Case Study: Clinical Reasoning Cycle for Elderly Patient Care

This case study presents a clinical reasoning cycle applied to a septuagenarian, Lina Liaw, residing in a retirement village. Diagnosed with hypertension and osteoporosis, she also suffers from depression, visual impairment, and low back pain. The case study focuses on osteoporosis as the primary concern, establishing goals to regain physical movement, implementing interventions like range-of-motion exercises and medication, and evaluating outcomes through pain scales and mobility assessments. The reflection highlights the increased risk of chronic illnesses in the elderly and the importance of interventions to prevent further health deterioration, while also acknowledging the need for consideration of nutritional supplements. References support the interventions and provide context for the patient's conditions and treatment options.

CLINICAL
REASONING CYCLE
Name of the Student
Name of the University

Description
 The case study involves a septuagenarian, Lina Liaw, who
decides in Brisbane, in a single storey apartment at retirement
village. She had been diagnosed with hypertension during her
late 50s and osteoporosis during early 60s.
 Following the death of her partner, she became socially
isolated, anxious, lost weight, and stopped self-care. This was
followed by diagnosis of depression and she is currently under
antidepressant medications.
 She suffers from visual impairment and low back pain. Her
presenting complaints include persistent cough, low blood
pressure, and pain severity of 9/10 during moving, and 6/10
when still.
 She also faces problems in performing activities of daily living.

Establish goals
 Taking into consideration the
three client problems of
hypertension, osteoporosis, and
cough, osteoporosis has been
selected as the major issue that
requires immediate intervention.
 S- Regain physical movement
 M- Movement of extremities and
use of verbal pain scale
 A- Medication and non-
pharmaceutical interventions
 R- Verbalise a reduction in pain
 T- 48 hours
Figure 1- Range-of-motion
exercise
Source- (McArthur, Laprade &
Giangregorio, 2016)

Take action
 Place the patient at a supine
periodically in order to stablise
the fracture
 Help the patient perform range
of motion exercise
 Re-position the patient at
regular intervals
 Administer bisphosphonates
 Administer teriparatide
 Provide assistance to the
patient at the time of walking by
providing a transfer belt
Figure 2- Range-of-motion
exercise
Source- (McArthur, Laprade &
Giangregorio, 2016)

Evaluate outcomes
 Effectiveness of the treatment can be
evaluated by asking the patient to walk
without assistance for a few steps after
48 hours.
 The severity of her pain will also be
measured by using a pain rating scale.

Reflect on the process
 I learnt that elderly people are at an increased risk of
suffering from several chronic illnesses such
as, osteoporosis, hypertension, and depression.
 Osteoporosis resulted in weakening of bones in the
patient, thereby increasing her risk of suffering from
a broken bone.
 Implementation of the intervention will help in
reducing further deterioration of her health condition.
 However, I must have considered nutritional
supplements as well for management of the
condition.

References
Castarlenas, E., Jensen, M. P., von Baeyer, C. L., & Miró, J. (2017). Psychometric properties of the
numerical rating scale to assess self-reported pain intensity in children and adolescents. The
Clinical journal of pain, 33(4), 376-383. https://doi.org/10.1097/AJP.0000000000000406
Daumer, M., Fürmetz, J., Keppler, A., Höfling, H., Müller, A., Hariry, S., ... & Aigner, G. (2018, April).
PRECISION AND PATIENT ACCEPTANCE OF A BELT-WORN WEARABLE (ACTIBELT) IN
PATIENTS WITH OSTEOPOROSIS AND/OR AFTER TRAUMA SURGERY. In Orthopaedic
Proceedings (Vol. 100, No. SUPP_4, pp. 17-17). The British Editorial Society of Bone & Joint
Surgery. https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.2018.4.017
Harvey, N. C., McCloskey, E., Kanis, J. A., Compston, J., & Cooper, C. (2017). Bisphosphonates in
osteoporosis: NICE and easy?. The Lancet, 390(10109), 2243-2244.
https://doi.org/10.1016/S0140-6736(17)32850-7
Lindsay, R., Krege, J. H., Marin, F., Jin, L., & Stepan, J. J. (2016). Teriparatide for osteoporosis:
importance of the full course. Osteoporosis international, 27(8), 2395-2410.
https://doi.org/10.1007/s00198-016-3534-6
McArthur, C., Laprade, J., & Giangregorio, L. M. (2016). Suggestions for adapting yoga to the
needs of older adults with osteoporosis. The Journal of Alternative and Complementary
Medicine, 22(3), 223-226. https://doi.org/10.1089/acm.2014.0397
Tanaka, S., Yoshida, A., Kono, S., Oguma, T., Hasegawa, K., & Ito, M. (2017). Effectiveness of
elcatonin for alleviating pain and inhibiting bone resorption in patients with osteoporotic
vertebral fractures. Journal of bone and mineral metabolism, 35(5), 544-553.
https://doi.org/10.1007/s00774-016-0791-6
Weiner, C., Kalichman, L., Ribak, J., & Alperovitch-Najenson, D. (2017). Repositioning a passive
patient in bed: Choosing an ergonomically advantageous assistive device. Applied
ergonomics, 60, 22-29. https://doi.org/10.1016/j.apergo.2016.10.007

Thank you!