NRSG372 Principles of Nursing Chronic Illness and Disability

Introduction

Mr. Noah Wilson is a 75-year elderly citizen who has been selected for the telephonic interview. He lives with his family which consists of his son, daughter in law and two grandchildren. 2 months back due to excessive chest pain he went to the clinician and was diagnosed with Coronary Artery Disease (Hayek et al., 2017). His real identify has not been used in this study for privacy and safety reasons and his consent before conduction of the interview has been taken. He is a retired individual and is quite social in nature. He claims to like it in presence of other people. But he is overweight and unable to walk much. He also has had a history of falls. He claims to have no information regarding the life style changes that he needs to do. He also mentions that he does not like to be home bound as he is scared to move because he thinks he might fall.

The recognised priorities of care for Noah are to increase his knowledge about the required lifestyle changes to prevent the adversities of Coronary Artery disease (CAD). He mentioned to be lazy, scared of moving as he might fall. But he is unaware of the changes he needs to make. The other care priority for Noah is to encourage him to move more frequently by providing him some accessories which will prevent his fall incidence.

The Clinical Reasoning Cycle used rationalised and explains the needs and preferences of the patient (Daly, 2018). The Ropar Logan Tierney model is used for estimating the status of the patient in terms of daily activities better (Williams, 2017). The aim of the care priorities that have been identified for the patient include educating him and his family members about his conditions and encourage for changes in lifestyle along with help him reduce the scare of falling by providing him better tools for safety.

Clinical Reason Cycle for Lifestyle changes

The primary goal for the patient is to consider the basic changes in the lifestyle of the patient that would help him reduce the adversities. This would be done by educating the patient and the family about the changes that are required along with encouraging the patient to facilitate these changes and make them as daily habits. By physical appearance the patient is obese and is very lazy. He mentions to like eating junk food along with watching movies on the television. He also like sipping on beer while doing it. When asked he said that he was unaware of the changes that he needs to make in terms of the food and beverages he consumes. The patient does not feel like walking much as he feels short of breath after walking a little and gets tired easily. Obesity is one of the factors and reasons behind the development of Coronary Artery Disease in which fat and cholesterol deposits on the walls of the arteries making it difficult for the blood to pass (Sharma et al., 2016). Sedentary lifestyles, wrong diet and food selection, excess of oily food, process food, no exercise, consumption of alcohol and smoking can increase the incidence obesity. Due to obesity the patient also cannot walk a lot and feel short of breath after applying little force while performing any activity. This also increases the risk of patient to face long term implications which are risk of heart attack, risk of development of diabetes, stroke, myocardial infarction, fatty liver etc. which are fatal (Bokma et al., 2018). Therefore, it is very important for the Noah to manage his condition before developing any comorbidity. Based on the data and information that has been gathered from the interview, I have identified the first priority of Noah is to inculcate better lifestyle habits to control is present condition and prevent any further adverse impacts (Chiou, Hsu & Hung, 2016). As a nurse, it is always a responsibility to promote patient’s awareness during the care program as that will increasing the drive towards managing the issue and better cooperation. For lifestyle habits to be changed, Noah needs a proper meal plan with a balance diet throughout the weak. The meal plan would be based on the nutrition that Noah needs and excludes the ones that can be potentially harmful like red meat which is cholesterol rich (Zeraatkar et al., 2019). Additionally, Noah also needs to start light daily exercise and slowly increase the intensity. He can start walking daily and also helping in household activities. Slowly he can increase the resistance by lifting grocery bags. This will help better functioning of the heart and the muscles in the body (Liu et al., 2019). Further, an improved diet and exercise are also known to control the weight of an individual.

The RLT model of daily activities enables a nurse to identify the dependency level of Noah with respect to performance in daily activities. The daily activities that are identified by this model include the assessment of the daily performances in activities like walking, eating breathing, etc. Based on the RLT model, Noah has been identified to dependent in terms of breathing, eating, communication etc. He feels short of breath while talking or performing any activity (Sarnak et al., 2019). He is also partially dependent on family members to provide him food. He cannot communicate fluently as he gets tired soon while talking.

As the nurse of Noah, it is my duty to use my communication skills effectively and communicate with him and identify the basic needs of the patient so that the interventions can be undertaken effectively for the management of the underlying condition of CAD (Hashim, 2017. I have identified that Noah needs proper education in terms of diet and exercises which should inculcated in his daily life. He also needs motivation to practice and cooperate win the care plan which is driven towards his improvement (Kvale et al., 2016). This can be done by providing him a written booklet which would be accessible to him and his family members. This is similar to NSQHS norm 2.3.1, which calls for working with patients and provide them continuous training by giving them quick access to the training materials (NSQHS, 2021).

Clinical reasoning Cycle for Reducing fall incidence

The goal of this priority is to reduce the risk of fall for Noah by encouraging participation into daily activities by providing him a support stick to walk and also low platform non slip slippers or shoes to walk. Noah mentioned that he is extremely friendly in nature and like to socialise. But as he has a history of fall, he is scared to walk often and go out. He thinks he might trip onto something and fall. He seemed to be quite upset mentally for this reason as he is unable to meet his friends. His son and daughter in law are also busy to attend him much as both are working. The grandchildren seldom give him company when they are not at school. Thus, he feels devoid of attention and love and is scared (Yeunhee & Yoonjung, 2017). He mentions that he would be happy to receive help more from his family members and also close friends as they would provide comfort. Therefore, it is important to educate the family members and the friends of Noah who can participate in his care and motivate him to improve his abilities to walk and move around, help him with his new tools and reduce his fear of falling. According to evidence, involvement of family members and friends will encourage the patient and help him recover faster because of enhanced understanding and comfort (Gill et al., 2016). This will also enhance the mental health of the patient and encourage him more. The fear of fall can also increase the patient’s tendency to feel unmotivated and left alone. This can trigger the degradation of the mental health (de Souza et al., 2016). Given the significance of Noah’s mental health, it is critical that this priority is given extreme importance as an improved mental health will inspire Noah and improve his speed of recovery which would help him reduce his fear and improve his cooperation in the recovery process of CAD.

One the basis of the RLT model, Noah is not motivated to go out and walk. He is scared. Therefore, is not independent on the daily activity of walking. Similarly maintaining for his own hygiene, he needs help. He also is not able to communicate affectively with his friends and family about the problem. He needs sufficient motivation for the same and he feels tired after performing some activities.

As a nurse of Noah, it is significant that I encourage the family and friends of the patient to take part in his care so that there is direct outcome on the mental as well as the physical health of Noah and motivate him to participate in his care process. Their active participation would improve the psychological status of the patient and make him comfortable in the surrounding. Further, as the patient has a history of fall, it is natural to feel scared to walk and go out (Lee, oh & Hong, 2018). With age, the risk of fall incidences increases and so do the development of fall injury (Lavedan et al., 2018). Due to immunosuppression and senescence of the cells, the recovery of the body is slowed down. Thus, after a fall accident a patient would not recover easily (Kritsilis et al., 2018). Therefore, to reduce the fall risk a walking stick would be helpful as a support and low platform shoes would also reduce the patient’s risk of fall as it improves balance while walking. All these decisions would be informed to the patient and their consent would be taken before performing any intervention. This act is parallel to the NSQHS standard 2.4 which is based on informed consent of the patient before making the clinical decision (NSQHS, 2021).

Conclusion

To conclude, this study was done to identify the priorities of care for the patient Noah Wilson with the help of CRC and RLT models. An interview was taken over phone and the information was analysed using these models to decide the care priorities for the patient’s condition of Coronary Artery Disease. Based on this, it was identified that the patient needed education and motivation for changing the lifestyle habits like maintaining a healthy diet and regular exercise. Along with this involvement of the patient family members and friends was also identified for increased comfort and providing support sticks and low-heeled shoes for support and better balance while walking to reduce the fear and incidence of falling.

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