NRSG259-The Use Of Clinical Reasoning Cycle

Question:

Mr Dinh Nguyen is an 83 year old widower who was diagnosed with Multiple Sclerosis (MS) six years ago. Four years ago he was diagnosed with osteoarthritis– which is now controlled on medication.
The Nguyen’s migrated from Vietnam in 1976. Dinh lives alone in his own two story home where he has lived with his wife, Ngoc, until she died twelve months ago. Dinh has remained independent since then, however with his ongoing grief and increasing isolation he has noticed a marked decline in his health with ongoing worsening exacerbations of his MS. Dinh and Ngoc did not have children, thus Dinh has no immediate family. However, he has a brother, Bao and his family, living close by. Dinh, however does not want to involve them in his daily life as he does not want to be a bother to them
Dinh has a small income from his self-managed superannuation and is careful with his money. This allows him some measure of financial independence, however, because of reduced investment returns, finances are now only just covering his expenses. He tries to go on a holiday once a year, but was unable to this year due to his altered mobility.
Dinh has been experiencing some blurred vision, numbness in his face, and an “electric shock” type of feeling when he moves his head and neck, often travelling down his back and into his legs, impacting his movement and gait severely. This is making tasks such as cooking, showering, and dressing difficult, particularly bending down to do up his shoe laces. Dinh has also started to experience some episodes of urinary incontinence. Because Dinh perceives that his disease process is worsening, he is starting to wonder how he can face the uncertainty of his future.

Answer:

The use of clinical reasoning cycle as developed by Levett Jones has been found to be extremely effective in dealing successfully with the complicated clinical scenarios in a convenient manner (Levett-Jones, 2013). The clinical reasoning cycle primarily based upon evaluating the condition of the patient based upon the collection of information, identification of the risk areas, undertaking decision about the interventions, setting goals, developing a care plan, evaluating the efficacy of the nursing goal based on the factors of evaluation and finally reflecting upon the clinical experience. The provided case study deals with the clinical scenario of 83 year old client, Mr. Dinh Nguyen and discusses about the intervention strategies based upon the practical use of the clinical reasoning cycle. The further sections of the paper would deal with identification of the physical health issues of Mr. Nguyen and critically proceed with designing an effective intervention with respect to all the steps that are followed in the clinical reasoning cycle. It is expected that this paper would successfully access the client and yield positive patient outcome.

The client Mr. Dinh Nguyen is 83 years old and immigrant from Vietnam. The client history reveals that Mr. Nguyen developed multiple sclerosis six years ago. The patient also reported to be affected with Osteoarthritis. However the condition of Osteoarthritis has been controlled to a considerable extent with the use of regular medication. The case study states that Mr. Nguyen lives alone and has been widowed twelve months ago on account of the death of his beloved wife Ngoc. It has also been reported in the case study that Mr. Nguyen does not have any children and although his brother and his family lives close by, he does not like seeking help from them. This is because the client does not want to bother his brother and his family with his physiological complications. The death of Mr. Nguyen’s wife has taken a toll on him and as a result he is finding it extremely difficult to manage the activities of daily living such as cooking, tying his shoe laces, showering and dressing up quite difficult for him. In addition Mr. Nguyen has also stated sensing a blurred vision, a sensation of a shock or tremor while he tries to move his head and neck. He also states that he is facing difficulty with urinary incontinence and a numbness in his face. On critically evaluating the medical history of the client and the medications that have been administered to the client, it can be said that the client has been administered medications which include the following:

  • Panadol Osteo 6/24 Oral prn (with a maximum limit of 6 dose per day)
  • Teriflunomide 14mg to be consumed orally daily
  • Prednisolone 25mg Oral BD (to be consumed orally in case of an exacerbation)

In addition to the above stated medications, no other medications have been prescribed to the client. On critically evaluating the information provided by the patient, it can be said that the patient is likely to need assistance with activities of daily living. It can also be said that on account of living in isolation, the client can be a potential victim of depression and age related emotional stress and trauma (Gallo et al., 2013).

On the basis of the information that has been collected from the case study, it can be said that the issues that Mr. Nguyen is facing with movement is primarily because of the effect of multiple sclerosis and old age related degenerative changes of the muscular tissues. Scientific evidences have revealed that with the onset of Senescence, negative consequences such as loss of muscular elasticity and degeneration are common (Rantakokko et al., 2013). The numbness in the face can also be related to as a symptom of multiple sclerosis (Galea et al., 2015). The blurred vision can also be related to as an age-related disorder. Evidences have revealed that after the age of 45, blurred vision due to development of cataract is extremely common in men and women (Zhang et al., 2013). The feeling of insecurity and fear can be related to the initial symptoms of depression associated with the negative impact of old age (Weiss Wiesel et al., 2015). The medications that are administered are primarily to help with pain relief and treat the relapsing symptoms of multiple sclerosis (Filippi et al., 2016).

The primary issue that has been identified on the basis of the present physical condition of the client is, assisting the client with activities of daily living. The case study characteristically mentions that the client is experiencing tremors at the back and in his legs that is making it difficult to manage activities such as cooking, dressing up or taking a shower. Scientific studies reveal that with advancing age the ability to manage activities of daily living independently gets impaired (Kalyani et al., 2014).