Considering patient situation
Clinical reasoning refers to the process that is commonly employed by nursing professionals and other clinicians for making informed decisions and solving all kinds of problems that are encountered while caring for patients. The term is often used interchangeably with other phrases as clinical judgment, decision making, problem solving or critical thinking (Levett-Jones, 2018). The essay will discuss a clinical reasoning cycle for a patient Janet McKay, with the aim of providing holistic care services. The case involves the patient Mrs Janet McKay, who is seen to suffer from an early stage Alzheimer’s disease and vascular dementia. The patient also has a risk of fall, as she had immediately undergone a hip replacement surgery. Another problem identified was the urine inconsistence. Through the use of the clinical reasoning cycle these nursing problems were identified and accordingly the nursing goals and interventions were mentioned.
The patient is Mrs Janet McKay, an octogenarian, and a widow, residing in the Sunset Residential Aged Care Facility. She has recently been operated for a hip replacement, after suffering a fall. She often forgets to use a wheelie walker and has also been diagnosed with early stage vascular dementia and Alzheimer’s disease that is in progress. Further presenting complaints are related to urinary incontinence and a large skin tear on the lower leg that often bumps against the walker.
One major reason that made it necessary for the client to undergo a hip replacement surgery was the fall incident. Time and again, researchers have identified falls as one of the leading causes that contribute to injuries and other health complications in adults aged more than 65 years (Ambrose, Paul & Hausdorff, 2013). The risk for falls generally increase with aging due to frailty, weakness balance disturbance, cognitive deficits, visual impairment and acute illness. These aforementioned factors might have increased the likelihood of Janet to suffer from a fall that resulted in hip fracture. Further analysis of her past medical records indicate the presence of Alzhiemer’s disease and vascular dementia. Clinico-pathological studies have established vascular dementia as one of the most common types of dementia that affects older people (McCance et al., 2010). This condition is primarily characterised by a decline in the cognitive skills that are caused due to presence of blockage that results in a reduction in the flow of blood to the brain (Forti et al., 2010). This condition subsequently deprives the brain cells of the vital nutrients and oxygen. Similar symptoms are also presented by Alzhiemer’s disease among the aged people where there occurs a slow decline of memory and thinking capacity, thereby creating an impact on the abilities of older people to conduct their activities of daily living (Sperling et al., 2011). As per the recent reports, Janet has been found to argue with the healthcare staff during showering and has also pushed away a caregiver when she was being taken to the shower. This suggests that although the hip replacement surgery has resulted in a decline in her abilities to perform common chores, she has not become accustomed to receiving help from the healthcare staff. She has been prescribed paracetamol, 100 mg aspirin and 0.2 mg desmopressin for managing her current situation.
Collecting information
From the given case of Mrs. Janet McKay, the nursing problems that have been identified includes the risk of fall as the patient has recently undergone a hip replacement surgery. The other problem is related to the urine incontinence as the patient fails to reach the toilet at all times. As the patient has been suffering from an early stage of Alzheimer’s disease along with vascular dementia, the patient Mrs. McKay tends to forget things. This is identified as another nursing problem (Gausvik et al., 2015).
In relation to the risk of fall, the short terms goals will be to identify the factors that are related to increasing the potential of the injury, mainly at the end of the day. The goal should also include making the patient remain free from falls per shift. The long term goals will include assuring that the client remains free from goals during the stay in the healthcare facility. In addition to this, it will be assured that necessary physical changes are made to ensure that there is no experience of fall even after the patient is no longer in the healthcare facility (Vandervoort et al., 2014).
With respect to urine incontinence, the goal will be to reduce the episodes of urine incontinence in Mrs. McKay within a period of one week.
The goal is to promote a two-way communication is an effective way. Eliciting a positive response from the patient towards the planned activities will be a part of the goal for the problem of dementia (Ennis Jr & Kazer, 2013).
Nursing care interventions will include increasing the awareness of the client about the factors that contribute majorly to fall. Assistance should be provided while use of toilet and keeping the bathrooms remain clear since falls are often related to the need to eliminate in a hurry. The patient needs to be made accustomed to the environment to use all bell, side rails, and bed controls. These measures will help in making a difference by making the patient cope with an environment that is unfamiliar.
The nursing care intervention would include implementation of individualized voiding schedule that is based on the needs of Mrs. McKay and it needs to be determined by the 3-day voiding record. Interventions for educating the patient for behaviour modification will be carried out. The interdisciplinary team will be engaged to evaluate the effectiveness of the prompted voiding program and to modify it when appropriate (Bardsley, 2013).
Identification of the nursing problems
In terms of dementia, it is required to communicate with the patient in a relaxed and calm manner. The patient should be given enough time to express herself and should be encouraged. Techniques should be demonstrated to the patient to improve memory. The nurse would try to reorient the patient when the patient shows any signs of confusion. The nurse would implement measures encourage the patient to be independent in activities of daily living.
Evaluation in relation to risk of fall will include that the client did not further experience any fall. The evaluation will also include that the client made a verbalised plan in order to make changes at the home setting in order to ensure safety and avoid fall. The client is verbalised into understanding of the risk that are associated with then factors of fall. Evaluation involved that the client did not experience fall during any shift.
Evaluation will involve the decreased rate of the episodes of incontinence within the first week of the plan.
The evaluation involves improvement in memory retaining through the demonstrated techniques. The patient will be reoriented when confusion is present. Evaluation of the autonomous nature of the patient while doing the activities of the daily life (Ueda et al., 2013).
In the process of providing optimal care to the patients, it is required to provide effective nursing care by improvement in certain aspects. While caring for Mrs. McKay, as I got involved in the care process I was better able to identify the nursing priorities along with the better understanding of the aactivities of the patient who is suffering from dementia and Alzimer’s and additionally has urine incontinence along with the risk of fall. The nursing interventions that were carried out through the engagement of the multidisciplinary team were conducted in a more effective manner. The multidisciplinary team included the social services, physiotherapist, occupational therapist along with the social workers and age concern. I also perceived that while working with the multidisciplinary team, my skills as a nurse were enhanced along with the professional skills and knowledge related to care. I also understood that the condition of the patient was debilitating, thus affecting the emotional, social, psychological status of the patient along with creating a physical distress. Through the nursing care plan, it was evident that planning was required for providing proper care to the patients that is quite crucial in determination of the activities that the patient can perform and how I being a nurse can help the patient in carrying out the activities.
Establishment of goals
Conclusion
In conclusion it can be stated that the professional nurses along with the medical professionals who have established skills of clinical reasoning, are able to put significant positive impact on the outcome of the nursing treatment plan provided. Evidenced based nursing in the revolutionary step forward for ensuring best possible nursing outcomes. Research evidences present in the clinical reasoning cycle can be highly important as it provides relevant clinical information, related to the interventions that are safest and most effective in nursing care plan for imposing a positive impact over health outcome of the patient. The interventions that were implemented helped in evaluation that ensured that the patients did not experience further falls during the stay in the healthcare facility. It also ensured that the episodes of the incontinence decreased along with the improvement in memory retaining through the demonstrated techniques of memory retention.
References
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