse disorder properly and emerge out victorious in providing the patient with better quality life.
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