Nursing Care Plan Essay

This nursing essay focuses on the case study of a patient named Alice Jones, an 89 year old patient that have been suffering from many age related conditions, all the while living in the Minnows aged care facility.

Running head: NURSING CARE PLAN ESSAY
Nursing care plan essay
Name of the student:
Name of the university:
Author note:

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NURSING CARE PLAN ESSAY
Table of Contents
Part A:........................................................................................................................................2
Medical diagnosis:.................................................................................................................2
Theory of aging:.....................................................................................................................2
Physiology of Ageing:............................................................................................................3
Primary health services:.........................................................................................................4
Strategies and Interventions for dementia/challenging behaviours:......................................5
Oral hygiene:..........................................................................................................................6
Pain:........................................................................................................................................7
Complementary therapies:.....................................................................................................7
Part B: Nursing Care Plan: Clinical Reasoning Cycle...............................................................8
References................................................................................................................................13

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Part A:
Medical diagnosis:
The nursing essay focuses on the case study of a patient named Alice Jones, an 89
year old patient that have been suffering from many age related conditions, all the while
living in the Minnows aged care facility. She has many concerning components in her past
medical history, including Myocardial infarct (MI), Hypertension, osteoarthritis, anxiety and
depression. Although, the most delimiting diagnosis and presenting complaint is the
Alzheimer’s Dementia and urinary incontinence. Her many complaints include mobility
assistance due to her osteoarthritis, and along with that, she even had had sustained two falls
in the past which could have potentially caused considerable injuries or concussions for her.
The presenting complaints include altered perception of time and place, as she had been
reported to be up at 2am and required redirecting to her bed. At time of report, she is having a
shower with the night Personal carer as she was up and at the nurses’ station requesting to go
to the shops. Her past medical history will have a huge impact; due to her altered perception
of time and place, her tendency to walk out of the bed can lead to fall, leading her to sustain
significant injuries. Similarly, her myocardial infarction indicates a blocked heart which in
turn can complicate her medical conditional and can even lead to fatal health risks. Hence,
her medical diagnosis based on the case assessment data includes Alzheimer’s dementia,
urinary continence and fall risk due to restricted mobility (Beck et al., 2015).
Theory of aging:
The ageing theory which would be appropriate is the neuroendocrine hypothesis of
ageing, which focuses extensively on the interconnectedness of the endocrinal system and the
central nervous system. The hypothalamus plays a key role in the hormonal activities outlined
in this theory and instructs the pituitary gland in the functional regulation of additional

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endocrinal glands such as ovaries, testes, adrenal and thyroid glands (Adelman & Roth,
2017). Due to the disruptive health effects characteristic of the ageing process, the efficiency
of this endocrinal system degrades and results in hindrances in cognitive functioning, sleep
disturbances, difficulties in sleeping further cascading into cardiovascular deficits and
hypertension (Bauer et al., 2015). Alice has demonstrated characteristic symptoms of
Alzheimer’s Dementia in the form of hypertension, damaged cardiovascular functioning,
cognitive loss and sleeplessness. As per the neuroendocrine theory of ageing, loss of
hypothalamic-pituitary-adrenal function due to ageing leads to hindered insulin-like growth
factor functioning, cortisol dysfunction and damage to the dehydroepiandrosterone (DHEA)
circadian activity further resulting in a hampered cortisol-DGE ratio and the resultant shift
from anabolism to catabolism, loss of appetite, immune system degradation cognitive loss
and increased cardiovascular disease susceptibility (Greenwood et al., 2018). The effects of
this theory can be observed in Alice’s symptoms and history of myocardial infarction,
sleeplessness, Alzheimer’s dementia, depression, hypertension and anxiety.
Physiology of Ageing:
Ageing results in detrimental impacts upon the musculoskeletal system leading to
reduced muscle tissue size, elasticity and strength. Ageing also leads to reduced ATP,
myoglobin and glycogens stores in muscles leading to mobility difficulties and impaired
movement of muscles as seen in Alice’s issues in daily activity performance (Palmer &
Goodson, 2015). Ageing is associated with neurosensory changes resulting in cerebral and
spinal neuronal loss, dendrite degradation, impaired transmission of synapses, inflammation
associated amyloid deposition in the brain further leading to hindered cognitive and sensory
capabilities, as evident in Alice’s acquisition of Alzheimer’s Dementia (Yanai et al., 2017).
The ageing process also results in malfunctioning cardiovascular processes leading to
increased risk of hypertension, stroke and myocardial infarction which are clearly observed in

