NRSG 259: Care Plan Promoting Health in Extended Care for Elderly

This essay presents a comprehensive care plan for Amalie, an 89-year-old woman, focusing on promoting her health in extended care. The plan identifies three key nursing priorities: activities of daily living (ADL), risk of falls, and pain management. Miller’s Functional Consequences Model and Levett-Jones Clinical Reasoning Cycle are used to guide the assessment, implementation, and evaluation of care. The essay details the rationale for each priority, including Amalie's rheumatoid and osteoarthritis, vision deficits, and isolation behaviors. Interventions such as geriatric assessment, fall prevention measures, and pharmacological and non-pharmacological pain management techniques are discussed. The care plan aims to improve Amalie's quality of life by reducing pain, enhancing mobility, and promoting social engagement. The essay concludes by emphasizing the importance of patient-centered and holistic care approaches in elderly care.

Running head: PROMOTING HEALTH IN EXTENED CARE 1
PROMOTING HEALTH IN EXTENED CARE
Student’s Name
University Affiliation
Course
Date

PROMOTING HEALTH IN EXTENED CARE 2
Introduction
Ageing being an irreversible and a gradual process of development, requires specialized
nursing care. Ageing is associated with physiological, psychological, physical and mental health
issues and should be put into consideration. This essay will discuss the major health issues
highlighted in the case study of Amalie. Amalie is a female client with an age of 89 years. She is
a German but she stays in Australia where she was married by a sailor who died two years ago
due to lung cancer. In the past two years, Amalie’s health status has been worsening gradually
forcing her to withdraw from all kind of the activities she had engaged herself in including losing
contact with the community.
Recently, Amalie developed dry macular degeneration and problems with mobility due to
rheumatoid and osteoarthritis. She has a positive medical history of hypothyroidism, macular
degeneration and arthritis. The three priorities of nursing care to be discussed are risk of falls,
pain management and activities of daily living (ADL). The Miller’s Functional Consequences
model and Levette-Jones Clinical Reasoning cycle will be used in identification, assessment,
implementation and evaluation of nursing care.
Body
The first priority of nursing care is activities of daily living. From the scenario, Amalie is
not able to conduct the various activities of daily living due to her health deterioration. She
developed rheumatoid and osteoarthritis which made her develop mobility issues. Additionally,
according to the referral letter from her GP, Amalie is stated to have joint stiffness, limited
movement of joints, painful joints, swollen feet and joints and occasional dizziness. Due to dry
macular degeneration, she is reported to have vision deficits which also contributed to her

PROMOTING HEALTH IN EXTENED CARE 3
limited movements from her house. Additionally, Amalie is reported to have isolation behaviors,
inadequate feeding and weight loss. Generally, these are some of the factors which largely
contributed to reduced ability to carry out daily activities of living (Clement, Ploennigs &
Kabitzsch, 2012).
Activities of Daily Living refers to basic form of activities that are performed by people
every day important for independent life in the community and at home. ADLs can be
categorized into five which include dressing, eating, continence maintenance and personal
hygiene which involves grooming, bathing and oral care (Clement, Ploennigs & Kabitzsch,
2012). Transferring oneself from one point to another is also an ADL. Instrumental Activities of
Daily Living (IADLs) refers to the actions that enable an individual have an independent life.
They are important to the health care professionals as they guide on the level and kind of
assistance needed by the patient (Capezuti, Boltz, Cline, Dickson, Rosenberg, Wagner &
Nigolian, 2012).
The IDLS include basic skills of communication, transportation which involves driving,
preparation of meals, shopping and medication. Management of medications without missing
doses and housework are also other useful IADLs. Geriatric assessment is a multidisciplinary
and multidimensional and it is sued in evaluation of the functioning ability, cognitive
functioning, physical health, socio-economic situations and mental health of an old patient
(Clement, Ploennigs & Kabitzsch, 2012).
The multidisciplinary team involved should conduct a complete assessment to detect
potential issues such as falls, confusions, incontinence and immobility. The multidisciplinary
team should adopt a structured approach of conducting the assessment to obtain all the
information required to make a proper diagnosis, implement and evaluate care. The assessment

