Nursing Care Plan
Introduction
Nurses should be in a position to develop a good nursing care plan that can help patients
who are suffering from Parkinson’s disease to regain good health and to continue with their
activities of daily living (Maville and Huerta, 2013). In order to achieve this, the nurse must be
able to identify the main health care priorities for the client and to take appropriate actions to
address them. According to Hunter (2016), for a nurse to develop a nursing care plan that can
assist geriatric patients to recover from a given health problem, he or she must understand and be
able to apply relevant wellness concepts and theoretical frameworks such as Miller’s Functional
Consequences Theory. The purpose of this paper is to identity, prioritize, and solve the most
important nursing care issues for Mr. Ratin Bhai, who is currently suffering from Parkinson’s
disease. This nursing care plan has been developed in accordance with the assumptions of
Clinical Reasoning Cycle and of Functional Consequences Theory as discussed by Levett-Jones
(2013) and Hunter (2016) respectively. Furthermore, the effectiveness of this plan has been
maximized by taking various ethical issues such as, respect for the client’s dignity and cultural
background into consideration.
Part A: Identifying three nursing care priorities
Three nursing care priorities for Mr. Bhai have been identified using the first four steps of
Levett-Jones’ Clinical Reasoning Cycle. During the identification process, the patient’s situation
has been considered, relevant information or cues have been gathered, the collected information
has been processed, and three specific healthcare issues have been established (Levett-Jones,
2013). Miller’s Functional Consequences Theory as described in Hunter (2016), has been used to
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describe age-related changes, risk factors associated with disease, as well as negative functional
consequences.
- Consider the patient
Mr. Bhai is a widower who is currently aged 87 years and who migrated from India in - Four years ago, Mr. Bhai was diagnosed with Parkinson’s disease and hypothyroidism.
Mr. Bhai’s wife, Amita, died twelve months ago and since then, he has been staying alone in a
two storey home. Unfortunately, the two did not have children. One strange thing about Mr. Bhai
is that, although his brother Niraj and his family stay closely nearby, he does not want to bother
them with his health problems. Mr. Bhai has explained that he is currently experiencing altered
mobility. - Collect cues or information
Following a comprehensive assessment, it has been discovered that Mr. Bhai has a slight
tremor in both hands, which is worsening as time goes by. For this reason, he finds it difficult to
effectively perform activities of daily living such as doing up buttons, cooking, doing shoelaces,
and making a cup of tea. As Mr. Bhai explains, he has reduced investment returns and he relies
on his small income to meet daily financial expenses and to purchase drugs, which he must use
on a daily basis. The drugs that he currently uses and that he must purchase using his small
income include; 200 milligrams of entacapone and 25/100 carbidopa/Levodopa at q8h each.
Moreover, he consumes 100 micrograms of thyroxine daily. Mr., Bhai feels that his disease
process is getting worse and he is very much uncertain about what the future holds for him.
However, he did not go on holiday this year, despite the fact that he used to go once year. - Process information
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There is a close association between Mr. Bhai’s life situation and the cues that have been
observed. For instance, the client is experiencing tremor in the hands due to his pathological
condition, physiological changes in old age, and factors in his living. In Miller’s Functional
Consequences Theory, Hunter (2016) has identified pathological conditions as one of the risk
factors for decreased health and functioning in older adults. According to Hallett (2012), and
Chen, Hopfner, Becktepe, and Deuschl (2017), hand tremor is normally one of the initial
symptoms of Parkinson’s disease that family members can easily notice. Mr. Bhai was diagnosed
with Parkinson’s disease four years ago, and he is therefore experiencing hand tremor as a result
of pathological effects of the disease.
In addition, Mr. Bhai is experiencing hand tremor due to reduced muscle tone which is a
common physiological change in musculoskeletal systems of older adults. According to Kalyani,
Corriere, and Ferrucci (2014), and Deuschl, Peterson, Lorenz, and Christensen (2015), old age is
associated with limited production of proteins for muscles. This causes muscle rigidity and
reduced muscle tone, thereby causing tremor on the joints. In the case of Mr. Bhai, reduced
muscle tone as a result of old age does not only causes tremor of the hands, but it is also
associated with altered mobility which has prevented him from going on holiday this year.
