Case Study of Mrs. Jones: Clinical Reasoning Cycle and Miller's Functional Consequences Theory

This case study analyzes the care priorities for Mrs. Jones, an 89-year-old widow suffering from osteoarthritis, macular degeneration, and constipation. The nursing professionals use the clinical reasoning cycle and Miller's functional consequences theory to identify the factors causing negative consequences and develop effective interventions for fall prevention and diet management.

Running head: CASE STUDY OF MRS. JONES
CASE STUDY OF MRS. JONES
Name of the student:
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CASE STUDY OF MRS. JONES
Introduction:
Clinical reasoning cycle can be developed as the procedure by which nursing
professionals can successfully collect information of the patient and process the information
(Levett- Jones, 2013). Thereby, they are seen to be able to come to an understanding of the
problem or situation of the patient and thereby plan and implement interventions of the patient
(Zudeima et al., 2015). The professionals then evaluate the outcome, reflect, and learn from the
entire process to develop their own knowledge and engage their skills for better service delivery
to patients in the future. With the help of this framework, nursing professionals would mainly
conduct analysis of the case of Amelie. She is 89 year old and has been suffering from a number
of different consequences due to old age. Arthritis and visual impairment had destroyed her
quality life. This has resulted in loss of mobility and pain in joints. She is also suffering from
constipation. In this assignment also, the clinical reasoning cycle should be used in order to
identify the care priority and accordingly intervention plan should be set for the patient to ensure
higher quality life of the patient.
Mrs. Amalie is an 89-year-old widow. She is a German by birth and her second husband
was an Australian who had died just two years ago. She had done extensive travelling with her
husband after their retirement and had been very active socially. She had good connections both
with her son from first husband who stays in Germany. She also has connections with the
daughter of her husband. However, recently due to macular degeneration, she has stopped
driving. Her arthritis of both kinds has affected her mobility that has now made her socially
excluded. She is not having proper diets as her house cupboards only show some tins of soup and
baked beans. She is also losing weight, not eating properly and is highly vulnerable to become

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socially excluded by not being able to keep physical contacts with relatives and other members
of the community.
It has been seen that the patient is suffering currently from a large number of symptoms
like joint stiffness, limited joint movements, painful joints in hip, knee, fingers and back, swollen
feet and enlarged joints. She also suffers from constipation as well as occasional dizziness.
Vision deficit, non-significant recent weight loss is also seen. Moreover, it is also seen that
patient in the case study also fails sometimes to take her medicines due to the excess pain she
faces because of her arthritis. Therefore, it is very important for the nursing professionals to
understand the main causes of the occurrence of the symptoms and thereby develop care
priorities to help the patients overcome the issues effectively.
The patient is mainly suffering from osteoarthritis that is a progressive joint disease that
affects mostly cartilage (Garner et al., 2017). Cartilage mainly helps the bones to glide over each
other when a joint bends or straightens. In case of osteoarthritis, the cartilage is seen to wear
away over time resulting in the rubbing of the bones with each other. This causes pain and
inflammation at the joints. For this reason only, Mrs. Jones is seen to suffer massively due to
paints resulting in occurrence of painful joints, swollenness and inflammation. The risk factors
that have made Amelie vulnerable are her age and her gender. Researchers are of the opinion
that aged individuals above the age of 65 are highly vulnerable to the disorders. Moreover,
females are more prone to development of such disorders than their male counterparts are.
Moreover, she is also seen to be exposed to rheumatoid arthritis. Researchers have stated that
this disorder is an autoimmune disorder where the immune systems of the individuals are seen to
attack the tissues of the body mistakenly. This in turn affects the lining of the joints, in turn
resulting in painful swelling. This causes bone erosion and joint deformity. Hence, the patient is

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also seen to have swollen joints. It has been seen in the case study that both the patient and her
husband had been undertaking extensive tours for travelling all over the world and such pressure
might have affected her joints causing osteoarthritis (Sorensen et al., 2015). Joint stiffness also
results as symptoms. Another issue that the client faces is occasional dizziness and visual deficit.
This is mainly due to the occurrence of the macular degeneration. This is the disorder of the
macula, which is that part of the retina that is responsible for the clear vision in the direct line of
sight. With that of old age, thinning of the macula takes place that affects the vision of
individuals. Hence, the client had not been able to drive properly as her eyesight had become
poor (Wan et al., 2015) . The patient is also seen to suffer from constipation that may give her
poor quality life. In the old age, poor diet, lack of adequate fluid, lack of movements and
exercise, use of certain drugs to treat other disorders and many others all may result in the
occurrence of the disorders. Moreover, being bedridden also may contribute to constipation
(Blekken te al., 2016). In case of the patient, her poor diet and her loss of mobility mat account
to occurrence of constipation.
From the entire discussion above, it becomes quite clear that the patient has been
suffering from loss of mobility that had resulted in social exclusion. Moreover, she is also having
issues with her vision due to her macular degeneration. Therefore, one of the most important care
priorities would be fall prevention of the patient as she is highly vulnerable to falling. The
second issue is that she is having poor diet for which she is suffering from weight loss and even
constipation. Therefore, her diet management would be the second care priority of the patient.
The two goals that should be set for the patient is to make sure that she is safe from any
vulnerability for falling and therefore the professionals should make sure those interventions are
taken which assesses her risk of falls and take necessary steps. The second goal would be

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increase of her weight and overcoming of constipation. Therefore, the nursing professionals
should ensure providing her a diet plan accordingly.
However, before approaching with the intervention two important things should be kept
in mind. She is a patient with German origin who still is highly connected with German
associations and shows her inclinations towards German communities along with other
communities. Therefore, professionals should provide culturally competent care being culturally
aware of her needs and being culturally sensitive to her beliefs, traditions, inhibitions and
preferences (Bakir et al., 2018). Proper communication skills should be applied and nurses
should be careful not to ask the patients to repeat her as that might hurt her dignity and self-
respect. Moreover, the professionals should also follow Miller’s functional consequences theory.
Nursing professionals should know that old adults experience functional consequences without
interventions (Hunter, 2016). Therefore, the duty of the nurses to identify the factors causes
negative consequences. The nurses through the clinical reasoning cycle had been successful in
understanding the causative factors and hence had taken proper care interventions. Therefore, the
nursing professionals should keep important objects of her use near the patient’s bed so that it
reduces the hazards associated with her walking to reach those (Emsfors et al., 2017). She should
be given switch alarms when she need other aides so that the nursing professional can reach her
on time. Her bed should have rails and her bed position should be lowered or made adjacent to
floor to reduce her risk for fall. Moreover, bathrooms and other places should have handrails.
She should be given non-skid soles or slippers for walking effectively. Moreover, lose clothes
should be avoided and she her pathway should be made free from any clutters (Roets et al.,
2018). Light furniture should be removes as that may make her fall down by tumbling.
Moreover, the professionals should also work with physiotherapist and occupational therapist for

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assisting with her gait techniques and provide the patient with her assistive devices. This would
help in transferring or ambulation. Regular physiotherapy would help her develop her mobility
and reduce her pain (Noh et al., 2015). The patient should also be given proper eyeglasses and
medications to her eyes so that she may experience betterment of her vision. The nursing
professionals should also provide diet plan that should have 25g of fiber other than nutrients. A
fluid intake of 1.5 to 2 liters per day should be given (Tian et al., 2016).
The nursing professionals should make sure that the patient is having proper diet by
evaluating her increase in weight and her bowel output. They should also evaluate her walking
ways to understand whether she is developing her gait or not. After the entire incident, the
professionals should reflect upon their entire experience of the case study so that they can
understand how the patient had responded to their entire care plans. Following their evaluation
and reflection, they can modify any intervention if that are not yielding proper results and
develop new plans accordingly (Trads et al., 2017).
From the above case study, it is very well seen that how the two theories of clinical
reasoning cycle and Miller Functional consequences theory that had helped the nurses to
correctly identify the care priorities. They have identified the factors that were resulting in poor
functional consequences of the client named Mrs. Amelie Jones. After identification of the
factors and linking them with the lifestyle of the patient, care plan was prepared that comprised
of goals of fall prevention and diet management. Therefore, effective interventions had been
proposed that would help the patient for a better quality life.

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References:
Bakir, E., Baglama, S. S., & Gursoy, S. (2018). The effects of reflexology on pain and sleep
deprivation in patients with rheumatoid arthritis: A randomized controlled
trial. Complementary Therapies in Clinical Practice.
Blekken, L. E., Nakrem, S., Vinsnes, A. G., Norton, C., Mørkved, S., Salvesen, Ø., & Gjeilo, K.
H. (2016). Constipation and laxative use among nursing home patients: prevalence and
associations derived from the residents assessment instrument for long-term care facilities
(interRAI LTCF). Gastroenterology research and practice, 2016.
Emsfors, Å., Christensson, L., & Elgán, C. (2017). Nursing actions that create a sense of good
nursing care in patients with wet age‐related macular degeneration. Journal of clinical
nursing, 26(17-18), 2680-2688.
Garner, S., Lopatina, E., Rankin, J. A., & Marshall, D. A. (2017). Nurse-led care for patients
with Rheumatoid Arthritis: a Systematic Review of the effect on Quality of Care. The
Journal of rheumatology, jrheum-160535.
Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New
Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest,
NSW: Pearson.

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CASE STUDY OF MRS. JONES
Levett-Jones, T., & Hoffman, K. (2013). Clinical reasoning: What it is and why it
matters. Clinical reasoning: learning to think like a nurse. Melbourne: Pearson
Australia, 2-15.
Metin, Z. G., & Ozdemir, L. (2016). The effects of aromatherapy massage and reflexology on
pain and fatigue in patients with rheumatoid arthritis: a randomized controlled trial. Pain
Management Nursing, 17(2), 140-149.
Noh, H. K., & Lee, E. (2015). Relationships Among NANDA‐I Diagnoses, Nursing Outcomes
Classification, and Nursing Interventions Classification by Nursing Students for Patients
in Medical‐Surgical Units in Korea. International journal of nursing knowledge, 26(1),
43-51.
Roets-Merken, L. M., Zuidema, S. U., Vernooij-Dassen, M. J., Teerenstra, S., Hermsen, P. G.,
Kempen, G. I., & Graff, M. J. (2018). Effectiveness of a nurse-supported self-
management programme for dual sensory impaired older adults in long-term care: a
cluster randomised controlled trial. BMJ open, 8(1), e016674.
Sørensen, J., Primdahl, J., Horn, H. C., & Hørslev-Petersen, K. (2015). Shared care or nurse
consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis (RA)
outpatients with stable low disease-activity RA: cost-effectiveness based on a 2-year
randomized trial. Scandinavian journal of rheumatology, 44(1), 13-21.
Tian, H., Ding, C., Gong, J., Ge, X., McFarland, L. V., Gu, L., ... & Li, N. (2016). An appraisal
of clinical practice guidelines for constipation: a right attitude towards to
guidelines. BMC gastroenterology, 16(1), 52.

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CASE STUDY OF MRS. JONES
Trads, M., Deutch, S. R., & Pedersen, P. U. (2017). Supporting patients in reducing
postoperative constipation: fundamental nursing care–a quasi‐experimental
study. Scandinavian journal of caring sciences.
Wan, S., He, H. G., Mak, A., Lahiri, M., Luo, N., Cheung, P. P., & Wang, W. (2015). AB1211-
HPR Health-Related Quality of Life and its Predictors Among Patients with Rheumatoid
Arthritis. Annals of the Rheumatic Diseases, 74, 1339.
Zuidema, R. M., Repping-Wuts, H., Evers, A. W. M., Van Gaal, B. G. I., & Van Achterberg, T.
(2015). What do we know about rheumatoid arthritis patients’ support needs for self-
management? A scoping review. International journal of nursing studies, 52(10), 1617-
1624.