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Nursing Care for Older Clients

Question:

Discuss about the Nursing Care for Older Clients.

Answer:

Introduction:

Mrs. Holt is an 85 years old female who has experienced femur fracture. After her recovery, the hospital authority will plan her discharge. However, addressing her present situation, as she lives alone, her discharge should be planned very carefully by ensuring her safety at home. Her primary concern is isolation, which is a major issue of her well being. Therefore, before her discharge from the hospital, a support worker should be appointed who can help in her ADLs as well as can emotionally support her loneliness, or he can take assistance from long-term care agency and home health care. In addition, the local social services for her assistance should be reviewed. The hospital should interact with community agencies and care facilities for promoting her access to consider the gaps in provided services (Altfeld et al., 2013). The presence of his basic needs including nutrition, oxygen, humidity, temperature, security and lighting should be assessed. Hazard assessment should include the assessment of bathroom. As she has pet cats, transmission of pathogens and pollution should be prevented.

Finally, a walker should be provided before her discharge. Mr. Holt should be educated by the RN and surgeon about her medications, assistance and follow-up appointments before discharge and a written document should be handed over for further assistance. A physiotherapist should be involved in his discharge planning for mobility improvement.

Lively50plus Brisbane QLD provides social activities to people more than 5o years old including social events, meetings, group activities and many other options. It promotes socialization of people by making new friends and having fun together. Contact no- 043181310. Metro community hub is also providing the chance to promote health and well being of older people as well as stimulating their mental abilities by a series of social activites. Contact no- 07 3391 8122. Age UK provides general information about social activities, advice and support services for assisting lonely older adults. Mrs. Holt can contact Age UK at 0208645792.

Urinary incontinence can be referred to the unconscious leakage of urine. People become unable to hold urine in urinary bladder due to loss of voluntary control over urinary sphincter. The phenomenon is common in older adults. The major trigger for urinary inconsistence is weakening of muscles in bladder, which controls the flow. It is a common symptom of aging. The muscles in bladder and urethra weaken during old age and thus bladder becomes unable to hold as much liquid as before, thereby increasing the risk of involuntary leakage. Mrs. Munyarryun can have this health issue because of simple aging. Multiple childbirth and hormone dis-balance are important triggers for urinary inconsistency in older female. Other triggers include urologic issue, environmental trigger, infection, neurological or gynecologic issues, iatrogenic and psychological factors (Clement et al., 2013). In addition, Alzheimer and multiple sclerosis are also major triggers. Stress is a significant trigger for urinary inconsistencies. Obesity and smoking also trigger the condition. In case of older women, after menopause, estrogen levels drop, which triggers muscle weakness and urinary inconsistency.

Mrs. Munyarryun should contact an urogynecologist or urologist. There are a number of management procedures for dealing with urinary inconsistency, including behavioral therapy, medical devices, medications and surgery. Diagnosis of urinary incontinence includes urinalysis for identifying infection or blood present in urine. Other blood test can be suggested by a urologist for assessing kidney function, calcium and glucose levels. In addition, pelvic and rectal functioning tests would also be done. I will advice to Mrs. Munyarryun to create bladder diary in this what she drinks, when she urinate, how much she urinates with the help of measuring cup, and describe her accidents. In severe cases, post void residua, cryptogram, urodynamic testing or crystoscopy can also be recommended.

Healthy lifestyle can help to manage and prevent the disease symptoms. She should take care of her diet, by avoiding unhealthy and fatty substances, which can make her obese, as obesity triggers the symptoms. She should include regular exercise in her daily routine for enhancing her muscle strength. She should take care of her drinking habit. As it has been seen that alcohol consumption and dehydration can trigger urinary inconsistency, Mrs. Munyarryun should avoid alcohol beverages and should intake adequate amount of water per day.

Pelvic exercise is one of the common treatments for UI patients. Pelvic floor muscle exercises or Kegels helps to strengthen muscles, which in turn helps in regulating urination. Bladder training is another common recommendation (Dumoulin, Hay‐Smith & Mac Habee‐Seguin, 2014). It involves learning to delay urination by systematically lengthening time between bathroom trips. In severe cases, antibiotics or hormone replacement can be suggested.

Mr. Konarski is 73 years old, who lives in a high-level care facility. He is currently experiencing unusual agitation and restlessness. He has a number of health issues, which has contributed in his health condition. He has hypertension; irritation and agitation are common symptoms of hypertension. Mental illness is a common cause of agitation and irritability. Mr. Konarski has Alzhimer’s type dementia, which is a major contributor of his agitation and irritability. In the case of mental health patients, behavioral changes or mood swing is very common due to altered functioning of brain. In addition, dementia is a disease, which promotes memory loss of a patient, thus, patient can forget about their daily activities. In case of Mr. Konarski, he might be agitated and irritated due to his forgetfulness, as it lowers the self-esteem and autonomy. The patient is aged and isolated; he lives in a care facility, in spite of living with his family. Therefore, it can be a major contributor to his behavioral change.  Mr. Konarski is experiencing severe pain in his ankle and knee related to osteoarthritis. It has restricted his mobility also (Jutkowitz et al., 2016). Therefore, severe pain can be a major cause of irritability an agitation. Mobility impairment has restricted his movement and autonomy. He needs assistance in all personal care including toileting and clothing. This is very embarrassing, especially for geriatric patients. Therefore, it can be interpreted that these factors has significantly contributed to his behavioral issues.

