Nursing Case Study Report: Patricia's Rehabilitation and Care Plan

This nursing case study focuses on Patricia, a 58-year-old Indigenous Australian woman undergoing rehabilitation after a below-knee amputation due to Type 2 Diabetes Mellitus (T2DM) and peripheral vascular disease (PVD). The assignment utilizes the Levette Jones Clinical Reasoning Cycle to address her clinical priorities. These priorities include improving self-management skills for diabetes, promoting independent living with prosthetics, and reducing the risk of accidental falls. The report analyzes Patricia's situation, collects and processes cues, identifies problems such as poor diabetes management, threats to independent living, and the risk of falls, and establishes goals to address these issues. Nursing interventions are devised, including education on diabetes management, gait training, and occupational therapy for fall prevention. The evaluation of outcomes focuses on regulated blood glucose levels, improved gait balance, and the ability to perform activities of daily living independently. The case study emphasizes the importance of informed consent, respect for autonomy, and effective communication in patient care, particularly when working with older adults.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The ssignment is based on the case study of Patricia, a 58-year old Indigenous
Australian woman. The assignment will deal with highlighting the clinical priority followed
by devising of the nursing interventions to address the clinical priority followed by the
evaluation of the outcomes. The structure of the assignment will be based on the Levette
Jones Clinical Reasoning Cycle.
Consider patient's situation
Patricia is a 58-year old Indigenous Australian woman with a history of Type 2
Diabetes Mellitus (T2DM) and peripheral vascular disease (PVD). She had a previous history
of developing large vascular ulcer on her left calf following fall and was sustained with large
graze and bruising. Due to extending wound, Patricia has developed left below knee
amputation. Currently she is in her 5th day of rehabilitation and has arrived to the in-patient
rehabilitation.
Collection of cues and Processing of information
The case study reported that her T2DM is controlled by diet and intake of the oral
hypoglycaemic medication. Vascular ulcers are defined as braches in the skin occur as a
result of complication in the vascular or circulatory system. The predisposition of the T2DM
has made Patiricia vulnerable towards PVD. Diabetes leads to the narrowing of the arteries
and the veins through deposition of cholesterol resulting in the PVD. The blockage on the
blood circulation increases the probability of developing ulcers or wound. The presence of
T2DM also delays the process of wound healing. This is the reason why Patricia was
suffering from PVD management for the past 6 months. Delay in wound healing increases the
vulnerability of developing bacterial infection. The bacterial infection occurring due to

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unmanaged wound is imparted by multi-drug resistant bacteria. This might be the reason why
her wound is unresponsive to the antibiotics (Chawla, Chawla & Jaggi, 2016).
Identification of problems
1. Lack of proper diabetes management
Though the case study highlighted that her T2DM is well-controlled by diet and
hypoglycaemic medication but the development of PVD indicates that she might be suffering
from high level of blood cholesterol resulting from the improper absorption of the cholesterol
due to disequilibrium in the concentration of glucose in the blood. This indicates that there is
lack in the effective self-management skills of diabetes. She works full-time in the local
news-paper even at the age of 58 and lives alone as she is a divorce and both her children
reside elsewhere. Nguyen, Chitturi and Maple‐Brown (2016) stated that among the
Aboriginal older adults who resides in the remote or in the rural areas of Australia, receive
less healthcare access. Due to lack of proper health-care access and since she lives alone, she
might be suffering the lack of poor self-management skills of diabetes and overall it increases
the severity of diabetes. Patricia is an indigenous women who lives alone in a rural area with
long history of type 2 diabetes and this indicate that she must be suffering from poor
healthcare access and lack of proper self-management skills of diabetes.
2. Threat in living independently and alone at home due to prosthetics
Davie-Smith et al. (2017) stated that the majority of the patients who have undertaken
the amputation in the lower limb and having PD have diabetes in 50% of the cases. These
people are known to have poor quality of life as they are unable to reside independently.
Being able to walk with prosthesis is of prime importance in order promote independent
living and to increase the overall quality of life. However, people with prosthetics and are

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older adults experience difficulties living independently as they are unable to walk alone
without in support or assistance coming from other person during the first few months of
surgery. Patricia wanted to live alone like she was doing and this impose threat to her overall
health and thus a care priority.
3. Risk of accidental fall
Hunter et al. (2017) stated that the vulnerability of encountering accidental falls
among the older adults who are with the limb amputation is high. The risk period start from
the time of amputation and extending up to the years during the later stages of life living
under the community healthcare settings. The risk factors for encountering accidental fall
vary across the different healthcare settings after the amputation surgery and this has
significant implications for the safety and other fall prevention strategies. The main risk
factors that increase the risk of falls include muscle weakness, age and other co-morbidities.
Patricia is 58 years old and thus might be in her menopause stage. Garcia-Alfaro et al. (2019)
menopause increase the tendency of developing bone and muscle weakness among the
women and thus increasing the chances of accidental fall. Thus management of the risk of
accidental fall is a health problem for Patricia.
Establishment of goals
Goal 1: Improving the self-management skills of T2DM management
In order to decrease the severity of the PVD and vulnerability of developing other
micro and macrovascular complications of diabetes like cardiovascular disease, peripheral
neuropathy and diabetic retinopathy improving the self-management skills of diabetes is
important. Self-management skills of diabetes will help to ensure proper healing of the
wound. The self-management skills of diabetes will be under through promoting education
and awareness about diabetes management. This will be done by the nursing managers and

