Extended Care Planning Essay

This essay discusses the impact of chronic diseases on patients and the importance of individualized care planning. It utilizes the clinical reasoning cycle to address care priorities for an elderly patient suffering from multiple sclerosis and osteoarthritis.

Running head: EXTENDED CARE PLANNING ESSAY
Extended care planning essay
Name of the student:
Name of the university:
Author note:

1
EXTENDED CARE PLANNING ESSAY
The impact of a severe or a delimiting disease is extreme on the patient, affecting the
lifestyle and abilities of the patient. However, for diseases that are intricately associated with
bringing forth nerve damage, the impact of the nerve damage causing disease is far more
deleterious on the patients (Dendrou, Fugger & Friese, 2015). Researchers are of the opinion
that for the patients that are elderly and are suffering from the co-morbid disorders, the care
planning must be patient centered and individualized. The clinical reasoning cycle serves as a
potent framework or tool that helps the nurses address each and every care need on a priority
based format, delivery care and reflecting on the procedure so that the care is safe, effective
and individualized for the patient (Levett-Jones, 2013). This essay will attempt to utilize the
clinical reasoning cycle to address to the care priorities that the patient is suffering from with
respected to the Miller’s functional framework taking the aid of the case study of Dinh Nguyen.
The first and foremost, the nurse while assessing the patient considering the patient
situation is extremely beneficial for the nurses to attain a basic understanding of the issues
presented by the patient (LeMone et al., 2015). Here the patient under consideration is an 83
year old patient named Dinh Nguyen, an old Widower who had been a diagnosis of Multiple
sclerosis 6 years ago. The comorbidity that Dinh had been suffering from includes osteoarthritis
which is medically managed. Dinh has been living alone in the two storied house since the
death of his wife and even though he has a brother, he is not willing to involve him with his life.
He has some extent of financial independence and he is careful with money but with reduced
investment returns, his earnings are only covering his own expenses.
The next step is for the nurse to collect and process all different kinds of information
about the patient and then review and process the information to arrive at a verdict regarding
bthe cared needs expressed by the student (Dalton, Gee & Levett-Jones, 2015). Considering the
past medical history, it has to be mentioned that Dinh had a diagnosis of multiple sclerosis 6
years ago and has also been suffering with osteoarthritis from last 4 years. The presenting
symptoms of the patient includes blurred vision, numbness in the face, feeling of electric shock
while moving head and neck that travels down his neck and into his legs and associated activity
intolerance, affecting his ability to cook, shower or dress up.

2
EXTENDED CARE PLANNING ESSAY
Processing the information, it is crucial for the nursing professional to interpret,
discriminate, relate, infer and match the collected cues with best practice evidence to be able
to arrive at an outcome. In this case, the most important health issue that Dinh is facing is the
Multiple sclerosis which is also causing most of the symptoms for him. As mentioned by
Dendrou, Fugger and Friese (2015), symptoms such as blurred vision, numbness, and electric
shock sensation and unsteady gait are very common symptoms of multiple sclerosis and
resultant brain lesions. Along with that, the impact osteoarthritis have also been reported to
deteriorate the gait balance and mobility status of the patient, which can be the case for Dinh
as well. On a more exploratory note, the impact of multiple sclerosis on the normal physiology
of an adult body and its possible link with the osteoarthritis symptoms cannot be ignored
either. Montalban et al. (2017), have mentioned that the risk factors of the osteoarthritis
include muscular weakness, especially in the quadriceps which has been reported to be caused
by MS. Along with that, people suffering with MS often have affected knee joints due to gait
imbalance and muscular atrophy which leads to joint degeneration associated with OA.
The next step of the care planning will need to focus on the identifying the care needs
based on the cues collected and processed by the nurse. In this case, the first and foremost
care need for him is the mobility restriction and the fall risk. Dinh had been suffering from
mobility resistance due to his MS symptoms which is known for causing unsteady gait. Along
with that, his diagnosis of osteoarthritis and blurred vision will also facilitate a significant
restriction in functional mobility for him. He lives in a two storied house alone, the mentioned
health issues can potentially lead to considerable fall risk for him (Dennett, Coulter, Paul &
Freeman, 2017). The second care issue that needs priority based intervention is the self-care
deficit; as mentioned in the case study, Dinh had blurred vision and electric shock sensation
which is caused by the multiple sclerosis which has affected his ability to move and participate
in activity drastically. As a result, he is incapable of cooking, showering and dressing himself
which is indicative of his self-care deficit affecting his hygiene and activities of daily living
(Munsell, Locklear, Phillips, Frean & Menzin, 2015). The third care priority for him is the
depression and anxiety that he is facing due to his perception of worsening symptoms and the
uncertain future due to his disorders. Exploring further, it is very important to analyze that old

