NRSG259 - Care Planning for Elderly: Assessment Task 1 Report Analysis

This report presents a comprehensive care plan for Mr. Dinh Nguyen, an 83-year-old widower with multiple sclerosis and osteoarthritis, using Miller's Functional Consequences Perspective and Levett-Jones’ Clinical Reasoning Cycle. The analysis begins with a thorough assessment of Mr. Nguyen's condition, considering age-related changes, risk factors, and negative functional consequences such as impaired coordination, blurred vision, and back pain. The report then utilizes the first four steps of the Clinical Reasoning Cycle to identify three nursing care priorities: impaired coordination, blurred vision, and back pain. The top priority, impaired coordination, is selected for further discussion, detailing the establishment of care goals (e.g., improving mobility), action plans (e.g., fall risk assessment, exercises), evaluation of outcomes, and reflection on the care provided. The discussion emphasizes the importance of considering the patient's dignity and cultural background. The conclusion underscores the value of integrating Miller’s and Levett-Jones’ frameworks to promote wellness and evidence-based care for elderly individuals.

Running Head: ASSESSMENT TASK 1 – CARE PLANNING 1
Assessment Task 1 – Care Planning
Author’s Name
Institution
Date

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Introduction
Care planning for the elderly is a major issue for the management and caring for the older
generation since these old folks are faced with disorders that are associated with old age through
nursing care prioritization. This article will analyze the scenario of Mr Dinh Nguyen by using
Millers Functional Consequences Perspective so as to come up with the level of function and the
influences that impact on the care given to the elderly (McMahon & Fleury, 2012). Levett-Jones’
Clinical Reasoning Cycle is used as a tool to recognize, assess, implement and evaluate the care
given to the elderly (Dalton, Gee & Levett-Jones, 2015). These two perspectives show that the
dignity of the elderly persons and their cultural background are important aspects to consider
while providing care for the older generation (Wrosch, Scheier & Miller, 2013). This paper
identifies three care priorities for Mr Dinh Nguyen through considering the patient, collecting
patient’s information and eventually processing the data collected. Top priority care will be
identified by the use of the first four steps of Levett-Jones’ Clinical Reasoning Cycle for which
goals will be set, action taken, outcomes observed and a reflection made. A conclusion that
outlines the important information gained regarding the care plan for the elderly is provided.
Discussion
Miller’s Functional Consequences Perspective
This theory provides a framework for evaluating age-related changes that should be taken
into consideration, wellness outcomes, nursing intervention and finally the risk factors that
should be addressed when giving care to the elderly. This perspective provides the base in which
the healthcare providers are able to identify health risk factors and address them accordingly
through taking into account the concepts of nursing, health, elderly person and the environment

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(Hunter, 2012). This theory can be applied to the evaluation of the care given to Mr Dinh
Nguyen who is elderly since he is 83 years old. He has increased risk as he lives alone in a two
storey building and the fact that he suffers from multiple sclerosis. He also has negative
functional consequences as he is not able to perform daily activities and is at a risk of social
isolation and depression (Currais & Maher, 2013).
Age-Related Changes
The age-related changes that occur in the elderly like in the case of Mr Nguyen are
inevitable, not modifiable, irreversible and progressive changes that occur to the older
generation. These changes that occur to the elderly are not dependent on the pathologic and
extrinsic conditions (Kraft, 2012). Mr Nguyen is diagnosed with Multiple Sclerosis and
Osteoarthritis which are associated with old age due to degenerate disorders and decreased bone
density. Therefore, age increases disease occurrence risk in old persons hence there are negative
functional consequences with advanced age. The healthcare provider should be able to identify
these age-related changes so that he or she can be able to provide the required medical
intervention. Through these interventions, the role of the nurse is brought out as enhancement of
health, functioning and improving the lives of the older persons.
Risk Factors
According to Miller’s Functional Consequence theory, hazard influences are changeable
factors that influence the health of an individual (World Health Organization, 2014). For
instance, Mr Nguyen risk factor includes living alone in a two storey building with functional
decline as he is not able to do daily activities, chronic diseases and geriatric syndromes that he
exhibits. The perspective advocate for the creation of models and strategies that address chronic

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disease management, lifestyle changes and behavioural risks to ensure wellness and the
promotion of health among the elderly generation.
Negative Functional Consequences
Miller’s Functional Consequence perspective state that old age results into adverse
functional consequences that lead to difficulty in performing day to day activities and increased
risk of social isolation and depression (Bonder & Dal Bello-Haas, 2017). Mr Nguyen has blurred
vision and experiences an electric shock feeling that makes it impossible for him to move his
head, neck and back hence reducing his mobility and making his gait severe. Due to these
functional consequences, Mr Dinh finds it difficult to carry out daily activities such as dressing,
cooking and showering. Another functional consequence that he faces is the inability to hold
urine which has made him experience urinary incontinence. Mr Dinh faces the risk of social
isolation and depression since he lives alone and this year he has not been able to go for his
annual holiday due to his deteriorating health.
Use Of Levett-Jones’ Clinical Reasoning Cycle For Mr Dinh
The next section of this article will involve the use of the first four steps of the Clinical
Reasoning Cycle to identify Mr Dinh’s three nursing care priorities. The three steps that are used
for Mr. Dinh includes; Nurse’s consideration of Mr. Nguyen, collecting information about him
and processing the information. From these three priorities and use of Miller’s Functional
Consequences theory, the most important care priority will be determined for further discussion.
Consideration of The Patient
The patient is Mr Dinh Nguyen who is an immigrant from Vietnam. He has Multiple
Sclerosis, osteoarthritis, urinary incontinence, blurred vision, face numbness, stiff neck and back

