NRSG 259 Case Study: Clinical Reasoning Cycle for Amalie Jones

This case study demonstrates the application of the clinical reasoning cycle in geriatric care, focusing on an 89-year-old female patient, Amalie Jones, with deteriorating health and multiple age-related morbidities. The study uses Miller’s Functional Consequences Theory to identify key nursing care priorities, including pain management and fall prevention. It outlines the process of collecting cues, processing information, identifying problems, establishing goals, taking action through interventions like physiotherapy and environmental modifications, and evaluating outcomes. The reflection emphasizes the importance of addressing both physical and psychological needs in geriatric care, suggesting alternative medications and constant monitoring to improve patient outcomes and prevent further complications. The clinical reasoning cycle is highlighted as a valuable tool for achieving the best possible patient-centered care.

Running head: CASE STUDY
Clinical Reasoning Cycle for Geriatric Patients
Name of Student
Name of University
Author Note

1CASE STUDY
Introduction:
There are numerous complications related to geriatric care given that the physical and
mental heaths of those patients are under deprived and the immunity is usually compromised
(Min et al., 2013). The aging population of the world has now become a matter of concern in the
healthcare industry. According to a report provided by National Institute of Health, the projected
number of geriatric population will reach 17% of the total world population in 2050 from the
current 8.5% as of now. This calls for more efficient and quicker actions to treat such an
enormous old age population (World’s older population grows dramatically, 2016). Utilization of
various techniques and care planning helps in providing a more efficient care service quickly.
Clinical reasoning cycle is a tool, which helps caregivers providing the best possible outcome in
regards to patient safety (Levett-Jones, 2013). The reports aims to discuss the use of clinical
reasoning cycle to treat an 89 year old female patient, named Amalie Jones who had been living
alone after her husband’s death and facing constant deterioration of health.
Part A
The Functional consequences Theory for geriatric care was provided by Miller in 2015
which provide a conceptual framework to promote geriatric patient safety in and helps the nurses
and practitioners to develop a wellness promotion plan for diagnosing the illness and give best
outcome (Hunter. 2016). The service provided to the patients apart from addressing the obvious
physical support provided even more in depth care focusing on emotional as well as
psychological needs and assess the cross talk of these aspects to provide a more focused patient
centred care (Birren et al., 2013). It is important to assess the interrelationship of the clinical
reasoning cycle steps with respect to the patient’s current condition, which will be discussed in

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the essay. The case of an 89-year-old female, named Amalie Jones, living all by herself in a one-
storey apartment she shared with her husband who passed away two years ago. This incident has
largely influenced the patient’s psychological and social health.
Consideration of the patient’s condition, helps to assess the current condition with
regards to the analysis if the patient’s history (Salminen et al., 2014). 89-year-old Amalie’s
health has been constantly deteriorating for the past couple of years, which forced her to pull out
from activity. She is frequently visited by her son and daughter but she refuses to take help from
them in assumption that she will become their burden. Currently, Amalie had stiffness in joint,
inflammation in foot extremities, pain in joints, mainly knee, hip and back. Moving joints is
difficult, slow bowel movement, momentary light-headedness, partial vision impairment, weight
loss and sometimes forgets to take her pain medication.
The cues for Amalie’s assessment helped the caregivers, understand the markers leading
up to the top priority for care service (Audétat et al., 2013). The clinical cues, which indicate
joint pain and movement difficulty from RA and osteoporosis, related to swelling of feet and
joints. The current medications are doses of paracetamol, Ibuprofen, Thyroxine and
hydrochloroquinone. Amalie seems to be suffering from age related morbidities. The patient as
of late has developed macular degeneration for which she withdrew from driving. Movement is
difficult for her, due to her history of Rheumatoid arthritis (RA) as well as osteoarthritis. This
had subjected her to house arrest, which will eventually force her into isolation and make her
more depressed.
This step defines the processing of the collected information of the patient, followed by
interpretation, discrimination, relation, inferring and corresponding those data with evidence

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based research and predicting the best outcome for the patient (Audétat et al., 2013). The current
condition of the patient is very common in geriatrics like rheumatoid arthritis as well as macular
degeneration. Chances of macular degeneration are very high in geriatric patients about 85% and
rheumatoid arthritis is about 25-45% more in elderly women (Kobak & Bes, 2017). Macular
degeneration is supposedly the leading cause for loss of vision in geriatric patients. It is an
incurable eye disease which progresses rapidly leading to permanent damage that is loss of
vision. The central portion of the retina slowly starts to degenerate which makes the central view
blurry. The degeneration is caused by deposition of certain substances called reasons drusen
under the macula (Wong et al., 2014). This causes loss of peripheral vision and ultimate
blindness. This condition is the reason for which Amalie had to quit driving. Rheumatoid
arthritis is an autoimmune inflammatory disease which is chronic in nature that causes body zone
antibodies to attack self cells mainly in joints and the extremities of the body. This causes
swelling which in case of the patient was observed in joints, feet et cetera. Progressive
degeneration of the joints made it difficult for the patient to move and perform other activities.
The patient was also observed to have osteoarthritis which caused her restricted mobility and
Limited the movement of her joints (Otter et al., 2010). Amalie is undergoing macular
degeneration, which in future will lead to permanent damage if left untreated. The pain
medication she receives is not enough as her condition is progressing with her age. This kind of
situation will be further enhanced if the patient is subjected to falling. Falling is the leading cause
of hospitalization in geriatric patients (Clegg et al., 2013). She is suffering fatigue due to the
autoimmune condition, which induces the occasional light-headedness and constipation.
This step of clinical reasoning cycle is used to identify the patient condition and issues.
Structure of the clinical reasoning cycle is to identify the patient's current condition and issues

