NSG 4067-SU_NSG4067_W2_Project_Tyce_A

NSG 4067-SU_NSG4067_W2_Project_Tyce_A ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 2 A comparison of age-related changes of the older person interviewed and assessed with those identified in this week’s reading assignment One of the age-related changes noted during the assessment is the risk of falls for the patient. The Tinetti Balance and Gait Evaluation established that the patient has a high risk of falling during his routine movements. He needs assistance, though minimal, when getting up from a chair and getting out of bed. Though he cannot swiftly get up from a chair or the bed, with a little support he is able to get up. This is because ligaments and tendons in his bone have become less elastic due to aging therefore leaving the joints stiff and tight. The Katz Index of Activities of Daily Living assessment revealed that the patient is able to performing all the tasks that pertain to grooming and feeding on his own. He is able to take a bath without assistance, empty his bowels and clean up afterwards, control urination, and feed without help. This is good as it means that he can be left alone in the house and does not need babysitting. This allows other members of the family to go about their daily duties without worry. He is also able to avoid embarrassment as not being able to do the simplest of tasks like cleaning up after a bowel movement can be quite embarrassing. The Barthel Index Test also affirms the patient’s independence in performing simple tasks. He only needs a little help while getting up the stairs and the chair. During the interview, he stated that he takes a daily walk that helps strengthen his bones. His is also on a healthy diet, as he has to manage his diabetes. The large portions of fruits and green leafy vegetables that he incorporates in his diet also help strengthen his bones as they contain calcium and potassium. More interventions are still needed to help him effectively manage his diabetic condition that will involve him, members of his family and the local health workers. ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 3 Issues Identified During Data Analysis During the data analysis, I identified the following issues 1. The patient manages his diabetes without support from his family. It is his personal responsibility to measure his blood glucose. No one in his family monitors him while taking his medication. He also does not have a partner to accompany him in his exercise routine. 2. Other family members are not aware that they are also predisposed to diabetes. This was revealed during the interview when he said that his granddaughter is overweight. In a family with a history of diabetes, being overweight predisposes one to the disease. 3. The house has to be safe and secure for the patient to aid in his easy movement to avoid falls. The patient’s Tinetti Balance and Gait Evaluation revealed that he has a high risk of falls. The living area therefore has to be safe for him to avoid falling and injuring himself in the process. Due to his age, even a small fall can lead to a fracture, as his bones are not as strong as they used to be. 4. He needs to add supplements to aid in strengthening his bones and avoid osteoarthritis. Bone density diminishes with age, in addition to a healthy diet, he needs to take food supplements to strengthen his bones and avoid fractures in case of a fall. Health Alterations and their Interventions 1. Family Support Managing diabetes requires the input of not only the patient but also members of his family. Members of the patient’s family should first learn how to measure blood glucose. They should be able to help the patient perform this task with ease. Secondly, they should know the symptoms to look out for during high blood sugar episodes. In this way, they are supposed to know the action to take during such episodes. They should be able to intervene and bring down the blood sugar without going to the doctor. Thirdly, they should also adapt to a change in diet and help the patient in eating healthy. They ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 4 should not for example be taking soda, French fries, burgers and the like in front of the patient as it might make him feel bad. Adapting to a new diet is hard as the body is used to taking certain foods. All family should be encouraged to have their blood sugar measured to determine if anyone else has diabetes or pre-diabetes. Emphasis should also be put on the importance of maintaining a healthy weight especially for a family with a history of diabetes. Their predisposition to diabetes should be clearly explained to them more so the teenagers in the household. Enough support from everyone involved is therefore vital for the patient. Due to the patient’s age, a member of the family must accompany him whenever he visits the clinic. He is supposed to follow up on the prescription and any recommendations made by the doctor for the patient to follow. It is also important for community health workers to follow up on the patient even at home to monitor his progress. In this way, the patient will feel well cared for both at home and by the health care providers. 