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pain hence he is not able to carry out daily activities such as dressing, cooking and showering.
He has reduced motility and has a severe gait. He is a widower and lives alone in a two-story
building. His wife died twelve months ago. His complications have denied him the opportunity
to go his annual holiday get-away and he is getting worried due to the undesirable course of his
illness and wonders if he will be able to manage it in future. Mr Dinh has no family members
living with him and he experiences financial problems. He is currently under the following
medications; Panadol Osteo, Prednisolone and Teriflunomide.
Collection Of Cues/Information
Mr Dinh Nguyen is an elderly managed 83 years. He was diagnosed with Multiple
Sclerosis 6 years ago and two years he was found to be having osteoarthritis which currently
being managed by medications. He has the following signs and symptoms; urinary incontinence,
blurred vision, face numbness, stiff neck and back pain, reduced motility and abnormal gait. Due
to his condition, he is unable to perform basic activities such as showering, tying shoelaces,
cooking and dressing. He lives alone in a two storey building and has financial problems.
Processing Information
Blurred vision – This is a symptom of Multiple sclerosis (Browne et al. 2014).
Back Pain – Caused by Multiple Sclerosis or can be a symptom of osteoarthritis
Impaired Coordination (reduced motility), numbness of the face – Results due to the
pathogenesis of MS.
Abnormal gait and Stiff neck – Related to osteoarthritis (Pirker & Katzenschlager, 2017).

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Osteoarthritis – May have resulted due to Mr Nguyen advanced age and due to multiple sclerosis
because MS increases the incidence of osteoarthritis (Berenbaum, 2013).
Prednisolone – Used for management of osteoarthritis as it is a corticosteroid which is used for
managing degenerative inflammatory diseases.
Teriflunomide – This is a medication used to control Mr Dinh Nguyen Multiple Sclerosis.
Panadol Osteo – Is used by Mr Nguyen to relieve the pain caused by osteoarthritis.
Living in a two storey building – Increases the risk of falling and hurting himself since he has
symptoms that make him weak hence proper care should be given to him and be given a
caregiver and the facility made safe.
Identifying Problems/Issues (3 Main Priorities)
1. Impaired Coordination that leads to reduced motility and makes the basic task like cooking,
dressing, showering and tying shoelaces impossible.
2. Blurred Vision
3. Back pain and stiff neck
Top Priority of Care (Understanding And Utilizing A Clinical Decision Making Framework To
Come Up With The Top Care Needed)
By use of the Miller’s Functional Consequence theory, there needs to be an effective
clinical decision making framework to determine the top care priority for Mr Dinh impaired
coordination which has reduced his mobility and has made performing basic activities hard
(Levett-Jones, 2013). The discussion below focuses on the framework which constitutes;

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establishing care goals, action to be taken, an evaluation of the outcomes and a reflection on care
given to manage impaired coordination (Edlin & Golanty, 2012).
Establishment of Goals
The goals for managing impaired coordination would be;
 To ensure Mr Dinh can perform tasks like cooking, showering and dressing.
 To ensure that Mr Dinh can walk properly.
 Mr Dinh to get a caregiver to watch him all the time due to his impaired coordination to
avoid accidents.
Action To Be Taken
 Falls’ risk assessment and management – The possibility of Mr Dinh falling due to impaired
coordination and reduced motility should be accessed and management actions are taken such as
providing him with a walking stick.
 Avail Emergency mechanisms – The include having someone to watch over Mr Dinh to help
him in case of a fall.
 Exercises and Physical activity (Lox, Ginis & Petruzzello, 2017). – Mr Dinh to do exercises
to ensure that his bones and joints are adapted to activities.
 Occupational Therapy and Surgery – This will help him recuperate from his illness
Evaluation of the Outcomes
 Mr Dihn is able to perform basic tasks such as cooking, showering and dressing.
 Mr Dinh is able to walk properly.

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 He has a caregiver who watches him and helps him in exercising and physical activities and
is there in case of an emergency.
Reflection
 By going through the case study and the two theories, I now understand that impaired
coordination is the major issue that faces people with multiple sclerosis and osteoarthritis.
 I now understand that to make sound decisions about the care given to the elderly, one has to
look at the risks, age changes and the loss of function.
 From the above discussion and case study, it is evident that care should be given while
observing the dignity of the patient as well as the cultural background.
Conclusion
Miller’s Functional Consequence theory deals with age-related changes, health risk
factors for the older generation and outlines the negative functional consequences that are
experienced by the elderly people. Nurses can apply this model to all the situations that have the
ultimate goal of promoting wellness and healthy lives for the older individuals (Rodin,
2014).Levett-Jones’ Clinical Reasoning Cycle has been used to identify, evaluate, assess,
implement, establish goals, take action, evaluate the outcomes of the care given to Mr Dihn
through critical thinking and development of an effective decision-making process.
Amalgamation of Miller’s Functional Consequence theory and Levett-Jones’ Medical Reasoning
Sequence provides a framework that promotes wellness for the older people by providing
evidence-based information.

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References
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