Evaluating Roper Activity of Daily Living - Essay Example

?Explanation of Roper et al's activity of living using a patient that was admitted to the hospital ward with fall secondary to excessive alcohol intake Introduction During times of illness and disability, a person’s ability to carry out his daily activities can be compromised. It can make patients dependent on caregivers and health professionals for the conduct of their daily activities generally compromising their general well-being. This paper seeks to explain Roper, et.al.’s activities of daily living using a patient who was admitted to the hospital ward after suffering a fall secondary to excessive alcohol intake. Other underpinning theories including dignity, consent, and privacy shall also be discussed in this paper as they relate to better and effective nursing care. Although not all of Roper’s activities of daily living apply to this case, they shall nevertheless be included for discussion purposes. This paper is being carried out in order to establish a clearer picture and understanding of Roper’s activities of daily living and the impact of disease, disability, and infirmities on such activities. Body The patient is a 55-year old Afro-Caribbean male who was admitted to the hospital after suffering a fall secondary to excessive alcohol intake. He also has Type 2 diabetes as his other co-morbid condition based on his previous medical history. He lives alone after his wife divorced him two and a half years ago. He is also unemployed because he lost his driving license three years ago and has since sought solace in alcohol which he initially thought he could control. Roper’s Activities of daily living 1. Maintaining a safe environment Maintaining a safe environment is crucial for this patient. Patients who have experienced falls are likely to fall again because of any injuries they may have suffered and any immobility which their fall might have caused (Lord, et.al., 2007). Maintaining a safe environment includes safety precautions which can be made on the home and in the patient’s hospital room. Guard rails on the bed have to be put up, especially in instances where the patient’s mental awareness is low (Miller, 2008). Since the patient is suffering from excessive alcohol intake, the guard rails need to be put up in order to prevent any repeat falls. Maintaining a safe environment also requires the nurses taking on leadership roles in order to maintain and monitor standards which can secure the cleanliness and effective infection control measures (Smith, n.d). The care administered to the patient therefore includes various remedies including infection control as well as monitoring of patient progress. Maintaining a safe environment for the patient also includes the process of ensuring that the nurses have the sufficient skills and training to care for the patient and administer to his needs (Smith, n.d). Such safe environment also includes working in partnership with health professionals in order to deliver adequate patient care (Smith, n.d). Ensuring a safe environment also includes the process of effective communication with the patient, gaining their consent before interventions are carried out (Department of Health, 2010). Maintaining a safe environment for the patient also involves patient education, teaching the patient about the dangers of alcoholism and any further injuries he may suffer due to his intoxication. It is also important to educate the patient about his disease and the risks he is taking with his alcohol intake (Gonzalez, et.al., 2005). Any injuries he may suffer would also likely take a long period of time to heal because of his diabetes. Maintaining his privacy at all times is also part of the safe environment created for the patient, ensuring that he can trust the nurse and his dignity can be respected at all times (Department of Health, 2010). 2. Communication Since the patient is still in the throes of his alcoholic stupor, there is a communication barrier between the nurse and the patient. When he was sober, there were no apparent communication barriers as the patient could easily understand English and had average intelligence to understand his condition and what he needed to do in order to recover. Without any known barriers to communication, it is nevertheless important for the nurse to explain clearly to the patient about his condition, making him understand what happened to him, the risks involved in his condition, the medications he needs to take, the interventions which have to be carried out or have already been carried out in his behalf (Stein-Parbury, 2011). The risks to his health in relation to his diabetes and his alcoholism also have to be communicated with the patient. It is important to use simple words which the patient can easily understand. Making frequent eye contact and asking the patient if he understands what is being said to him is also an important part of the communication process (Stein-Parbury, 2011). The patient would likely be antagonistic and be in denial about his alcohol problem, however, it is still important to explain his options to him and to explain and communicate matters in a calm, even-toned, and non-threatening manner (Stein-Parbury, 2011). Therapeutic communication also needs to be a patient-centred process where the patient is allowed to express his feelings and his preferences and the nurse would evaluate how well these choices fit into the patient’s nursing care (Stein-Parbury, 2011). The nurse must also apply the art of active listening, not just on the verbal, but also the non-verbal cues from the patient which may indicate pain, evasion, anxiety, distress, anger, sadness, and depression (Stein-Parbury, 2011). Noting these aspects of communication can help the nurse establish accurate assessment of patient condition and verbalizations. 