Nursing for Health and Wellbeing 2011 - Essay Example

Nursing for Health and Wellbeing Number : Patient Name: Mr. Sylvester Nursing Issue: Geriatric: Risk of falls (00155) (2000) Domain 11Safety /Protection (Herdman, 2008, p312). Goals/s: improving quality of life and preventing falls. Interventions……………………. Rationale for interventions………………….................................. Home modifications Risk for falls is the condition in which the individual has increased pre-disposition to falling (Carpenito-Moyet, 2006) Risk of falls in older people due to environmental factors. Home assessment reveals the existence of slippery floor surfaces, loose rugs, upended carpet edges, lack of grab rails in the bath room, no handrails on the stairs, stairs are carpeted but they are upended, stairs too steep ,and toilet is slippery, Most homes are potentially hazardous that would increase the risk of falls. Survey reveals among older subjects that they had at least one environmental falls hazard. Older people report falls inside the home. There should be evidence that these hazards are potential or causally linked to falls. Apart from the evidence of falls history among older people linked to household hazards, stronger evidence are available from studies where household hazards were identified first and subsequent falls were monitored. Further, frail people suffered more frequent falls but they were not due to environmental hazards. Studies indicate healthy people are likely to fall more frequently due to environmental hazards. Thus environmental hazards are likely to cause falls in vigorous older people than in frail older people. Since the patient Mr. Sylvester is a vigorous category (as he is able to live alone), he is more prone to falls. Risk taking behavior in vigorous older people is the likely cause for more frequent falls. Home hazards alone cannot be a single cause for falls (Lord, Sherrington, Menz 2007). Home modifications may be done with an objective of maximizing the patient’s independent activity. Patient’s bed maybe moved for an easy access to bath room. His daughter is advised to get him energy saving gadgets like elevated toilet seat, trapeze bar on the bed and an armed chair and seat so that it can support patient’s standing position. To conduct health assessments periodically. His complaints of weakness to be monitored so as to determine if the cause is acute illness or chronic condition. To discuss with his daughter about the impact on his self-esteem through use of attendants or assistive devices. Patient may be encouraged to interview home-health care professionals for selection so as to give him a feeling of independence (Ralph, Taylor, 2005, p533). Carpets may be mended and slippery tiles removed. Where not possible, carpets providing rough surface maybe laid. Foster care While the patient can remain in his own home with the home modifications done, he may also move to a foster care home. Foster care provides home like environment in order to enhance his functionality and improve quality of his life while he remains in a community based setting. This is not the same as other residential care settings in terms of home size and family oriented care. Foster care is defined as a service offering community based living environment for adults who cannot live independently. Since Mr. Sylvester, the patient herein seems to experience physical and/or mental impairment; he needs supervision and/or personal care. As his only daughter is away from him and cannot join him, foster care is desirable. Adult foster care is a 24 hours service offering supervision, protection, and personal care along with food and room. They may also be offering additional services. The home may house small number of groups of individuals like this patient taken care of by a primary care giver who also resides at home along with them (Ebersole, Hess, 1998). Interventions related to activity intolerance This refers to functional changes associated with old age. This is due to lack of sufficient physical or psychological energy necessary for daily activities. Usual activities such as self-care, dressing, feeding self and toileting, transfer, walking, climbing of stairs and ambulatory aid are assessed. Sensory deficits such as hard of hearing, poor vision are noticed. Interventions include establishment of goals to improve activity level of the patient within the context of patient’s physical limitations and energy level so as to improve quality of life. Use of cane or walker is to be encouraged. Wheel chair may be kept in place whenever patient feels like using it. To coordinate the services if interdisciplinary team while prescribing activity regiment for the patient. Having the physician to prescribe treatment for the patient’s medical condition, attendance of physical therapist who will design a exercise regimen, reference to dietician for an ideal nutrition plan, reference to social worker who will assist in locating services such of serving of meals, home health care services and to refer for services regarding patient’s physical and psychological needs. For possible mental depression, the patient may be referred to a mental health professional who can attend to his psychosocial problems that may be one of the reasons for the patient’s impaired activities. Patient must be taken into confidence to express his feelings about the decreasing energy levels. To monitor patient’s medication regimen if any after referral to physician and mental health specialist (Ralph, Taylor, 2005, p 533). Specialist treatment for Impaired hearing and poor vision and treatment for his recent physical injuries Impaired hearing and poor vision can be improved consistent with his age and his unattended physical injuries are to be treated to prevent possible development of sepsis and associated complications (White, Duncan, 2002). “Hearing loss is one of the most prevalent health conditions in older people with recent Australian studies reporting that approximately 60–70% of older people have a hearing impairment”(Donaldson, Worrall, and Hickson, 2004 , p 30 ). Visual risk factors increase risk of falls. Poor vision affects posture and can cause falls leading to fractures. Multifocal glasses can aggravate this risk.(Lord, 2004) “This reduces the ability of an older person to detect environmental hazards. There is now evidence that maximising vision through cataract surgery is an effective strategy for preventing falls “ (Lord, 2004, ii42 ) References Carpenito-Moyet ,Juall Lynda (2006). Handbook of nursing diagnosis, PA, USA, Lippincott Williams & Wilkins. Donaldson Nerina, Worrall Linda , Hickson Louise (2004) Older People with Hearing Impairment: A Literature Review of the Spouse’s Perspective, THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF AUDIOLOGY VOLUME 26 NUMBER 1 MAY 2004 pp. 30–39 Ebersole Prisilla, Hess Patricia (1998) Towards Healthy Aging: Human aging and nursing response. St Louis: Mosby. Ralph Sparks Sheilla, Taylor M Cynthia (2005) Nursing Diagnosis reference manual, PA, USA: Lipincot Williams and Wilkins. Herdman Heather T (2008) NANDA International, Nursing Diagnoses 2009-2011: Definitions and Classification, West Sussex, U.K. John Wiley and Sons. Lord R Stephen, Sherrington Catherine, Menz B Hylton. (2007) Falls in older people: risk factors and strategies for prevention, Cambridge, Cambridge University Press. Lord R Stephen (2004) Visual risk factors for falls in older people, Age and Ageing 2006; 35-S2: ii42–ii45 White Lois and Duncan Gena (2002). Medical- Surgical Nursing: an integrated approach. NY, USA Cengage Learning Report Nursing for Health and Wellbeing 2011 Student Name : Student Number : Patient Name: Mr. Sylvester Nursing Issue: Geriatric: Risk of falls (00155) (2000) Domain 11Safety /Protection (Herdman, 2008, p312). Goals/s: improving quality of life and preventing falls. The 78 years-old Mr Sylvester’s condition has been assessed as a risk for falls following NANDA-I diagnoses and interventions are suggested in the accompanying form. He has the option of either remaining at home with home modifications carried out or move to a foster care facility . In case of his choosing to remain at home with modifications carried out, it would be advisable to arrange for the daily visit of a carer on part-time or full time basis. Even if he moves to a foster care, he may choose to return to his own home later on some improvement to his conditions and hence, the home medications may be carried out in anticipation of his future return. As he shows signs of activity intolerance, interventions towards that end have also been suggested. Besides, he needs specific interventions in regards to his hearing impairment and poor visions suspected to contribute to his falls. It is hoped that the accompanying form containing the said interventions would form the basis of a holistic care to be provided to the patient. Read More