Role of Community Nurse in Managing a Nursing Case Study

This case study explores the role of a community nurse in managing the case of Jenny Peterson, focusing on the management of seizures and maintenance of positive health outcomes. The nurse uses the clinical reasoning cycle to assess the patient's situation, collect relevant information, process the information, identify problems, establish goals, take action, and evaluate outcomes. The case study highlights the importance of considering multiple dimensions of a patient's health and collaborating with other healthcare professionals.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student:
Name of the University:
Author note:

1NURSING CASE STUDY
Introduction: Community nurses are entrusted with responsibilities of maintaining
positive health outcomes within the community and hence, must considered multiple dimensions
to a patient’s health other than physiological consequences of diseases, such as emotional,
psychological and social well being (Bain & Chilton, 2017). The following paragraphs aim to
shed light on the role of the community health nurse in the management of the case of Jenny
Peterson, using two nursing priorities of: Management of seizures and Maintenance of
Positive Health Outcomes through eradication of minor gastrointestinal illnesses, with the
help of the clinical reasoning cycle (CRC). The CRC is the nursing process of patient
information collection, processing of patient data, consideration of the patient’s issues, planning
of interventions prior to implementations, evaluation of outcomes and engagement in nursing
reflective practice (Levett-Jones, 2017). .
Consider Patient Situation: This is the initial stage of the CRC and necessitates the
nursing process of observation and noticing the concerned patient closely for the detection of
the key problems and issues to be considered. Recalling that this process is the pre-requisite for
the determination of patient assessment and treatment methods, nurses must evaluate the
situation of the patient without any bias or judgment and engage in empathy, patient listening
and insightful observation (Levett-Jones, 2017). The nurse must consider that the patient in
question, Jenny Peterson, is suffering from a frequent problem of seizures after a recent injury
to her brain following a car accident. Despite observed to have regulated the occurrences of
these symptoms, her epileptic symptoms have resurfaced resulting employment and financial
hindrances – which the community nurse must consider as pre-requisites for improvement
social wellbeing and patient empowerment. Jenny is observed to exhibit frequent illnesses in the
form of gastrointestinal disturbance such as diarrhea, nausea as well as common cold. The
community nurse must consider improvement of Jenny’s wellbeing for future occupational
engagement and care of her daughter Samantha (Strandås & Bondas, 2018).
Collect Cues/Information: This step of the CRC is characterized by the community
nurse collecting relevant patient information through assessments and screening tools for the
purpose of formulating a nursing diagnosis (Levett-Jones, 2017). Considering that Jenny’s
symptoms of epilepsy have been reported to resurface, the community nurse may need to work
collaboratively with a neurologist and psychiatrist to undertake assessments relevant for seizure
screening, since these are beyond her scope. These include electroencephalogram (EEG),
neuro-imaging procedures such as Magnetic Resource Imaging, Computer Tomography and
neuro-psychological assessments in the form of tests assessing memory, reasoning or thinking

2NURSING CASE STUDY
such as Mini-Mental Status Examination (MMSE) (Sidhu, Duncan & Sander, 2018).
Considering that stress is positively linked with incidence, the nurse and associated
psychologist may work collaboratively to administer a Personal Wellbeing Index in order to
assess Jenny’s level of satisfaction with her life, job, personal relationships, community and
future (Australian Center on Quality of Life, 2019). Jenny’s relapse of a seizure may be linked
to a cerebrovasvular accidence or a transient ischemic attack since these have been linked to
cause epilepsy. The nurse must collaboratively work with a cardiologist to perform a
cardiovascular assessment (Pitkänen, Roivainen & Lukasiuk, 2016). The nurse may work with a
gastroenterologist to conduct an abdominal assessment to detect any blockages in her
gastrointestinal tract which may contribute to her nausea and vomiting (Hall, 2017). The
community nurse can collect information on possible side effects of Jenny’s present medications
on sodium valproate and lamotrigine using evidence based research (Blond, Detyniecki &
Hirsch, 2016).
Process Information: The community nurse in this step is required to link the results
obtained from the above assessments and link the same with previously acquired knowledge
through experiences and evidence based research (Levett-Jones, 2017). Hence, upon detecting
high levels of stress or poor results of satisfaction or wellbeing the nurse may link the Jenny’s
epileptic symptoms with detrimental psychological wellbeing since stress life events have been
documented to cause epileptic seizures (Van Campen et al., 2016). Further, the nurse may
process Jenny’s level of stress by linking it to the significant events in her life, like separation
from her husband and distress concerning her daughter’s health and wellbeing (Shoemaker et
al., 2016). Further, assessments of side effects of Jenny’s medications may reveal causative
mechanism underlying her frequent association with colds, diarrhea and vomiting since
medications like lamotrigine and valproate include diarrhea, nausea, vomiting and fever
(Grevers et al., 2016). Abnormalities in structural changes in the brain, detected through EEG,
neuro-imaging of MMSE can aid the nurse in processing Jenny’s relapse by associating these
with an aggravation of her epileptic condition, hence, necessitating alternative or more
comprehensive treatments in the future (Vogt et al., 2017).
Identify Problems/Issues: The community nurse will henceforth utilize her clinical
knowledge in the identification of key problems prevalent in Jenny’s condition of epilepsy
(Levett-Jones, 2017). The prevalence of stressful life events have aggravated the reoccurrence
of epileptic symptoms in Jenny as evidenced by her reduced levels of wellbeing and satisfaction
and detected cerebral abnormalities, epileptiform discharges and MMSE results, possibly

3NURSING CASE STUDY
attributable to distress concerning her daughter and separate from her partner (Gélisse et al.,
2015). It must also be considered that Jenny’s prevalence of gastrointestinal illnesses and colds
have emerged in the form of health implications of her present medications since sodium
valproate and lamotrigine have been attributed to side effects such as abdominal cramping,
nausea, vomiting, diarrhea and fevers (Bryant & Knights, 2014). Further, Jenny’s relapse of her
epileptic symptoms may indicate inefficiencies of her current treatment hence necessitating
alternative therapies or altered medications, along with targeting the mitigation of the above
mentioned problems (Ou et al., 2018).
Establish Goals: The nurse will be required to prioritize the problems identified above
for Jenny and hence proceed with the plan of treatment (Levett-Jones, 2017). One of the key
problems faced by Jenny is her recurrence of epileptic seizures which are affecting her
occupational activities and contributing to financial distresses. Further, an additional problem
which is notable in Jenny is her constant acquisition of minor illnesses such as colds, diarrhea
and nausea which are affecting her overall sense of wellbeing. Further, additional problem
which must be considered is the possibility of Jenny’s condition relapsing again which may
indirectly impact Samantha’s safety and wellbeing in the future. Hence, the community nurse
must plan Jenny’s care procedures by considering the following SMART goals:
1. To reduce Jenny’s occurrence of seizures through alternative epileptic treatment
procedures and reduction of stress within the next 3 weeks.
2. To improve Jenny’s wellbeing and occurrence of minor illnesses through alternative
epileptic medications or their respective dosages within the next 3 weeks.
3. To reduce the possibilities of further epileptic relapse and ensure familial wellbeing
through provision of a nurse monitoring and care bundle/package.
Take Action: Stress and the psychological or emotional consequences of stressful life
events have been linked with the reoccurrence of symptoms in patient suffering from epilepsy
(den Heijer et al., 2018). Hence, considering the fact that Jenny’s symptoms of seizures have
resurfaced along with consideration her constant stress concerning her daughter’s wellbeing
and the lack of support from her husband, it can be implied that such challenging life events
have contributed to this situation. Hence, the nurse must consider the possible ineffectiveness
of present pharmacological interventions, the observed side effects and the administration of
treatment techniques to mitigate Jenny’s epilepsy as well as her levels of psychological distress
(Dubé et al., 2015).

4NURSING CASE STUDY
A multidisciplinary care approach can be considered where the community nurse may
have to work collaboratively with a psychologist who will administer psychotherapeutic and
counseling techniques targeted at Jenny’s stress reduction such cognitive behavioral therapy
(CBT), mindfulness and self-reflection techniques (Valeta, 2017). Complementary therapies
such as massages and mediations have been implicated to be effective in the management of
epilepsy and life stresses which the nurse may consider via interpersonal and inter-professional
communication with the psychologist or Jenny’s general practitioner (Farrukh, et al., 2018).
Secondly, considering the links between the side effects of valproate and lamotrigine and
Jenny’s issues with diarrhea, nausea and colds, the nurse must collaboratively communicate
with a neurologist for dosage alteration and replacement with complementary or behavior
modification therapies since the side effects of epilepsy medications have been known to
reduce upon dosage reduction or withdrawal (Moura et al., 2016). To further prevent
reoccurrence, reduce Jenny’s distress and hasten her joining of her job, the community nurse
and community health organization can collaboratively work with support groups who can visit
Jenny weekly or engage in telephonic conversations to enquire about her condition and
administer self-reflection, resilience or self-reflection techniques to increased her sense of self-
esteem and self-empowerment (Wood et al., 2017).
Evaluate Outcomes: The community nurse must conduct another cycle of the CRC to
assess treatment outcomes (Levett-Jones, 2017). The nurse may be required to collaboratively
engage in administration of neuro-imaging, neuro-psychological and quality of life
measurements to evaluate Jenny’s present level of stress, satisfaction and seizure possibility
(Anderson et al., 2016). In case of another occurrence of seizure, a cardiovascular assessment
may be required to detect strokes considering its associations with seizures. A patient centered
approach through personal discussion with Jenny can help the nurse to identify her needs,
preferences and opinions about the care plan (Nursing and Midwifery Board of Australia, 2019).
Reflection: Managing the case scenario of Jenny Peterson, was an influential
experience during my working as a community nurse. The case was reported to our
organization in the form of Jenny’s relapse of seizures and minor illnesses of colds, diarrhea
and nausea. As a community nurse, I successfully engaged in collaborative working in a
multidisciplinary team to manage Jenny’s multi morbid scenario. Considering Jenny’s case, I
learned that the nurse must consider emotional and psychological wellbeing of a patient to
ensure positive health outcomes (Jakimowicz & Perry, 2015). However, I lacked significant
knowledge on alternative therapies or causative factors underlying epilepsy. Hence, for future

5NURSING CASE STUDY
practice, I must conduct evidence based research concerning the same and collaborative with
relevant health professionals.

6NURSING CASE STUDY
References
Anderson, J., Hill, J., Alford, M., Oto, M., Russell, A., & Razvi, S. (2016). Healthcare resource
utilization after medium-term residential assessment for epilepsy and psychogenic
nonepileptic seizures. Epilepsy & Behavior, 62, 147-152. doi:
https://doi.org/10.1016/j.yebeh.2016.06.004.
Australian Center on Quality of Life. (2019). Australian Centre on Quality of Life. Retrieved from
http://www.acqol.com.au/instruments.
Bain, H., & Chilton, S. (2017). The role of the community nurse in mental health. In A Textbook
of Community Nursing(pp. 147-162). Routledge. doi:
https://www.taylorfrancis.com/books/e/9781498725385/chapters/10.1201/978131515720
7-8.
Blond, B. N., Detyniecki, K., & Hirsch, L. J. (2016). Assessment of treatment side effects and
quality of life in people with epilepsy. Neurologic clinics, 34(2), 395-410. doi:
https://doi.org/10.1016/j.ncl.2015.11.002.
Bryant, B., & Knights, K. (2014). Pharmacology for Health Professionals ebook. Elsevier Health
Sciences. doi: https://www.elsevier.com/books/pharmacology-for-health-professionals/
bryant/978-0-7295-4170-1.
den Heijer, J. M., Otte, W. M., van Diessen, E., van Campen, J. S., Lorraine Hompe, E., Jansen,
F. E., ... & Zijlmans, M. (2018). The relation between cortisol and functional connectivity
in people with and without stress‐sensitive epilepsy. Epilepsia, 59(1), 179-189. doi:
https://doi.org/10.1111/epi.13947.
Dubé, C. M., Molet, J., Singh-Taylor, A., Ivy, A., Maras, P. M., & Baram, T. Z. (2015). Hyper-
excitability and epilepsy generated by chronic early-life stress. Neurobiology of stress, 2,
10-19. doi: https://doi.org/10.1016/j.ynstr.2015.03.001.
Farrukh, M. J., Makmor-Bakry, M., Hatah, E., & Tan, H. J. (2018). Use of complementary and
alternative medicine and adherence to antiepileptic drug therapy among epilepsy
patients: a systematic review. Patient preference and adherence, 12, 2111. doi:
https://dx.doi.org/10.2147%2FPPA.S179031.

