Nursing Assignment: Clinical Reasoning Cycle and Fall Risk

This report is a nursing assignment that focuses on the application of the clinical reasoning cycle in the care of an elderly patient, Mr. Ratin Bhai, who is suffering from Parkinson's disease and hypothyroidism. The assignment details the process of considering the patient's condition, collecting relevant information, processing the information to identify issues, establishing goals, taking action through nursing interventions, and evaluating outcomes. Fall risk management is identified as a major nursing priority, and the report explores the patient's history, current symptoms, and the challenges he faces due to his conditions. It analyzes the patient's social isolation and financial constraints and applies the Miller's theory to assess and manage the fall risks. The report also includes a SMART objective for the patient's care, emphasizing specific, measurable, achievable, realistic, and time-bound goals. The report highlights the importance of comprehensive care measures, including medication management and exercises, to improve the patient's quality of life and reduce the risk of falls. It also references relevant statistical data and literature to support its findings.

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the student
University name
Author’s note

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Table of Contents
Introduction..................................................................................................................................2
Consider the patient.........................................................................................................................2
Collection of cues/information........................................................................................................3
Process information.........................................................................................................................4
Identification of issues or problems.................................................................................................4
Establish goals.................................................................................................................................7
Take action.......................................................................................................................................9
Evaluating outcomes......................................................................................................................10
Conclusion.................................................................................................................................11
References..................................................................................................................................13

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Introduction
The current chapter focuses on the concept clinical reasoning cycle and its application for
the care and supervision of the ones seeking health care services. The clinical reasoning cycle
could be divided into a number of components such as considering the present clinical condition
of the patient, collecting cues and information regarding the patient health , processing the
health information of the patient for relating with specific health concerns, identification of the
dominant health issues or problems, setting up of a smart objective for achievement of the goals,
development of nursing intervention or strategies, evaluating the outcomes and then reflecting
upon the whole process.
For the present assignment, the case study of an 87 year old Mr. Ratin Bhai had been
highlighted. Mr. Ratin Bhai had been living alone in a two storeyed house after the death of his
wife and had been suffering from Parkinson’s and hypothyroidism since the last four years.
Though his hypothyroidism has been under control, the symptoms of Parkinson’s seemed to be
getting worse with the patient experiencing tremors in both his hands. The unstable movements
had made performing Activities of Daily Life (ADL) difficult for him. For the current
assignment fall risk management has been taken as one of the major nursing priorities and the
clinical reasoning cycle applied for assessment and controlling of the same.
Consider the patient
In the present context, the patient had been suffering from advanced stage of Parkinson’s
and hypothyroidism which had been detected four4 years ago. The chronic condition of the
patient has a profound effect on the daily life activities of the patient. The patient had been
experiencing tremors in his hands which has made managing some of the daily activities

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difficult for the patient such as cooking, making himself a cup of coffee, tying of his shoelaces.
The increased tremors experienced also affect the ability to move independently of the patient
(Baars et al. 2014). The patient had already experienced fall a number of times when getting up
from a chair, during taking of a shower and feels an increased tendency to fall. As commented by
Ham et al. (2014), inability to perform the daily life activities owing to disabilities can result in
the development of depressive behaviour in an individual.
Collection of cues/information
The current literature present the case history of Mr. Ratin Bhai who had been suffering
from adverse health issues such as Parkinson’s and hypothyroidism. Mr. Ratin had been living
on a two storeyed house alone after the death of his wife. Moreover, due to the increased tremors
he had been experiencing in both his hands owing to Parkinson’s, managing the daily life
activities had become increasingly difficult for him. Additionally, Mr. Ratin being an introvert
in nature likes to keep up to himself and does not approve of escalating his problems to his
brother and his family living close by. Therefore, his social isolation can subject him to increased
risk of depression (Hiorth et al. 2014).
The patient had also been suffering from decreased level of BMI, which could be
attributed to the presence of hypothyroidism. The patient also has a very small source of income
funded by his self managed superannuation. Therefore, managing the medications for
Parkinson’s becomes a difficult thing for him. As commented by Johnson & Chang (2014), the
annual charge of Parkinson’s management is almost 10 billion Australian dollars and a sharp
increase of 42 % in the burden of the disease in noted every year (de Bock et al.2016). Mr. Ratin

