Australian Catholic University: Chronic Illness Report, NRSG372

This report analyzes the case of David Jones, a 65-year-old patient experiencing dementia, discussing the impact of the illness on his life and family. It applies the Levett-Jones Clinical Reasoning Cycle to assess David's condition, including his symptoms, pathophysiological conditions, and communication challenges. The report also integrates the Roper-Logan-Tierney Model to evaluate the patient's dependence and independence in daily activities. It identifies nursing care priorities, such as educating the patient and providing positive reinforcement, and sets goals to maintain quality of life and enhance mood and cognition, referencing the NSQHS standards. The report highlights the importance of family support and addresses the social and emotional impacts of dementia, offering comprehensive insights into patient care and management strategies for chronic illnesses.

Running Head: Principle of Chronic Illness and Disability
PRINCIPLE OF CHRONIC ILLNESS AND DISABILITY

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Principle of Chronic Illness and Disability
Table of Contents
Introduction............................................................................................................................ 3
Background (CRC1, 2)........................................................................................................... 3
Discussion (CRC3)................................................................................................................. 4
Priorities of care and goal setting (CRC4,5)...........................................................................5
Conclusion............................................................................................................................. 6
Reference list......................................................................................................................... 7

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Principle of Chronic Illness and Disability
Introduction
Different chronic illnesses limit the capacity of living of a person by worsening overall
health. Diseases such as dementia limit functional capabilities of a person and reduce
productivity. The scope of this essay is to evaluate the condition of a patient and its impact
on life and family. This has helped to identify nursing care priorities and goals for the patient.
The content of this paper includes a detailed overview of a patient's health overview who is
suffering from dementia and nursing care priorities and goals. In this essay, the background
of the patient is discussed along with a discussion about the condition of interviewee.
Background (CRC1, 2)
The clinical reasoning cycle of Levitt-Jones helps to incorporate the process of
clinical reasoning (Bregagnollo, Lopes, Barbosa & Stamm, 2017). Here, the name of the
interviewee is David Jones and he is 65 years old. David has been experiencing dementia
for the last 3 years. He is a retired person and lives with his son and his family in Melbourne.
During the interview, he has shared that this chronic disease has changed his lifestyle and
daily habits. Currently, he is in the middle stage of Alzheimer's disease. In this stage,
patients forget the names of their close ones and recent incidents (Who.int, 2020). These
symptoms are present in David. Moreover, he is facing difficulties to communicate with his
family members. His speaking skills have been affected by dementia. During the interview, I
noticed that he is asking the same questions repeatedly. However, it has been found that he
still remembers some past incidents of his life. He has mentioned that his family members
are calling him moody at some times. It means that they are noticing frequent mood swings
of David many times (Horsburgh et al. 2018). He is facing problems while walking. However,
his blood pressure and body sugar level are normal.
From the findings of this investigation, it can be stated that two specific
pathophysiologies are present in the body of David. Deposition of extracellular beta-amyloid
and tangles intracellular neurofibrillary are these two pathophysiological conditions that are
present in David. As a result of these two conditions, neurons and the synapses are getting
lost. Miners, Palmer & Love (2016) have mentioned that a part of the brain gets affected by

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Principle of Chronic Illness and Disability
these situations and changes in the habits of the concerned person can take place.
According to Schilling et al. (2016), mild to moderate dementia can be treated with AChEIs.
Along with this, rivastigmine and galantamine can be administered to manage dementia. As
these chronic diseases can move to the late stage in David's case of David, it is the
responsibility of his family members to ensure health checkups for him regularly. Stephan et
al.(2017) have mentioned that relying on cognitions scores is not a good option in case of
managing dementia. Rather, physical, sensory and communication issues must be
evaluated to assess the severity of the diseases. Schaap, Fokkens, Dijkstra, Reijneveld &
Finnema (2018) have mentioned that it is important to understand the cultural beliefs and
needs of dementia patients and show values to their dignity. David has mentioned that he is
from the Christian community. However, he believes in humanity over all regions. It means
that caregivers need to pay respect to their view of equality.
Discussion (CRC3)
The third step of the clinical reasoning cycle is processing the information, which is a
critical stage that facilitates decision making. David is suffering from Alzheimer's disease,
which is a type of dementia that includes different behaviors such as confusion, repetition,
resistance, and delusions. This change in behavior has a significant impact on the life and
family of the patient. During the interview, it was noticed that David gets confused while
speaking and repetition often occurred. Moreover, it was found that he is experiencing a
range of emotions that includes anger, fear, shock, and disbelief. Besides, he is struggling to
deal with these emotions that are impacting his personal life and his relationship with the
family. As opined by Sansevero & Sale (2017), those who are around the person with
dementia have their own emotional reactions to deal with the situation. Family persons often
get irritated that this impacts on the internal relationships (Williams, 2017). Family members
of David are currently struggling to deal with the aggressive behavior of him. On the other
hand, it was found that David has gone into depression and anxiety because he got
dependent on others for walking. This change in lifestyle is the major cause of anxiety and
for which he is getting isolated from society. As said by Van Gennip et al. (2016),

