Mechanisms Impact and Management

Question: Discuss about the Mechanisms Impact and Management. Answer: Introduction: In the following assignment discussions will be carried out with respect to the case scenario relevant to Mrs. Barbara Green who has recently been sent to the local community health centre following the referral from her GP for the sake of assessment and review of her present condition. Discussions will be made from the perspective of the Registered Nurse (RN) working at the local community health centre who has been assigned for taking care and looking after Mrs. Green. The clinical reasoning cycle framework will be utilized for identifying and prioritizing the nursing care needs in the context of the given circumstances. The pertinent skills and expertise that a nurse must possess in order harbor optimum outcomes for the patient forms the central theme of the clinical reasoning cycle (Levett-Jones, 2013). The preparations of the nursing care plan will essentially follow the vital steps of the clinical reasoning cycle including the collection of cues, processing of information, iden tification of problems, and establishment of goals. Subsequent measures of taking actions, evaluating outcomes and reflecting on process of new learning will be adopted to complete the process of clinical reasoning. Thus a succinct overview on the overall topic will be presented here. Identifying nursing care priorities Mr. Barbara Green is an 89 year old lady who lives alone in her one storey house. She lost her husband two years ago and since then her health has been deteriorating. She used to be a primary school teacher and retired from her job 24 years ago. Barbara along with her husband, were active members and volunteers at the local church as well the local shop. She has a German lineage as she migrated from Germany and settled in Australia 40 years ago and maintained deeper contact with the German Association. A son and daughter from her previous marriage and her husbands previous marriage constitute the immediate family for her. She shares good relationship with both of them although both stay far away from her home. Barbara has been recently referred to the local community health centre by her GP to undergo health assessment and review. She has the medical history of having macular degeneration, hypothyroidism, osteoarthritis and rheumatoid arthritis and is under daily prescribed medications. Currently she has given up driving on being diagnosed with macular degeneration, limited her level of activities and rarely gets out of home and consecutively shunned her physical association with friends and members at the German Association. Her house is strangely disheveled with the cupboards storing minimal quantity of food storage with some tins of soup and baked beans. Although Barbara feels oneness with her community, yet she prefers to stay alone at home on realizing that in order to have her wish fulfilled she might require assistance. Presently Barbara has been observed to be suffering from symptoms encompassing joint stiffness, swollen feet and enlarged joints, pain in the knee, hip, back and finger joints coupled with limited joint movement. Constipation, vision deficit, occasional dizziness and non-significant recent weight loss has also been reported for Barbara. The restricted movement and joint pain related symptoms may be well corroborated with the prevalence of osteoarthritis and osteoarthritis (Kurt et al., 2016). Osteoarthritis is likely to have affected her major body parts that have resulted in the pain generation. The joints are particularly affected due to chronic inflammation because of rheumatoid arthritis that in turn has limited her mobility (Messier et al., 2013). Symptoms of dizziness might have ensued from her prevalent condition of hypothyroidism due to underactive thyroid hormones (Cappola, 2016). The underlying cause for vision deficit is likely to be embedded in the age related progressive thinning and degeneration of the macula that lead to blurred or diminished central vision (Christen et al., 2014). Moreover the sudden loss in weight may be speculated to have occurred because of under-eating. Reviewing the information obtained from referral letter from Barbaras GP it is evident that she has certain issues that calls for immediate attention and subsequent interventions. The problems that have been recognized in this case include: Loss of body weight Reduction in consumption of food Tendency of isolation Selection of top priority of care Analyzing the condition specific to Barbara, the issue pertinent to the sudden reduction in body weight has been identified as the top priority care that deserves prompt intervention. The potential goals for managing the loss of body weight could be: Barbara will show improvements in her appetite and engage in proper dietary habits with adequate proportion of meals within one week. She will gain weight in a month. She will express her keenness towards going out of home and socializing with her friends and members at the German Association. Her quality of living