Pathophysiology and Management Advances †MyAssignmenthelp.com

Question: Discuss about the Pathophysiology and Management Advances. Answer: Introduction: Primary care for chronic illness is very complicated as it is multifactorial in nature. The patients health may be affected by different factors. To provide high quality and safe care the nurse must consider the patient and associated clinical needs (Helgeson Zajdel, 2017). The essay deals with the case study of Philip, 67 years old male, with primary diagnosis of Parkinsons disease. The case study will be analysed to identify the two priorities of care. The aim of the essay is to develop comprehensive care plan for him applying the clinical reasoning cycle. It is the tool for nurses to develop the goal driven nursing care, considering the spiral of series of linked clinical encounters (Dalton, Gee Levett-Jones, 2015). It will help in prioritisation of care while integrating different aspects of the Philips clinical condition. Prioritisation and care plan involves use of clinical reasoning and decision making skills (Papastavrou, Andreou Efstathiou, 2014). To understand the patients health status it is necessary to consider the present situation (Dalton, Gee Levett-Jones, 2015). In the given case study, Philips 67-years old male is presented to the medical ward after losing balance and fall. After two weeks he was diagnosed with Parkinsons disease. His symptoms were numbness in his hands and difficult speech. He feels everything is spinning around. Further, process may involve collection of cues and information from the patients health history, previous assessment and further assessment (Dalton, Gee Levett-Jones, 2015). The patient history shows presence of high cholesterol. He has surgical history of Left knee arthoplasty. As a child he had tonsillectomy and adenoidectomy. The discharge history shows patient under variety of medication for Parkinsons disease. At the time of admission he had upper limb tremor that was more pronounced on right side. The patient experiences drooling, fatigue and sleepy episodes during the day time. The patients history also highlights the feelings of blue and fluctuations of mood, global bradykinesia, and increasing hypoponia. The cumulative effect of these may have manifested as difficulty in working with hot water or making tea. His occuputational history showed him as semi-retired worker. He worked part time at tea store. It may be associated with serious financial implications. His social life is poor. He is separated from his wife and his children do not support enough. It may be related to emotional issues if unaddressed. These conditions if untreated may lead to other comorbidities such as hypertension, diabetes, paralysis, chronic pulmonary disease and others (Lubomski et al., 2014). It is necessary to process this information, to prioritize the care. It involves use of critical thinking and relation of information to clinical knowledge (Dalton, Gee Levett-Jones, 2015). Philips fails to coordinate at work may be due to lack of dopamine. The loss of neurons and cells from the substantia nigra of the brain leads to decreased dopamine secretion. Dopamine is responsible for impairing the basal ganglia in low levels, thereby affecting movement and coordination of activity (Schulz-Schaeffer, 2015). Gait is the most telling signal of Parkinsons disease. In normal condition the patient can walk from head to toe but in Parkinson disease the patient does not lift the feet at all. As the gait shuffling becomes more pronounced, the patient suffers from fall. It is known as freezing of gait (Reichmann et al., 2016). Falls may be due to failure in sustaining the waking velocity as in normal condition for longer distances (Schulz-Schaeffer, 2015). Parkinsons disease results in deteriorating rhythm control, bilateral coordination of gait, Sleep scaling, gait symmetry, and decrease the dynamic postural control. It may be the rationale for motor symptoms, upper limb tremor, and bradykinesia and sleepy episodes. It is manifested as drooling, confusion, and dropping of equipments at work (Schulz-Schaeffer, 2015). Fatigue presented by Philips is the insidious symptom of Parkinsons disease. It is also known as Parkinsons apathy where the individual fails to initiate projects or follow complex interactions and have short term memory loss. Even simple daily life activities like walking, results in energy drain, causing fatigue (Serrano-Dueas et al., 2018). The pathophysiology is however not very clear. The absence of dopamine in the Parkinsons prevents protection of cochlea and result in hearing loss (Lai et al., 2014). Philips is thus experiencing increasing hypoponia. The slurred speech in Philips may be due to dysarthria that is impairment of muscles required for speaking. It may have caused by hypoponia that result in weakening of muscles and weak voice (Rusz et al., 2015). Parkinsons has profound impact on the emotional and the psychological wellbeing. The out of proportion emotional reactions in Philips may be due to biochemical changes wrought by the disease. Depression and denial of the reality of the situation are the adverse outcomes. It in turn starts a chain of reaction that manifests as spiral