Contribute to the Complex Nursing of Clients - Case Study Example

Contribute to the complex nursing of Introduction more often than not, manifest with different problems; and even when they manifest with similar symptoms, they sometimes end up requiring different modes and types of treatment from the health care professionals. In coming up with an effective plan of care for any patient, there is a need to consider the different aspects of the patient’s life and care. In considering these aspects, we may be able to accurately assess whether or not a treatment scheme would work for a patient. This paper shall evaluate the case of Mrs. Carr, a 49 year old woman with early onset Alzheimer’s disease, osteoarthritis, Type I diabetes, asthma, and a history of DVT. She was admitted into the ward by wheel chair for investigation of increased abdominal girth and jaundice. She has been taking corticosteroids for her asthma for 6 months and has been receiving insulin SC, BD which her husband has been administering at home. This paper shall discuss the clinical manifestations of Mrs. Carr’s diagnosis. It shall outline the appropriate nursing interventions for Mrs. Carr, taking into consideration her physical, emotional, and psychosocial needs. A rationale for these interventions shall also be discussed. Mrs. Carr’s medical management shall also be discussed along with an outline of their mode of action and what reactions may be observed from these medications. This paper shall also discuss the observations I would perform on Mrs. Carr, and the rationale for such observations. Finally, this paper shall discuss how I, as an enrolled nurse, can maintain the client’s dignity and rights within legal and ethical guidelines. Discussion Signs and Symptoms There are numerous manifestations of Mrs. Carr’s disease. Since, she has multiple diseases, various signs and symptoms will be seen. Mrs. Carr’s Alzheimer’s disease manifests with her loss of memory, disorientation, mood changes, and difficulties in performing her activities of daily living. These symptoms are consistent with the symptoms of Alzheimer’s as enumerated by Vishnu (“Conditions and Diseases”). Mrs. Carr’s osteoarthritis manifests with symptoms which include pain and stiffness in her joints, loss of flexibility in her joints, and very often swelling and tenderness in the vicinity of her joints. These symptoms are consistent with the symptoms of the disease as enumerated by the Mayo Clinic (“Disease and Conditions”). Her Type I diabetes manifests with excessive thirst and fatigue, weight loss, blurred vision, and frequent urination. Such symptoms, according to Griffith, et.al., (p. 259) are expected in Type I diabetes patients. Her asthma manifests signs and symptoms of coughing, wheezing, difficulty of breathing, shortness of breath, and chest tightness. These symptoms are also discussed by the National Heart, Blood, and Lung Institute (“Lung Diseases”) as typical symptoms of asthma. Nursing Interventions Physical Needs In order to address Mrs. Carr’s physical needs, a routine has to be set with the caregiver and the nurse regarding the conduct of the patient’s activities of daily living. As much as possible the patient’s independence should be encouraged during these activities, however, the nurse must still be physically present during these activities in order to ensure that the patient does not injure herself and to assist the patient in activities which she cannot accomplish on her own (White & Duncan, p. 961). Since the patient has osteoarthritis, there is a need to physically assist the patient in her activities of daily living. Advising the patient to use canes or walkers or other assistive devices when standing up, sitting down, or when walking are also important interventions for the patient. The nurse must also encourage the patient in performing range of motion exercises in order to provide strength and flexibility to her joints. Hot soaks can also help relieve pain in the hips and joints. Firm mattresses or bed boards can also be provided for the patient in order to decrease pain and stiffness of joints in the morning. Adequate rest must also be reminded for Mrs. Carr in order to prevent over-straining of her bones and joints (Lippincott Williams & Wilkins, p. 567). For the patient’s asthma, nursing interventions include administration of medications at designated time intervals, exercise, adequate hydration, and breathing retraining (Meiner & Lueckenotte, p. 24). Since Mrs. Carr has Alzheimer’s, she might forget to take her medications, therefore, the nurse must remind Mrs. Carr to take her medications at designated times. Exercise appropriate for her condition has also to be undertaken only after proper consultation with a physical therapist or with the patient’s physician. The activities must be prepared based on her existing health problems. Mrs. Carr can also be taught proper breathing techniques in order to ensure proper lung filling and ventilation. This will help strengthen her chest muscles and other muscles being used for inspiration and expiration (Meiner & Lueckenotte, p. 24). For her Type I diabetes, a healthy diet must be prepared for Mrs. Carr. Since she has Alzheimer’s, she may likely forget her regular monitoring process. She must be reminded all the time to monitor her blood sugar. Timers must be provided for her in order to ensure that she is monitoring her blood sugar regularly and that she is taking her medications on time. A schedule of her medication intake or her insulin monitoring times can also be posted on her medication box or containers. The nurse can secure a medication bracelet for Mrs. Carr in order to indicate that she is a diabetic patient and that she must be monitored. Regular foot care for Mrs. Carr must also be undertaken in order to assess her for possible injuries and possible peripheral neuropathies (Griffith, et.al., p. 259). Emotional needs Due to the various diseases that Mrs. Carr is afflicted with, there is a need to provide her with strong emotional support. This strong emotional support will help encourage her in her exercises, in maintaining a healthy diet, in asserting