Adapting to Health Changes - Assignment Example

? Adapting to Health Changes This essay aims to address a two-fold objective, to wit to detail, prioritize, identify rationale for each assessments and plan of care, and 2) to critically analyze the attitudes and beliefs of nurses towards elderly and how these influence the practice of other health care professionals. It also includes the topics related to elder abuse. Introduction The most difficult challenge a nurse could face is caring for an elderly ill client (Alexander, 2004, p. 1005). Due to developmental changes in physical and mental state, some of the clinical manifestations of certain diseases are hard to detect. One of these diseases is the diabetic ketoacidosis. Emergencies related to endocrine diseases account for approximately 1.5% of all hospital emergency admissions in England; the majority is related to diabetes and its complications (Dunning, 2005, p. 113). Mortality rates among elderly are 20% (Jevon, 2010, p. 9). Diabetic ketoacidosis (DKA) is a life-threatening diabetic condition caused by deficiency in insulin and results in severe hyperglycemia (Sinclair, 2009, p. 198). Diabetic ketoacidosis usually occurs in younger people with type 1 diabetes. Fortunately, older diabetics are less prone to DKA although a few cases exist (Roach, 2001, p. 324). Assessment Elderly people require individualized assessment ranging from simple screenings to in-depth evaluations. Health providers, particularly the nurses must be very knowledgeable and skillful in detecting deviation among elderly (Wold, 2004, p. 105). In the clinical scenario stated, the man is approximately in mid-sixties of age. The man is confused upon bringing him to the emergency department. He was not able to provide any information about himself or his condition so the staff called him Nic. He kept on insisting to leave the department and go home for dinner yet was unable to state his address. The hygiene was described as poor due to disheveled and unkempt condition. His appearance and odor suggested that he had not washed for some time and his breath had an acetone odor. The client frequently scratched his right upper arm and examination revealed that he had a hematoma (50 cents size) on the right side of his forehead and he repeatedly stated that he wanted to pass urine. Base on observation, the patient has an indication of a fall due to hematoma; possible concussion due to confusion is exhibited. Nursing assessment undertaken are measuring of vital signs for blood pressure elevation and tachycardia, blood glucose level for determining hyperglycemia, neurological observations such as Glasgow coma scale to determine the client’s mental state, and mini-mental state examination (MMSE) for possible dementia (Melillo, 2011, p. 279). Plan of Care The plan of care for Nic depends upon the nursing diagnosis that has been found out and has been prioritized according to the assessment findings. The nursing diagnosis and each plan of care are elaborated below: Nursing Diagnosis #1: Risk for Injury related to unfamiliar environment and physical or mental limitations secondary to disease condition Assessment: The client is confused and unable to provide information of previous environment. He frequently scratched his right upper arm and has a fifty cents-size hematoma. Expected Outcome: The client will be free from further injury. Interventions and Rationales: 1. Orient the client to his environment. Orientation helps provide familiarity. 2. Instruct the client to wear slippers with nonskid soles and to avoid newly washed floors. These precautions can help prevent foot injuries and falls from slipping. 3. Teach him to keep the bed in the low position with side rails up at night. The low position makes it easier for the client to get in and out of the bed. 4. Make sure that personal belongings are within easy reach. Keeping objects at hand prevent falls from overreaching and overextending. 5. Instruct the client to request assistance whenever needed. Getting needed help with ambulation and other needed activities reduces a client’s risk for injury. 6. Explain the hospital’s smoking policy. The hospital is a non-smoking institution. 7. For an uncooperative, high risk client, consult with the physician for a 24-hour sitter or restraints, as indicated. In some cases, extra measures are necessary to ensure a client’s safety and prevent injury to him and others. Nursing Diagnosis #2: Acute Confusion related to disease condition Assessment: Abrupt onset of the following: reduced ability to focus, disorientation, incoherence, anxiety, confusion, hypervigilance, restlessness. The general appearance of the patient was described as disheveled. The communication level for the situation is not appropriate as he repeatedly saying that he wants to go home but can’t convey address. Based on his appearance on the emergency department, one can observed the evidence of poor self-care. Expected Outcome: The person will have diminished episodes of confusion. Interventions and Rationales: 1. Assess for causative and contributing factors to ensure that diagnostic work up has been completed and evaluate for signs of depression. 2. Examine attitudes about confusion. Differentiating between acute and chronic episodes of confusion is important for nurses and physician (Moyet, 2008, p. 166). 3. Keep person oriented to time and place. Four biologic mechanisms are required for coping: movement, energy, production, sensing, and cerebral integrating. “As competence decreases, external environmental factors become increasingly important determinants of behavior and affect” (Moyet, 2008, p. 167). 