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Alice. This is due to ageing-induced interstitial fibrosis and decreased response to
catecholamines and cardiac glycosides resulting plaque formulation, endothelial thickening
and hindered cardiac output (Costantino, Paneni & Cosentino, 2016). Ageing-induced
neuronal changes also results in bladder sensation loss and urinary incontinence, with greater
susceptibility in geriatric females as seen in Alice (van del Heuvel, 2018). Ageing also leads
to loss of equilibrium between osteoclastic bone resorption and osteoblastic bone modeling
processes resulting in osteoporosis evident in Alice (Farzi et al., 2018). Age associated
compromises in neuronal activities increases one’s susceptibility of depression and anxiety,
demonstrated clearly in Alice (Verhoeven et al., 2015). Lastly, physiological effects of ageing
result in disrupted endocrinal activities and the resultant beta cell associated insulin secretion,
comprised glucose metabolism and increased hypertensive and cardiovascular susceptibilities
as seen in Alice (El Assar, Angulo & Rodríguez‐Mañas, 2016).
Primary health services:
Two very important concerns that the patient in this case have includes Alzheimer’s
dementia and fall risk due to heavily restricted mobility with regards to the osteoarthritis that
the patient had been suffering with. Hence, based on her presenting care needs, there are
certain primary care services that can be accessed for the patient to provide care, assistance
and support the patient requires in the process of successful disease management and coping
with the presenting problems that she is facing. First and foremost, the national dementia
helpline can be a very important support for the patient in light of the deteriorating dementia
that is evident from the case reports. The national dementia helpline is an Australia-wide
confidential telephone information and support service which provides immediate relief to
the patients by trained and experienced professional (Burns et al., 2018). The range of
services that are provided includes dementia patients, their family and friends, and can
provide immediate assistance to anyone that is suffering from immediate risk of memory loss.

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Another primary care service that can be of extreme help to the patient is cognitive dementia
and memory services or CDAMS. In contrary with the national dementia services, the
cognitive dementia and memory service is a specialist service which provides assistance to
the individuals with memory loss or the individuals that have disturbed thought processes.
They provide expert clinical diagnosis information on appropriate treatments, education,
support and information, direction in planning for the future, information on dealing with
day-to-day issues, and links for people with dementia and their carers to other services and
community supports. Along with support and assistance for her to manage her dementia
successfully, it is also equally important to provide services that provide assistance to her
while living at her home. The Home and community care or the HACC program can provide
her with adequate self-care assistance. These services provide assistance with activities of
daily living, such as cleaning and other household tasks, respite support, assistance with
social opportunities, along with information and counselling (Betterhealth.vic.gov.au, 2019).
All these primary care services can be of assistance to the Alice as she attempts to cope with
her presenting condition in the future.
Strategies and Interventions for dementia/challenging behaviours:
The most notable complication that the patient is suffering from presently is the
Alzheimer’s dementia and the related challenging behaviours that are associated with it. The
first and foremost strategy for the maintenance of dementia and associated challenging
behaviour would be the pharmacological management of the disease. For instance, it has to
be mentioned that first and foremost, the glutamate regulation medications such as
remacemide, memantine, riluzole, and budipine (Berry et al., 2017). These medications will
help in blocking the receptor group to glutamate which is also known as N-methyl-D-
aspartate or NMDA. Furthermore it has to be mentioned that Budapine specifically not only
blocks NMDA, but it increases levels of two enzymes involved in the production of

