Considering the Patient History

Discuss about the Nursing Care Practices And Its Importance.

The current assignment focuses upon the aspect of nursing care practices and its importance in the regulation and management of chronic illnesses. The nursing practices are based upon a number of set principles or guidelines which places patient care experience at the centre of the health care delivery.  The current study uses the Miller’s functional consequences theory to understand the effect of various social, economical, biological and physical determinants on the health of a person. The study over here uses the Levett Jone’s clinical reasoning cycle to identify access, implement and evaluate the care processes. The topic also emphasizes upon construction of suitable goals and actions which could be taken in order to provide optimum care services to the patient.

The assignment helps in the identification of different steps or measures which could be taken in order to provide support to the patient here who had been suffering from Parkinson’s. Additionally, the man was also lacking sufficient financial resources which also affected his care retrieval processes. The assignment describes the clinical reasoning cycle in detail which consist of a total of 8 steps and has been discussed elaborately under each sub-head of the assignment.

This is the first step of the clinical reasoning cycle where the health care professional collects pivotal information about the patient health. These forms the backbone of the care delivery processes based on which further therapeutic and clinical interventions can be implemented. The care personnel here can use through questioning and interviewing methods to collect sufficient and relevant health information about the patient. Here, the patient name Mr. Ratin Bhai was an 87 year old Indian who had migrated from his native land with his wife and extended family. He was recently diagnosed with Parkinson’s and hypothyroidism both of which have affected the daily life processes of the man. Ratin had been living in a two –storeyed house alone and has been managing his cooking and daily activities all alone.

However, as per miller’s theory the reduced mobility and tremors experienced in both the hands can expose him to increased risk of accidents from fall. In this context, the locomotor abilities of the man are severely impaired causing safe movement through the stairs of a two storeyed house difficult for him. Though, the hypothyroidism has been under control his Parkinson’s has been getting worse. Additionally, dwelling alone he doesn’t have anyone to support him with his daily course of activities. It has also been mentioned that the man has little or no source of income. The care professional has also recorded the present medication pattern and doses of the patient. The man has been taking 100µg of thyroxin daily along with carbidopa/Levodopa 25/100 q8h, entacapone 20 mg q8h.

Collection of Cues or Information

The recent condition of the patient had been getting worse attributed to his Parkinson’s. The man had been experiencing slights tremor in both of his hand which has been getting worse. As commented by Odin et al. (2015), impaired locomotor abilities can affect the daily life processes of an individual. In this context, the patient had been living alone and had been suffering from advanced stages of Parkinson’s. Moreover, he had been experiencing increased tremors in both his hands due to Parkinson’s.  This could make him more prone to injury from falling down as a result of poorly coordinated movements.

Additionally, the man had been dwelling alone which could subject him to increased risk of depression. Moreover, the lack of support care along with affected cognition can affect his medication patterns. It has been mentioned by the man that he does not wish to bother his family living next door. Therefore, as per Miller’s Functional consequences theory such isolated environment can result in the onset of depression within the individual.

The man had been suffering from hypothyroidism along with Parkinson’s which had affected his daily set of activities. Reports and evidences have suggested that the presence of hypothyroidism is almost 10% higher in people with idiopathic Parkinson’s disease. However as argued by Hutchinson & Wick (2016), there has been little or less clinical correlation between the two. As mentioned by Chenet al. (2016), less thyroxin within the blood have also been known to cause tremors in the patient. However, with medication the condition of hypothyroidism has been controlled in the patient. The condition of Parkinson’s had been found to be getting worse in the patient causing increased tremors of arms and legs.  As commented by Magennis et al.(2016), Parkinson’s is a progressive neurodegeneration disease affecting the cerebral cortex of the brain and has severe consequences on motor abilities of a person. In this context, the progressive neurodegeneration disease also affects the degree of mental awareness and cognition of the person.  Therefore, the reduced decision making skills can affect the medicine schedule of the person. The increase in the tremors could also make the person unable to travel the clinics situated distantly or access regular medical services. Therefore, preparation of rosters for time and schedule of medicine uptake along with constant supervision can aid the process.

From a detailed analysis of the case scenario of the patient three most significant issues or problems encountered by the patient can be highlighted over here which needs proper care and intervention. The patient had been living alone therefore his worsening Parkinson’s calls for support care. Additionally, the patient also suffers from hypothyroidism which has been found to be present as a co-morbid condition in Parkinson’s. Therefore, his current situation calls for sufficient clinical intervention and medication management. Additionally, the man reportedly does not have enough financial resources to avail proper care treatment. This calls for the sufficient support from health care professionals and community care concerns.For the current assignment, proper medication management for Parkinson’s has been undertaken as one of the prime nursing concerns.