2. Routine Exams and Tests To start with, the patient should undergo a foot exam at least twice a year. This is to ensure that he does not have an infection in his feet as diabetes predisposes one to a foot infection. He should be educated on proper caring for his feet and the correct footwear recommended to him. Another important test is the dilated eye exam. He should have an annual dilated eye test to determine if he is losing his sight. The patient is encouraged to have his blood pressure checked regularly. High blood pressure increases the patient’s risk to cardiovascular disease and renal disease. Blood pressure can be controlled through medication and proper diet. More community health workers need training on how to educate patients on the importance of these tests. They should also be able to follow up and establish if the patient actually takes the tests. There has been an improvement in record keeping at our health facilities ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 5 through Electronic Health Records. An Electronic Health Recording system can be programmed and be used to remind the patient when a test or an exam is due. This is because a patient might forget to go for an examination or a test that only takes place once a year which might later lead to complications on his health. Other tests the patients should routinely have are a dental check up and a microalbuminuria test to determine the level of albumin in the urine. Albumin is a protein that indicates a kidney disease if it is found to be present in the urine. 3. Glycemic Control Glycemic control; which is keeping blood sugar levels at normal ranges, should be done through diet and medication. Poor glycemic control could result in serious complications such as cardiovascular disease and renal malfunction. At the same time, lipid control should be done through exercise as high cholesterol can also lead to high blood pressure. High cholesterol is also associated with being overweight and obese and therefore family members need to exercise as well. They need to be encouraged to accompany the patient during his daily walk and during other exercises. This will encourage him, take away the feeling of being sick, and start having fun while exercising. They should however obtain information from the health worker on the type of exercises that are suitable for the patient in consideration of his age and diabetic condition. If there are several elderly people in the community, a support group comprising of the elderly people can be formed where they interact and share their experiences. They can have bonding sessions and activities like exercising, playing games that are not too involving, and just sitting down and talk. The elderly should feel that they are useful members of the society and they should not be sidelined in any way. Their opinion should be sought in matters that concern them and their health. They also need to be involved in the day-to-day happenings in the home though minimally. ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 6 References Finch, L. P. (2008). Knowing the Patient: A Substantive Theory of Nurse Caring in Chronically Ill Elderly Patients. International Journal of Human Caring, 12(3), 90.1-90. doi:10.20467/1091- 5710.12.3.90 Liu, Y. (2018). Clinical effects of evidence-based nursing care in elderly patients with type 2 diabetes and peptic ulcer. World Chinese Journal of Digestology, 26(3), 209-214. doi:10.11569/wcjd.v26.i3.209 Zhang, L., & Zhang, M. (2014). Health education intervention for diabetic elderly patients in community. Human Health and Medical Engineering. doi:10.2495/hhme Retrieved from Retrieved from pdf Retrieved from ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 7 Appendix 1: Patient Questionnaire INTERVIEW OF CHOSEN ELDER ADULT Name: ________________________________ Age: 70 years Brief Introduction (Background information): A retired teacher who lives with his son after his wife died two years ago. He says that he has enjoyed good health throughout his life until he was diagnosed with type 2 diabetes 5 years ago. The wife passed on aged 65 after a motor vehicle accident and she enjoyed good health as well. 1. Philosophy on living a long life His philosophy on living a long life is eating healthy foods and remaining active through exercise and working. He says that he does not take fast foods, soda and caffeinated drinks, and only takes white meat. He incorporates fruits and vegetables into his diet. He takes a one-hour walk every day and helps with simple house chores. When he was still working, he was the captain of the school basketball team. 2. Thoughts about when a person is considered “too old” A person is considered ‘too old’ when he is unable to do even the most basic things like bathing, properly feeding himself and even going to the bathroom. An old person also develops hearing problems and is unable to walk as fast as he used to. He says that old people do not like noise and prefer their own company. 3. Opinion on the status and treatment of older adults According to him, the society and the government have neglected older adults. He feels that all people over 65 years should be able to get treatment free of charge. This is because they are retired without an income and some cannot even properly feed themselves. He feels that the government should follow up on the welfare of retirees as others are neglected by their families. 