3
EXTENDED CARE PLANNING ESSAY
age and loneliness can have a significant impact on the mental health of the patients, coupled
with a deteriorating MS, the inabilities, restrictions and uncertainty of the future can lead to
depression and anxiety disorders easily, further deteriorating his conditions. In this case, the
self-care deficit has the most pressing potential to harm the patient causing nutritional
imbalance, skin integrity issues and irritability and behavioral issues further complicating the
situation, hence the chosen care priority is self-care deficit (Ma, Chan & Carruthers, 2014).
Establishing care goals is a crucial step of the care planning scenario, especially for the
patient population of older adults, the care goals need to be definite and in accordance with
the age related changes and restrictions (LeMone et al., 2015). Dinh is an 82 year old patient
who is suffering from two delimiting health disorders, and the impact of aging is needed to be
taken into consideration while establishing the care goals. The theory of functional
consequences by Miller can be incorporated to understand impact of aging on Dinh and his
disease and inabilities. The theory of functional consequences by Miller states that older adults
experience functional consequences caused by age derived changes coupled with additional
risk factors (Hunter, 2012). Exploring further, the impact of these functional consequences are
negative and they require interventions. For the nursing care to be effective and functional the
nursing professionals also require to recognize the functional consequences, both positive and
negative and address them in the care goal establishment. In this case, the care priority
selected is self-care deficit, caused mainly due to osteoarthritis related mobility deterioration
and the clinical manifestation of multiple sclerosis. Multiple sclerosis most common
demyelinating disease of the CNS, although age has no associated with the HLA DR15
phenotype, although aging can deteriorate the symptoms of MS by the normal physiologic
changes (Marrie et al., 2015). Along with that, osteoarthritis, on the other hand is the result of
age derived joint degeneration, hence this factor acts as a potent negative functional
consequence for Dinh, contributing to his activity intolerance and self-care deficit. Hence, the
care goals will have to address both multiple sclerosis symptoms and the age derived
osteoarthritis to help him recover completely. The care goals for him will be:
 Better management of his MS symptoms, especially blurred vision, unstable gait
and electric shock sensation that affected his activity tolerance and ADLs.

4
EXTENDED CARE PLANNING ESSAY
 Better management of his osteoarthritis related joint deterioration so that Dinh
is able to mobilize better with slight assistance (Afrasiabifar, Mehri, Sadat &
Shirazi, 2016).
The next step in the procedure is taking actions or implementing interventions to
achieve the care goals that has been developed for Dinh (Dalton, Gee & Levett-Jones, 2015).
The first and foremost treatment interventions that is important for Dinh is symptom
management for his multiple sclerosis. The disease modifying drugs or the DMDs or the disease
modifying drugs such as ocrelizumab which helps in slowing down the worsening disability.
However, along with that oral corticosteroids such as prednisone can help in reducing the nerve
inflammation which in turn will help in decreasing the intensity and frequency of electric shock
sensation causing the activity intolerance (Feinstein, Freeman & Lo, 2015). Along with that as
Dinh had been fatigued the aid of muscle relaxants and medication to reduce fatigue will also
be administered to him. Lastly, I would also arrange physical therapy for Dinh by collaborating
with a physiotherapist involving Dinh in stretching and strengthening exercises which will help
him with his osteoarthritis and help him in completing daily tasks. I will also arrange for a
support worker to help Dinh with his activities of daily living and go through a fall risk
assessment to ensure his safety (Munsell, Locklear, Phillips, Frean & Menzin, 2015).
In the next step, the framework of clinical reasoning allows the nurse to focus on
evaluating the outcome of the interventions implemented to improve practice and enhance
efficiency of the care provided (Levett-Jones, 2013). After the implementation of the care
interventions, there had been a marked difference in the activity tolerance of the patient. The
pharmacological interventions were helpful in reducing the intensity of the electric shock
sensation that he had been experiencing. The aid of physical therapy also helped him regain his
strength slowly and improved the activity tolerance gradually (Rathert, Williams, McCaughey &
Ishqaidef, 2015). Although, in the initial stage, it was difficult for him to carry on ADLs and the
aid of support worker was beneficial but with perseverant utilization of treatment interventions
he required lesser and lesser assistance in self-care activities with time.

