Nursing Care Plan: Comprehensive Assessment of an Older Adult Patient

This assignment presents a nursing care plan developed for an eighty-nine-year-old patient, Amalie Jones, focusing on her specific needs and health conditions. The paper utilizes the clinical reasoning cycle to assess the patient, identify three key nursing diagnoses, and prioritize them based on their importance. The nursing diagnoses include impaired physical mobility, self-care deficit, and impaired social interaction. The assignment emphasizes the importance of establishing SMART goals, taking appropriate nursing actions with scientific rationales, and evaluating the outcomes. The Millers functional consequences theory is used to explain the relationship between the patient’s presentations and aging. The care plan prioritizes addressing impaired social interaction, recognizing its impact on other areas of the patient's life, such as nutrition and potential for depression. Interventions include instilling coping mechanisms, encouraging involvement in physical and social activities, and involving the patient's family. The expected outcomes include improved activities of daily living, increased social interaction, and a stronger connection with family. The student reflects on the process, highlighting the importance of clinical reasoning in providing dignified and effective care for older adults.

Running Header: assessment of the older adults. 1
Nursing care plan
Students name
Institutional affiliation

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The paper tests the student’s ability to be able to identify the nursing care requirements of
the patient and prioritize them in accordance with the importance. The assessment is on patient
Amalie Jones who is eighty-nine years old. Firstly, on assessment, three nursing diagnosis/care
will be identified with the help of the clinical reasoning cycle using its firsts four steps:
considering the patient, collecting the necessary cues/information, processing the information
and identifying the problem/issue. Secondly, the above-formulated nursing care will be
prioritized according to their importance using the remaining four steps of the clinical reasoning
cycle. Thirdly, establishing the goals of patient care. The goals set have to be SMART, that is,
specific, time-bound, accurate, realistic, and measurable. These goals will demonstrate
consideration of the patient’s dignity. Fourthly, taking action on the nursing care identified and
prioritized, giving a scientific rationale for each action taken. Next, evaluation of the outcome
will be done. This will be done so as to assess the attainment of the goals that had been set.
Patient Jone is elderly so the Millers functional consequences will be useful in explaining the
relationship between the patient’s presentation and aging. Lastly, the conclusion will summarize
the work.
Clinical reasoning is used to explain the process in which the nurses gather cues,
processes this information, have an understanding of the patient condition, plan the patient care,
plan on how the patient care will be done, have an evaluation of the results after evaluation and
lastly have a self-reflection and learning from the whole process (Millard, Hallet, & Luker, 2009;
Laurie et al., 2011). It is important as the nurses who have effective clinical reasoning impacts
positively on the patient’s outcome (Bannings, 2008). Those whose clinical thinking is poor in
most cases fails to detect patient deterioration which causes failure-to-rescue (Aiken, Cheung,
Clarke, Sloane & Silber, 2013). As discussed above the clinical reasoning has eight steps. These
include; looking, collecting, processing, deciding, planning, acting, evaluating and reflecting.
These steps do not have distinct boundaries and in most cases, they merge.
Mrs. Amalie Jones is eighty-nine years old woman. A retired primary teacher. She is a
widow. She has lived in Australia for the past 40 years after migrating from Germany. She has a
daughter, Tracy with whom they are always in touch. Her past medical history includes
hypothyroidism, arthritis, and macular degeneration. She suffers from joint stiffness, swollen
joints, painful joints, limited joint movement, constipation, occasional dizziness, vision deficit,

Nursing care plan for the older adults. 3
non-significant weight loss recently and forgetfulness. She is on Paracetamol, ibuprofen,
thyroxine, and hydroxychloroquine.
Patient Jones most presentations are as a result of aging. Miller, (2004) developed the
functional consequences theory that helps to explain the correlation between age and health. The
pain, stiffness and limited movement of the joints can be explained by the changes that occur due
to age (WHO, 2008). As people age the bone density and mass is reduced especially in women
due to menopause. During this phase, there is a reduction in estrogen which causes a reduction in
calcium and other minerals absorption (Guyton, 2015; Hinkler & Cheever, 2013; Barret, 2009).
There is stiffness and limited range of motion as the fluid in the joints decreases this makes the
cartilage to rub against each other causing cartilage deterioration. As the cartilage rubs against
each other there is tearing and inflammation causing pain. Calcification of the joints as minerals
gets deposited on the joints contributes to the joints stiffness and reduced flexibility. These
presentations are made worse by the fact that she has arthritis (Gregson, 2017 &Weber, 2016).
Vision deficiency as explained above is as a result of macular degeneration. This is a
condition associated with old age. The macula is the central point of the retina that has
concentrated rods and cones responsible for vision. The cells death is more than cell generation.
the rate at which this dead cells (wastes) are eliminated is reduced. These wastes accumulate at
the retina forming a blind spot which impairs vision (Barret, Barman, Boitano, 2009).
Forgetfulness or memory loss is a result of aging. It is attributed to, one, the hippocampus
deterioration. The hippocampus is the part of the brain that is involved in forming and retrieving
memories. Two, the proteins and the hormones that repairs, protects the brain cells and
stimulates the neural growth decline as one ages. Three there is reduced blood flow to the brain
cells. This has an effect on memory and cognitive skills. The reduced blood flow to the brain can
be associated with dizziness (Guyton, 2015; Hinkler & Cheever, 2013; Barret, 2009).
The millers functioning consequences theory focusses on the older patients. It provides a
framework for the promotion of the wellness in older patients (Campbell & Hughes, 2016). It
aids the nurses in focusing reducing the negative effects that are age-related and removing the
risk factors so as to improve the wellness of the elderly patients. It helps the nurses to recognize
that the older adults have a potential for growth. With this, they are able to come up with the
nursing diagnosis that cultivates a sense of dignity and value. Miller's theory enables nurses to be

