Clinical Reasoning Cycle In Parkinson Disease Scenario

Scenario of Diana Harrison

Discuss about the Clinical Reasoning Cycle in Parkinson Disease Scenario.

Parkinson’s disease (PD) is a multidimensional and neurodegenerative disorder that targets the central nervous system causing deficits in neurotransmitter production. This disease mainly targets the motor system of the victim causing symptoms like shaking, rigidity, and difficulty in walking with stalled movements at large (Allen, Schwarzel & Canning, 2013). Studies suggest that approximately 1 % of the male and female population suffer from this ailment worldwide, specifically the ageing population over the bar of 60 years. This particular disease does not have a definite cure and that complicates the health care for the patient, care plans only focussing on minimizing the challenges associated with the disease (Allen, Schwarzel & Canning, 2013). Therefore the nursing care for the patients of this particular disease needs to be multidisciplinary and specific. Application of clinical reasoning cycle can prove to be beneficial for constructing a highly specific and optimal care plan for such patients. This report attempts to address the complexities of caring for Diana Harrison, a 64 year old dealing with Parkinson’s disease and identify two care priorities in such a scenario by the virtue of applying clinical reasoning cycle by Levette Jones.

Clinical reasoning cycle is a simplified framework using highly logical and realistic steps to construct an optimally curated care plan for a particular patient. This revolutionary tool in the field of nursing and health care by Levette Jones, and has caused a paradigm shift in the field of nursing (Chaffey, Unsworth & Fossey, 2012). The purpose of using a clinical reasoning cycle is to conduct the investigation of the symptoms of the patient, characterizing the disease and arriving at a logically and optimally sustainable treatment or care plan for the patient that will lead him to a hassle free speedy recovery. The clinical reasoning cycle comprises of a number of systematic steps that guides the nurses to arrive at the best possible solution for the patient (Delany & Golding, 2014).

The context of nursing care should be focussed on biopsychosocial factors incorporating legal, ethical, theoretical and practical concepts for the patients of Parkinson’s disease in order to promote and facilitate treatment and rehabilitation. One might raise a question as to how application clinical reasoning can help with achieving the above mentioned outcome. The answer to this question should be the accuracy and efficiency clinical reasoning provides in the entire caring procedure and the strategic simplification and clarity that it brings. Taking the example of Diana Harrison, a 64 year old lady suffering from the parkinson’s disease it is possible to arrive at a conclusive care plan using clinical reasoning cycle (Contreras & Grandas, 2012).

The very first step of clinical reasoning is to consider the situation that the patient under consideration is in. It has to be considered that Parkinson’s disease already is a complicated medical condition, and sometimes this disease comes accompanied with other medical complexities like dementia (Contreras & Grandas, 2012). In this case, Diana is a semi-retired part time high school teacher for the subject for science, mother of three children and grandmother of 5 grandchildren. However all of her three children live interstate and Diana had participated in many outdoor activities along with her husband and has been quite an active lady all throughout her life. She has partaken in activities like bushwalking, gardening and cryptic crosswords as hobbies; however she started experiencing the onset of the disease as small tremors in her hands which escalated into much more complex health problems later on. Hence considering her situation we can come to the conclusion that she had been an active lady all her life and the disease has taken away from her the active participation in life affecting her locomotor skills completely and which has depressed her to no end (Ironside, McNelis & Ebright, 2014).

Prioritization of caring needs

The next step to clinical reasoning is the collection of cues and information about the patient and his or her medical history. In this step the nursing professional is supposed to review all the information available about the patient till date, including reports, patient history charts, and investigative test results and nursing history if available for the patient. In this case for example, this step will facilitate collection of all the information that will guide the healthcare team to determine how her symptoms manifested (Phillips, Duke & Weerasuriya, 2017).

