• Internal Code :
  • Subject Code : NRSG372
  • University : Australian Catholic University
  • Subject Name : Nursing

Case Study Analysis: Mr Jason Williams

The case described in the essay is of Mr Jason Williams (Fictional name) who was diagnosed with rheumatoid arthritis. The assessment was conducted using a phone interview in which essential mandates were obtained including history, current issues and socio-cultural factors. Mr Jason is a 76-year-old widowed man who has got shifted with his daughter after the death of his wife. Jason has 2 sons who live on the driving distance of 3 hours and they do not visit Jason frequently. James is a very religious person and frequently visits the Church.

James enjoys a glass of wine with his meal every day and has a history of smoking, James has a past medical history of stroke, diabetes mellitus, hypothyroidism and he had been through cholecystectomy. Jason also has the condition of obesity and his current weight is 104 kg. Additionally, Jason has been clinically diagnosed with depression and is currently under treatment. Jason constantly complaints about severe joint pain majorly in knees, hips and back and rates it 7/10 on pain assessment scale.

The current medication of Jason includes Levothyroxine 25 mcg OD, Metformin 30 mcg daily, Mirtazapine 15 mcg daily, Aspirin 75 mg BID. Jason has also developed the condition of osteoporosis and Jason is not able to do much of the movements because of intense pain. The current essay has used the steps of Clinical reasoning cycle and RLT model of nursing to discuss the case of Jason and adequate nursing interventions for providing person-centred care to Jason.

The Roper-Logan-Tierney (R-L-T) model of nursing majorly emphasizes on person-centred care in nursing (Williams, 2017). The major aspects that this model includes are planning and intervention. Furthermore, the RLT model also includes assessment, diagnosis and evaluation of the patient’s condition. Jason has been diagnosed with hip osteoarthritis at an old age and the condition of obesity makes his condition even worse. Obesity has been found to promote arthritis activity and it also increases the exposure to cardiovascular disease (Moroni et al., 2020).

Jason does not have much family support except his daughter and the trauma of the death of his wife has adversely affected his mental health as well. Families play a key role in supporting an individual mentally during their course of illness and thereby promotes positive patient outcome (Whitehead et al., 2017). Jason is a religious person and strongly believes in spirituality that has helped in strengthening up the psychological state. The illness of Jason does not only affects himself but also the people with whom he is living with.

Jason is not able to perform daily routine tasks by himself and requires assistance that affects the life and routine of his daughter and her family. Ted requires psychological and social support along with the medication to cope up with his depression. Social and psychological support helps a person to overcome depression (Ullrich et al., 2017). The care provided to Jason shall consider a holistic approach that will help achieve a positive patient outcome.

The second stage of the clinical reasoning cycle includes the collection of information followed by the third stage which is the processing of information. As the phone interview was conducted for the collection of information, therefore knowledge about the vital stats of Jason was not able to be retrieved. However, the information that was retrieved helped identify that Jason is suffering from auto-immunity disorder. The dependency of Jason on other people has been affecting the lives of his family as well. The quality of life of the patient and their family members is adversely affected due to dependency.

Failure to perform any physical activity independently results in deterioration of the quality of life of a patient (Malm et al., 2017). The condition of hypothyroidism promotes obesity in an individual (Gawlik et al., 2015). Obesity worsens the situation for the patient with rheumatoid arthritis by promoting the severity of the pain. Jason rates his pain 7 on the scale of 10 that underlies in the category of severe pain. A healthy individual rates his pain from 0 to 1 on pain assessment scale (Harvard medical school, 2020). Jason has also developed the condition of osteoporosis that results in the weakening of bones and decrease in bone density, thereby making the bones fragile and worsening the condition of arthritis.

The fourth stage of a clinical reasoning cycle includes the identification of health issues. The major issue diagnosed in the case of Mr Jason is rheumatoid arthritis and osteoporosis. Rheumatoid arthritis is an autoimmune disorder that could either be triggered by genetic factors such as HLA, PTPN22 or it could be developed by environmental factors like smoking and drinking (Sokolove, 2017). The autoimmune reaction results in the release of numerous amounts of inflammatory mediators and cytokines. The released chemicals result in the chronic inflammation in the synovial fluid that is present between the joint capsule. The chronic inflammation results in proliferation of the local tissue which is known as Pannus.

Afterwards, the Pannus invades the surfaces of cartilage and bones resulting in the erosion of cartilage and bones. The erosion ultimately destroys joints and the condition is called rheumatoid arthritis (Sokolove, 2017). Osteoporosis is characterized by the depletion in the bone mass density and decaying of the bone tissue (Shane & Marcus, 2013). The risks associated with rheumatoid arthritis can manifest even farther than the musculoskeletal system and can result in the occurrence of ischemic stroke (Behrouz, 2014).

The fifth stage of clinical reasoning cycle includes the establishment of goals. The goals should be SMART i.e. they have to be specific, measurable, attainable, relevant and time-bound. The SMART objective for the condition of Jason will include the effective management of his rheumatoid arthritis condition. Jason would provide a lower score for his pain in comparison with the current score. The pain management would be done to manage his condition which is relevant to his situation and it would be achieved within the first week of the care.

The sixth stage of clinical reasoning cycle includes the actions. The suitable actions that are required to be taken in the case of Jason will include the following interventions:

Pain management: Rheumatoid arthritis develops an inflammatory response causing a severe amount of pain in the joints and skeletomuscular system of a person (Johansson et al., 2016). The administration of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids medications can be effective in proving relief in pain and in reducing the inflammation. NSAIDs are anti-inflammatory medications and analgesics that inhibits the factors promoting the biosynthesis of prostaglandin thereby, relieving the pain (Cofford, 2013). Furthermore, some non-pharmacological interventions like the use of ice pack can also help in reducing the inflammation.

