Clinical Reasoning Cycle for Geriatric Patient with Mobility Impairment

This article discusses the clinical reasoning cycle for geriatric patients with mobility impairment. It explains the steps involved in the cycle and how it can be used to improve the quality of life of elderly patients. The article also presents a case study of a geriatric patient, Mrs. Amalie Jones, and discusses how the clinical reasoning cycle can be applied to her case. The subject of the article is geriatric nursing, and the course code is not mentioned. The article is relevant for healthcare professionals working with elderly patients.

Running head: ASSESSMENT ONE
Case Study analysis
Name of the Student
Name of the University
Author Note

1ASSESSMENT ONE
Ageing refers to the process of growing older and encompasses several aspects related to
psychological, physical and social changes. Furthermore, ageing is often considered as the
primary risk factor that increases the susceptibility of individuals to get affected by a range of
diseases. In other words, healthy ageing can be defined impetrative for healthy living and often
creates a significant impact on the overall health and quality of life of the geriatric population
(Bacsu et al., 2012). Gerontological nursing refers to the nursing specialty that pertains to older
adults and these nurses most commonly work in collaboration with the elders, their families and
the entire community to support maximum functioning of the elders (Neville, Dickie & Goetz,
2013). Thus, in order to meet the health needs of an aging individual, it is essential to employ the
clinical reasoning cycle that will allow making appropriate healthcare decisions through adoption
of a systematic process that considers the major predisposing factors (Levett-Jones, 2013). The
assignment will also utilise the Miller’s Functional consequences theory for facilitating adoption
of a holistic perspective of the spirit, mind and body inter-relatedness, while discussing a case
study of a geriatric patient, Mrs. Amalie Jones (Hirst, Lane & Miller, 2015).
Considering the patient situation forms the first step of the clinical reasoning cycle
(Levett-Jones, 2013). In the case scenario, the patient Mrs. Amalie Jones is German and aged 89
years. She migrated to Australia, following her marriage with Henry Jones, an Australian sailor.
She is found to maintain good contacts with her son from a previous marriage, Dominik.
Furthermore, she also has cordial realtions with Henry’s daughter Tracy and her family, and
reports having regular conversations with them over the telephone. However, recent deterioration
in her physical condition due to the onset of macular degeneration, and subsequent development
of rheumatoid arthritis and osteoarthritis has resulted in impairment in mobility. This has
restricted her movement outside the house premises and led to loss of contacts with members of

2ASSESSMENT ONE
her community. The fact that she has been socially active throughout, has made this social
withdrawal create significant negative impacts on her quality of life, by increasing frailty and
leading to possible decline in the overall health condition.
Collecting essential patient cues or information refers to conducting a review of the
current and available information related to patient history, charts and recalling knowledge of the
underlying pathophysiology of the presenting compliant. This forms that second step of the
clinical reasoning cycle (Levett-Jones, 2013). In addition to her medical history of
hypothyroidism and arthritis, the Mrs. Jones also presents complaints related to swollen feet,
stiffness in joints, limited joint movements, and pain in the joints of fingers, knee, hips and back.
All of these factors significantly contributed to limitations in her movement, which in turn
prevented her from going outside her home and socializing with the community members,
thereby leading to social isolation (Nicholson, 2012). Presence of constipation can be attributed
to the fact that she is not consuming appropriate nutrients (Bailes & Reeve, 2013). Furthermore,
vision impairment, as a direct manifestation of macular degeneration, has also worsened her
health. The aforementioned information related to the patient might contribute significantly to
deterioration in physical and psychological health condition, which can increase isolation and
lead to possible depression.
Analysis of the patient symptoms and matching the current situation to information
collected previously forms the third part of the clinical reasoning cycle, and is commonly
referred to as processing information (Levett-Jones, 2013). Osteoarthritis refers to a joint
disorder, which commonly results from breakdown of bones and joint cartilages. In other words,
it commonly refers to the condition that involves inflammation of the joints due to cartilage
degeneration. Heredity, aging and injuries due to trauma are the most common factors that

3ASSESSMENT ONE
increase the likelihood of a person to suffer from osteoarthritis (Weinans et al., 2012).
Disorganisation of the collagen matrix decreases the content of proteoglycan present in the
cartilage and brings about a net increase in the content of water. This directly contributes to
exacerbation of degeneration, thereby resulting in pain, stiffness, and loss of motor abilities, all
of which are presented by Mrs. Jones (Roman-Blas & Herrero-Beaumont, 2013). In addition, the
patient is also seen to suffer from rheumatoid arthritis, a long-term autoimmune disorder that is
found to primarily affect the joints (Furst & Emery, 2014). Congestion and swelling in the
synovial membrane might have contributed to swollen feet and enlarged joints in the patient
(Choy, 2012). A plethora of risk factors might be considered accountable for the development of
symptoms presented by Mrs. Jones such as, gender, age and physical activities (Pahor et al.,
2014). Arthritis has been found to affect women disproportionately, with a female to male ratio
of 3:1 (Eder et al., 2013).
Furthermore, research evidences have correlated development of arthritis symptoms
among individuals over 50 years of age (Frisell et al., 2013). The fact that the patient is an
octogenarian, might have increased her susceptibility to the current health condition. In addition,
researchers have also identified a list of occupations that involve wear and tear of the bones, with
a higher risk of osteoarthritis (Prodinger et al., 2014). The fact that Mrs. Jones and her husband
were extensive travellers and participated in several community activities, post-retirement might
be considered as a major risk factor. Furthermore, she also complains of constipation that has
been correlated by several studies, with intake of low fibre diet, inactive lifestyle, and lack of
consumption of appropriate food supplements (Kranz et al., 2012). Macular degeneration
symptoms, as presented by the patient can also be linked to her old age that acts as the strongest

4ASSESSMENT ONE
predictor of the condition and results in gradual worsening of vision in the eyes (Wong et al.,
2014).
Identification of the problem or issue forms the fourth step and will facilitate making an
appropriate diagnosis for the health abnormality (Levett-Jones, 2013). An analysis of the
previous steps helps in deducing that mobility impairment in the elderly patient is the major
problem that is contributing to significant disability and worsening the overall health related
quality of life. The second nursing care priority would be focused on constipation that makes it
difficult for the patient to empty her bowels. This condition will be considered as a care priority
since it can lead to bloating and abdominal pain. Visual impairment due to macular degeneration
is the third care priority as partial or complete loss of vision can increase risks of injurious falls
and can also make it difficult for the patient to identify places and people. Owing to the fact that
she lives alone, visual problems might also lead to medication errors.
Goal establishment forms the fifth step where the desired health outcome will be
discussed, that is intended to be achieved within a pre-determine time span (Levett-Jones, 2013).
The major care goals will be related to adoption of effective home-based exercise, as a part of
fall prevention measures that will help in reducing or eliminating chances of Mr. Jones getting
suffering injurious falls that can lead to hospitalization or can even be fatal. Further goals are
related to implementation of dietary modifications to improve her bowel movements.
Selecting a course of action in order to accomplish the intended goals, form the sixth step
of the clinical reasoning cycle (Levett-Jones, 2013). The elderly people are prone to experience a
plethora of functional consequences due to several age related variations, in addition to a wide
range of environmental, lifestyle and genetic risk factors (Stewart et al., 2012). Hence,

5ASSESSMENT ONE
inadequate implementation of nursing intervention might create potential negative effects on the
functional consequences, experienced by the client The nurse should focus on recognition of the
effect of older age on the current health condition of the patient. The probable factors that might
have created negative functional consequences should be identified, with the aim of initiating
interventions that will enhance patient outcomes (Hirst, Lane & Miller, 2015). The nurses should
make Mrs. Jones follow easy home-based exercises that involve knee bends, toe raises, turning
and walking around, heel toe standing and walking the stairs. These exercises will be conducted
in presence of a physiotherapist (Stevens & Phelan, 2013). Further interventions include,
installing grab rails in the bathrooms to prevent tripping over slippery surfaces. Installation of
bed-side alarms will also allow create provisions for the caregiver to monitor the patient’s
activity, thereby reducing fall risks (Ungar et al., 2013). Providing walking aids, removing clutter
and loose rugs from the floor, and installing bright light bulbs in the stairways and hallways
would also help. Constipation can be prevented by forming a diet plan that makes the patient
drink enough water, avoid caffeinated beverages and eat vegetables and fruits that are rich in
fibre. This will act as a natural laxative and help in bowel movement (Yang, Wang, Zhou & Xu,
2012). The nursing care strategies should be implemented in a manner that recognizes her
cultural background, preferences and traditions. Furthermore, efforts will be taken to maintain
her dignity and ask for her consent, before implementing any of the strategies.
Evaluation of the outcomes forms the next part of the reasoning cycle (Levett-Jones,
2013). Expected outcomes will include the fact Mrs. Jones is able to move on her own and is
able to perform the daily activities independently, such as, dressing, washing and feeding. Given
the devastating effects of falls on the patients and their family members, the in suggested
interventions have shown meaningful results in most people. Demonstrating an ability to take the

6ASSESSMENT ONE
steps or move outside her home and interact with the community members will indicate success
of the interventions. Furthermore, easy bowel movements, and reports of less constipation are
also expected. This can be related to the fact that fibres act as natural laxatives and increase
water content of the stool.
The above discussion helped me learn that there are several lifestyle factors that create
substantial effect on the lifespan of individuals. I realize that solitary lifestyle contributes greatly
to falls among the elderly. Next time I would also involve the patient’s family in the decision
making process with the intention of determining their choices that would guide the behaviour.
To conclude, it can be stated that various factors related to loss of loved person or
disabilities put the older adults at an increased risk of getting socially isolated, or becoming
lonely. Hence, such socially isolated elderly people are likely to experience a poor quality of life
and need assistance from the healthcare professionals and the community, to deal with concerns
about their aging in place. Progressing diseases in the older age often contributes to functional
limitations that lead to a decline in mobility and limits their access to life-spaces. Such
limitations often contribute to high rates of falls in the geriatric population that leads to recurrent
hospitalization. Moreover, isolated life also leads to harmful impacts on the feeding habits of
older adults. Hence, efforts must be taken to implement all strategies and interventions that have
been proved successful in reducing fall rates, improving mobility, and enhancing bowel patterns
among the elders. This would directly enhance overall health and wellbeing of the elderly and
improve patient satisfaction.

7ASSESSMENT ONE
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