3. Breathing Breathing is also part of patient’s normal activities of daily living. In assessing the patient’s condition, his ability to breathe and to cough does not seem hampered. He is also not suffering from any respiratory tract infection so he is breathing well (Callahan, 2007). Breathing is often a major problem among patients with respiratory infection, chronic obstructive pulmonary disease, or asthma (Callahan, 2007). It can also be a symptom for any other condition causing respiratory failure, especially in instances of stroke or heart attacks. It is important for the nurse to immediately manage any difficulties in breathing by checking the airways for any obstruction and helping the patient ease his breathing (Callahan, 2007). More drastic remedies including intubation may be needed based on assessment of causes of breathing disturbances or difficulties. 4. Eating and drinking When the patient was admitted into the ward, he was having difficulty eating and drinking because he kept vomiting his food, mostly due to the fact that he was still drunk. He could also drink only small amounts of water. Nevertheless, he did not need any assistance in carrying out independently the task of eating and drinking. Eating and drinking are regular activities of daily living. Issues in the conduct of these activities are common to those who have swallowing difficulties, where their food has to be passed via an NGT (Zhang, 2008). These patients may include those who are paralyzed from the neck down or who may have had surgical restrictions. Eating and drinking also includes the process of preparing for the food. The patient normally can carry out these tasks, however his injury would likely limit his ability to prepare his own food; the fact that he lives alone would likely not be favourable to his condition (Zhang, 2008). Recommendations and arrangements for hiring a live-in help were also rejected by the patient because he could not afford one. Arrangements with the community health nurse and the social worker are therefore necessary in order to ensure that the patient would still be adequately nourished during his recovery (Zhang, 2008). 5. Elimination Elimination can be a problem with this patient because of his injury. The fact that he has limited mobility can reduce bowel movement and cause constipation. Moreover, getting to and from the toilet can be dangerous for the patient. Since he is living alone, it is important to establish measures which can promote his elimination. While in the hospital ward, the patient must be made to move often, log-rolling every two hours is one of the main interventions to promote elimination and prevent constipation (Kyle, 2007). A diet rich in fibre must also be administered to the patient. Upon discharge, the patient must be taught the importance of moving about and of having a fibre-rich diet (Kyle, 2007). Patients suffering from limited mobility often suffer from constipation, hence interventions which promote mobility and build bulk in the stool can help promote elimination (Kyle, 2007). 6. Washing and dressing In general, the patient can relatively manage to wash and dress himself with limited assistance. He needs assistance in showering and needs limited assistance in dressing. He can also carry out grooming activities (brushing his teeth, combing his hair, shaving, etc) independent of any assistance. Washing and dressing is also a major issue among those who have suffered injuries which limit their mobility (Rensbergen and Pacolet 2012). In instances of fracture, paralysis, or major surgery, the ability to wash and dress oneself can be a major issue and assistance may be needed in carrying out these activities. Nevertheless, techniques can be taught by the nurse to the patient despite their limited mobility in order to encourage independence (Rensbergen and Pacolet, 2012). Simple tricks like using slip-on, no-lace shoes or modified shirts are just some of the options which can be offered for patients in order to maintain relative independence (Rensbergen and Pacolet, 2012). 7. Controlling body temperature Controlling body temperature does not seem to be an issue with this patient. He expresses that he does not experience difficulties in coping with extreme temperature changes—warm or cold weather. Managing temperature is often an issue among the elderly individuals, especially the extremely cold winter months (Lloyd, 1986). Adequate heating, wearing warm and appropriate clothes, engaging in low-impact exercises can help generate heat and reduce issues with hypothermia (Lloyd, 1986). 8. Mobilizing The patient’s injury caused limited mobility. He could not comfortably walk and he needed assistance in getting to and from the bathroom. After the medical intervention, he was able to partially gain relative mobility. Assistance was given to him where needed. The fact that he is living alone once again proved to be a primary concern for the patient. The community health nurse can be engaged to assist in the patient’s care, scheduling regular visits and follow-ups to the patient’s home in order to ensure that the patient is not injured and in order to assist the patient in his regular activities (Rubenstein, et.al., 2000). In the hospital setting, physical therapy can already be started in order to facilitate the patient’s recovery and to help him regain his normal movements. Muscle strengthening exercises can also be undertaken in order to facilitate recovery (Rubenstein, et.al., 2000). 