PROMOTING HEALTH IN EXTENED CARE 4
should incorporate people like nutritionists, physicians, nurses, social workers and occupational
therapists (Ward & Reuben, 2016).
Physical assessment should be systematic to capture the musculoskeletal which should
include reduced range of movement, pain and swelling of legs, osteoarthritis and gait
disturbances. When assessing the eyes, they should ask about loss of central vison which is
associated with age-related macular degeneration. On general assessment, they should ask on
depression, isolation and unintentional loss of weight which impact on one’s ability to carry out
daily activities (Karlsson, Magnusson, Schewelov & Rosengren, 2013)
The second priority in Amalie’s scenario is risk of falls. Amalie is age-89 years with
rheumatoid and osteoarthritis which pose a great risk of falls to her. She has a positive medical
history of arthritis which can lead to falls risk. Based on the scenario she has vision deficits, joint
stiffness, painful joints, dizziness and swollen and painful joints which could lead to falls
(Karlsson, Magnusson, Schewelov & Rosengren, 2013) Falls are regarded as a marker of
immobility, frailty, chronic and acute impairment of health in the elderly. Falls diminish one’s
level of functioning causing fear of falling, activity limitations, injury and mobility loss. Most
injuries such as fractures of forearm, pelvis, humerus or hips among old people result from falls
(Gillespie, Robertson, Gillespie, Sherrington, Gates, Clemson & Lamb, 2012).
The risk factors of falls include demographics such as age more than 75 years, status of
household, living alone and history of previous falls (Hunter, 2016). Acute and chronic illnesses,
physical deficits, medical prescriptions, cognitive impairment, foot and vision problems.
Environmental hazards such as poor lighting and stairs can also lead to falls to the elderly.
Medications that are associated with high risk of falls include corticosteroids, non-steroidal anti-

PROMOTING HEALTH IN EXTENED CARE 5
inflammatory drugs, ant-depressants and ant-hypertensives (Huang, Mallet, Rochefort, Eguale,
Buckeridge & Tamblyn, 2012).
When performing a physical assessment on Amalie, the nurses should ask about
deformities or problems of joints such as inflammation, visual problems, illnesses, gait
disturbance, nutrition and weigh loss (Ward & Reuben, 2016). Other things they should ask
about are lighting conditions of the home compound and stairs at her home that might lead to her
falls. Appropriate measures such as physiotherapy, education on impacts of medications
regarding falls and other factors which can lead to falls, proper lighting at home and avoidance
of stairs at her home. Medical management is also useful for the illnesses which cause risk of
falls. Prevention of falls should be multidisciplinary and multidimensional for positive patent
outcome (Carolan & Jorgensen, 2013).
The third priority is pain management. Amalie is aged 89 years and she has swollen and
painful joints especially the hip, knee, back and fingers as stated in the referral letter from her GP
in the case scenario. From the scenario, Amalie has rheumatoid and osteoarthritis and a positive
medical history of arthritis which have largely contributed to her mobility issues making her
unable to move out of her house. Due to these mobility problems, Amalie consequently lost
physical contact with the community, friends and members of the association she was in.
Osteoarthritis is a bone disorder associated with continuous wearing and tearing of specific body
joints while rheumatoid is an autoimmune disorder characterized by inflammation of joints
(Hunter, 2016).
This priority will include the last four steps of the Clinical Reasoning Cycle which
include: goal setting, taking action, evaluation of care and a reflection of the entire scenario. The
fifth step on setting goals, the main goals of pain management in Amalie’s scenario is that she

