Identifying Nursing Care Priorities for an Elderly Patient with Multiple Health Issues

This assignment reviews the case scenario of an elderly patient with multiple health issues and identifies nursing care priorities using the Levett Jones clinical reasoning cycle and Miller’s functional consequence theory. The top priority of care is to address the patient's feelings of grief and isolation through personalized counseling and social support. The report also discusses the impact of aging-related changes and social factors on the health and well-being of older adults.

Running head: HEALTH CARE PLANNING
Health care planning
Name of the student:
Name of the University:
Author’s note

1HEALTH CARE PLANNING
Introduction:
The main purpose of the assignment is to review the case scenario of Mr Dinh
Nguyen, an 83 year old widower with history of health issues and ongoing symptoms
of grief and isolation and identify the main nursing care issues for the client. It
engages in critical reflection using the Levett Jones clinical reasoning cycle to
identify three nursing care priorities for the patient and then discuss on the most
important care priority. The Miller’s functional consequence theory will be utilized to
identify the important care priorities for the patient.
Consider the patient:
Mr. Dinh Nguyen is an 83 year old patient who lives alone in his two story
home. Earlier his wife used to live before she died twelve months ago. Mr. Dinh has
migrated from Vietnam in 1976 and the current health issue for him is that he is
suffering from ongoing grief and isolation. As he does not have any children,
isolation and grief has significantly affected health of the client. Currently he is also
facing issues in doing daily activities like cooking, showering and dressing because
of blurred vision, electric shock type feeling during head and neck movement and
numbness in his face. He is also experiencing urinary incontinence.
Collect cues/information:
The cause behind Mr. Dinh’s current health condition can also be understood
from review of past medical history too. Six years ago, Mr. Dinh was diagnosed with
multiple sclerosis. Four years ago he was diagnosed with osteoarthritis. In addition,
issues related to feelings of isolation and grief has emerged after the death of his
wife. As he does not have any children and do not want to involve them in his daily
life, getting no social support is also a cause behind depressive symptom for the
client. Currently he is also on three medications and one is for exacerbation of
symptoms.
Process information:
The above symptoms and current challenges for Mr. Dinh can be understood
from the application of Miller’s functional consequences theory. He has been
experiencing challenges in daily life activities because of age related changes and

2HEALTH CARE PLANNING
presence of many risk factors too. He suffered from osteoarthritis in the past. This
might have occurred because of aging related changes. Osteoarthritis is highly
recognized as an age related disease because it is the most common disorder in
eldelrly people. Anderson and Loeser (2010) explains that age is the greatest risk
factor for the development of osteoarthritis because of age related changes in the
function of cells and tissues of the body. The cells and tissues lose the capability to
maintain homeostasis due to aging particularly during stress. The same issue is not
so serious in young adults because young age adults can compensate for stress
declines compared to older adults. Hence, it can be said that decline in basic cellular
mechanism involved in homeostasis with aging is the reason for joint tissue loss and
osteoarthritis for Mr. Dinh. Urinary incontinence was also a problem for Mr. Dinh and
this also limits social activity of people. It also contributes to multiple sclerosis (Nerli
& Hiremath, 2017).
Another negative functional aspect that has been identified for Mr. Dinh based
on the review of health issues is the issue of depressive symptom in patient. His
symptom of grief and increasing isolation is an indication of depression. Depression
is a mental health condition associated with symptom of low mood, feelings of
sadness and loss of interest in activities. Lack of family member’s support and living
alone has been recognized as the risk factor of grief and isolation in patient. Another
risk factor for depression might include presence of many physical illness. Mr. Dinh
suffered from many health issues in the past such as multiple sclerosis, blurred
vision, mobility issues and gait impairment. There is a complex relationship between
physical illness, disability and depression. Evidence suggests that physical illness in
old age contribute to permanent disabilities and this negative has an impact on
mobility and self care needs of patients (Fässberg et al., 2016). Hence, they start
developing feelings of depression. It is crucial that Mr. Dinh received proper attention
at this age and his dignity be respected too so that his depressive symptoms can
alleviate.
Social isolation and loneliness is also predictive of depressive symptom in
elderly people. Lack of children, death of Mr. Dinh’s wife and lack of any other form
of support is indicative of loneliness and reduces connection with families. This might
have significantly affected emotional wellbeing for the client and eventually
contributed to depression. It has an adverse impact on functional status of elderly

3HEALTH CARE PLANNING
people too as they become dependent on activities of daily living (Shankar et al.,
2017). Courtin and Knapp (2017) suggest that large number of people are living
alone now and this might be a risk factor of being isolated, physically and mentally ill.
Dinh is experiencing challenges in daily task like cooking, showering and dressing
also because of age associated physical changes such as blurred vision, electric
shock feeling and numbness in the face. Kempen et al. (2012) explains that low
vision has an impact on activities of daily living and feelings of anxiety in older adults.
The health related quality of life of older adults with vision problem is low because of
its impact on functioning and symptoms of depression. Therefore, rehabilitative
service is needed to improve the quality of care.
Identify problem or issues:
Based on the review and interpretation of all information available related to
Mr. Dinh, three major health issues has been identified for Mr. Dinh. The first health
issue is the presence of symptom of depression indicated by feelings of grief and
isolation. Many risk factors such as diagnosis of physical illness, loneliness and lack
of social support has been recognized as a risk factor of grief in patient. Controlling
his symptom is important as this may worsen his mental state and may lead to
suicide ideation and self harm tendency too.
The second health issue identified for Mr. Dinh is dependence on activities of
daily living because of blurred vision, numbness in the face and electric shock. This
might have occurred because of risk factors such as aging and diagnosis of
osteoarthritis and multiple sclerosis in patient. Hence, controlling signs of shock is
important as this may help to address mobility issue and also increase participation
in social activities. Urinary incontinence is also identified as a health issue for Mr.
Dinh as the symptom is worsening and he is feeling uncertain about his future
because of multiple comorbidities. Treating these three factors will be important to
promote functional progress in patient.
Top priority of care:
Establish goals:
Among the three health care priorities, feelings of grief and isolation has been
identified as the top priority for patient because of multiple illness and age related

