Care Planning: Prioritizing Nursing Care for Elderly Patients

This report provides a comprehensive analysis of care planning for an elderly patient, Mr. Ratin Bhai, who is diagnosed with Parkinson's disease and hypothyroidism. The assignment utilizes two theoretical frameworks: Miller's Functional Consequences Theory and Levett-Jones' Clinical Reasoning Cycle. Part A identifies three nursing care priorities based on age-related changes, risk factors, and functional consequences, both negative and positive, using Miller's theory. Part B applies the first four steps of the Levett-Jones' cycle to collect and process information, and identify problems. The report then focuses on the top care priority, establishing SMART goals, taking action, evaluating outcomes, and reflecting on the process, all within the Levett-Jones' Clinical Reasoning Cycle. The report emphasizes the importance of prioritizing patient needs, medication management, and psychological support for improved quality of life.

Care Planning: Individual Discussion

Table of contents
Introduction:..................................................................................................................... 2
I. Part A – identification of the three nursing care priorities by Miller’s Functional
Consequences Theory.....................................................................................................3
II. Identification of the three nursing care priorities using the first four steps of the Levett
Jones’ Clinical Reasoning Cycle......................................................................................4
III. Part B: Having identified all of the nursing care priorities, choose the top priority of
care and then discuss using the remaining 4 steps in the Levett Jones’ Clinical
Reasoning Cycle..............................................................................................................5
Conclusion:...................................................................................................................... 6
Reference List:................................................................................................................. 7

Introduction:
This assignment will deal with gauging the capability of a nurse in prioritising the most
significant nursing care matters for a service user. For the convenience of the
understanding the assignment two theoretical frameworks namely Miller’s Functional
Consequences Theory and Levett-Jones’ Clinical Reasoning Cycle is taken. This two
theories underpin the nursing practice and used as a tool to initiate the practice of
identification and assessment, implementation and evaluation of care service (Castles
et al. 2013, p.45). The total assignment is divided in to two parts namely Part A and Part
B. In the beginning of the assignment the identification of the three nursing care
priorities by Miller’s Functional Consequences Theory is proffered as part A. This
portion specifies the Age related changes; associated risk factor, negative functional
consequence as well as positives functional consequence are identified and addressed.
In the next stage the identification of all the nursing care priorities in accordance with
the 8 steps in the Levett-Jones’ Clinical Reasoning Cycle is done. The Levett-Jones’
Clinical Reasoning Cycle is comprised of Consideration of the patient situation;
collection of the cues or information; processing of the information; identification of the
problems or issues; establishment of the desired goals; taking action for changing the
situation; evaluation of the outcomes by showing the expected outcomes and reflection
(Reuter Lorenz and Park, 2014, p.355).
I. Part A – identification of the three nursing care priorities by Miller’s Functional
Consequences Theory
Age related changes: When people getting old, several inconvenience may developed.
This inconvenience can range from the physiological implication to psychological
problem. After evaluating the entire case study it has been seen that the contextual
person Mr Ratin Bhai who is 87 year old is diagnosed with Parkinson’s disease
accompanied by hypothyroidism from past four years. He also lost his wife in eh past
year. His medical condition is now controlled with the help of medication namely
Thyroxine 100 micrograms daily; Carbidopa or Levodopa 25/100 q8h and Entacapone
200 mg q8h. As he does not have any immediate family member looking after him at
such old age is problematic (Childs et al. 2015, p.1424).