Processing of Information

The medication management is taken as the top priority for establishing the goals in the treatment plan of Parkinson disease in order to follow the Miller’s consequences theories.  As stated already in the scenario, that Ratin has problems regarding the medications. He has been prescribed with medicines like Thyroxine, carbidopa, and Entacapone  Considering the symptoms of Parkinson disease, thyroxine is given to the patient to manage the thyroid hormone which would be necessary for motor movements (Odin et al, 2015). Carbipoa is given to lessen nausea. Entacapone would manage the involuntary functions. Based on these the intervention goals would be set up following the SMART rules:

The above quasi experimental strategy used by the nurses can help them to take interventions and fulfill all the rationales in medication management for Parkinson disease. The interventions are to be taken that will help Ratin to take medicines on time. He faces problem in medication intake because he has both financial problems and he lives alone. The nurses can prepare for him rooster that would help him take the medicines daily as prescribed by his physicians. The telephonic calls by nurses can remind him of the medicines that are to be taken with the oncoming of different symptoms and can also change the doses according to the problems he faces (Rascol, 2015).  In this way, nurses can describe the medication administration, monitor their dosage systems, multi dosage system analysis and dose administration aids. The nurses can also use the telecommunication systems like electronic health records for describing the patient with medication protocols and the medicine reconciliation. The rationale for this intervention is that it would help nurses to give the list of the drug name, dosage, frequency, discrepancies, omissions (Katus  & Shtilbans, 2014).

The evaluation of the entire process would be extended from the goals that were set in the analysis of the medication management. This is done by collecting the objective data that would give the measurable data on the situations observed. It is the quasi experimental study that would be developed in order to understand the new concerns and the interventions taken for the medicine management of Ratin. The primary data is collected by the questionnaires made on the nurses that are involved in handling the treatment of Ratin (Connolly & Lang, 2014). This would be specifically tailored to identify and evaluate the current conditions and quality in the medicinal management for the patient.  This would be a research based study and would practically identify if the interventions are been performed well.  The process would be more effective is done on the analysis of qualitative data (Morton et al, 2017).  This data gives the measurement not in terms of the numbers of nurses involved in the medication plan but with the natural description of the recurrent situation. The inferential statistics can be used to identify the situation in the medicinal management.

Identification of Problem/Issues

Thus, from this entire report, I as a nurse have identified three main categories for enhancing the Miller’s consequences theories that would provide the wellness of old people like Ratin. I have also understood that clinical reasoning cycle would be useful in a collection of the cues and information. The process information can also be made that can predict the outcome (Urden et al, 2015). Finally, I can easily identify the problems and issues. When the problems are known then the goals can be established that is based on the main priority of medication management of Ratin. The interventions were also taken accordingly following the rationales. The recent use of electronic health records, telephone, rooster can be used by the nurses to help him take medicines properly. Thus I now have more knowledge in understanding the impact of Parkinson disease and the interventions that can be taken for the management. Next time I would take more steps in more improvement of the treatments that are to be provided to Ratin.

Conclusion

The following treatment plan for the management of Parkinson disease would help the nurses to take useful strategies to provide patient centered care. This is based on studying the current situation and the problems of Ratin and then applying the clinical reasoning model for getting the priorities on which the nurses must observe to provide high-quality treatment to the patient. This would be based on collecting all the information of the patient and then make a critical analysis of the information to identify the top 3 requirements which are the medication management, management of patient symptoms of Parkinson and providing health care financial support for him. The take home message from this report is that the patient centered care would be well provided for fixing a particular goal and then taking the interventions and rationales based on the situation. There would be complete evaluation and statistical analysis that would reflect the performance of the nurses in medicinal management.  Thus the report in future would give the preferences, needs, and values for the patient and guide the clinical decisions based on it.

References

Castrioto, A., Lhommée, E., Moro, E., & Krack, P. (2014). Mood and behavioural effects of subthalamic stimulation in Parkinson’s disease. The Lancet Neurology, 13(3), 287-305.

Chen, S., Chan, P., Sun, S., Chen, H., Zhang, B., Le, W., … & Cheng, Y. (2016). The recommendations of Chinese Parkinson’s disease and movement disorder society consensus on therapeutic management of Parkinson’s disease. Translational neurodegeneration, 5(1), 12.

Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. Jama, 311(16), 1670-1683.

Ferreira, J. J., Katzenschlager, R., Bloem, B. R., Bonuccelli, U., Burn, D., Deuschl, G., … & Kostic, V. (2013). Summary of the recommendations of the EFNS/MDS?ES review on therapeutic management of Parkinson’s disease. European journal of neurology, 20(1), 5-15.

Hutchinson, K., & Wick, J. Y. (2016). Deep brain stimulation and medication management in parkinson’s disease. The Consultant Pharmacist®, 31(2), 73-84.

Julius, A., & Longfellow, K. (2016). Movement Disorders. Medical Clinics, 100(4), 733-761.

Katus, L., & Shtilbans, A. (2014). Perioperative management of patients with Parkinson’s disease. The American journal of medicine, 127(4), 275-280.

Magennis, B., Lynch, T., & Corry, M. (2014). Current trends in the medical management of Parkinson’s disease: implications for nursing practice. British Journal of Neuroscience Nursing, 10(2).

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Odin, P., Chaudhuri, K. R., Slevin, J. T., Volkmann, J., Dietrichs, E., Martinez-Martin, P., … & Rascol, O. (2015). Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: consensus from an international survey and discussion program. Parkinsonism & related disorders, 21(10), 1133-1144.

Odin, P., Chaudhuri, K. R., Slevin, J. T., Volkmann, J., Dietrichs, E., Martinez-Martin, P., … & Rascol, O. (2015). Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: consensus from an international survey and discussion program. Parkinsonism & related disorders, 21(10), 1133-1144.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2015). Priorities in critical care nursing. Elsevier Health Sciences.