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Bhai had been taking medications such as Thyroxine, Carbidopa and Entacapone , which is
costly medicines to manage over the long term use.
Process information
The presence of hypothyroidism has made the muscles of the patients weak, which have
further contributed in increased incidences of fall in the patients (de Bock et al. 2016). The
patient had been suffering from tremors in both his hand along with a lack of muscular strength.
This could be attributed to the age related weakness of muscles as proposed by Miller. As
commented by Srivanitchapoom & Hallett (2015), muscle weakness in hypothyroidism could be
linked to the deficit of the thyroxin hormone. This results in lack of muscle stamina often
developing into feelings such as Paresthesia, Carpel tunnel syndrome and peripheral
neuropathy(Haick et al. 2016).As asserted by de Bock et al.(2016), development of locomotors
disabilities in the patient due to the presence of Parkinson’s , the self managerial and daily life
events of the patient are challenged. This can make him exposed to an increased risk of
depression.In this context, Mr. Ratin Bhai is a retired employee and lacks any stable source of
income. Thus, much of his financial requirements are met through the bare minimum offered by
his superannuation fund. Also, Mr. Ratin Bhai has no additional monetary support from his
family, which makes management of his financial liabilities difficult.
Identification of issues or problems
The case study analysis of Mr. Ratin Bhai had pointed towards three major nursing
priorities such as fall risk management, assessment of isolation and financial needs of the patient.

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Fall risk- the patient had been experiencing increased tremors attributed to muscle
weakness which made management of daily activities difficult for him. Additionally, increased
dependency on some of the medicines used by the patient for hypothyroidism can have profound
side effects. This is because increased dose of thyroxin can lead to dizziness along with
carbidopa which can lead to muscle stiffness (Alzoubi et al. 2016).Thus, such medicines can
increase the fall risk in the patients by development of side effects.
Additionally, the person was living in a two storeyed house alone and had to manage with
most of his activities alone. He was also unwilling to take help from his relatives staying nearby.
The aggravated symptoms of Parkinson’s made him unfit to perform some of the basic jobs such
as cooking, making himself a hot cup of tea or even tie the lace of his shoes. As commented by
Weiss et al. (2014), unsupervised medication can often increase the risks exposing an individual
to plethora of diseases such as cardiovascular sickness, hypertension etc. Unsupervised
medications for Parkinson’s often lead to dyskinetic movements, which can increase the risk of
falls (Ejupi et al. 2016). Additionally, the orthostatic hypotension results in dizziness and light-
headedness during changing positions.
Social isolation- MR. Ratin Bhai being an introvert in nature manages most of his tasks
by himself and doesnot attribute much of his problems to his extended family living there.
Additionally, his ill health can also result in the development of feelings of depression in him.
Depression can develop into a number of mental and physical problems, which could develop
into associated co-morbid conditions. As commented by Cancela et al. (2014), the presence of
mental illnesses is often ignored due to the lack of knowledge or sufficient awareness in an
individual. Therefore, adequate measures need to be employed for the purpose of depression care