Risk factor: Age is accompanied by many health implications. It is also important to be
mentioned here that people like Mr Ratin Bhai is at risk of suffering injury due to fall. It
has been seen that people above the age of 87 more prone to suffer fall due to lack of
orientation (Currais and Maher, 2013, p.813). Furthermore, as the contextual person is
diagnosed with Parkinson’s disease, his daily work habit is hampered which can in turn
affects the wellbeing of the contextual person. Dependency on other person can cause
low self-esteem in the contextual person who is in need of support (Dijkstra, 2017,
p.54). These low self-esteem and lack of motivation for living can affects the mental
makeup of the contextual person.
Negative functional consequence: There are many negative functional consequence
of aging, the primary implication is loss of health and physical vigour and thus to work.
In the given case it is also observed that the financial condition of the contextual person
is not that much sound. Furthermore, he also has no immediate family member to look
after him (Hunter, 2012).
Positives functional consequence: Without any medical interventions, the functional
consequences of the age are always negative. However, with proper intervention plan
the functional consequences can be turn as positive (Eliopoulos, 2013, p.67). With
proper medication and care the age related risk can be diminished. This also helps in
the improvement of the quality of life among the older adults. Appropriate intervention in
proper time helps the contextual person to face the age related implications and prepare
for good (Dalton et al. 2015 p.29).
II. Identification of the three nursing care priorities using the first four steps of the
Levett Jones’ Clinical Reasoning Cycle
1. Consider the patient - The present client is 87 years old widower namely Mr Ratin
Bhai who has been diagnosed with Parkinson disease traced four years back and also
has been suffering from hyperthyroidism. His hyperthyroidism also has been diagnosed
four years back and currently it has been controlled by medication (Hunter and Arthur,
2016, p.73). Mr Ratin has been suffering from slight tremor in both hands which is
worsening day by day and the basic house hold jobs such as cooking; making tea
etcetera has become critical for him (Liou et al. 2016, p.707). Mr Ratin has developed a

thought about the present worsening health condition and getting worried about the
insecurity of the coming future.
2. Collect cues or information - Mr Ratin has been suffering from Parkinson disease for
last four years along with the hyperthyroidism about the same period of time. Both the
diseases have been accumulated by the time of the visit and many symptoms has been
escalated during this period (Mather et al. 2015, p.625). There has been tremor in both
hands of Mr Ratin which makes the situation worse for him as he is unable to perform
day to day basis domestic jobs such as making tea, cooking etcetera (Castles et al.
2013, p.45). Mr. Ratin also have developed psychological discomfort due to the
worsening physical condition. Altogether Mr. Ratin developed a critical condition
physiologically as well as psychologically (Reuter Lorenz and Park, 2014, p.355).
3. Process information - Parkinson disease: Mr. Ratin is a widower residing in a two
story home and staying almost alone although he has brother and his wife staying close
to him. He has no children to look after (Childs et al. 2015, p.1424). Parkinson disease
is a genetically developed condition which has been diagnosed four years back and it
has been getting day by day.
Hyperthyroidism: apart from Parkinson disease Mr. Ratin also has been developed
hyperthyroidism which makes the situation worse for him (Currais and Maher, 2013,
p.813). There are many symptoms that has been developed due to the worsening
physical condition of Mr. Ratin such as tremor in legs and hands which hindered for his
daily basis house hold jobs (Dalton et al. 2015 p.29).
4. Identify problems or issues - The patient has developed Parkinson decease along
with hyperthyroidism which has been developed four years back. Mr. Ratin has been
migrated in 1946 and currently staying alone in two story home after his wife’s demise.
Financial along with psychological issues has been developed alongside the diseases
(Hunter and Arthur, 2016, p.73). The persisting effect of both Parkinson’s and
hyperthyroidism have induces multiple complications such has tremor in hand and legs
and partial disability of performing house hold jobs. Therefore a psychological setback
also has been developed due to his worsening condition and uncertain future (Liou et al.
2016, p.707).

III. Part B: Having identified all of the nursing care priorities, choose the top
priority of care and then discuss using the remaining 4 steps in the Levett Jones’
Clinical Reasoning Cycle
5. Establish goals - In accordance with the SMART objectives the specific goals has
been set such as
i. Specific - ensuring the wellbeing of Mr. Ratin as he is staying alone in his two
story hose after the demise of his wife. The first specific goal is to transfer him to
a medical centre for ensuring the safety and wellbeing apart from medical
attention through professional help (Mather et al. 2015, p.625).
ii. Measureable - The tremor and worsening condition could be improved through
timely medication and professional attention (Castles et al. 2013, p.45).
iii. Achievable - total wellbeing of Mr. Ratin in the medical centre through
professional help and timely medication and care (Reuter Lorenz and Park, 2014,
p.355).
iv. Realistic - assessment of the Parkinson disease and hyperthyroidism and
preparation of action plan in accordance with the outcome (Childs et al. 2015,
p.1424).
v. Timely - overall wellbeing of the Mr. Ratin in comparison with the present
situation is restored within next 1 month (Currais and Maher, 2013, p.813).
6. Take action –
i. Shifting Mr. Ratin to the medical centre for care and professional assistance for
the assessment of the present condition and preparing a treatment plan
accordingly (Levett-Jones, 2013).
ii. Regular medication and exercise has been incorporated for the improvement of
hand and leg tremor (Hunter and Arthur, 2016, p.73).
iii. Immediate preparation of treatment plan has been taken place for
hyperthyroidism and diet chart for the maintaining and improvement from the
present condition (Liou et al. 2016, p.707).
iv. Psychological counselling need to be arranged for the understanding of the
present situation and also has been preparing him for the future to cope with the
present condition (Mather et al. 2015, p.625).