9. Working and playing The patient is not working, nor is he playing. He does not exercise nor does he engage in any healthy activities. He spends a lot of his time in bars and socializing with his friends. Working and playing are important activities of daily living (Mulligan, 2003). Working provides purpose and more importantly, a means of support. Since the patient is unemployed, it may be helpful to refer him to an employment agency or to a social worker for employment assistance (Mulligan, 2003). Working would help reduce the feelings of despair which often drives the patient to drink excessively and it would help bring his life back on a better and more encouraging track. Playing and exercising can also be encouraged. These are activities which can help him regain his health (Fulmer, et.al., 2001). Playing and exercise are important activities which can reduce the risk for diseases and in diabetic patients can promote a healthy lifestyle. These exercises however should be low-impact exercises in order to prevent any injuries, calluses and similar tissue damage (Fulmer, et.al., 2001). Wound healing can be a long process for diabetic patients, hence, the importance of preventing any injuries (Ross, et.al., 2005). 10. Expressing sexuality The patient has indicated that he sometimes suffers from sexual dysfunction. This may be attributed to the normal process of ageing and his excessive alcohol intake. Ageing can reduce sexual drive and excessive alcohol intake can often cause erectile dysfunction (WebMd, 2003). It is therefore crucial for the patient to eliminate or at least reduce his alcohol intake in order to regain normal sexual functions. Recommendations for visit with a physician specializing in sexual health can also be given to the patient, for possible prescription of Viagra or other drugs which can help manage sexual dysfunction (WebMd, 2003). Sexual health is important for most individuals as a means of securing confidence (WebMd, 2003). Such sexual activity must however be held off until full recovery from the patient’s injury is secured. 11. Sleeping The patient expresses that he does not suffer from any sleep difficulties or dysfunction. He says that he normally sleeps about 6-8 hours every night. With his recent injury however, his limited mobility and the pain sensations have already affected his normal sleep patterns in the hospital. In order to facilitate sleep, efforts to reduce any disturbances are important. Putting off lights at night, playing soft music (as preferred by patient), and limiting disturbances for patient monitoring during night hours are some of the interventions which can help facilitate sleep (Lee, et.al., 2008). Sleep is an important part of any patient’s recovery and therefore providing opportunities of rest for patients who are sick must be carried out as much as possible (Lee, et.al., 2008). Patient-centred care is crucial of facilitating sleep and rest because the patient can express what can help him sleep and the nurse can help provide these conditions of sleep. 12. Death and dying Death and dying are inevitable parts of life. For the older adults, it is often a possibility that they think of more than usual. For the patient, death and dying are more significant possibilities to him because he has a chronic disease and he is advancing in age. He is also an alcoholic and thereby vulnerable to a host of other diseases, including heart disease and liver disease. Psychologically, he is in a state of despair, being driven to drink as often as possible by the unfavourable and unhappy state of his personal and professional life. Many older adults go through a period of depression and despair, especially those who are retired or widowed (Leishman, 2009). They are also often driven to suicide and depression by their loneliness and unfavourable economic status. For this patient, he has reached the state of despair earlier than his elderly counterparts, mostly because he was divorced by his wife and now suffers from unemployment. There is a need to address these psychological issues through therapy in order to engage the patient towards a better perspective in his life (Leishman, 2009). If unaddressed, these psychological problems may drive the patient further into despair and may drive him to commit suicide. It would also likely exacerbate his alcoholism which can then lead to other health issues which can then lead to his death. Death and dying are a normal part of life; however, there are ways of viewing these prospects in a less grim and hopeless way. Therapy and social support can facilitate more hopeful views on death and dying and these elements can be promoted for the general well-being of the patient (Leishman, 2009). Conclusion Based on the above discussion, the patient is in need of assistance in his daily activities. Since he was injured after his fall, he is partially immobile, and would likely need assistance in his mobility, elimination, sleeping, working and playing, and in washing and dressing. Other aspects also need to be given attention, but only to a minimal degree. These areas are crucial in order to promote normal functioning and general well-being. References Callahan, M., 2007. Breathe out: living life to the fullest, with emphysema, copd, or smoker's lung. London: AuthorHouse. Department of Health, 2010. Confidentiality: NHS code of practice. London: NHS. 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