NUR341 Healthy Ageing

Interdisciplinary care services and aged care services

The patients Alex and Sarah that have been presented in the study are above 80 years. According to their background, they used to regularly visit clinicians for a routine check-up. But according their physical appearance and descriptions, it has been noted that they have not received sufficient care services for a prolonged period which is due their individual difficulties. Alex is having problems with his leg and there appears to be a wound because of which the patient is facing difficulties in mobility. Alex’s wife Sarah is dependent on Alex for her care as she has dementia but Alex is having problems due to his wound. Both patients need interdisciplinary and aged care services which would help them to attain a better quality of life and be independent (Hoerger et al., 2019). Being independent is one of their prior needs as their children live in different Australian States. Thus, such service would be useful for them to be independent and have easier lives.

Elderly patients face a lot of problems when transitioning to ageing. Further, these problems keep on escalating with the age. The problems can be due to presence of multiple comorbidities, weakness die to increased age, reduced immune response etc. (Bajaj et al., 2021) All these problems make it difficult for patients like Alex and Sarah to manage their daily activities of living independently. As Sarah is a dementia patient, she is not able to help Alex sufficiently and instead depends on Alex more for her care needs. Alex is unable to take proper actions for his wound which he has been trying for three months and that the wound has not recovered. The Australian Government is known to fund two programs under the aged acre services. One of them is the Regional Assessment Services or RAS. Under this program the assessors would delegate the assessments at the homes of the patients. This program would provide assistance to the patients to the patients who need support at the entry level and help them stay at home. The assessor would conduct assessments and help the patient to reach out to appropriate Services for Commonwealth Home Support Programme (Department of Health, 2021). This group consists of nurses, and allied care health professionals and medical experts who analyse the physical, medical, restorative, psychological, cultural and social requirements of the elderly and assist them and in receiving the best care for themselves. The assessments for Alex and Sarah would be conducted at their home thus reducing the problems they face while travelling. These assessments would focus on their individual needs and recommend them an expert who would help both of them with a care plan and support them.

The second care service that would be helpful for them is an occupational therapist (OT). The OT would assess the daily activities of the patients and help with understanding and learning skills that would help the patients perform their daily activities easily and independently (Arsh et al., 2020). This specialist would also help them to maintain the activities and eventually recover from their problems of performing daily activities. For example, the OT can help Alex to learn proper posture techniques, toileting, wound debridement etc. For Sarah the OT can add dementia friendly clocks or label doors to make it easier for her to remember (Evans et al., 2019).

Form the physical appearance of Alex it can be understood that he has lost weight. It is important that both Alex and Sarah receive proper amount of nutrition. This would be involved in one of the interdisciplinary care services that can be recommended to the old couple. A nutritionist can be recommended to both of them. Proper supply of nutrition is important for the elderly patients as lack of it may accelerate the problems like weakness, immune deficiency etc. which can be related to insufficient nutrients in the body. Therefore, proper nutrition can keep them away from infections, and also preventing any physical illness. Proper food and nutrition also help in lifting the mood thus keeping away mental illnesses (Clegg & William, 2018).  

Alex and Sarah can also be recommended a mental health councillor. Both of them are aged individuals with their children living apart. They do not have anyone other than themselves. Alex as he is unable to take proper care of Sarah can be stressed and Sarah’s mental health can be affected due to the dementia. Therefore, a mental health counsellor can help both of them with their individual concerns, as maintaining the emotional well-being is important to have a physical well-being (Kim et al., 2017).

Medication management

It is a role of the registered nurse to promote the patient safety (Murray, Sundin & Cope, 2018). Therefore, a registered nurse should prescribe medications to the patients only after considering the adverse drugs reactions that can happen and the factors responsible for such events. The three factors that can be identified in the case study which can increase the chances of adverse drug reactions include age of the patients, the state of the illness which is the wound infection for Alex and dementia for Sarah and the psychological stress.

Age is one of the most common factors of adverse drug reactions because with the excessive age, the body of individual becomes weaker because the cells in various tissues lose the capacity of regeneration. Further, these cells also lose various other protective mechanism thus enabling the cells to react with the drugs in different manner. These can be because of decreased body mass and volume, different body composition of molecules like water, fat and reduced functioning of important organs like the liver of kidney which are responsible for most of the drugs thus increasing the toxicity (Zazzara et al., 2021).

Presence of diseases and comorbidities can also affect the drug pharmacodynamic and pharmacokinetic characteristic which can modify the body’s mechanism or response to the drug (Li et al., 2017). In both the patients Alex and Sarah there is a chance that their illnesses can affect the mechanism of various drugs. Further, the ongoing medications for the diseases can also react with the new drugs thus increasing the adverse drug event possibilities. The dementia of Sarah can also alter the functioning of brain cells which can therefore result in altered functioning of other drugs. In case of Alex, presence of bacteria at the wound site can change the dynamics of the cell thus increasing the risk of other drugs.