effect. Starting with sleep disorder, to concentration issues, the apathy increases (Reichmann et al., 2016). Therefore, the mood swings in Philips may be the cause of cumulative effect of emotional impact as well as motor function decline. Depression also causes the memory impairment and slow response (Schrag et al., 2015). High cholesterol in the patient is risk factor for hypertension and other comorbidities (Mark Somers, 2016). In order to prioritise the care the main health issues of the client must be identified. Based on the above analysis and from the synthesis of fact, it can be concluded that the main health issues are impaired physical mobility and speech and hearing impairment. The other symptoms such as gait, balance, tremors, fatigue, slow response are all interrelated to this main health issues. Sequentially, it is hampering the activities of daily life of Philips as well as social life. Interventions are required to minimise the risk associated with these health issues. The main risks associated this health issue is risk of injury (Lubomski, Rushworth Tisch, 2014). Addressing these issues will help Philip manage his daily life activities. Therefore, the nursing care priorities applying the clinical reasoning for Philips are- 1 improvement in functional mobility within the limitations of disease and 2 prevent risk of injury. Hence, to fulfil the two priorities of care comprehensive nursing care plan will be developed based on evidence. An action plan is required to fulfil the priorities of care to yield positive health outcomes (Dalton et al., 2015). The action plan for maintaining functional mobility and reducing the complications may involve patient education on safe techniques of movement. For instance, rocking from sideways may help in leg movement. Bradykinesia and tremors may increase difficulty in getting out of chair. The patient may be instructed to move to edge of seat, take arm support followed by standing position (via rocking). To decrease muscle rigidity, the patient may be provided with warm bath and messages (Van der Eijk et al., 2013). To prevent the risk of injury it is necessary to assess ambulation and movement to plan appropriate patient centered interventions. During ambulation, the patient may be recommended to swing arms and lift heels. It will assist in gait and prevent falls (Van der Eijk et al., 2013).The patient may be instructed to maintain an upright posture to maintain functional mobi lity. Philips may be requested to look up while walking. It will prohibit the patient to have the stoped posture and prevent collision with objects while walking. In order to improve balance, a wide base gait may be instructed (Tomlinson et al., 2012). To prevent injury, patient education may involve teaching Philips to turn in wide arcs. It will prevent crossing of legs over one another and falls. Further, teach range of motion exercises. The patient may be referred to physical therapist for safe exercise program. Philips will be trained to use facial muscle for exercises for effective communication of needs. He may be assisted to perform daily stretching activities. This intervention is effective in improving strength, flexibility and balance (Van der Eijk et al., 2013). The patient may be educated to undertake rehab services instead of staying at house. To integrate the Philips needs the patient may be monitored for non verbal messages and ensure calm and relaxed communication as speech and hearing is weakened. Positive body language and soft tone of voice will be used communicate care needs and prevent Philipss anxiety (Gulanick Myers, 2013). The patient will be educated to talk slowly in short phrases and provide him with hea ring aid, for addressing care needs (Van der Eijk et al., 2013). Pharmaceutical interventions may include use of dopamine agonists or levadopa for motor symptoms. Cholinesterase inhibitors may improve depression (Connolly Lang, 2014). Evaluating the nursing action plan is mandatory to ensure effectiveness of interventions and modify in case of adverse outcomes (Dalton, Gee Levett-Jones, 2015). The evaluation may involve ensuring that home environment is free of barriers. The patient must be safe from environmental hazards. Philips to be monitored during exercises for adherence to guidelines. He will be monitored for speech and hearing cooping. Assess about knowledge of potential hazards and its elimination. Client will be assessd to show willingness to join rehabilitation service. On reflection it appears that the patient may have challenges in adhering to treatment. The patient may be evaluated for anxiety and aggression during treatment. He may be referred to cognitive behavioural therapist for controlling irrational thoughts and behaviours. It will also reduce depression (Troeung, Egan Gasson, 2014). In conclusion, the essay helped to understand the process of prioritising the care for chronic illness, applying the clinical reasoning cycle. It is an effective method to rationalise the illness symptoms and identify the main health issue. In case of Philips, the mobility impairment and weak speech and hearing are the main health issues. Both increases risk of fall and injury. 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