Management of depression: Psychological therapies along with the pharmacological treatment can be effective for managing the depressive symptoms and promotes positive patient outcome. Cognitive behavioural therapy (CBT) and interpersonal and social rhythm therapy (IPSRT) can be effective for managing depressive symptoms. Stress management is an essential element of CBT (Naik, 2015). Furthermore, psychoeducation and family-focused therapy can help in empowering Jason and the people with whom Jason is living.

Weight Management: Weight management is necessary for Jason as it will result in less strain and pressure on the bones and joints of Jason thereby, relieving in the condition of osteoporosis and rheumatoid arthritis as well. ‘Cooperative lifestyle intervention program (CLIP)’ helps restore a healthy lifestyle for a person and also helps provide the required nutrition to the body (Gill et al., 2017). Weight management and proper nutrition can help in managing diabetes and metabolic abnormalities (Coker & Wolfe, 2017).

Prevention of osteoporosis: Pharmacological treatment and adequate exercise would help reduce the ill effects of osteoporosis (Rizzoli, 2018). Administration of calcium tablets and vitamin D cumulatively help to restore the bone density in a patient and thus reliving in the condition of osteoporosis.

After the effective nursing interventions, Jason will feel relived in the pain and will provide a low score for his pain. Additionally, Jason will be able to overcome his depression. Jason will be able to effectively manage his weight and diabetic condition. Jason will be able to restore his movements after continuous exercise thereby, making him less dependent on other people for executing his daily activities. The bone density will be improved thereby, reducing the ill effects due to osteoporosis.

The case study provided practical exposure to the problems that are being faced by the patient of rheumatoid arthritis and its effect on the community. The patient experiences an immense amount of pain and their movements get restricted that makes them dependent on other people. The dependency does not only affect the quality of life of a patient but also other people of the community. Administration of anti-inflammatory drugs, weight management and exercise can help in restoring the movements and reliving in pain, thereby restoring the movements and improving the quality of life of a patient. The study was beneficial for providing an experience for handling the patient with arthritis and other comorbidities that would help improve the future nursing practice.

References

Behrouz, R. (2014). The risk of ischemic stroke in major rheumatic disorders. Journal of Neuroimmunology, 277(1-2), 1–5. DOI:10.1016/j.jneuroim.2014.09.009

Coker, R. H., & Wolfe, R. R. (2017). Weight loss strategies in the elderly: A clinical conundrum. Obesity, 26(1), 22–28. DOI:10.1002/oby.21961

Crofford L. J. (2013). Use of NSAIDs in treating patients with arthritis. Arthritis research & therapy, 15(3), S2. https://doi.org/10.1186/ar4174

Gawlik, A., Such, K., Dejner, A., Zachurzok, A., Antosz, A., & Malecka-Tendera, E. (2015). Subclinical Hypothyroidism in Children and Adolescents: Is It Clinically Relevant?. International Journal of Endocrinology, 2015, 1–12. DOI:10.1155/2015/691071

Gill, L. E., Bartels, S. J., & Batsis, J. A. (2015). Weight management in older adults. Current obesity reports, 4(3), 379–388. https://doi.org/10.1007/s13679-015-0161-z

Harvard medical school. (2020). The pain of measuring pain. Retrieved from https://www.health.harvard.edu/pain/the-pain-of-measuring-pain

Johansson, L., Sherina, N., Kharlamova, N., Potempa, B., Larsson, B., Israelsson, L., … Lundberg, K. (2016). Concentration of antibodies against Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis. Arthritis Research & Therapy, 18(1), 1-10. DOI:10.1186/s13075-016-1100-4

Malm, K., Bergman, S., Andersson, M. L., Bremander, A., & Larsson, I. (2017). Quality of life in patients with established rheumatoid arthritis: A phenomenographic study. SAGE open medicine, 5, 2050312117713647. https://doi.org/10.1177/2050312117713647

Moroni, L., Farina, N., & Dagna, L. (2020). Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clinical Rheumatology, 39, 1039-1047. DOI:10.1007/s10067-020-04963-2

Naik, S. K. (2015). Management of bipolar disorders in women by non-pharmacological methods. Indian Journal of Psychiatry, 57(2), 264-374. DOI: 10.4103/0019-5545.161490

Rizzoli R. (2019) Prevention of osteoporosis and fragility fractures. In: Ferrari S., Roux C. (eds) Pocket Reference to Osteoporosis. Springer, Cham. DOI:10.1007/978-3-319-26757-9_4

Shane, E., & Marcus, R. (2013). Osteoporosis Associated with Illnesses and Medications. Osteoporosis, 1173–1190. DOI:10.1016/b978-0-12-415853-5.00048-0

Sokolove, J. (2017). Rheumatoid Arthritis Pathogenesis and Pathophysiology. Respiratory Medicine, 19–30. DOI:10.1007/978-3-319-68888-6_2

Whitehead, L., Jacob, E., Towell, A., Abu-qamarMa’en, & Cole-Heath, A. (2017). The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review. Journal of Clinical Nursing, 27(1-2), 22–30. DOI: 10.1111/jocn.13775

Williams, B. C. (2017). The Roper-Logan-Tierney model of nursing. Nursing2019 Critical Care, 12(1), 17-20. DOI:10.1097/01.NURSE.0000460730.79859.d4

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