her independence (especially in her ADLs), and in persisting with and following her treatment regimen (Lippincott Williams & Wilkinson, p. 567). In order to provide for Mrs. Carr’s emotional needs, the nurse must also try to teach the patient about her different diseases. More often than not, patients do not understand the nature of their diseases. As a result, they become uncooperative during treatment. By helping Mrs. Carr understand her illnesses, she can be more cooperative with the members of the health care team. She may even feel more involved and more in control of her life and the things happening to her body (Stanhope & Lancaster, p. 499). Psychosocial Needs In order to sufficiently address her psychosocial needs, the nurse can assist by providing adequate communication techniques with the patient. This will help build a trusting and open relationship with the patient. This will also help the patient not feel so isolated and alone. Open communication techniques can also help the patient have more control in her treatment (Miller, p. 212). Nurses can also use “life review and reminiscence interventions, especially in-home and long-term care settings” (Miller, p. 212). The nurse can also assist Mrs. Carr to join social support groups in order to encourage her to be involved with the community and to be more in touch with other people in the same situation as hers. Through these activities, the patient’s psychosocial wellness is improved and her emotional needs, as well as her social needs, can also be met. Medication management Based on the various diseases that Mrs. Carr is afflicted with, she will also likely be under several medications. For her Alzheimer’s, she may possibly be put on risperidone. Risperidone is an antipsychotic agent which will help manage her hallucinations, paranoia, and psychosis. For her moments of acute agitation, she may be given Ativan (Sabbagh, p. 250). Headaches, drowsiness, insomnia, extreme salivation, and dizziness may be expected as side effects from her medication intake (Monson, p. 1). For Mrs. Carr’s osteoarthritis, she would most likely be given a non-steroidal anti-inflammatory drug (NSAIDS). NSAIDS help reduce swelling, and they also do not contain steroids. They also help reduce pain. Effects to look out for in the patient may include stomach upset, nausea, heartburn, and vomiting (Phillips, p. 65). As was previously mentioned for her Type I diabetes, she is already on insulin (Griffith, p. 259). Insulin is a type of hormone which will help convert sugar into other energy sources for the body. Signs to watch out for would include hypoglycemia. This is manifested as shakiness, nervousness, irritability, weakness, sudden changes in behavior or mood, sweating, numbness or tingling around the mouth, and hunger (The American Society of Health-System Pharmacists “Drugs and Supplements”). Finally, for Mrs. Carr’s asthma, she is on corticosteroids. Corticosteroids often act locally in order to decrease inflammation within the breathing passages (eMedicine Health, p. 5). I should observe Mrs. Carr for headache, dizziness, seizures and sudden pain and swelling which may be some of the adverse effects of corticosteroids. Observations The observations I would make on Mrs. Carr would be on her medication intake. Since she has Alzheimer’s, she would most likely forget to take her medications, especially her insulin. It is important to maintain Mrs. Carr’s blood sugar levels in order to prevent extreme levels in her blood sugar. Her forgetfulness might also cause accidents or injuries. She might forget she is cooking something or that she has left the water running, or that she already took her medications. By monitoring her activities, accidents, injuries, and possible overdose may be prevented. Since she is asthmatic, it is also important to note possible triggers to her asthma attacks. These triggers should be avoided as much as possible, and the nurse and the patient must be ready to deal with asthma attacks. The nurse should ensure that the patient’s inhaler or bronchodilator is within the patient’s reach at all times. Since she has osteoarthritis, possible dangers of falls should be prevented. I should observe her techniques in sitting down and in standing up and even walking. Techniques that endanger her balance and her posture should be corrected in order to prevent possible falls. Ethical and Legal Considerations The ethical and legal considerations related to the care of Mrs. Carr refer to various matters. First and foremost, Mrs. Carr must give her informed consent to the treatment and to interventions which are going to be undertaken in her favor (Videbeck, p. 5). Without such consent, I may be charged for assault for any interventions that I may be undertaking on Mrs. Carr. The patient’s religious and cultural considerations must also be considered. I must establish if Mrs. Carr has religious preferences that might not allow for some forms of treatment to be undertaken on her (Benjamin & Curtis, p. 44). I must also be aware of my legal and ethical responsibilities as far as the patient is concerned. I may be liable for neglecting the patient’s needs or for overstepping the bounds of my role as a nurse. The laws are laid out for me to follow, and I must follow them. Conclusion Mrs. Carr has various afflictions which have to be observed and addressed. The way each disease manifests must be observed by the nurse. There are different interventions which can be applied to Mrs. Carr, however, such interventions must fit her condition. Since she has Alzheimer’s disease, memory loss is expected. This memory loss must be taken into consideration in the administration of care for Mrs. Carr. She may forget to take her medications, and to regularly monitor her blood sugar. The nurse, therefore, should endeavor to note that that her medication and her monitoring are also not forgotten. Works Cited “Asthma What Are the Signs and Symptoms of Asthma?” Lung Diseases. (n.d) National Heart, Blood, Lung Institute. 01 October 2009 Benjamin, M. & Curtis, J. “Ethics in nursing”. 1992. p. 44. 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