Furthermore, Mr. Bhai’s living environment has a negative impact on his health. Since
Mr. Bhai stays independently, he is highly likely to spend much of his time pondering over his
health condition and how he will manage it in the near future. In addition, deterioration in health
is making Mr. Bhai to have a lot of stress (Hunter, 2016).
- Identifying problems or issues
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Based on the information that has been gathered about Mr. Bhai, it is evident that there
are three health issues that he should be assisted to address. The three issues in order of
importance include; impaired physical mobility due to tremors that occur as a result of
Parkinson’s disease and reduced muscle tone and efficiency (Hallett, 2012; Deuschl, Peterson,
Lorenz, and Christensen, 2015), self-care deficits which prevent him from managing daily
activities, and stress which is brought about by deterioration in health (Verra, 2016). According
to Verra (2016) and Magrinelli et al., (2016), patients who are suffering from Parkinson’s disease
often have impaired physical mobility and this is normally evidenced by tremors and inability to
move willingly.
Furthermore, Verra (2016) points out that people with Parkinson’s disease have self-care
deficits because they are unable to successfully accomplish activities of daily living (ADLs) such
as dressing and cooking. These deficits prevent them from managing their daily activities
effectively like in Mr. Bhai’s case. According to Aziz and Steffens, (2013) and Marsh (2013),
stress that occurs as a result of deteriorating health condition has been identified as one of the
major causes of depression in older adults. Therefore, the three issues identified in Mr. Bhai are
all supported by research-based evidence. The processed patient information reveals that Mr.
Bhai should be helped to manage impaired physical mobility, self-care deficits, and stress.
Part B: Top priority of care
The top priority of care that has been chosen for Mr. Bhai is impaired physical mobility.
In this section, the remaining four steps of Clinical Reasoning Cycle as explained by Levett-
Jones (2013) will be used to discuss a nursing care plan for Mr. Bhai in order to help him to
recover from impaired physical mobility and tremors. Specifically, three major outcome goals
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for the patient have been identified. This has been followed by an explanation of nursing
interventions that will help to eliminate ill health, as well as how the nurse will evaluate whether
the expected outcomes have been met. Developing top priority of care for Mr. Bhai is a good
step towards assisting him to eliminate ill health (Hunter, 2016).
- Establish goals
There are three goals for managing impaired physical mobility for Mr. Bhai. The first
goal that a nursing intervention should achieve is to help Mr, Bhai to have a controlled hand
tremor and to sustain functional physical mobility during the entire period of disease process..
The second goal is to ensure that Mr. Bhai has a safe environment which is free from hazards
within a period of one week (McMahon and Fleury, 2013). Third, the nurse should assist Mr.
Bhai to regain independence in performing activities of daily living within a period of one month
(Verra, 2016). When developing these goals, the nurse has taken into account Mr. Bhai’s beliefs,
values, cultural preferences, and dignity as these factors will greatly determine the success of the
selected nursing intervention. The three goals have been developed in accordance with
assumptions of Functional Consequences Theory of healthy ageing as described by Hunter
(2016). - Take action
One of the most appropriate nursing interventions for Mr. Bhai is engaging in techniques
that initiate movement such as side-to-side rocking. The main rationale for this intervention is
that it will help the client to start leg movement, which will result into improved physical
mobility (Verra, 2016). Moreover, Mr. Bhai should be instructed to support his arms on the chair
whenever he is standing up as this will help to solve rigidity problems that are currently causing
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hand tremor. The other nursing intervention that is of great help to Mr. Bhai is advising him to
engage in physical exercise in order to increase the strength of body muscles. A good example of
physical exercise that is appropriate for Mr. Bhai is walking regularly. The main rationale for
physical exercise is that, it will help to reduce muscular rigidity that causes tremor, thereby
improving disease progress (Hunter, 2016).