The next step is the processing of all the information that has been collected about the patient and her medical history till date (Sniderman et al., 2013). This step includes interpretation of the symptoms that Diana is exhibiting, like fatigue, Bradykinesia, increasing termors in her left hand, unsteady gait with unnecessary tripping and stumbling and lastly emotional outburst and depression. This is the step that allows the nurses to arrive a predictable outcome followed a strategic treatment plan. It is vital for a proper diagnosis that there is clear discrimination between the relevant and irrelevant information, so that the diagnosis is neither delayed nor clouded by useless information (Victor-Chmil, 2013).

The next obvious step is the diagnosis of the disease of identification of the problem that has led the patient to where she is. In this case the patient is discovered to be having Parkinsonian syndrome, with having prior medical history of high cholesterol-lipitor in the past. The very next step in the cycle is to establish goals that will help the patient overcome her symptoms (Zamani et al., 2017).

The clinical reasoning cycle enables the health care professionals to apply logical and reasonable [perception to the construction of the care plan. The benefits of this novel concept in nursing is that it allows the treatment plan to prioritize the specific needs and requirements making the care plan very specific rather than being very generalized. For example in case of Parkinson’s disease, the caring priorities for the patient are not very difficult to identify.

In case of Diana she was suffering from extreme nausea and unsteady gait and fatigue, few common occurrences of parkinsonian syndrome. The first and foremost priority for her is the immediate commencement of dopamine antagonist medication. Studies suggest that this neurodegenerative disorder targets the dopamine receptors to destroy the motor signalling system of the body (Lill et al., 2012). The dopamine antagonist medication, levodopa coupled with dopamine releasers Amantadine can be highly beneficial in diminishing the locomotor system problems. Levodopa serves in downward titration of dopamine in the body and amantadine serves to increase the efficacy and longevity of the drug in the body to target the issues like tremors and unsteady gait (Lill et al., 2012).

Selegilline and rasagilline are another group of abundantly used prescription medication in the management of Parkinson’s disease. This medications function in the body by conserving the amount of dopamine saving it from being destroyed. Another vital medicine for this disease is the COMT inhibitors, tolcapone and entacapone fall under this group of drugs inhibit the COMT system and in retention o dopamine and increases the efficacy of levodopa.

Parkinson’s disease already impairs the movement capability of the patients; however it also comes coupled with alarming levels of weight loss (Lill et al., 2012). There are various reasons that contribute to the frightening weight loss that is associated with parkinsonian syndrome however the faulty signalling system in the motor signalling pathway of the body heavily affects the energy intake and energy expenditure ratio of human body leading much more elevated levels of exhaustions (Aviles-Olmos et al., 2013).

Irrespective of the reasons, reduction in body weight interferes with the recovery heavily, hence the caring priorities should include addressing and preventing weight loss in the patient. The medication provided for the PD symptoms like levadopa has a positive impact on the glucose metabolism but this is not enough, the care provider must prioritize weight gain (Lill et al., 2012).

Nutrition is the first step to handle the weight loss issue in the scenario of parkinsonian syndrome; the care provider must incorporate elements of all food groups into the diet plan for the patient like whole grain, fruits, vegetables and dairy items. High protein diet can also be beneficial for such patients like meat, fish, soy, beans and egg. The patient should be advised to introduce herself to frequent eating habits, eating small nutritious meals every two to three hour to accustom her body to the changes (Aviles-Olmos et al., 2013). The patient can also include high calorie items like cream and butter but will also need to include exercise as a daily regimen to help with balancing g the weight gain. The patient must also be referred to a registered nutritionist periodically followibg her recovery journey.

Conclusion:

Undoubtedly, the need for comprehensive and multidisciplinary albeit practical nursing approach is a necessity in treatment and care delivery of patients of Parkinson’s disease. And the steps of clinical reasoning cycle enable the nursing professionals and the physicians to apply cognitive reasoning and logical thinking that articulate sets of strategies to find optimal care plan for the patient having the most realistic approach to it. The advantages to the framework of this cycle is that it not only helps the nursing professionals attain better understanding on the condition of the patients but also helps them device sets of strategic interventions that will prioritize the specifics needs of the patient helping them attain speedy recovery as well. Hence it can be hoped that the revolutionary concept of clinical reasoning will change the face of health care for the better.

References:

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