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dopamine. Hence, administering these medication and educating the patient to take these
medications will be the most important strategies or interventions that will be taken.
The next set of interventions will be to help the patient adhere to the medications and
make a routine which would help the patient adhere to the medications properly. For instance,
as Alice is exhibiting signs of altered sensory perception and the idea of the time and space,
adhering to medication properly would be a huge risk for the patient, and forgetting to take
the medication can have a huge impact on her health and wellbeing. Hence, making her a
routine or helping her adhere to her routine can be of extreme help to the patient (Brooker &
Latham, 2015).
The next intervention is specifically for the challenging behaviour that the patient is
experiencing, which is counselling and group therapies. The counselling and group therapies
will help in improving and eliminating the impact of the triggers or stimulus that contributes
to the challenging behaviour. The group therapies will also help in Alice familiarizing with
people that are suffering from similar condition and will help in motivating her in coping
with the disease more effectively.
Oral hygiene:
Another very important aspect associated with the health and disease management pf
the patients with dementia or Alzheimer’s dementia is maintaining proper oral hygiene is a
very important aspect associated with the patient. More importantly it is extremely crucial for
the care workers understand the impact of the oral hygiene, educate Alice regarding the
impact of oral care and how to implement proper oral hygiene practices (Burns et al., 2018).
For instance, for people with progressing dementia, the risk of overlooking oral hygiene is
very common. Hence, instructing Alice regarding proper oral care and providing informative
brochures with simple instructions to main oral health such as brushing her teeth twice,
putting paste on the brush, use flossing once a day, etc. Along with that, monitoring her daily

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oral care practices will also be needed to take into consideration for Alice Jones.
Pain:
Pain assessment encompasses a vital position in the care routine of the dementia
patients. Although providing adequate support and management of the pain, it is crucial for
the care professionals to adequately assess the pain. Although it has to be mentioned in this
context that the regular pain assessment scores or scales are usually not as effective for
dementia patients due to their limited sensory perception and altered thought process.
Although, in this case, there are many advanced or specified pain assessment tools which can
be used for the dementia patients (Gomolin et al., 2017). One of the tools are the PAINAD
scale of pain assessment a behaviour-observation tool, designed specifically for the dementia
patients that cannot properly vocalize or verbally communicate the fact they are in pain.
There are five criteria associated with the pain assessment scale, breathing: labored breathing
or hyperventilating, vocalization: moaning or crying, facial expression: frowning or
grimacing, body language: clenching fists or pushing away caregivers, and lastly,
consolability: an inability to be comforted. This pain assessment technique can be used for
Alice and based on the findings adequate treatment interventions can be provided (Hunter,
Hadjistavropoulos & Kaasalainen, 2016).
Complementary therapies:
Dementia is a chronic diseases, which is not associated with a curative measure. On a
more elaborative note, dementia is a disorder which can be managed with specific and
patoent centred interventions, but at the same time it is crucial for the nurses to provide
complementary or alternative therapies or treatment that can provide comfort, assurance and
better control at their own life for the dementia patients (Yanai et al., 2017). For Alice the
psychological impact of the social isolation or withdrawal, the impact of the disease and
successful coping of the disorder might require additional efforts of complementary therapies.

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First and foremost, the patient might be given the aid of aromatherapy for comfort and
composure. Aromatherapy is a very potent tool at establishing composure and managing the
frequency or intensity of challenging behaviour. Similarly, the aid of yoga and mindfulness
based therapies can also help the patients in managing her anxiety and attain a better control
at her disease management. Music therapy can be another notable alternative therapeutic
measure which can help Alice develop a calm composure and can provide her peace of mind
when she is panicking and agitated (McKenzie et al., 2017). In certain cases, the use of dolls
can bring great benefits to some people with a diagnosis of dementia, particularly those in
later stages.
Part B: Nursing Care Plan: Clinical Reasoning Cycle
Identification of
Issue/Problem
Goal
Establishme
nt
Action to be taken Evaluation of
Outcomes
Process
Reflection
Actual
Problem/Issue:
Fall risk as a
result of
unmonitored
wandering
To avoid
future fall
incidences in
Alice and the
resultant
negative
health
implications
during aged
care stay.
 Formulation
of nursing
and clinical
workforce
team who
will conduct
timely
monitoring
on Alice and
identify
potential
Adequate and
timely
supervision will
not only prevent
fall risk in Alice
but will also aid
nursing staff in
the
identification of
unmet patient
needs or signs
Alice was
once caught
wandering in
search of her
sister and for
shopping. I
gently
persuaded
her to her
bed and
engaged in

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situations of
unchecked
wandering.
 Nursing
usage of
empathetic
communicati
on and
gentle
persuasion to
supervise
Alice if she
is caught
wandering.
 Removal of
clutter and
obstacles to
prevent
accidental
falls (Berry
et al., 2017).
of agitation
(McKenzie et
al., 2017).
empathetic
listening in
order to
identify her
needs.
Actual
Problem/Issue:
Loss of memory
and cognitive
To improve
Alice’s
memory and
perception
 Administrati
on of
glutamate
regulatory
Medications
like memantine
improve
memory and
Alice was
observed to
forget eating
her meal. I