Additionally, the nurse should refer Mr. Bhai to a physiotherapist who will help him to
develop an individualized exercise program. The physiotherapist should also look at Mr. Bhai’s
mobility and offer guidance on the types of exercise he should consider in order to regain
functionality during the entire period of disease process (Verra, 2016). Moreover, the nurse
should conduct daily activity assessment and falls risk assessment as frequently as possible. The
rationale behind daily activity assessment and falls risk assessment is to help monitor Mr. Bhai’s
progress and to establish whether further actions are necessary to help him achieve the nursing
care goals (Phelan, Mahoney, Voit, and Stevens, 2016). Again, Mr. Bhai should be referred to a
GP to help him control his Parkinson’s disease and hand tremor (Hunter, 2016).
- Evaluate outcomes
Following successful implementation of the above nursing strategies, Mr. Bhai will be
expected to have achieved the expected outcomes as outlined in the outcome goals (Verra, 2016).
The nurse will confirm effectiveness of the interventions if Mr. Bhai has a controlled hand
tremor and if he sustains functional physical mobility during the entire period of disease process.
In addition, the interventions will be considered to be effective if the client regains independence
in performing activities of daily living within a period of one month, and if has a safe
environment which is free from hazards within a period of one week (Hunter, 2016). Evaluating
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outcomes is extremely crucial because it will guide the nurse on whether he or she should
continue implementing the already chosen strategies or if they should be changed.
- Reflection
Next time, I will involve my client’s family members in developing his or her nursing
care plan, in order to determine whether this will increase the accuracy with which a patient’s
healthcare needs can be established (Dongen, Bokhoven, Daniels, Weijden, Emonts, and
Beurskens, 2016). Additionally, based on the ideas presented by Hunter (2016), I now
understand the importance of utilizing a nursing theory in evaluating a patient’s needs and in
developing a nursing care plan. Furthermore, I now understand the ability of Parkinson’s disease
in limiting physical mobility in the elderly. Based on information documented by Verra (2016), I
have learnt the best interventions that I can implement in order to eliminate ill health for a
geriatric patient who is suffering from impaired physical mobility due to Parkinson’s disease.
Conclusion
In conclusion, when developing a nursing care plan for an elderly patient who is suffering
from Parkinson’s disease, the nurse must prioritize healthcare issues for the client, considering
the fact that geriatric patients may have several healthcare problems working together to limit
physiological functioning (Hong-Ying and Xin, 2016; Goodman et al., 2016; & Johnson and
Chang, 2014). This paper explores the process of prioritizing healthcare issues for Mr. Bhai
using Levett-Jones’ Clinical Reasoning Cycle and Muller’s Functional Consequences Theory.
From the analysis, it has been discovered that the top priority of care for Mr. Bhai is impaired
physical mobility. Relevant nursing interventions have been chosen to help him to maintain
functional mobility and to be able to effectively perform his daily living activities. The most
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important thing that should be learnt from this nursing care plan is that, a nurse should always
remember to choose nursing interventions that will enable his or her patient to achieve specific
healthcare goals for a particular health care priority (Ballantyne, 2016).
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References
Aziz, R. & Steffens, D. C. (2013). What are the causes of late-life depression? Psychiatric
Clinics of North America, 36(4), 497-516.
Ballantyne, H. (2016). Developing nursing care plans. Nursing Standard, 30(26), 51-57. .
Chen, W., Hopfner, F., Becktepe, J. & Deuschl, G. (2017). Rest tremor revisited: Parkinson’s
disease and other disorders. Translational Neurodegeneration, 6, 16.
Deuschl, G., Peterson, I., Lorenz, D. & Christensen, K. (2015). Tremor in the elderly: Essential
and aging-related tremor. Movement Disorders, 30(10), 1327-1334. doi:
10.1002/mds.26265
Dongen, J., Bokhoven, M., Daniels, R., Weijden, T., Emonts, W. & Beurskens, A. (2016).
Developing interprofessional care plans in chronic care: A scoping review. BMC Family
Practice, 17, 137.