Validity therapy is a kind of therapy used for older people with cognitive impairment and dementia. It was developed by Naomi Feil; he classified the cognitive impairment process in four stages, these are, mal orientation, time confusion, repetitive motion and vegetative state. In validation therapy, caregiver usually enters into the reality of dementia person instead of bring back the dementia person to the actual truth. By doing this caregiver can devolve the empathy, trust and sense of security with the dementia patient (Feil, 2014). In this therapy, patients are treated with respect, as a legitimate expression of their feelings, instead of marginalizing them as mentally impaired. The validation therapy helps to enhance patient’s self-esteem, to improve their quality of life.

Instead of ignoring or stopping the irrational behavior of the patient, the validation therapy offers alternative therapy. The therapy influence older people to fight, for resolving incomplete issues. While dealing with these issues, patients would express their past conflicts in concealed forms and would rely on movements in spite of words, in this way they would be able to shut out the world.  The validation therapy concentrates upon responding to the emotion or affect expressed by the patient, instead of concentrating on the content. In spite of correcting or reorienting the patient’s thought, positive reinforcement is provided, which can help to reduce patient’s behavioral issues, whereas, reorientation might have negative effect upon the patient.

Mrs. Lusk should always be supportive to him. For example, when Mr. Lusk is finding his car keys, instead of the fact that he does not even have a car, she should show respect towards his needs and help him to deal overcome the situation. The following conversation she can have with her husband:

Mr. Lusk: “I am not finding my car keys!”

Mrs. Lusk: “your car keys….”

Mr. Lusk: “Yes, I need it right now, as I have to go to outside for work!”

Mrs. Lusk: “Oh! You are busy today?”

Mr. Lusk: “Hell, yeh! I’m always busy!”

Mrs. Lusk: “So you like to be busy?”

Mr. Lusk: “What are you talking about? It’s not about likeness; it’s about life needs, like all others do!”

Mrs. Lusk: “I know about work! I do some of that myself. In fact, I’m thinking about arranging some lunch for us. Do you want to join me?”

Mr. Lusk: “Lunch, huh? What are you having?”

Restrain is the method of restricting patient’s movement by the health care staffs. There are four types of restrains. These are physical restrain, chemical restrain, environmental or confinement restrain and psychological restrain.

Physical restrain- It is the a type of restrain, through which patient’s movement can be purposefully limited or obstructed with the help of any physical means near the body. The procedure can be referred to forceful limitation of one’s bodily movement (Cleary & Prescott, 2015).

Chemical restrain- Chemical restrain is the process of restricting or limiting patient’s movement by the use of medications, thereby modifying patient’s behavior related to movement.

Environmental restrain- Environmental restrain is referred to the modification of the environment surrounding the patient in such a way that can control patient’s movement.

Psychological restrain- Psychological restrain refers to the process of restrain, by which care providers tend to restrict the psychology related to movement, i.e. modifying patient’s thought in such way that reduce their willingness related to movement.

The physical restrain can be applied to a patient by the use of Lap buddies, belts or bed rails. Bed rails are used for keeping the patient’s body immobile in bed or wheelchair (Cleary & Prescott, 2015).

The Chemical restrain can be implemented by administering medications, which are known as the “Psychotropic drug” or “psychopharmacologic agent” or “therapeutic restrains”. The chemical restrains include benzodiapines, dissociative anesthetics, antipsychotics, tranquilizers and sedatives.

The environmental restrain can be implemented by protecting the garden in a old age home, thereby restricting the mobility of the dementia patients.

The psychological restrains can be implemented by convincing someone not to move from his place. It can be done by building positive relationship and speaking softly with soothing voice along with gentle approach to the patient.

The first alternative is assessment. Assessment helps to identify the risk factors for the patient and thereby allowing the elimination of these factors. The second one is attitude; positive attitude and respect towards patient can reduce the use of restrain. It can help to avoid situations that might cause anxiety to the patient. The third alternative of restrain is anticipation (Barnett et al., 2012). Anticipation allows the evidence-based practice and thereby reducing the use of restrains by other alternatives. In resident cares, evidence-based social and developmental activities have shown significant benefits as an alternative of restrains.

Reference List

Altfeld, S. J., Shier, G. E., Rooney, M., Johnson, T. J., Golden, R. L., Karavolos, K., ... & Perry, A. J. (2013). Effects of an enhanced discharge planning intervention for hospitalized older adults: a randomized trial. The Gerontologist, 53(3), 430-440.

Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet,380(9836), 37-43.

Cleary, K. K., & Prescott, K. (2015). The Use of Physical Restraints in Acute and Long-term Care: An Updated Review of the Evidence, Regulations, Ethics, and Legality. The Journal of Acute Care Physical Therapy, 6(1), 8-15.

Clement, K. D., Lapitan, M. C. M., Omar, M. I., & Glazener, C. (2013). Urodynamic studies for management of urinary incontinence in children and adults. The Cochrane Library.

Dumoulin, C., Hay‐Smith, E. J. C., & Mac Habée‐Séguin, G. (2014). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. The Cochrane Library.

Feil, N. (2014). Validation therapy with late-onset dementia populations.Caregiving in dementia: Research and applications, 199-218.

Jutkowitz, E., MacLehose, R. F., Gaugler, J. E., Dowd, B., Kuntz, K. M., & Kane, R. L. (2016). Risk Factors Associated With Cognitive, Functional, and Behavioral Trajectories of Newly Diagnosed Dementia Patients. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, glw079.

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