Case Study: Assessing and Managing Health Risks for Leonard (Nursing)

This case study examines the case of Leonard, a 73-year-old man admitted to the emergency department with various health issues, including mild cognitive impairment due to Alzheimer's disease, fall risk, and anemia. The study utilizes the clinical reasoning cycle to identify care priorities and appropriate interventions. It details the assessment of Leonard's condition, including the use of tools like the Mini Mental State Examination (MMSE), Hendrich II Fall Risk Model, and Subjective Global Assessment (SGA). The study also outlines patient-centered care strategies, such as involving Leonard in decision-making and providing community nursing support and physiotherapy. Interventions focus on fall prevention, cognitive development, and diet management. The study highlights the importance of reflecting on the outcomes of interventions to improve future care practices. The conclusion emphasizes the effectiveness of the clinical reasoning cycle in identifying health risks and planning patient-centered interventions to enhance Leonard's quality of life.

Running head: CASE STUDY OF LEONARD
CASE STUDY OF LEONARD
Name of the student:
Name of the university:
Author note:

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CASE STUDY OF LEONARD
Introduction:
Clinical reasoning cycle helps professionals to identify the condition of the patients, their
symptoms and thereby process the information to identify the care priorities. Accordingly,
interventions are set for peeving bets quality care to patients helping them to come back to their
normal lives (Vanderberg et al. 2017). In this assignment, clinical reasoning cycle and
assessment tools would be used identify the care priorities of the patient named Leonardo and
interventions would be given to them accordingly.
Clinical reasoning cycle and identification of three health risk factors:
Considering the patient situation:
Leoonard is a 73-year-old man who is admitted to the emergency department in the acute
care ward after he had a fall in the local shops. The presenting symptoms that were noticed were
bruises on face and hip region, low body weight, mild confusion and low body weight. He is
unable to cope with his present condition and is seen by a social worker at home.
Collecting cues and information:
When medical history of Leonard is documented, it is seen that he has mild cognitive
impairment that is secondary to Alzheimer’s disease. It is also seen that he has a decubitus ulcer
on his left leg, arthritis in his back, anaemia, mild hypotension and industrial deafness. He also
has urinary incontinence. He has already fallen twice in the last six months and he is also facing
huge issues in coping up with the situations. He is unable to conduct his daily activities like
cooking, cleaning, self-care and other activities.

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Processing the information:
With gradual aging, his mobility has degraded and this had exposed him to risks of
falling. He had already fallen twice although severe fractures had not taken place before the last
fall at the shop. Secondly, he has been suffering from mild cognitive impairment secondary to
Alzheimer’s that might aggravate if not treated properly resulting him in complete loss of
cognitive ability and hence may result him to live poor quality life. Moreover, he is also seen to
have issues with coping with his home chore activities and activities of daily life. Researchers
are of the opinion that mild cognitive development affects the self care activities of human
beings making them more dependent on others for their personal hygiene and regular activities of
life (Stam et al. 2016). He is not being able to clean, cook, self-care, not being able to perform
his favourite activities like gardening and many others. Moreover, he is anaemic and decreased
body weight. This is actually making him tired, he is not feeling to work, and therefore he is
sleeping throughout the day. All these had resulted in very poor quality life.
Identification of the problems and issues:
From the above analysis, different important risk factors are identified in case of
Leonardo. The first one is that he is highly prone to fall due to loss of motor functioning due to
aging procedures. The second risk factor is that he has mild cognitive impairment where he is
exposed at the risk of noticeable as well as measurable decline in memory and thinking skills that
would affect his daily life (Webster et al. 2016). The third health risk factor that is identified is
his anaemic conditions and low body weight that is making him lethargic and sleepy throughout
the day. This would make him suffer from shortness of breath, dizziness, headaches, and

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coldness in feet, weakness and fatigue. The heart has to pump faster and work harder to carry
more oxygen rich blood throughout the body that may expose the patient to heart failure.
Establishment of goals:
Fall risk assessment should be done at his house to reduce chances of fall and develop his
motor skills so that he can walk effectively reducing chances of fall. Therapy for cognitive
development of the patient should be ensured. Diet management and caring for his activities of
daily lives should be ensured.
Actions steps:
Community registered nurses should be assigned for him who would be taking effective
interventions for his motor skill development and diet management. Physiotherapists can be
allocated to make him develop his mobility. Moreover, effective therapy for cognitive
development should also be proposed to help him develop his memory and thinking skills.
Evaluation of outcomes:
Positive outcomes need to be monitored after the application of the interventions. The
better his mobility, cognitive status and body weight, the better would be his quality life.
Reflection:
After allocation of the interventions and evaluating the results, the nursing individuals
would reflect on the practices and their experiences so that they can develop their knowledge and
skills for the future.