7NURSING CASE STUDY
Gélisse, P., Genton, P., Coubes, P., Tang, N. P. L., & Crespel, A. (2015). Can emotional stress
trigger the onset of epilepsy?. Epilepsy & Behavior, 48, 15-20. doi:
https://doi.org/10.1016/j.yebeh.2015.05.010.
Grevers, E., Breuer, L. E. M., IJff, D. M., & Aldenkamp, A. P. (2016). Mental slowing in relation
to epilepsy and antiepileptic medication. Acta Neurologica Scandinavica, 134(2), 116-
122. doi: https://doi.org/10.1111/ane.12517.
Hall, C. (2017). Back to basics: Abdominal assessments. Australian Midwifery News, 17(2), 17.
Retrieved from:
https://search.informit.com.au/documentSummary;dn=929839608457890;res=IELHEA.
Jakimowicz, S., & Perry, L. (2015). A concept analysis of patient‐centred nursing in the intensive
care unit. Journal of advanced nursing, 71(7), 1499-1517.
Levett-Jones, T. (Ed.). (2017). 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.
Moura, L. M., Carneiro, T. S., Cole, A. J., Hsu, J., Vickrey, B. G., & Hoch, D. B. (2016).
Association between addressing antiseizure drug side effects and patient-reported
medication adherence in epilepsy. Patient preference and adherence, 10, 2197. doi:
https://dx.doi.org/10.2147%2FPPA.S119973.
Nursing and Midwifery Board of Australia. (2019). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved from
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx.
Ou, S., Xia, L., Li, R., Wang, L., Xia, L., Zhou, Q., & Pan, S. (2018). Long-term outcome of
seizure-free patients and risk factors of relapse following antiepileptic drug
withdrawal. Epilepsy & Behavior, 88, 295-300. doi:
https://doi.org/10.1016/j.yebeh.2018.09.028.
Pitkänen, A., Roivainen, R., & Lukasiuk, K. (2016). Development of epilepsy after ischaemic
stroke. The Lancet Neurology, 15(2), 185-197. doi: https://doi.org/10.1016/S1474-
4422(15)00248-3.

8NURSING CASE STUDY
Schoemaker, M. J., Jones, M. E., Wright, L. B., Griffin, J., McFadden, E., Ashworth, A., &
Swerdlow, A. J. (2016). Psychological stress, adverse life events and breast cancer
incidence: a cohort investigation in 106,000 women in the United Kingdom. Breast
Cancer Research, 18(1), 72. doi: https://doi.org/10.1186/s13058-016-0733-1.
Sidhu, M. K., Duncan, J. S., & Sander, J. W. (2018). Neuroimaging in epilepsy. Current opinion
in neurology, 31(4), 371-378. doi: 10.1097/WCO.0000000000000568.
Strandås, M., & Bondas, T. (2018). The nurse–patient relationship as a story of health
enhancement in community care: A meta‐ethnography. Journal of advanced
nursing, 74(1), 11-22. doi: https://doi.org/10.1111/jan.13389.
Valeta, T. (2017). Psychological Treatments for Epilepsy. In The Epilepsy Book: A Companion
for Patients (pp. 119-126). Springer, Cham. doi: https://doi.org/10.1007/978-3-319-
61679-7_18.
Van Campen, J. S., Hompe, E. L., Jansen, F. E., Velis, D. N., Otte, W. M., Van De Berg, F., ... &
Zijlmans, M. (2016). Cortisol fluctuations relate to interictal epileptiform discharges in
stress sensitive epilepsy. Brain, 139(6), 1673-1679. doi:
https://doi.org/10.1093/brain/aww071.
Vogt, V. L., Äikiä, M., Del Barrio, A., Boon, P., Borbély, C., Bran, E., ... & Dimova, P. (2017).
Current standards of neuropsychological assessment in epilepsy surgery centers across
Europe. Epilepsia, 58(3), 343-355. doi: https://doi.org/10.1111/epi.13646.
Wood, K., Lawrence, M., Jani, B., Simpson, R., & Mercer, S. W. (2017). Mindfulness-based
interventions in epilepsy: a systematic review. BMC neurology, 17(1), 52. doi:
https://doi.org/10.1186/s12883-017-0832-3.