7. Evaluate outcomes showing the expected outcomes - The present assessment of the
hyperthyroidism shows the condition has been improved from the last condition. Mr.
Ratin able to do all house holds jobs of his own and the effect of Parkinson also
diminished from the last assessment (Reuter Lorenz and Park, 2014, p.355). Regular
medication and physical exercise helped him to perform some of his daily activities and
some degree of normalcy also has been restored The tremor has been showing signs of
improvement and holistic wellbeing of Mr Ratin has been developed as the effect of the
Parkinson and hyperthyroidism has been showed down (Levett-Jones, 2013). The
psychological wellbeing also has been restored due to the physical development.
8. Reflection - Next time I would do an assessment for the determination of exact
physiological and psychological situation of the patient for the understanding of the
immediate course of action regarding the treatment. I should have proper medical
professional help for the proper and timely treatment of the patient. If, I have the proper
understanding of the background of the patient; it will help me to evaluate the present
condition and reason of the condition. I now understand the exact procedure of the
development of the action plan for the patient and timeframe in which the patient could
restore from the last physiological condition.
Conclusion:
It can be concluded from the above assignment that the ageing is an inevitable and it is
accompanied by much negative consequence. The first foremost consequence is a loss
of a companion and physical ability to work and earn the livelihood. In the initial portion
of the assignment, the age related implications are discussed with the help of Miller’s
Functional Consequences Theory. As the assignment precedes the problem that is
associated with the ageing are identified and address. Levett Jones’ Clinical Reasoning
Cycle is applied to understand the modes of intervention. In the first 4 steps of this
theory helps the contextual health and social care personnel to understand the entire
situation for planning intervention. In the final 4 step, the established goal in accordance
with the SMART category is set along with taking the appropriate action and evaluation
of the plan. In the concluding portion, a reflective note is also shared including the
experience of the person who plans the intervention.

Reference List:
Castles, S., De Haas, H. and Miller, M.J., 2013. The age of migration: International
population movements in the modern world. Palgrave Macmillan.
Childs, B.G., Durik, M., Baker, D.J. and Van Deursen, J.M., 2015. Cellular senescence
in ageing and age-related disease: from mechanisms to therapy. Nature
medicine, 21(12), p.1424.
Currais, A. and Maher, P., 2013. Functional consequences of age-dependent changes
in glutathione status in the brain. Antioxidants & redox signalling, 19(8), pp.813-822.
Dalton, L., Gee, T. and 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), p.29.
Dijkstra, A., 2017. Care dependency. In Dementia in Nursing Homes (pp. 229-248).
Springer International Publishing.
Eliopoulos, C., 2013. Gerontological nursing. Lippincott Williams & Wilkins.
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters
Kluwer/Lippincott, Williams and Wilkins.
Hunter, S. and Arthur, C., 2016. The clinical reasoning of nursing students on clinical
placement: Clinical educators' perceptions. Nurse education in practice, 18, pp.73-79.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse.
Frenchs Forest, NSW: Pearson.
Liou, S.R., Liu, H.C., Tsai, H.M., Tsai, Y.H., Lin, Y.C., Chang, C.H. and Cheng, C.Y.,
2016. The development and psychometric testing of a theory‐based instrument to
evaluate nurses’ perception of clinical reasoning competence. Journal of advanced
nursing, 72(3), pp.707-717.
Mather, C.A., McKay, A. and Allen, P., 2015. Clinical supervisors' perspectives on
delivering work integrated learning: A survey study. Nurse education today, 35(4),
pp.625-631.
Reuter-Lorenz, P.A. and Park, D.C., 2014. How does it STAC up? Revisiting the
scaffolding theory of ageing and cognition. Neuropsychology Review, 24(3), pp.355-
370.