Clinical Reasoning Essay: Neurology, Neurosurgery & Psychiatry

Question:

Discuss about the Clinical Reasoning Essay for Neurology, Neurosurgery & Psychiatry.

Answer:

Introduction

A Nursing practitioner with effective and positive impact in clinical practice often displays implementable clinical reasoning ability to manage patients. A nursing practitioner with appropriate skills often eliminates error actions on clinical judgement and decision making with regard to managing a Parkinson’s disease patients. As clinical reasoning is a learnt skill, it needs active engagement and determination on the patient which ensures that critical care management for patients is achieved. Thus towards achieving this goal, this case analysis will utilise on Levett-Jones, (2013) clinical reasoning cycle. In handling Mr Bhai case based on this clinical cycle tool, patient status will be assessed with regard to his social life and family affairs. Collection of the cues of the patient assessed will form part of the basis of disease diagnosis. Upon collection of this information, it will inform the clinical diagnosis. Further for appropriate diseases management major issues of concern will be sought from the patient which include bradykinesia, slow tremor and neuropsychosis. The second part of the essay will form assessment strategies from the nursing perspectives. These include management of tremor, nursing action strategies, evaluation of management practices and nursing reflection towards this patient.

Assesment based on the clinical reasoning cycle

Patient status

The case involves patient Bhai Ratin, aged 87 years who is diagnosed with Parkinson disease. Further four years ago, he was diagnosed with hypothyroidism and he is currently under medication. These challenges posses a double challenge to Mr Bhai. The patient got married to Mrs Amita, whom she died 12 months ago. They were unlucky to have children so now he is living alone. The patient is trying to manage his daily expenses from his superannuation income, which enable him to sustain his basic life expenses, however not enough to cater for all his expenses including holiday vacation.

His state is continuing to worsen daily, as he has started to experience tremor in his hands. This is making him to gain difficulty in managing basic activities like cooking, dressing and basic actions such as making shoe laces difficult process for him. From the assessment the disease is continuing to worsen making the life of Mr Bhai difficult. The only dependent he has is his brother and family, who live nearby, whoever he is afraid of bothering them.

Collecting cues for patient

Mr. Bhai, has been diagnosed with hyperthyroidism for close to four years now and he is still undergoing medication. He is currently ailing from Parkinson disease and the condition is worsening as he is unable to do most of the basic functions. The current medication he is taking are aimed at alleviating the symptoms of the disease however no improvement are being noticed, her condition is deteriorating.

Aging generally comes with its own challenges. Mr. Bhai faces loss of independence and is currently faces difficulty with the diminishing physical ability, (Sixsmith et al 2014). The senescence to the aging process of this patient is characterised by loss of biological, emotional and social ability, (Allen et al 2013). The acute changes in the health state of Mr Bhai, has lead to imminent disability, which needs a caregiver to take care of him. He is facing loss of his independence due to the advanced age and the disease state he is facing right now, (Alsnih & Hensher, 2003). Often presence of immediate families often take cover to assist the patient to cope up with this critical phase, however with Mr. Bhai, he is afraid of disturbing his brother’s family as they are close family to him at the moment.

Processing the collecting information

Mr Bhai is ailing from Parkinson disease which is a long term degenerative disease affecting the central nervous system and affects the motor system. The characteristics are typically slower at times; early diagnosis of the diseases displays signs of shaking, rigidity, slowness of movement and experiencing difficulty in walking. Often it can spill over to behavioural patterns display, (Sveinbjornsdottir, 2016). The early stages of the disease, Mr. Bhai is experiencing is characterised by little actions on the swinging and movement of arms, distorted speech movements and it continues to worsen as time goes by.

Currently there are limited treatment options of the diseases. With the progression of the disease, neurons loss its ability and the medications become less effective and produces signs of involuntary writhing movements, (Cruz et al., 2016). Proper dieting and rehabilitation process have shown to improve the disease state and improving the symptoms.

Parkinson is major disease affecting the elderly with approximately 6.2 million elderly in 2015 experiencing the disease with estimated 117, 400 deaths around the globe, (Feigin, 2016). The prevalence of the disease is more so prevalent among the elderly compared to the females and is characterised with life expectancy of 7-14 years after diagnosis, (Mustafa et al., n.d).

Major issues of concern to the patient

Parkinson disease is the most common form of the disease and has been referred to as idiopathic Parkinsonism and has no identifiable causes. Some of the identified cause of the disease include toxins, drugs, infections, drugs side effects, strokes and brain lesions, (Jankovic & Tolosa, 2007). The major issues affecting patient Bhai has been summarised into three majors which include; slow tremor. It is a common disease state which affects the arms and the limbs, (Jankovic, 2008). Common traits with the disease include index finger thumbness to perform duties. Another relevant issue is bradykinesia, which is characterised by slowness movement which affects mobility. Mr Bhai is at risk of facing issues with mobility which will affect tremendously his functionality. Another issue at risks is neuropsychosis. It is associated with cognition, mood and behaviour disorientation. Cognitive disturbance can be observed in the early stages of the disease and increase the prevalence of the disease, (Parker et al., 2013).

Objectives of managing slow tremor

Tremor occurrence in Parkinson’s disease is a characteristic for patient Bhai and occurs at rest occasions when the limb is not being used and during slow movements, (Deusch et al 2015). Tremor movements begin at the arm which posses’ disability which ensures that the patient functions well in doing other chores like dressing and cooking. For the patient at times medication are not effective in treating tremors, however implantation of brain stimulations in the thalamus system can achieve satisfactory results.