Nursing care plan for the older adults. 4
holistic when dealing with the aged. It focusses on age-related changes, environmental factors,
modifiable risk factors and unmodifiable risk factors (McMahon & Fleury, 2012).
The non-modified risk factors include age, arthritis and the female gender. The aging
process predisposes her to osteoporosis, painful joints, reduced flexibility, reduced movement
ranges, blurred vision, forgetfulness, and dizziness. she is an elderly female at menopause. This
means that her estrogen levels are lower than normal predisposing her to osteoporosis (Barrett,
Barman, & Boitano, 2009). Arthritis makes her joints painful, reduces the joints range of
movement and also causes the joints stiffness. The modified risk factors include her lifestyle. She
lives alone, she has a problem communicating with others and she has reduced mobility as she
cannot drive herself around due to macular degeneration. The negative functioning consequences
are that she can barely perform her daily activities and she is at risk of being socially isolated
which will translate to depression. This is as a result of lack of intervening the modifiable factors
(Miller, 2011).
The cluster of clues gathered from the case study: Mrs. Jone’s place is usually unkempt
and her cupboards are usually empty. The cupboards usually contain baked beans and soup tins.
She feels that she needs help to keep connected with the society although she is afraid of
bothering Tracy. She is losing weight due to improper feeding and also she has become so
isolated.
Patient Jone’s nursing diagnosis includes one, the patient has impaired physical mobility
related to arthritis. Osteoarthritis occurs when the cartilages between the joint bones wear off.
This causes the bone joints to rub against each other. The rubbing causing swelling, pain and the
joints stiffness (Guyton, 2015; Hinkler & Cheever, 2013; Barret, 2009).
The patient complains of pain and she is on analgesics, paracetamol, and ibuprofen. Two,
the patient has self-care deficiency in the daily living activities related to immobility. The
immobility is as a result of the osteoarthritis which causes pain and impedes joints movement.
Vision deficit, being withdrawn from the community and dizziness are contributing factors to the
self-care deficit. Three, impaired social interaction related to social withdrawal. She reports that
it has been hard to keep in touch with others, (Germany association). She does not open up to her
daughter as she is afraid of being a burden.

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Impaired social interaction related to social withdrawal should be the one priority when it
comes to nursing care plan formulation of Mrs. Jone. This is so because: one, it has a
contributing factor to most of the other nursing diagnosis that can be identified, for example,
nutritional imbalance, less than the body requirement related to psychological factors. She has
gradually been losing weight. Two, it highlights family process dysfunction related to social
withdrawal. She feels that she needs help but she is afraid of asking Tracy. She does not want to
bother her. it is also the most important because if no action is taken, the patient will develop
depression which greater negative effects on her health.
Impaired social interaction related to social withdraw is the ineffective/insufficient social
exchange. The nursing care interventions directed to correct this has the following goals: one,
restore Mrs. Jones social interaction with the community. Two, restore Mrs. Jones independence.
Three, restore the family attachment and functioning. This is restoring the family process
between Mrs. Jones and her daughter Tracy ((Hinkler & Cheever, 2013).
For the above goals to be achieved the following should be done: one, instill the coping
mechanisms in the patient. One of the best ways to instill these mechanisms is by encouraging
the patient and in this case, Mrs. Jone to perform her own activities of the daily living; the ADLs.
This includes bathing, tidying, dressing, feeding, toileting, continence and transferring. For
example, Mrs. Jones’ house is unkempt, when encouraged to tidy it herself it will make her feel
independent. The other way is by praising and complimenting her for the tasks she performs to
completion. This boosts her self-esteem (Lauri, 2011).
The second intervention is encouraging her to be involved in physical and social
activities. This will be helpful in conquering the feeling of being isolated by being involved in
social activities with other people at least once a week. The patient should also be encouraged to
perform physical activities. Exercising helps in improving the mental state and it also distracts
the patient from their daily routine. For long-term care, the patient should be enrolled in a
support group. The last and the most important is by involving the patients’ family in her care.
The expected outcome after intervening include: one, Mrs. Jones should be able to
successfully perform the activities of the daily living. Mrs. Jones should be able to feed and meet
the body requirement. With this, she will be able to regain her lost weight. She will be able to
tidy her house. Two, she will be able to interact with the community members. The support

Nursing care plan for the older adults. 6
groups and social activities will help her get a sense of belonging and not isolated. Mrs. Jones
will be able to open up to Tracy without feeling like she is a burden (Hinkler & Cheever, 2013).
From the assessment, I should have clinical reasoning so as to be able to detect when a
patient is deteriorating and be able to prioritize the patients’ nursing care. I now understand that
the older adults care focusses on giving them a sense of dignity and value. With this in mind, I
will be able to effectively take care of the elderly patients.
The paper has assessed Mrs. Jones. Three nursing diagnosis has been formulated with
one of them being prioritized. The nursing diagnosis: impaired physical mobility, self-care
deficit, and impaired social interaction. the former is the one prioritized. The following goals
were set: was to restore the interaction with the community and attachment with the daughter.
This goal will be achieved through instilling coping mechanisms and making her join support
groups. The interventions formulated: ensure she participates in social and physical activities and
instills coping mechanisms. The expected outcomes were discussed. The clinical reasoning cycle
was used when formulating the nursing care plan. The Millers functional consequences helped in
elaborating the clinical presentation. The biological changes are a result of the aging process.
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