Comprehensive Nursing Care Plan for Mrs. McKay: A Case Study

This case study focuses on Mrs. McKay, a patient residing in an aged care facility with early-stage Alzheimer's and vascular dementia, who recently underwent a hip replacement and is experiencing mobility issues, fall risks, wound care needs, and intermittent incontinence. The assignment applies the clinical reasoning cycle to assess Mrs. McKay's condition, identify three key nursing issues: fall risk, wound care, and incontinence. It establishes goals for nursing care, including fall risk assessment, wound dressing, and incontinence management. The care plan involves environmental modifications, pain management, and interventions for incontinence. The evaluation of nursing strategies and reflection on patient outcomes are included, emphasizing the importance of a patient-centered approach and the nurse's role in providing quality care and improving the patient's quality of life through effective clinical reasoning.

Running head: CARE FOR MRS. McKay
CARE FOR MRS. McKay
Name of the student:
Name of the university:
Author note:

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CARE FOR MRS. McKay
Introduction:
Clinical reasoning cycle is one of the most effective tools that are used by the nursing
professionals to provide a comprehensive care to the patients. This procedure contains eight
important steps which is carried on properly will help the professionals to give the best care to
the patient in a sequential manner which will address all her symptoms effectively (Dalton, Gee
& Levett-Jones, 2015). Dementia and Alzheimer’s disease affect the lives of many old men and
women in Australia. There are more than 413106 patients living in the nation with dementia and
the 228238 (55%) are female and 184161(45%). This number would increase to 536164 by 2025.
are male In this case study, the nurse will also follow the tool to address each of the nursing
issues of the patients and with the sequential steps, he will effectively develop a care plan that
will be beneficial for the patients recovery fork her present situation.
Considering the patient situation, collecting cues, processing and presenting related health
information:
Clinical reason cycle is often used by a large number of healthcare professionals as it acts
as a tool which helps them to sequentially collect cues about the patients’ condition, process the
information and also come to an understanding of the patient problems (Hunter & Arthur, 2016).
This toll then helps the nurse to plan and develop interventions which ultimately help in the
evaluation of the outcome followed by the reflection o the nurse form this entire episode. Form
the case study, it is seen that the patient is a widow who has been residing in an aged care facility
and has returned from hospitals after a hip replacement after fall in the rehabilitation center. She
is in the preliminary stage of the Alzheimer’s disorder and vascular dementia. She is also not
used to walking with wheelie walker and has been bruised due to bumping on the walker.

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Previously, she used to be strong independent minded person and therefore she cannot accept the
fact that she is dependent now on carers for her daily activities. Therefore she is being rude to the
carers and are not helping them in her care. She is also intermittently incontinent due to her
failure in reaching toilet on time. Mostly old people of Australia are found to suffer from
dementia and Alzheimer’s and the patient had been no exception. Her will to walk alone makes
her more risky towards fall as he is yet not habituated with the fact that her mobility is reduced
and she needs assistance in walking. The occurrence of the disorder has affected the patient who
has therefore developed shuffling, leaning patterns, unsteady balance and also decreased
coordination as well as physical strength as they are the common symptoms of dementia. The
unsteady balance may also be due to the medical as well as physical reason of Alzheimer’s
which cause occurrence of plaques in the brain of the individuals and tangles as well (Koivisto et
al., 2016). The cause of the incontinence may be due to the presence of Alzheimer’s diseases
which results in development of overactive bladders those results in leakage of urine
involuntarily before reaching restrooms. The falls are mainly due to unsteady balance and
inability to be practiced with restricted movement. She also has a tear in her lower right leg and
therefore it is also causing her huge pain which also needs to be addressed.
Identification and prioritization of three nursing issues:
Three important areas need to be addressed by the nurses who will be in charge of the
patient. While identifying the domains, where the patient will require care, it is also important for
the nurse to keep in mind that she is in the first stages of dementia and Alzheimer’s diseases and
therefore a patient centred care with compassion and empathy is important in the case (Kuiper,
Pesut & Arms, 2016). Firstly, the patient is yet not accustomed with the fact that she is having
restricted mobility and therefore she is not careful in her movement and was not able to conduct