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and management in an individual. The living environment can also be a contributing factor for
increasing the risk of depression in an individual(Pahwa & Lyons, 2013).
Financial stability- Mr. Ratin Bhai had limited or no source of income, therefore
managing the cost of his medicines was a major problem with him. Mr. Ratin Bhai had been
living upon the bare minimum offered to him by his superannuation funds. Parkinson’s need to
be managed with proper medication and care depending upon the severity (Alzoubi et al. 2016).
However, the financial condition of Mr. Bhai made it a challenge for him.
For the current scenario, priority has been given to assessment of the fall risks of the
patient. The fall risks could result into major incidents such as injury to the head and fracture
(Fox et al. 2017). In the current context, the Miller’s theory could be applied as a nursing
assessment framework for the care and management of the elderly patients (Miller, 2014). The
millers’ theory also addresses the physiological inherent changes that are brought about by
ageing and make an individual weak and more prone to risks such as injury due to falling
(Callisaya et al. 2014). The implementation of the model in the context of Mr. Bhai would
enable him to perform the daily set of activities and reduce the risk of fall in the patient.
The Millers’ theory places the interventions given by the care givers at the centre that
facilitates the highest level of independent functioning by the support users (Miller, 2014). This
further improves the quality of life by reducing the dependency on the care givers.The risk factor
of falling cannot be totally cured in the context of Mr. Ratin bhai due to his old age. However,
with the provision of proper care and management the risk falling could be controlled in the care
of Mr.bhai. The tremors could also be associated with the presence of hypothyroidism in the
patient along with old age (Duncan et al. 2013).

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Statistical Data:
The incidents of tremors increases manifolds in the patients with the increasing age. The
risk factors are mainly reported in people with the age group of 80 and above (Murray et al.
2012). The rates of tremors have also been related to other causes. Reports suggested that 80% of
people aged 65 and above suffer from fall risks annually. Evidences suggest Parkinson’s is a
neurodegenerative disorder affecting 1% of the population older than 65 years (Pahwa, & Lyons,
2013). Therefore, the figures and the statistics suggest that apart from Parkinson’s old age
vulnerability could be another contributing factor towards fall and injury due to Parkinson’s
(Sangün et al. 2015). Therefore, comprehensive care measures along with planning of a Smart
objective could help in the care and management of the progressive neurodegenerative disease.
Establish goals
The nurse could develop a SMART objective for the catering to the care needs of the
patient. The SMART objectives refer to the Specific, Measurable, Achievable, Realistic and
Time-bound.
Specific  Implementation of a fall risk assessment program
 To inculcate support services from the nursing professional
 To be implemented within the living environment of the patient
Measurable  To take regular feedback from the patient
 Constant monitoring through a fall risk assessment tool
Achievable  To collect suitable resources for designing proper care plan
 To implement light balancing exercises to help the patient to cope up

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with movement difficulties
Realistic  To sponsor generic medicines for Parkinson’s management
Time bound  The entire goal to be achieved in six months time
Table 1: SMART Table
(Source: researcher)
Analysis:
For the conditions management of Mr. Ratin Bhai suffering from Parkinson’s there is a
need to design a set of goals. The goals and the objectives have been designed as per the
SMART framework. The SMART framework refers to specific, measurable. Achievable,
realistic and time bound. The following helps in evaluating the performance of the measures or
the process implemented for the conditions monitoring of Mr. Ratin Bhai. Some of the effective
measures could be implemented within the living environment of the support user. In this
respect, the patient needs to be provided with sufficient access to allied health care services such
as nursing staff and support personals. Additionally, implementation of fall risk assessment
programs could reduce the risk of injuries in the Patients. As commented by Pan et al. (2015),
implementation of effective exercises within the fall risk assessment program can help can be
beneficial. Some of the light weight exercises which could be implemented over here are
balancing exercises. This can help in restoring the mobility in the patient by providing them with
individual self belief and confidence.