4. Explain all activities. Memory loss and diminished intellectual functioning create a need for consistency. Sensory input is carefully planned to reduce excess stimuli, which increase confusion (Moyet, 2008, p. 168). 5. Promote a well role. Anxiety influences cognitive abilities through excessive self-focusing and worrying. Depression causes decreased concentration, attention deficits, and negative expectation. (Moyet, 2008, p. 168). 6. Do not endorse confusion. Unconditional positive regard communicates acceptance and affection to a person who has difficulty interpreting the environment. Careful listening is critical to evaluate responses to prevent escalation of anxiety and to detect physiologic discomforts (Moyet, 2008, p. 168). 7. Prevent injury to the individual. Discourage use of restraints. Restraints are a violation of a person’s right and increase anxiety. All attempts to protect the person should be use before selecting restraint (Moyet, 2008, p. 169). Nursing Diagnosis #3: Impaired Skin Integrity related to prolonged pressure Assessment: The client frequently scratched his right upper arm and has a fifty cents-size hematoma. Expected Outcome: The client will maintain intact skin tissue. Interventions and Rationales: 1. Upon admission, assess skin for risk factors that predisposes skin breakdown. Individual risk must be identified so that risk factors can be reduced through intervention (Ralph, 2005, p. 582). 2. Limit friction injuries. Friction injuries to the skin occur when it moves across a coarse surface such as the fingernails. Most friction injuries can be avoided by using appropriate techniques and protective barriers (Ralph, 2005, p. 582). 3. Assess nutritional status. Nutritional deficit is a known risk factor for skin breakdown. Poor nutrition also interferes with wound healing (Ralph, 2005, p. 582). 4. Promote skin care. Skin inspection is fundamental to any plan for preventing skin breakdown. Skin inspection provides the information essential for designing interventions to reduce risk and for evaluating the outcomes of those interventions (Ralph, 2005, p. 582). Nursing Diagnosis #4: Self-care Deficit related to confusion Assessment: The client is disheveled and unkempt. His appearance and odor suggested that he had not washed for some time and his breath had an acetone odor. Expected Outcome: The client will tolerate personal care activities. Interventions and Rationales: 1. Offer the client small amounts of food and fortified liquids. Use of fortified liquids will provide the maximum amount of nutrition without fatiguing the client. 2. Provide a quiet environment with decrease stimulation. The client may be easily distracted with external stimuli. 3. Monitor the client’s urination and bowel movements. The client’s inactivity, as well as demographic factors can increase the frequency of urination and bowel impaction. 4. Assess the client’s ability to ambulate independently. Independence is important for the client but safety is the priority. 5. Explain any task in clear, short and simple steps to facilitate understanding. 6. Do not confuse the client with reasons as to why things are done. Abstract ideas will not be comprehend. 7. Allow the client an ample amount of time to perform any given task. It may take the client longer to do even simple tasks because of altered mental state. 8. Remain the client throughout the task; do not hurry the client. Trying to push the client will frustrate him making the task impossible. 9. Assist the client as needed to maintain daily functions and adequate personal hygiene. The client’s sense of dignity and well-being is enhanced if he is clean, smells good, and looks nice. Nursing Diagnosis #5: Anxiety related to unfamiliar environment Assessment: The client anxiously kept trying to leave the department saying that he wanted to get home for dinner, yet was unable to state his address. Expected Outcome: The client will communicate feelings regarding the condition and admission. Interventions and Rationales: 1. Introduce yourself and other members of the health care team, and orient the client to the room. A smooth, professional admission process and warm introduction can put the client at ease and set a positive tone for his admission. 2. Explain hospital policies and routines. Determine the client’s knowledge of his condition, its prognosis, and treatment measures. Reinforce and supplement the physician’s explanation as necessary. Providing accurate information can help decrease the client’s anxiety associated with the unknown and unfamiliar. 3. Explain any scheduled diagnostic test. Teaching the client about test and treatment measures can help decrease his fear and anxiety associated with the unknown, and improve his sense of control over the situation. 4. Provide the client with opportunities to make decisions about his care whenever possible. Participating in decision-making can help give a client a sense of control, which enhances his coping ability. Perception of loss of control can result in a sense of powerlessness, then hopelessness. 