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her activities independently and therefore it is important for the nurse to conduct a fall risk
assessment and take precautionary measures accordingly. Secondly, the patient is having a large
tear in her lower right leg and therefore the nurse should undertake proper dressing procedure for
the healing of the bruises. It should be taken care that she is quite aged and her healing should
require more time and therefore proper planning and care should be taken by the nurse wile
caring for her wound. Thirdly, the patient has intermittent incontinence and therefore it very
much important for the nurse to undertake proper interventions so that the issue can be handled
properly and the patient does not have leaked urine before reaching the restroom.
Establishment of goals of nursing care:
The nurse should first conduct FRAT which is a fall risk assessment tool that was
actually developed by Peninsula Health Falls Prevention service in the year 1999. It mainly
contains three parts which are assessing falls risk status, risk factor checklist and also developing
action plan. This will help the nurse to develop an idea about the severity of the issue and
following this the interventions to prevent fall will be developed (Palvelen et al., 2014). The
nurse should ask herself self assessment question regarding the patients risk of fall, communicate
with the patient, and also take undertake environmental changes such as adequate lighting,
developing visual contrast, keeping pathways clear and others. Secondly the nurse should follow
a proper wound dressing procedure which will help the patient to overcome the pain from her
tear and also help it to get dry soon. She will also be assessed on the pain management scale
from 1 to 10 and depending upon her score, interventions need to be taken for both of her wound
management. Moreover she had gone hip arthroplasty and therefore she may also face pain in the
surgical sites which also needs to be checked. Hence, pain management should be done
accordingly so that both the factor can be addresses (Joshi et al., 2014). The third intervention

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would be to take proper care for the patients’ issue in urination as she is suffering from
incontinence. The goal should be that the patient has reduced episode of such independence,
receive assistance in such time; can overcome environmental barriers, allocation of proper
adaptive equipment and others (Teunisen et al., 2015). The main goal of the nurse should
however be an overall comprehensive care to the patient by attending all her symptoms of the
Alzheimer and dementia so that the patient can age well with a better quality life in the aged
care.
Nursing care for the person:
After assessing the fall risk assessment, the nurse should accordingly take actions.
Besides advising the patients with proper precautions (the patient is in preliminary stage so her
cognitive ability is not completely lost), the nurse should make the environment risk free as
much as possible (Vlayen et al., 2015). She should ensure adequate lighting, reduction of glare
and also limit the shadows. She should also provide the patient with visual; contrast by using
obvious contrast in colour to define objects form the background, using of solid colours with in
pattern to decrease confusion and also avoiding black surfaces which the patient might
misinterpret as black hole as her cognitive ability is declining. Her pathways should be kept clear
by keeping the surface level dry and non slippery. The floors, furniture and the outdoors would
be modified accordingly. The nurse should also enhance accessibility by keeping important
things in visible, easy to reach places, using a firm mattress, using adaptive equipment and also
lowering the bed light. The bathroom should have increase safety by sing bath chairs, proper
bathroom rails, properly placed bards, using right footwear (Miake et al., 2013)

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For management of the pain after hip replacement surgery, the nurse should use proper
pain assessment scales, maintain proper position of the operated extremity and also provide her
with comfort measures that include frequent repositioning and diversion activities. Stress
management techniques should be encouraged like progressive relaxation, meditation, guided
imagery and others (Wilson, 2017). Proper pain management medications should be provided on
a regular schedule and before activities. The nurse should also be alert and investigate reports for
suffering severe joint pain, muscular spasms and changes in joint mobility, severe chest pain and
restlessness. Application of ice packs, initiation and maintenance of extremity mobilization
ambulation, light exercise and physical therapies should also be conducted. For the bruises, she
should use the correct dressing depending upon the depth and condition for the wound, change
them at the correct interval and apply the right medication so that the wound may dry as rapid as
it can (Benditz et al., 2016).
For maintaining her incontinence issue, the nurse should first introduce a toileting
schedule, eliminate all the environmental barriers to the washroom in the care, improve lighting
in hallways and bathrooms and also remove rugs form the floor is any present. The nurse can
also use urinary receptacle in 3 in 1 commode, containment device. Clothing should be such that
it maximizes toileting access of the patient. A prompted voiding program or patterned urge
response toileting program should be initiated. Frequency of urination with the sue of alarm
clock, changing device, noting urinary elimination and incontinence pattern, starting prompted
toileting program on the results of the toileting frequency, parsing the patient when toileting
occurs with prompting all helps in managing the situation effectively (Zarowitz et al., 2015).
Evaluation of the nursing strategies:

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For each of the nursing priorities, the nurse should set up a timeframe until which she
would be continuing the interventions. Then she would be conducting an evaluation of the results
of each of the interventions. If they are achieved successfully or are showing positive results, the
interventions should be carried out. If the outcomes are not positive, the nurse should discuss the
case with mentor and introduce new interventions in accordance with the situation.
Reflection on the patient’s outcomes:
While handling the case study, it was getting really difficult for me to handle so many co-
morbidities together and I was getting stressed and was not being able to manage the
interventions properly. However, with the guide of the mentor, I correctly made a care plan for
the patient and followed ach of the intervention appropriately. Moreover, as she was not
complying with us, I had a counselling session with her, where I treated her with compassion and
empathy providing her the autonomy and dignity to take her own decisions. This helped me to
develop a therapeutic relationship with her where she also started helping me in the interventions
and her cooperation’s made the process easier and also made me stress free.
Conclusion:
From the case study, the nursing priorities were first indentified. Following the
identification of the priorities, proper interventions were introduced. Effective pain
management, proper management of incontinence, proper care for her fall management risks had
been taken effectively. Following the application of the intervention, evaluation of the outcomes
is needed to be done by the nurse to ensure safe practice and quality care. The nurse should
reflect the entire process in order to gain new insights from the experience. Therefore, following

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a clinical reasoning cycle, a nurse can effectively manage patient and care for her to give her a
better quality life.
References:
Benditz, A., Greimel, F., Auer, P., Zeman, F., Göttermann, A., Grifka, J., ... & von Kunow, F.
(2016). Can consistent benchmarking within a standardized pain management concept
decrease postoperative pain after total hip arthroplasty? A prospective cohort study
including 367 patients. Journal of pain research, 9, 1205.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
The, 33(2), 29.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Joshi, G. P., Schug, S. A., & Kehlet, H. (2014). Procedure-specific pain management and
outcome strategies. Best Practice & Research Clinical Anaesthesiology, 28(2), 191-201.
Koivisto, J. M., Multisilta, J., Niemi, H., Katajisto, J., & Eriksson, E. (2016). Learning by
playing: A cross-sectional descriptive study of nursing students' experiences of learning
clinical reasoning. Nurse education today, 45, 22-28.
Kuiper, R., Pesut, D. J., & Arms, T. E. (2016). Clinical reasoning and care coordination in
advanced practice nursing. Springer Publishing Company.

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Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient Fall Prevention
Programs as a Patient Safety StrategyA Systematic Review. Annals of internal
medicine, 158(5_Part_2), 390-396.
Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Järvinen, M. (2014).
Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling
older adults: a randomised controlled trial. Injury, 45(1), 265-271.
Teunissen, D. T., Stegeman, M. M., Bor, H. H., & Lagro-Janssen, T. A. (2015). Treatment by a
nurse practitioner in primary care improves the severity and impact of urinary
incontinence in women. An observational study. BMC urology, 15(1), 51.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., ... &
Dejaeger, E. (2015). Characteristics and Effectiveness of Fall Prevention Programs in
Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled
Trials. Journal of the American Geriatrics Society, 63(2), 211-221.
Wilson, A. (2017). Assistive devices, hip precautions, environmental modifications and training
to prevent dislocation and improve function after hip arthroplasty. International Journal
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Zarowitz, B. J., Allen, C., O'Shea, T., Tangalos, E., Berner, T., & Ouslander, J. G. (2015).
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542.

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Appendix:
Source: aihw.gov.au (2015)