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should report reduced pain after nursing intervention, she should demonstrate restored emotional,
physical and social function after implementation of nursing care interventions and improved
adherence to prescribed medications which she seems to skip when she is on intense pain
(Levett-Jones, 2013).
Pain is among the commonest complaints among old people due to increased chronic
diseases and frailty which are associated with increased pain (Hunter, 2016). According to
Miller’s Functional Consequences Model, old people are likely to develop joint and bone
disorders, arthritis and other chronic illnesses that are associated with pain (Horgas, Yoon &
Grall, 2012). If the pain remains untreated, it can lead to negative consequences such as reduced
quality of life and health leading to anxiety, depression, social isolation, sleep disturbances,
immobility and cognitive impairment (Horgas, 2017). Based on Amalie’s scenario, it is evident
that she has poor quality of life associated with continued isolation behaviors, inability to leave
the house due to problems of mobility which are caused by rheumatoid and osteoarthritis bone
and joint disorders (Carolan & Jorgensen, 2013).
On the sixth step-taking action- (Levett-Jones, 2013). The best action is provision of
analgesics such as paracetamol for relieving pain and anti-inflammatory drugs such as ibuprofen
which relieves fever, pain and inflammation since she has swollen joints. The second action is
the non-pharmacological approach of managing pain (Horgas, 2017). This approach should
involve educating the patient on nature of pain, instruments used in pain assessment, use of
medications, involvement in group programs and strategies of coping with pain to enhance pain
tolerance and sooth the pain. Cognitive Behavioral Therapy can also be used to promote coping
mechanisms (Horgas, 2017).

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Some of the risk factors associated with rheumatoid arthritis include female gender, age
60 years and above and a medical history of arthritis. Based on these risk factors, it was possible
for Amalie to develop rheumatoid and osteoarthritis. Both rheumatoid and osteoarthritis are
associated with joint pain especially the fingers, hips, knee, hands and elbow. At the onset,
rheumatoid is associated with fever, weight loss, loss of appetite and fatigue which indicate
development of the disease (Singh, Saag, Bridges, Akl, Bannuru, Sullivan & Curtis, 2016). Some
other symptoms of rheumatoid include joint stiffness, multiple joint swelling and general malaise
(Carolan & Jorgensen, 2013).
The seventh step of the Clinical Reasoning Cycle about evaluation of care should states
the outcome of the nursing care. Amalie’s pain should be reduced and she should be adhering to
medications properly. She should also be physically, emotionally and socially active without
having to isolate herself from others.
Nurses should adequately assess pain in Amalie based on onset, location, frequency,
duration, causative factors, aggravating factors, relieving factors of pain and any medications
that she has used for pain management. For instance, from the scenario, the referral letter from
Amalie’s GP states that she is on slow release paracetamol and ibuprofen which are important in
relieving pain, inflammation and fever (Horgas, Yoon & Grall, 2012).
As a reflection of the entire scenario, it is my clear understanding that pain, risk of falls
and ADLs can largely impact on the general functioning of the elderly. I now understand that
patient-centered and holistic care approaches are very useful in the care of the elderly. The
clinical Reasoning Model is very critical in nursing care for prioritization of patient needs.

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Conclusion
This essay was meant to purposely analyze the scenario of Amalie and plan for care
based on Miller’s Functional Consequences theory and Levette-Jones Model of Clinical
Reasoning. Based on these two models, it was realized that nurses need to be knowledgeable and
critically think in order to implement appropriate care. Ageing is an irreversible developmental
process that impacts on the functioning of most of the body systems including the
musculoskeletal. Ageing is a risk factor to various health conditions such as age-related macular
degeneration, rheumatoid arthritis and depression especially in a female gender.
Nursing priorities such as pain management, risk of falls and Activities of Daily Living
were fully addressed in this essay. Both multidimensional and multidisciplinary approaches were
discussed on management of these priorities of care. Levette-Jones model of clinical reasoning
was used to provide guidance on identification of patient’s priorities of care, setting of goals,
planning of care, implementation of interventions and evaluation of the outcome of nursing care.
Based on this, I believe that important information regarding Amalie was discussed in the essay.

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