4. Beliefs about health and illness He believes that maintaining good health is important. One should take care of his body by avoiding habits that can harm their health like smoking, eating a lot of junk foods, and excessive alcohol intake. He says that despite maintaining a healthy lifestyle, he still got diabetes but he attributes it to his genes as his father also had the disease. 5. Health promotion activities he or she participates in To remain healthy, he makes sure that he takes a serving of fruits and vegetables every day, takes a walk daily, he also measures his blood sugar 3 times a day to make sure that it is within normal levels and religiously takes his medication. ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 8 6. Something special that helped the person live so long He attributes his long life to healthy eating, not smoking and staying positive in every situation as well as having a loving family. 7. Life span of other family members Father 75 yrs Deceased Mother 72 yrs Deceased Wife 65yrs Deceased Son 45 yrs Living Grandson 20 Yrs Living Granddaughter 15 yrs Living 8. Special dietary traditions in patient’s culture attributed with aiding long life He takes yams and sweet potatoes for breakfast instead of cake and bread, prefers a piece of chicken to sausages or bacon, takes fruit and vegetable smoothies and fresh fruit juice instead of soda, and also takes a lot of milk. Instead of frying an egg, he prefers boiling one. There is a small vegetable garden where they live where he grows vegetables like spinach, kales, onions, and tomatoes. 9. Any remedies/medications that have been handed down in family/group. If yes, describe. The tradition of incorporating as many traditional foods as possible in the diet was handed down by his mother who developed the habit after his father was diagnosed with diabetes aged 50 years old 10. Patient’s description of current and past health status Currently, he is suffering from type 2 diabetes but he is managing the condition through medication, exercise and proper diet. Prior to the diabetes diagnosis, he had no major illness except for the occasional cold and flu. 11. The values that guided life so far To live a long and fruitful life, one has to eat healthy. They should also exercise and stay active. Avoid excess alcohol and do not smoke and most of all avoid stress. Engage in activities that make you happy and give you satisfaction. On top of this, keep your family members close. Additional Questions 1. Despite observing good eating habits and healthy living, how did the patient feel when he was diagnosed with diabetes? At first, he was angry and almost went into depression but he was counseled at the health center and finally accepted his condition. He decided to take his medication without fail, regularly monitor his blood sugar and stick to his healthy eating habits. ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 9 2. Are there other family members with the condition? There is none but he is getting worried, as his granddaughter is overweight. He feels that this might predispose her to the disease unless there is a quick intervention to help her reduce her weight. 3. According to the patient, does he get all the care he needs at the local health center? He is satisfied by the care given to diabetes patients at the health center though he feels that that the nurses should follow up on the patients at home to monitor their progress. Summary The patient is trying to live a healthy and productive life the best way he knows how, his diabetes not withstanding. He has accepted his condition and is managing it with a proper diet and medication. He keeps his bones strong by exercising and eating healthy. Contrast of client’s responses with findings in current literature  One of the age-related changes noted during the assessment is the risk of falls for the patient. The Tinetti Balance and Gait Evaluation established that the patient has a high risk of falling during his routine movements. He needs assistance, though minimal, when getting up from a chair and getting out of bed. Though he cannot swiftly get up from a chair or the bed, with a little support he is able to get up. This is because ligaments and tendons in his bone have become less elastic due to aging therefore leaving the joints stiff and tight.  The Katz Index of Activities of Daily Living assessment revealed that the patient is able to performing all the tasks that pertain to grooming and feeding on his own. He is able to take a bath without assistance, empty his bowels and clean up afterwards, control urination, and feed without help. This is good as it means that he can be left alone in the house and does not need babysitting. This allows other members of the family to go about their daily duties without worry.  The Barthel Index Test also affirms the patient’s independence in performing simple tasks. He only needs a little help while getting up the stairs and the chair. During the interview, he stated that he takes a daily walk that helps strengthen his bones. His is also on a healthy diet, as he has to manage his diabetes. The large portions of fruits and green leafy vegetables that he incorporates in his diet also help strengthen his bones as they contain calcium and potassium. ASSESSING AND PLANNING CARE FOR AN ELDERLY PERSON 10 Appendix 2: Tinetti Balance and Gait Evaluation Tinetti Performance Oriented Mobility Assessment (POMA) - Balance Tests - Initial instructions: Subject is seated in hard, armless chair. The following maneuvers are tested. 1. Sitting Balance Leans or