5
EXTENDED CARE PLANNING ESSAY
The last step of the complete care planning activity is the reflection stage. I would like to
state that this had been a reveling experience for me and it has helped me tremendously in
understanding how to implement clinical reasoning and decision making while I am required to
make judgments for providing care to a patient with severe health issues. Now I understand the
impact of multiple sclerosis on the ability of patients to complete ADLs, and the exact issues of
Dinh and associated care interventions has helped me understand how to design the care
interventions to address the care needs of patients (Fredericks, Lapum & Hui, 2015). I did not
have an experience of care prioritizing either, however, I have learned it while going through
with this activity and I believe this exercise will help me exceptionally in my future practice.
On a concluding note, it has to be mentioned that is crucial for the nurses to understand
the impact of chronic diseases such as multiple sclerosis on the life of the patient and living
condition. It must not be ignored that for chronic illnesses, the patients often experience care
needs and demands that are unique for them. Similarly, the care plans must include
interventions that are individualized with patient centered care interventions so that each and
every care intervention can be provided to the patient. This case study involved an elderly
patient who had been suffering from the co-morbid disorders; in such cases, care planning for
such patients must take into consideration not just addressing the symptoms that the patient is
suffering from, but helping the patient cope with each and every change that has been brought
forward by the disease in their lives. The clinical reasoning cycle and functional consequences
theory by Miller helped in designing a curated individualized care plan which is essential for
care provided to be safe, effective and patient centred.

6
EXTENDED CARE PLANNING ESSAY
References:
Afrasiabifar, A., Mehri, Z., Sadat, S. J., & Shirazi, H. R. G. (2016). The effect of orem’s self-care
model on fatigue in patients with multiple sclerosis: a single blind randomized clinical
trial study. Iranian Red Crescent Medical Journal, 18(8). doi: 10.5812/ircmj.31955
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
The, 33(2), 29. Retrieved from
https://search.informit.com.au/documentSummary;dn=018184224173600;res=IELHEA
Dendrou, C. A., Fugger, L., & Friese, M. A. (2015). Immunopathology of multiple
sclerosis. Nature Reviews Immunology, 15(9), 545. Retrieved from
https://www.nature.com/articles/nri3871
Dennett, R., Coulter, E., Paul, L., & Freeman, J. (2017). Participants' Experience of a Web-based
Physiotherapy Programme for people with Multiple Sclerosis (MS): Does it impact
physical activity levels?. Retrieved from http://hdl.handle.net/10026.1/10876
Feinstein, A., Freeman, J., & Lo, A. C. (2015). Treatment of progressive multiple sclerosis: what
works, what does not, and what is needed. The Lancet Neurology, 14(2), 194-207. Doi:
10.1016/S1474-4422(14)70231-5
Fredericks, S., Lapum, J., & Hui, G. (2015). Examining the effect of patient-centred care on
outcomes. British Journal of Nursing, 24(7), 394-400. Doi: 10.12968/bjon.2015.24.7.394
Hunter, S. (Ed.). (2012). Miller's nursing for wellness in older adults. Lippincott Williams &
Wilkins. Doi: 10.1111/ajag.12387
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-
surgical nursing. Pearson Higher Education AU. Retrieved from
https://books.google.co.in/books?
hl=en&lr=&id=MDXiBAAAQBAJ&oi=fnd&pg=PP1&dq=clinical+reasoning+levett+jones&o
ts=UI7W5Ii36h&sig=M1jPIusYgYK48SvgDhv1xFNFA5o

7
EXTENDED CARE PLANNING ESSAY
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson
Australia. Retrieved from
https://books.google.co.in/books/about/Clinical_Reasoning.html?
id=rwc0MwEACAAJ&redir_esc=y
Ma, V. Y., Chan, L., & Carruthers, K. J. (2014). Incidence, prevalence, costs, and impact on
disability of common conditions requiring rehabilitation in the United States: stroke,
spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid
arthritis, limb loss, and back pain. Archives of physical medicine and rehabilitation, 95(5),
986-995. Doi: 10.1016/j.apmr.2013.10.032
Marrie, R. A., Cohen, J., Stuve, O., Trojano, M., Sørensen, P. S., Reingold, S., ... & Reider, N.
(2015). A systematic review of the incidence and prevalence of comorbidity in multiple
sclerosis: overview. Multiple Sclerosis Journal, 21(3), 263-281. Doi:
10.1177/1352458514564491
Montalban, X., Hauser, S. L., Kappos, L., Arnold, D. L., Bar-Or, A., Comi, G., ... & Lublin, F. (2017).
Ocrelizumab versus placebo in primary progressive multiple sclerosis. New England
Journal of Medicine, 376(3), 209-220. Doi: 10.1056/NEJMoa1606468
Munsell, M., Locklear, J. C., Phillips, A. L., Frean, M., & Menzin, J. (2015). An assessment of
adherence among multiple sclerosis patients newly initiating treatment with a self-
injectable versus oral disease-modifying drug. Neurology, 84(14), 3. Doi:
10.1177/0269215517730670
Rathert, C., Williams, E. S., McCaughey, D., & Ishqaidef, G. (2015). Patient perceptions of
patient centred care: empirical test of a theoretical model.‐ Health Expectations, 18(2),
199-209. Doi: 10.1111/hex.12020

8
EXTENDED CARE PLANNING ESSAY