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For the measurement of the patient condition regular feedback needs to be taken from the
patient regarding the changes or improvement in the health condition. A risk assessment
checklist could be designed which helps in controlling the risks of fall and managing the patient
condition effectively. Light balancing exercise could be implemented for the patient as a measure
for restoring the mobility of the patient (Wulf et al. 2016) additionally, as Mr. Bhai had
relatively low income, thus provision of generic or cost effective medicine could help in
providing the patient with sufficient financial stability. The process had to be bound within a
time frame of 6 months which helps in achieving the objectives.
Take action
In order to cope up with the difficulties faced by Mr. Ratin Bhai a number of care options
need to be provided such as implementing light exercises, palliative care. The implementation of
such measures would help in meeting the care requirements of patients like Mr .Ratin Bhai. The
training exercises would also help in strengthening the muscle.
Palliative care- Parkinson’s had been defined as a progressive neurodegenerative disease
with no proper cure (Haick et al. 2016). The Parkinson’s disease is progressive in nature and
needs palliative or specialised care techniques (Ham et al. 2014). The palliative care helps in the
long term treatment and care management of the patient. Additionally, Mr. Bhai had been
complaining of pain in both his hands which made the daily tasks difficult for him. Therefore,
palliative care processes can help in controlling the pain in both his hands.
Rationale- the enabling of support from nursing professional would help in looking after
the locomotor disabilities in the patient and also help in help him in performing the daily set of
activities. Moreover, Mr. Bhai being an introvert would otherwise not access support and help

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from his relatives. Thus, provision of extended care services would help in managing the
loneliness and risk of depression in the patient.
Evaluating outcomes
The outcomes need to be evaluated based upon the action plan implemented for looking
after the immediate concerns of Mr. Bhai. For example, implementing the balance exercises
would help in providing some stability to the patient. This would reduce the dependency of the
patient over the nurses. Additionally, the implementation of the palliative health care policies
would help in addressing the long concerns along with providing additional financial support to
the patient (Sangün et al. 2015). Additionally, the implementation of the risk assessment tools
would help in providing appropriate and optimum care services to the support users.
Mr. Ratin Bhai had been living in a two storeyed house alone without any help to
accommodate for his care requirements. Therefore, provision of guidance and care through
implementation of the palliative care programs would help in the restoring the previous condition
of the patient. Additionally, the balancing exercises could help him gaining more confidence in
doing the daily life activities (Alzoubi et al. 2014). The provision of community based free check
up and free health care services could also help in the management of the financial liabilities of
the patient (Sangün et al. 2015). Additionally, help from a large and collaborative team of
medical professionals could help in delivery of appropriate health care services.
Reflection

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The assignment helped me in the understanding the nitty grities of the Parkinson’s
disease. This, Parkinson can limit the movement as well as the self managerial skills of a person.
The assessment would help me in the development of appropriate tools which would help me in
providing fall support to the patients receiving treatment for Parkinson’s. This would also help
me develop my skills as a nursing professional. The assignment helped me in understanding the
details of nursing management for Parkinson’s management.
The assignment helped me in understanding the contradictions associated with
Parkinson’s and the associated co-morbid conditions. However, I think implementation of a
collaborative health care system could help in provision of a wide spectrum health management
system to the support users. Moreover, the assignment also helped me in understanding the
details of medication management in the patient. A vivid idea about Parkinson’s medicines can
help in controlling the aggravates symptoms of the disease and help in reducing the fall risks in
the patient.
Conclusion
The eight steps of the clinical reasoning cycle had been used for the identification of the
priorities of nursing care. For provision of support services to care users like Mr. Ratin Bhai the
major nursing priorities had been designed as follows such as provision of financial stability to
the patient, assessment of the isolation and the fall risks of the patients. Therefore, the
undertakings of the clinical reasoning cycle helps in the long term care plan and understand the
in-depth problem associated with the patient. Thus, for helping Mr. Bhai handle his advanced
stage of Parkinson’s a number of objectives or smart goals could be designed such as
implementation of light balancing exercises within the care regimen of the patient. This helps in

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restoring the mobility in the patient. Additionally, inculcation of effective medicines can help in
controlling the condition of the patient. Moreover, occupational therapies could be applied for
providing stability to the patient. The implementation of the methods ensured that Mr.Bhai had
better control over his Parkinson’s control and management.

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