will improve through better participation at social events through proper assistance. Barbara will be having increased compliance to medications and express better feeling towards general living. On matter related to healthy weight gain in the patient, nutritional supplements along with the normal diet may be applied following recommendation and suitable advice from the attending physicians (Parsons et al., 2017). Pain management for the prevalent arthritis condition may also be promoted through physical therapy that in turn will lead to amelioration of pain in the patient thereby leading to improved quality of living (Katz et al., 2013). Comfort in the form of pain management is likely to improve the dietary habits in the person (Walsh McWilliams, 2014). Social communication will also be enhanced as a result of improved mobility due to intervention for arthritis (Benka et al., 2016). The weight loss issue thus may be regulated through making arrangements for managing and treating the pain due to arthritis that had limited her movement and subsequently social participation. The course of actions taken in relation to the prevalent condition for Barbara will be evaluated for their effectiveness. Determination of the weight for Barbara shows that she has put on weight and has improved appetite as well. Barbara has improved pain score depicted in Pain Assessment Scale and show improvement in motion. Increased participation in the German Association is noted in case of Barbara. Barbara is diligently following the prescribed medication without skipping or forgetting them and mentions about her wellbeing after taking the drugs and eating healthy. The quality of living has visibly improved for Barbara. The opportunity to serve Barbara has left me with vital information regarding certain issues at old age. I now understand the impacts of arthritis both of rheumatoid type and osteoarthritis upon the activities of daily living in case of aged persons. I further came to know about the psychological effects of pathological conditions due to arthritis, hypothyroidism and visual deficit that often prompt them to be isolated. I wish I had more knowledge specific to these conditions to better treat Barbara and improve her overall healthy by means of accounting for increasing the dietary intake. I now understand the underlying effects of chronic ailments like arthritis and hypothyroidism that exerts their definite impacts upon the physical as well as mental health of the affected individual. The case study of Mrs. Barbara offered an insight into the multifaceted impacts of conditions relevant to arthritis and hypothyroidism in case of older adults especially among the females. The efficacy of the available treatment modalities other than medications in case of the victims other than medications is also known. The feasibility of applying physical therapy techniques along with appropriate nutritional supplements in case of arthritis affected person has also been a remarkable observation. Apart from these the importance of healthy eating and weight gain for sustaining and maintaining quality of life is further revealed. Thus in fine it may be said that management of old age related issues must be done in a collaborative manner with engagements from professionals from diverse fields and backgrounds, nursing being one of the vital vocations in this regard (Bramble, 2017). References Benka, J., Nagyova, I., Rosenberger, J., Macejova, Z., Lazurova, I., van der Klink, J. L., van Dijk, J. P. (2016). Social participation in early and established rheumatoid arthritis patients. Disability and rehabilitation, 38(12), 1172-1179. Bramble, M. (2017). Nursing for wellness in older adults S. Hunter and C. Miller. Wolters Kluwer, Philadelphia, 2016. ISBN 9781922228758 (paperback). Australasian Journal on Ageing, 36(1), 77-77. Cappola, A. R. (2016). Hypothyroidism in the Elderly. In 2016 Meet-The-Professor: Endocrine Case Management (pp. 355-358). The Endocrine Society. Christen, W. G., Glynn, R. J., Manson, J. E., MacFadyen, J., Bubes, V., Schvartz, M., Gaziano, J. M. (2014). Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology, 121(2), 525-534. Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., Levy, B. A. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684. Kurt, E., zdilli, K., Yorulmaz, H., Sar?soy, G., Durmu?, D., Bke, ., Akbaba, N. (2016). Body Image and Self-Esteem in Patients with Rheumatoid Arthritis. Body Image, 53(4). Levett-Jones, T. (2013). Clinical reasoning: learning to think like a nurse| NOVA. The University of Newcastle's Digital Repository. Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., DeVita, P., Williamson, J. D. (2013). Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. Jama, 310(12), 1263-1273. Parsons, E. L., Stratton, R. J., Cawood, A. L., Smith, T. R., Elia, M. (2017). Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clinical Nutrition, 36(1), 134-142. Walsh, D. A., McWilliams, D. F. (2014). Mechanisms, impact and management of pain in rheumatoid arthritis. Nature Reviews Rheumatology, 10(10), 581-592