In case of Sarah, the stress can be generated as she is unable to take her responsibility can generate stress and also her inability to communicate her feelings effectively. Further, absence of her children can also affect her. In case of Alex increased responsibilities in the form care for Sarah and also managing his wound simultaneously can increase his chances of developing anxiety and thus generation of stress hormones. Emotional and psychological stress can also hamper the functioning of certain drugs. Upon stressful situations, the body can release certain hormones like anxiety hormones which can interact with certain drugs and reduce their functionality while increasing their toxicity (Fiaschi et al., 2019).

Medication for Alex

The first priority that is to be considered for Alex is the management of his wound. Therefore, Alex should be considered to be prescribed an antibiotic for his wound on his leg. As he has been struggling with the wound for three months, there a possibility that the wound has developed an infection and given the improper access to care, the wound is not recovering. Therefore, the antibiotic therapy would be helpful in managing the situation. Given his age, from this wound he is also at risk of developing sepsis due to low immune system responses. The antibiotics would also help preventing sepsis. A very common antibiotic for wound infection that is used is Amoxicillin clavulanate (Rattes et al., 2016). The drug is indicated in cases of wound infection, skin infection and also infection in lungs, sinus, ears and urinary tract. It is mostly effective on bacteria which are antibiotic resistance. It is from the penicillin class of antibiotics. The drug works on various bacterial species for example Staphylococcus aureus, Escherichia coli, Haemophilus influenzae, Moraxella catarrhalis, Haemophilus influenzae and Klebsiella species. One of the complications of the antibiotic therapy that Alex can suffer from is the diarrhea. This happens as the antibiotic also kills the good bacteria that is present in our gut thus impairing the digestive system balance (Werner et al., 2020).

The second medication that can be prescribed to Alex is NSAIDs. These are anti-inflammatory medication that can be prescribed. Due to excessive stress and not enough rest, Alex can have pain in the wound. The common indication for this medication is headache, migraine, arthritis and other conditions that can cause pain. Taking a pain medication, will also help improving her quality of life. One of the common side effects that Alex can have due to this medication is indigestion and other stomach problems. NSAIDs can cause ulcers and bleeding by inhibiting the enzyme Cox-1 and altering the generation of prostaglandins inside the stomach. Some NSAIDs have a smaller effect on stomach prostaglandins than other medications, and hence may have a lower risk of ulcers, although the danger of ulcers is still present (Bjarnason et al., 2018).

Reflection

As a healthcare professional or a registered nurse my primary concern is for the patient's entire health. In addition, my own personal development is critical at the same time. This is aided by a wide range of experiences. Alex and Sarah's case has been extremely important in gaining experience. It is a representation of one of the most common scenarios of the society which is elderly patients trying to be independent and lack access to necessary healthcare services. As a registered nurse, I am expected to have a broad range of expertise, and this experience has aided me in gaining that expertise, particularly in the area of services related to aged care. Both patients appeared to be frail at first glance, which must be taken into account throughout the assessment and diagnosis. When I learn about their social background, it's heartbreaking to see how they're in such bad shape and unable to cope with regular activities without the assistance of close ones. I understand their predicament. Their children are working and busy with their jobs and daily lives. However, but it is critical that they assist their parents by giving elderly care. As a human being, visualising their personal conditions was very sad and heart breaking for me. However, according to the registered nurse standards it is important to develop a therapeutic and professional relationship with the patients. During interaction it is important that I conduct a proper nursing diagnosis and empathize their conditions simultaneously to make them feel cared and important. This will also enhance their cooperation during the care process (Gholamzadeh et al., 2018). Following this, medications would be prescribed to them after thorough assessment. Along with these, I could also help them by referring interdisciplinary care services and aged care services that could help their underlying problems which are common with ageing and improve their quality of life. With this experience I gained ample amount of confidence to diagnose aged patients and would also help me in future to use proper communication skills which would be patients centred.

As the elderly population forms one of the largest population groups of Australia their care is of immense importance. Thus, by providing care to aged patients would help me contribute to the facilities which are trying to improve the living conditions of the aged care.  As a registered nurse, this would also help me acquire a better knowledge of adherence to the NMBA and NSQHS standards that must be followed. Effective communication, Informed consent, thorough assessment and diagnosis are only a few of the principles (Cashin et al., 2017). Interacting with a patient having dementia can also help me develop patience, which is vital for a registered nurse in healthcare environment and clinical practice because I see a variety of patients who require different treatment times to recover. Addressing wound infection and dementia problems would also help me get vast knowledge about these issues, which would add to my experience and make it easier for me to diagnose such circumstances in the future.

References

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Bajaj, V., Gadi, N., Spihlman, A. P., Wu, S. C., Choi, C. H., & Moulton, V. R. (2021). Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections?. Frontiers in Physiology, 11, 1793. https://doi.org/10.3389/fphys.2020.571416 

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