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education will be directed towards periodic checking of the blood glucose level, measuring
body weight and regulation of anti-diabetic diet while maintaining healthy lifestyle activities.
The education will be given under the presence of the Indigenous nursing professionals. The
presence of the indigenous nursing professional will help to increase the involvement of
Patricia in the overall care plan (Powers et al., 2017). Moore et al. (2019) stated that presence
of Aboriginal healthcare worker is important to improve the diabetes self-management skills
among the indigenous population who are residing in the rural areas.
Goal 2: Assistance in independent living
In order to promote independent living and to ensure that Patricia is capable to
conducting the activities of daily living providing assistance and education about prosthetics
is important. Devinuwara, Dworak-Kula and O'Connor (2018) stated that rehabilitation is an
educational and problem-solving clinical intervention. It aims towards reducing the impact of
the overall limb loss on the amputee's functioning. This is obtained through three different
strategies. First is restoration of function of the impaired structures. Second is reorganisation
of the impaired pathways to deliver improved abilities in activities of daily living. Third is
decreasing the discrepancy between the restricted ability of the disabled people and their
overall demands of the environment. The assistance to work with prosthetics foot will be
done through providing gait training to Patricia. This will help to maximize the concept of
independent living. The steps that will be used in the gait training like wheelchair training,
providing compression therapy, sit-to-stand practice, and progression to early use of walking
aid (Devinuwara, Dworak-Kula & O'Connor, 2018). Education about the prosthetic will be
directed towards impending pain associated with amputation. Patricia is prescribed with
pregabalin, a medication for neurotropic pain. Thus Patricia will be educated about the
importance of the proper adherence of medication. Under this educational program,

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involvement of his children (family members) is also important as this will help to increase
the collaborative approach of care (Torresan et al., 2015).
3. Reducing the chances of accidental fall
Role of the occupational therapists is vital for decreasing the chances of the accidental
fall while moving with prosthetics. The duty of the occupational therapists is reduction of the
vulnerability of the accidental fall by implementing interventions like self-navigation of the
wheel chair, managing the upholstery of the room for ensure hassle free navigation,
increasing indoor lightening of the room. Apart from this, Patricia must be asked to avail
assistance from residential health care nurse or social worker while going to bathroom (Elliott
& Leland, 2018). Elliott and Leland (2018) stated that older adults with prosthetic impact
have vulnerable in encountering accidental fall in the bathrooms and manual assistance in this
domain help in significant reduction of the fall threat.
Take action
Action must be taken by the nursing professional in order to earn approval from
Patricia for availing assistance from residential healthcare nurses. According to the case
study, Patricia wishes to stay independently like she used to do previously. Thus, forcing her
to avail help from the residential care nurse will go against the bio-ethics of autonomy.
Kogan, Wilber and Mosqueda (2016) are of the opinion, in order to handle the ethical
obligation of autonomy, patient education about the disease progression and therapy planning
is important. Educating Patricia about the risk factors associated with the accidental fall
might prove to be helpful for availing her informed consent and this helping to secure
autonomy.
Australian aged care services (2019) is a subsidised services directed towards the
older adults for conducting remote health assessment. Making a periodic tabulation of the

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blood glucose level of Patricia via visiting healthcare service centre might be difficult for her
taking her post-surgical condition. Home-based assistance for measuring blood glucose level
will be helpful for the effective management of T2DM.
Evaluation of outcomes
Evaluation of the outcome will be done based on the effective management of T2DM
as imparted from the regulated blood glucose level. The outcome will also be studied based
on the improvement in the gait balance and ability of Patricia to conduct the activities of daily
living independent living.
Personal reflection
The analysis of the case study helped me to understand that while handling the older
adults, informed consent and respect towards autonomy holds prime importance. In order to
informed consent for respecting the ethics of the autonomy, the execution of the effective
communication skills holds prime importance. Bramhall (2014) stated that execution of
effective communication skills help to establish therapeutic relationship with the patient and
thereby helping to earn trust and facilitating the path to fetch informed consent. Going
forward I will try to improve my effective communications skills (verbal and non-verbal
communication skills) by working under the supervision of the registered nursing
professionals.
Conclusion
Thus from the above discussion it can be concluded that three primary priority of care
for Patricia include improving self manage skills for effective management of diabetes,
reducing the chances of the accidental fall under the supervision of the occupational

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therapists and education of the patient about the prosthetic in leg amputation, therapy
adherence for pain management and training for maintaining gait balance.

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References
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