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CASE STUDY OF LEONARD
Three (3) best-practice assessment tools appropriate for this case:
The patient is already identified with wild cognitive impairment that in course of time
will affect his thinking capability and memory. The nursing individuals in such condition will be
mainly using the Mini Mental State Examination (MMSE) to assess his present mental health
status. It is mainly an 11 questionnaire set that will help to test Leonardo’s ability to test five
areas of cognitive functioning. These are orientation, registration, attention, calculation, recalling
power as well as language (Ginter et al. 2018). The maximum score is 30 and the score of 23 is
the lowest. When an individual is scoring less than 23, then poor cognitive capability is ensured.
Based on the score that Leonardo receives in this assessment tool of cognitive ability, suitable
interventions would be developed by the professional.
Leonardo is highly vulnerable to fall due to his motor disabilities. He has already fallen
thrice and there is also high chance of him falling in the near future that may or may not
accompany severe potential harm to him. Therefore, in order to be cautious and preventive of the
situation of fall. Therefore, healthcare professionals are often seen to use of the Hendrich II Fall
Risk Model. This tool is very quick to administer and successfully provides determination of risk
for falling based on different factors that are gender, mental health and emotional status, known
categories for medication increasing risk, symptoms of dizziness and others. (Petersen et al.
2014) This tool is found to be suitable for fall risk assessment and even for post fall assessment
for secondary prevention of fall. The instrument is found to be sensitive to a degree of about
74.9% and specific as if that to about 74% with inter reliability that measures to around 100%.
The use of this tool may help the patient named Leonardo to prevent secondary fall in the future.

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CASE STUDY OF LEONARD
Leonardo is seen to have low body weight and he is also a suffering from anaemia. A
non-communicable disorder mainly occurs due to deficiency of iron in diet. Moreover, his low
body weight may be due to improper diet management that may be either due to his lack of
knowledge of the important of specific diet on his health or his inability to cook food properly.
Recently, he has become unable to take care of himself and conduct cooking as well. Therefore,
with the help of the subjective Global assessment, nursing professionals will be able to take data
on his nutrition intake, weight symptoms, functional capacity, metabolic requirements and many
others. The tool also helps the individuals to assess the patient’s physical examination, SGA
rating, contributing factors and many others (Cooper et al. 2015). This would help them to
develop ideas about his health condition depending on the nutritional intakes and would help
them to take effective interventions are diet management.
Interventions that will support Leonard:
Patient centred care helps nursing professionals to keep the patient in the centre of the
care plan allowing them to participate in the decision making and respecting their dignity as well
as autonomy to the best extent (Strohle et al. 2015). Nursing professionals should ensure that
they are providing safe and competent care services and work in accordance with that of the
standards of professional and broader health system. The nursing professionals need to support
Leonard and his well-being by incorporating him into informed decision-making (Code of
conduct, NMBA 2017). This would help him to feel that his dignity and autonomy is respected.
The professionals should also be promoting and preserving trust as well as privilege of the
patient by developing effective therapeutic relationship. Shared decision making, effective
communication with the patient, culturally safe practice, effective partnership and others should
also be maintained (For registered health practitioners Code of conduct, APHRA 2018). As

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Leonardo is not ready to shift to residential care, the nursing professionals should arrange for
community nurses who would be conducting his treatment procedures in his home only. For
preventing falls, interventions like maintaining bed position is important. It should be kept
adjacent to floor reducing risk of fall. Hand bars in the washrooms and other places can be used
to provide a support to him while he is mobilising. Moreover, heavy furniture should be kept and
light furniture should be removed so that chances of tumbling are reduced. Loose clothes should
be avoided and clutters on the pathways of his walking should be removed to reduce chances of
fall. To develop his motor skills, the community nurse should fix appointments with the
physiotherapists who would be helping to develop his gait and motor skills. This would help to
develop his mobility and reduce chances of fall (Langa et al. 2014). In order to develop his
condition of mild cognitive impairment, the nursing professionals should help the patient to
undertake a number of lifestyle interventions. The professionals would communicate effectively
with him with the interventions that would be helping him to develop his cognitive abilities
(Booth et al. 2015). The professionals should respect his discussions and should not put upon the
intervention plan on him. Rather they should educate him about the rationale of the interventions
so that the patient feel that he is included in the treatment procedures. Regular physical exercise,
a diet low in fat, rich fruits and vegetables, incorporation of omega 3 fatty acids, intellectual
stimulation, social engagement and memory training should be ensured to improve his cognitive
ability (Dobner and Kaser 2018). The nursing professionals should also allocate a dietician for
him to develop his diet chart and educate him about the importance of nutrients and diet he
should follow. All these would not only improve better quality life of the patient but would also
ensure patient satisfaction due to patient centred care (Kader and Peera 2014).
Conclusion:

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From the above discussion, it is seen that clinical reasoning cycle had helped to identify
the health risk factors of the patient named Leonardo. Moreover, appropriate tools had been used
to assess the above mentioned three health issues so that his present status of heal can be
identified and accordingly interventions are planned. With the help of appropriate patient centred
care, effective interventions were planned that have the potential to ensure better quality life of
the patient.

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References:
Amarya, S., Singh, K. and Sabharwal, M., 2015. Changes during aging and their association with
malnutrition. Journal of Clinical Gerontology and Geriatrics, 6(3), pp.78-84.
Booth, A.O., Huggins, C.E., Wattanapenpaiboon, N. and Nowson, C.A., 2015. Effect of
increasing dietary calcium through supplements and dairy food on body weight and body
composition: a meta-analysis of randomised controlled trials. British Journal of
Nutrition, 114(7), pp.1013-1025.
Code of Ethics for Nurses in Australia. 2017. 5_New-Code-of-Ethics-for-Nurses-. Retrieved 27
April 2018, from http://www.nursingmidwiferyboard.gov.au/News/2017-09-28-new-codes-of-
conduct.aspx
Cooper, C., Sommerlad, A., Lyketsos, C.G. and Livingston, G., 2015. Modifiable predictors of
dementia in mild cognitive impairment: a systematic review and meta-analysis. American
Journal of Psychiatry, 172(4), pp.323-334.
Dobner, J. and Kaser, S., 2018. Body mass index and the risk of infection-from underweight to
obesity. Clinical Microbiology and Infection, 24(1), pp.24-28.
For registered health practitioners Code of conduct 2018, The Australian Health Practitioner
Regulation Agency (AHPRA) retrieved from https://www.ahpra.gov.au/documents/default.aspx?
record=WD14%2F13138&dbid=AP&chksum=oAdDsB0efRLnLo2K3bGkYA%3D%3D
Ginter, P.M., 2018. The strategic management of health care organizations. John Wiley & Sons.
Kader, M. and Perera, N.K.P., 2014. Socio-economic and nutritional determinants of low birth
weight in India. North American journal of medical sciences, 6(7), p.302.

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Langa, K.M. and Levine, D.A., 2014. The diagnosis and management of mild cognitive
impairment: a clinical review. Jama, 312(23), pp.2551-2561.
Petersen, R.C., Caracciolo, B., Brayne, C., Gauthier, S., Jelic, V. and Fratiglioni, L., 2014. Mild
cognitive impairment: a concept in evolution. Journal of internal medicine, 275(3), pp.214-228.
Stam, H., Harting, T., Sluijs, M.V.D., Marum, R.V., Horst, H.V.D., Wouden, J.C.V.D. and
Maarsingh, O.R., 2016. Usual care and management of fall risk increasing drugs in older dizzy
patients in Dutch general practice. Scandinavian journal of primary health care, 34(2), pp.165-
171.
Ströhle, A., Schmidt, D.K., Schultz, F., Fricke, N., Staden, T., Hellweg, R., Priller, J., Rapp,
M.A. and Rieckmann, N., 2015. Drug and exercise treatment of Alzheimer disease and mild
cognitive impairment: a systematic review and meta-analysis of effects on cognition in
randomized controlled trials. The American Journal of Geriatric Psychiatry, 23(12), pp.1234-
1249.
Vandenberg, A.E., van Beijnum, B.J., Overdevest, V.G., Capezuti, E. and Johnson, T.M., 2017.
US and Dutch nurse experiences with fall prevention technology within nursing home
environment and workflow: A qualitative study. Geriatric nursing, 38(4), pp.276-282.
Webster, B.R., Strauss, J., Butler, E. and Prentiss, A., 2016. Fall management in a mixed
neuroscience unit: The predictive ability of the Morse Fall Scale.