4HEALTH CARE PLANNING
disability in patient. The issue of numbness and worsening of urinary incontinence
has made Mr. Dinh anxious and he is suffering from grief because of inability to
manage his health issues and not being able to receive appropriate family support
too. Hence, to reduce symptom of grief and isolation, the main goal of care is to
reduce feelings of grief and anxiety in patient, improve his ability to engage in self
care activities and prevent depression from returning. It is also planned to mitigate
feelings of social isolation in patient to reduce the risk of suicide. Landeiro et al.
(2017) argues that reducing social isolation and loneliness is important as it is highly
prevalence in elderly population and negative influence physical and mental health
too.
Take action:
To achieve the above mentioned goals based on the care priority of
addressing depression and isolation in patient, it is planned to implement the nursing
intervention of personal counselling so that feelings of grief and low self esteem can
be addressed. Personal counselling can also help to interpret mental thought
process and reason behind grief in patient and provide ideal environment for
promotion of health (Aakhus et al., 2015). To address feelings of isolation in patient
because of impaired social interaction, it is planned to engage client in social
activities that reduce feelings of social isolation and distracts him from negative
thoughts. He can also be referred to self help group who can provide right support to
cope with physical illness as well as depression. As his self care activities have been
affected too, assistance will be provided during mobility (Liu, Gou & Zuo, 2016). The
client can also be referred to clinician to address signs of electric shock and
numbness affecting gait.
Evaluate outcomes:
In response to the above intervention, it is expected that Mr. Din would be
able to manage his illness and positively cope with stress in life. Mr. Din would feel
happy and pleasant by taking part in group activities and getting support in self care
activities will reduce feelings of isolation. By engaging in patient centred care and
respecting client’s diversity, the patient will be able to realize his self worth and
dignity too. He will also be able to manage his illness well by getting the right referral
for management of health.

5HEALTH CARE PLANNING
Reflection:
The process of reflecting on health issues and identifying care priorities for
Mr. Dinh has helped me to understand the impact of aging related changes and
social factors on health and well being of older adults. However, I lacked knowledge
about cause behind electric shock in the neck and I aim to learn more about the
pathophysiology of such condition in elderly so that I can plan appropriate care for
patient.
Conclusion:
The report gave an insight into three health issues for Mr. Dinh based on
interpretation of current and past health issues for the client. The Miller’s functional
consequences theory helped to identify negative functional consequences for the
client, the risk factor of illness and its impact on overall health of patient. As
depressive symptom was found to be the main consequence of all types of illness,
addressing feelings of grief and isolation was identified as the top most priority.
Personalized counselling and social support were planned as important nursing
intervention to address disturbed though process and decrease the risk of social
isolation in patient.

6HEALTH CARE PLANNING
References:
Aakhus, E., Granlund, I., Oxman, A. D., & Flottorp, S. A. (2015). Tailoring
interventions to implement recommendations for the treatment of elderly
patients with depression: a qualitative study. International journal of mental
health systems, 9(1), 36.
Anderson, A. S., & Loeser, R. F. (2010). Why is osteoarthritis an age-related
disease?. Best practice & research Clinical rheumatology, 24(1), 15-26.
doi: 10.1016/j.berh.2009.08.006
Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: a
scoping review. Health & social care in the community, 25(3), 799-812.
Fässberg, M. M., Cheung, G., Canetto, S. S., Erlangsen, A., Lapierre, S., Lindner,
R., ... & Duberstein, P. (2016). A systematic review of physical illness,
functional disability, and suicidal behaviour among older adults. Aging &
mental health, 20(2), 166-194. https://doi.org/10.1080/13607863.2015.1083945
Kempen, G. I., Ballemans, J., Ranchor, A. V., van Rens, G. H., & Zijlstra, G. R.
(2012). The impact of low vision on activities of daily living, symptoms of
depression, feelings of anxiety and social support in community-living older
adults seeking vision rehabilitation services. Quality of life research, 21(8),
1405-1411. doi: 10.1007/s11136-011-0061-y
Landeiro, F., Barrows, P., Musson, E. N., Gray, A. M., & Leal, J. (2017). Reducing
social isolation and loneliness in older people: a systematic review
protocol. BMJ open, 7(5), e013778.
https://bmjopen.bmj.com/content/7/5/e013778
Liu, L., Gou, Z., & Zuo, J. (2016). Social support mediates loneliness and depression
in elderly people. Journal of health psychology, 21(5), 750-758.

7HEALTH CARE PLANNING
Nerli, R. B., & Hiremath, M. B. (2017). Urinary Incontinence in the Elderly. RGUHS
Journal of Medical Sciences, 7(3), 90-93. DOI:
10.26463/rjms/2017/v7/i3/116933
Shankar, A., McMunn, A., Demakakos, P., Hamer, M., & Steptoe, A. (2017). Social
isolation and loneliness: Prospective associations with functional status in
older adults. Health psychology, 36(2), 179. Retrieved from:
https://dspace.lboro.ac.uk/dspace-jspui/bitstream/2134/22377/3/ELSA
%20functional%20status_HealthPsych_final.pdf