5. Correct any misconceptions and inaccurate information the client may express. A common contributing factor to fear and anxiety is incomplete or inaccurate information; providing adequate, accurate information can help allay client’s fears. Conclusion The scenario described an elderly client condition upon presentation to the emergency department. As a registered nurse, the challenge of delivering quality health care to the different needs of a specific age bracket such as the elderly remains to be the most vital function of a nurse. Caring for an old adult is not an easy task. It requires a lot professionalism, skills, and knowledge. Registered nurses might encounter scenarios beyond their expectations so there is an increasing need to become versatile to adapt in different health settings. Examining the different areas of assessment, the client therefore suffers from diabetic ketoacidosis and physical neglect. Information from the assessment concluding that it is DKA is the presence of acetone breath (Daniels, 2004, p. 313) and the older adult’s appearance and confusion suggest that he might be a victim of abuse. However, an in-depth and further assessment needs to conduct in order to significantly conclude that this elderly suffers from DKA and abuse. The health needs of the client were identified and prioritized based on the assessments severity of condition, and nursing diagnosis. Ranking from the most prioritized to the least prioritized are Risk for Injury related to unfamiliar environment and physical or mental limitations secondary to disease condition, Acute Confusion related to disease condition, Impaired Skin Integrity related to prolonged pressure, Self-care Deficit related to confusion, and Anxiety related to unfamiliar environment. An older adult may have varying needs that is why an individualized and holistic care is necessary for nurses to apply (Andrews, 2003, p. 222). Attitudes Barriers in Caring for an Elderly “When handing over patient’s care to a colleague, the nurse responds by saying, ‘I’m not going near that dirty old nutter. Old people – they’re all senile and they smell”. The beliefs, values, and attitudes of a nurse could influence the practice of other health care professionals (Basford, 2004, p. 91). A recent report from the Institute of Medicine of the National Academies (IOM) challenges all health care professionals to recognize the need for effective interdisciplinary care (Fitzpatrick, 2006, p. 228). Nurses have preconceived ideas about caring for older adults; such observations are influenced by family, media, and experiences (Mauk, 2010, p. 7). The way we view aging and older adults reflects our experiences and environments. Negative attitudes, just like the statement of a nurse in the start of this essay, often arise from negative experiences. According to the US Census Bureau (2008), 12.3% of the American population is now age 65 and over (Gueldner, 2011, p. 254). This newest trend in population statistics presents new challenges in emergency health care delivery such as barriers to geriatric care. Recent surveys among health care workers report that health care workers feel less comfortable treating seniors. Nurses, in particular, view elderly as more difficult to evaluate and more time-consuming to care (Miller, 2009, p. 574). Growing old is an unfortunate state and many view elderly as depressing, senile, untreatable, or rigid (Gueldner, 2011, p. 254). Aside from the attitudes and preconceptions of nurses, the inadequate geriatric knowledge of norms yields inaccurate assessment and poor nursing care (Webb, 2007. p. 211). Elderly also faced the challenge of compensation and communication barriers. Due to cognitive and sensory impairments, elderly are deprived of quality nursing care. These attitudes, as well as the other barriers presented directly affect the quality of care seniors received from their nurse or from other health care providers. Elder Abuse Older people are prone to abuse and neglect because of biological and physiological effects of ageing. Abuse and neglect are society’s problems for decades and awareness and unacceptability has grown in recent decades. Abuse and neglect is a very pertinent issue involving the home care setting and residential aged care facilities (Anetzberger, 2005, p. 44). Every individual is mandated to report suspected or recognized abusive situation but must be acted and handled in a sensitive and professional manner. Incidences of elder abuse are often undetected and unreported (Haley, 2010, p. 91). However, a recent national prevalence study of elder abuse was conducted in private households in England, Scotland, Wales, and Northern Ireland (Biggs, 2009, p. 1). Of the 2111 respondents, 2.6% reported abuse by family members, close friends, or health care workers. Most of the reported type of abuse was neglect with 1.1%, followed by financial abuse with 0.6%, psychological abuse with 0.4%, 0.4% also with physical abuse, and 0.2% sexual abuse (Biggs, 2009, p. 1). The older person requires a thorough and careful assessment. Confidentiality of information must be maintained as well as privacy of the elderly victim. In Australia, elder abuse is a recognized issue and there are specialized advocacy services available to assist in dealing with abuse matters (Byrne, 2010, p. 144). Caring for an abused elderly individual depends on the identified needs. Proper and updated screening tools, assessment instruments, protocols, and guidelines, would aid in early detection of abuse, prevention of abuse in the elderly, and necessary interventions (Anthony, 2009, p. 815). Elder abuse requires immediate attention from the health care providers (nurses, physician), government, and general public. References: Alexander, M.F., Fawcett, J.N. & Runciman, P.J. (2004). The Older Person. Nursing Practice Hospital and Home: The Adult (2nd ed.) (p. 999-1014) London: Elsevier Limited. Andrews, M.M., Boyle, J.S. & Carr, T.J. (2003). Transcultural Nursing Care of Older Adults. Transcultural Concepts in Nursing Care (4th ed.) (p. 211-246) Philadelphia: Lippincott Williams and Wilkins. Anetzberger, G.J. (2005). 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