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NURSING CARE PLAN ESSAY
functioning due
to Alzheimer’s
Dementia
skills within
her next
month of
aged care
stay.
medications
like
memantine
and
galantamine.
 Removal of
environment
al
distractions
and
provision of
simple
patient
activity
routine
(Beck et al.,
2017).
cognitive
through
regulation of
glutamate – an
excitatory
neurotransmitter
(Gomolin et al.,
2017).
Removal of
light and noise
distractions and
establishment of
simple
instructions will
encourage Alice
to remember
eating her food
(Hunter,
Hadjistavropoul
os &
Kaasalainen,
2016).
ensured that
her
medications
were
administered
and patiently
instructed
and assisted
her in
feeding in a
peaceful
environment.
Potential
Problem/Issue:
Cardiovascular
To prevent
future
occurrences
Ensure timely
administration of
beta blocker
Beta blockers
like atenolol
will aid in
I regularly
monitor
Alice’s blood

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NURSING CARE PLAN ESSAY
disease risk due
to history of
Myocardial
Infarction
of
cardiovascula
r risks and
maintain
health
cardiovascula
r status
throughout
aged care
stay.
medications and
monitoring of blood
pressure (Wong,
Boyda & Wright,
2016).
prevention of
hypertension
and Alice’s
susceptibility to
be diagnosed
with stroke
myocardial
infarction
(Wysonge et al.,
2017).
pressure to
check for
possibilities
of
cardiovascul
ar diseases. I
also ensure
her timely
medication
consumption
of atenolol.
Potential
Problem Issue:
Self-care deficit
due to
neurodegenerati
ve condition of
Alzheimer’s
Dementia
To encourage
enhanced self
conductance
of activities
of daily
living in
Alice within
her next
month of
aged care
stay.
 Nursing
assistance
and
encouragem
ent during
Alice’s
performance
of self care
activities
like
dressing,
grooming,
eating,
walking and
Gentle nursing
persuasion and
provision of
instruction will
ensure safe self
care activity
performance in
Alice and also
enhance her
memory and
ability to
practice the
same.
Administration
I assist and
gently
encourage
Alice to
perform self
care tasks by
herself daily.
I also work
collaborative
ly with the
psychologist
and geriatric
specialist to
perform

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NURSING CARE PLAN ESSAY
personal
hygiene.
 Performance
of
stimulating
activities in
collaboration
with a
psychologist
or geriatric
specialist
such as list
preparation
and
organization,
reading,
music, art,
craft or
problem
solving
activities
(Brooker &
Latahm,
2015).
of creative
stimulatory
activities will
aid in memory
and perception
enhancement in
Alice (Burns et
al., 2018).
enjoyable
cognitive
stimulating
activities
with Alice.

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NURSING CARE PLAN ESSAY
References:
Adelman, R. C., & Roth, G. S. (Eds.). (2017). Endocrine and Neuroendocrine
Mechanisms of Aging. CRC Press.
Bauer, M. E., Wieck, A., Petersen, L. E., & Baptista, T. S. (2015). Neuroendocrine and
viral correlates of premature immunosenescence. Annals of the New York
Academy of Sciences, 1351(1), 11-21.
Beck, E. R., McIlfatrick, S., Hasson, F., & Leavey, G. (2017). Nursing home manager's
knowledge, attitudes and beliefs about advance care planning for people with
dementia in long‐term care settings: a cross‐sectional survey. Journal of clinical
nursing, 26(17-18), 2633-2645.
Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in
nursing care facilities and the hospital setting.
Betterhealth.vic.gov.au. (2019). Services to support people with dementia and their
carers. [online] Available at:
https://www.betterhealth.vic.gov.au/health/servicesandsupport/dementia-and-
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Vidoni, E. D. (2018). The Impact of Creative Arts in Alzheimer’s Disease and
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cardiovascular disease. The Journal of physiology, 594(8), 2061-2073.
El Assar, M., Angulo, J., & Rodríguez‐Mañas, L. (2016). Diabetes and ageing‐induced

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