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(Levett-Jones, 2013). The main conditions troubling the patient are as follows partial impaired
vision which might be a potential cause of fall associated risks and injury. The care that's the
patient needs is treatment from joint stiffness and overcoming mobility limitations. This causes
her pain and also increase the risk of fall associated injury given the circumstances that she lives
alone. The last assessment of risk that can be identified is the occasional lightheadedness she
experiences. Rheumatoid arthritis along with osteoarthritis facilitates the patient's susceptibility
to falling associated injury. The patient Orphan forgets to take her medication and only takes
them when the pain is severe this issue can be addressed with patient centered education or
referring her to a nursing care home
Part B
In this portion, top priority if care was pain management and minimizing the risk of
falling to achieve the best patient outcome. In this step of clinical reasoning cycle the goals,
which will provide the best possible patient outcome, are analyzed and based on that
intervention is set (Hayes, 2016). This form of approach is specific measurable achievable
realistic and timely smart. Considering the age of the patient the pathological condition the
psychological stress living environment and the social status the goal for this assessment would
be to ensure that the risk of falling is minimized. The patient needs to be educated on safety
measurements that she can implement herself or a point someone to take care of her. Thirdly
emotional and psychological support is to be provided to the patient to prevent social isolation
and clinical depression (Sadock & Sadock, 2011).
The next step of clinical reasoning cycle is to take necessary actions to address the
current patient condition. Intervention procedures would be physiotherapy that would help her
mobility and recover from joint ache. Various exercises can be implemented on her to improve

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her sense of balance and strengthen knees joints at cetera. It must be made sure that the patients
living conditions are free from fall risk. This can be ensured buy lowering the height of a bed
putting railings on the side of a bed improving the lighting conditions et cetera.
This segment of the critical reasoning cycle addresses evaluation of the goal of the care
plan and predicting the patient outcome. It is essential to evaluate the intervention procedures
setup during nursing care the outcome of the Patient Safety will be evaluated according to the
performance and improvement after patient's current condition (Kable et al., 2013). Improvement
can be observed if the patient is completely dependent on herself shows more interest in social
interactions take some medicines properly regularly follows up with her children and allow them
to help her physical problems will be minimized. Complete success of the integration procedures
can be analyzed when the patient will be free from the limitations she currently faces. The safety
measurements undertaken will be successful if the fall associated risk is minimized and no
further hospitalization is recorded concerning that issue.
Lastly, critical reasoning cycle ends with the reflection on the set goals for the clinical
assessment of the patient. From this case study I learnt about the complications which are
associated with the geriatric care not just physical but psychological conditions that might affect
the patient's physical and mental health. Firstly I would have prevented the fall associated risk as
much as possible to ensure that the patient's condition is not further under Jeopardy. Secondly I
would provide alternative medication to minimize her pain related to rheumatoid arthritis and
osteoarthritis like disease modifying antiemetic drugs (DMARD) (Singh et al., 2016). I would
have suggested resting and referred her to a nursing care home so that she does not have to do
physical activity alone this would have made sure that the patient was under constant monitoring
which food have reduced the chances of falling. The clinical reasoning cycle made it easier for

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me to make an efficient care plan for the patient and analyze the situation better to achieve best
patient outcome.
Conclusion:
The above discussion makes it clear that clinical reasoning cycle is an important technique which
helps achieving the best possible outcome for the patient. This technique allows caregivers to
understand, assess, evaluate and predict the best possible outcome for the patient. The discussion
addresses the implications and consequences which are important part of geriatric care. It is
important to note that geriatric care requires both physical and mental health assessment to
derive a more focused patient centered care. The report will help future caregivers to understand
the importance of falling in geriatric patients and how easy it is for such patients to succumb to
social isolation. The report will also help the caregiver to set evidence-based goals to achieve
best possible patient outcome with regards to critical thoughts and analysis implementing patient
history and general knowledge.

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References:
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Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly
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Hayes, S. C. (2016). Acceptance and Commitment Therapy, Relational Frame Theory, and the
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Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New
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Kobak, S., & Bes, C. (2017). An autumn tale: geriatric rheumatoid arthritis. Therapeutic
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Min, L., Wenger, N., Walling, A. M., Blaum, C., Cigolle, C., Ganz, D. A., ... & Kerr, E. A.
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Retrieved 11 April 2018, from https://www.nih.gov/news-events/news-releases/worlds-
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