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dependence on others or other changes in lifestyle often instigates depression in a person
that can be addressed through encouragement. The treatment and caring expenses of David
are huge and are impacting the economic condition of the family. Talbot, O'Dwyer, Clare,
Heaton & Anderson (2020) stated that family caregivers often face different negative impacts
like psychological morbidity, social isolation, and financial trouble. David also feels low
confidence and self-esteem due to losing several abilities and getting dependent on others.
This disease has also impacted his self-esteem because he is not treated the same by his
friends and family members like before due to social stigma.
The RLT model has identified five factors that have an impact on the living of
patients. According to Ellis & Astell (2017), the RLT model has listed communication in the
activities of living to assess the dependence and independence of a patient. David is facing
communication with others due to problems like confusion and repetition. This can be
identified as a biological factor, which addresses the effect of the condition on the patient.
The psychosocial factors address the effect of cognition, emotions, and ability to
understanding (Daley et al. 2019). This factor impacts the living of David and he is facing a
change in emotions and has gone depressed. It was also discussed that social stigma is
impacting the life of this patient and the behavior of family and friends towards him has
changed. As opined by Bregagnollo, Lopes, Barbosa & Stamm (2017), the sociocultural
factor of the RLT model describes the impact of a society that has been experienced by the
patient. The behavior from society and personal expectations and values of David are not
the same in this case, which is lowering the confidence of this patient. Thus, it can be
concluded that different impacts on this chronic health condition has impacted on the lifestyle
of this person and thus require a proper care plan for managing this condition.
Priorities of care and goal setting (CRC4,5)
After interviewing David, it has been understood that the lack of support from family
and society is one of the reasons behind the present state of David. His family members are
calling him moody despite considering his mental condition. Social isolation is bothering
David and he is unable to accept the fact that he is now partially dependent on other people.

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Principle of Chronic Illness and Disability
According to Handley, Bunn & Goodman (2019), the first priority of a nurse, in this
situation, is to make the patient aware of the reality. David needs to understand that he is
suffering from a chronic disease that cannot be cured ever. However, if he obeys all the
medical advice, he will be able to cope up with his behavioral changes. The second priority
of a nurse is to encourage patients by providing positive feedback when they are showing
the right behaviors. Williams (2017) has mentioned that this approach can help patients to
provide their best effort to maintain normal behavior. It can help David to understand that
certain behaviors of him are affecting others and as a result, they are being rude to him.
Positive feedback can enhance the desire of David to repeat good behaviors. On the other
hand, it can help to increase the level of self-esteem in terms of patients with dementia.
Two different goals of care are developed with the interviewee, which includes
maintaining the quality of life of the person. This is an essential goal that can help the
patient to achieve relief from the physical and psychological complications by gaining
support. Action 2.2 of the NSQHS standard is used in this goal. The main intent of this action
is to use various quality improvement systems for supporting the consumer
(Safetyandquality.gov.au, 2020). Quality improvement systems such as monitoring,
implementation of strategies and regular reporting can be implemented in this case. Another
goal is to enhance the mood, behavior, and cognition of the person. For this goal, action
2.8 of the NSQHS standard can be used. This states that consumers need to achieve the
information they need in such a way, which is appropriate for them. Different tasks need to
be involved to achieve this goal like developing a framework of the meeting, ensuring
mechanisms, which facilitate communication and others.
Conclusion
From the entire discussion of this study, it can be concluded that the interviewee
needs nursing care and support from his family. His mental condition is being affected by the
social isolation and negative behavior of family members. This kind of patient is unable to
accept the fact of being dependent. He needs to be encouraged by the concerned nurse to
accept reality and try to repeat positive behaviors.

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