Nursing objectives geared towards managing the patient include;

  1. Providing proximal input to the affected arms, with an aim of providing stable surface for the arm affected arm which leads to increase ease and decreased tremor.
  2. Providing and improvising various adaptive equipment like weighted utensils, elastics shoe laces and weighted pen to alleviate weight overload on the hands.
  3. Exploring and devising forearm cooling management, this will be facilitated by a trained occupational therapists.
  4. To manage level of stress and manage tremor with an aim of eliminating multitasking and ensuring that the patient takes medication as required and prescribed.

Nursing action strategies

As the most identified nursing issue when handling a Parkinson’s diseases is tremor management, it has been known to have resting tremors which occur when the arms and the legs are resting. Often medication prescribed just like the case of patient Bhai, can serve meaningful purpose in managing the tremors. As a nurse, there is need to incorporate other non-pharmacological strategies to manage tremor for the patient. The strategies to be involved include:

  1. Ensuring the arms of patient Bhai are close to the body. This is aimed at ensuring that the proximal stability and input provided to the affected area can be able to manage the tremors and hands shake during functional abilities like cooking, and small chores around the house.
  2. Ensuring that the patient is advised not to multi task activities, avoidance of standing when doing activities such as shaving, brushing or even meal preparation can prove to be a challenge for a PD just like Mr. Bhai.
  3. Managing stress, anxiety and frustration caused by loneliness and inability occasion by the life Mr Bhai is living. These factors have tremendous effects on the state of Parkinson disease. Often when a patient gets frustrated, the best strategy to advise in this case Mr Bhai, is to take deep breaths and start whatever task he was doing.
  4. Ensuring that as a general practitioner, the patient ensures that they keep log of everything scheduling of tremors that occur. Ensuring complete daily activities when the tremors are severe and better is crucial. This is often linked to timing of medication and to ensure that they are functioning well.

Outcome evaluation process

With the implementation of the prescribed strategies, it is important to expect that the patient will be able to manage the level of stress and tremor he is starting to experience. At the end of implementing the strategies, it is geared that Mr Bhai, will be able to manage his chores effectively and avoid multitasking actions. Also it is expected that the level of stress and neuropsychosis experienced can be handled effectively and well by him. As a general practitioner it is important that the stated coping mechanisms are well implemented and adhered to.

My Reflection

With the implantation of this task, based on clinical reasoning skills, it is important to note that every step is relevant towards patient care management. With in-depth knowledge acquisition of Parkinson disease I know understand the major issues which affect the elderly towards managing the disease. The elderly need effective support mechanism so as to cope well with the disease and try to manage the level of issues surrounding the daily activities of an elderly person. Hence my key role as a nursing practitioner is paramount in this case.

Conclusion

Finally it is important to note that management of Parkinson disease in general ensures that clinical skills are implemented. As a nursing practitioner with effective skills of clinical reasoning based on Levett-Jones, (2013) and Hunters, (2016) concepts on wellness of older people, the skills acquired are crucial towards managing clinical based conditions among the elderly. Especially this time the patient is living alone with no social support, can worsen the neuropsychosis state of the Mr Bhai, (Friedman, 2010). With the implementation of the nursing strategies is crucial in ensuring the patient state is managed. The overview of the nursing strategies for Mr Bhai ensures that the arms are well functioning, avoidance of multitasking activities , stress management and anxiety disorders caused by loneliness. As a nurse ensuring proper documentation of all events taking place is crucial in ensuring that the patient is managed well and effectively. Nursing practices gears towards ensuring that the patient recuperates effectively and well and the need to ensure that the nursing strategies are well implemented well is crucial. Thus nursing role is essential for patient care process.

References

Alsnih, R., & Hensher, D. A. (2003). The mobility and accessibility expectations of seniors in an aging population. Transportation Research Part A: Policy and Practice, 37(10), 903-916.

Allen, N. E., Schwarzel, A. K., & Canning, C. G. (2013). Recurrent falls in Parkinson’s disease: a systematic review. Parkinson’s disease, 2013.

Cruz, A. N. D., Beber, B. C., Olchik, M. R., Chaves, M. L. F., Rieder, C. R. D. M., & Dornelles, S. (2016). Aspects of oral communication in patients with Parkinson’s disease submitted to Deep Brain Stimulation. In CoDAS (No. AHEAD, pp. 0-0). Sociedade Brasileira de Fonoaudiologia.

Deuschl, G., Petersen, I., Lorenz, D., & Christensen, K. (2015). Tremor in the elderly: Essential and aging?related tremor. Movement Disorders, 30(10), 1327-1334.

Feigin, V. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet, 388(10053), 1459-1544.

Friedman, J. H. (2010). Parkinson’s disease psychosis 2010: a review article. Parkinsonism & related disorders, 16(9), 553-560

Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.

Jankovic, J. (2008). Parkinson’s disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry, 79(4), 368-376.

Jankovic, J., & Tolosa, E. (Eds.). (2007). Parkinson's disease and movement disorders. Lippincott Williams & Wilkins.

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.

Mustafa, M., Menon, J., Kassim, M., Illzam, E. M., Muniandy, R. K., Firdaus, H., ... & Hud, M. Z. Gut-Microbiota Link in Parkinson’s Disease: Current Perspectives.

Parker, K. L., Lamichhane, D., Caetano, M. S., & Narayanan, N. S. (2013). Executive dysfunction in Parkinson’s disease and timing deficits. Frontiers in integrative neuroscience, 7.

Sixsmith, J., Sixsmith, A., F?nge, A. M., Naumann, D., Kucsera, C. S. A. B. A., Tomsone, S., ... & Woolrych, R. (2014). Healthy ageing and home: The perspectives of very old people in five European countries. Social Science & Medicine, 106, 1-9.

Sveinbjornsdottir, S. (2016). The clinical symptoms of Parkinson's disease. Journal of neurochemistry, 139(S1), 318-324.

How to cite this essay: