Health and Social Care - Case Study Example

Name: xxxxxxxxxx Course: xxxxxxxxxx Institution: xxxxxxxxxx Title: Health and social care Date: xxxxxxxxxxxxx Health and social care Introduction A seventy year old patient has over the years suffered from Diabetes Mellitus and Chronic Renal Failure. The patient has been on dialysis for ten years and has communicated to the nurse that he wants to discontinue his dialysis treatment. Generally, his quality of health has diminished for the past two years since his wife passed on. The patient in discussion is not a prospect. This paper seeks to analyze the issues and questions revolving around the patient’s medical condition. This paper will depict why nursing assessment is required. Moreover, this paper will explore the possible nursing interventions in reference to current literature. In addition, this paper will discuss the recommended patient education and teaching based on the finding of current literature. Issues and questions One of the key issues in this case study revolves around the patient’s request to discontinue his dialysis treatments. His request to stop dialysis raises ethical and legal issues to both the patient and the nurses. In Australia, there are over 7, 000 patients undergoing dialysis treatment, it has been predicted that this number will increase as a result of the ageing population and the increasing incidences of diabetes mellitus (White & Fitzpatrick 2006, p99-103). The discontinuation of Diabetes treatment has been ranked as the second frequent cause of death among patients who undergo dialysis in Australia. Risk factors that are commonly associated with the discontinuation of the dialysis treatment include co-morbidities particularly in elderly patients with diabetes mellitus (White & Fitzpatrick 2006, p99-103). Owing to the fact that the decision to stop dialysis is a crucial life choice, nurses in charge are faced with an ethical quandary that requires a collaborative and ethical decision making framework in order for them to uphold their work ethics (White & Fitzpatrick 2006, p99-103). The decision of the patient to stop dialysis treatment may be viewed as acceptable provided that the patient has been living an intolerable quality of life characterized by depression and physical pain, however, the legality of this action is questionable. The laws in Australia do not have a definite approach to addressing issues revolving around patient’s choice to discontinue dialysis treatment. Nevertheless, the laws on Euthanasia could apply in this case. Carrying out euthanasia is illegal in Australia, following the nullification of the Rights of the Terminally Ill Act of 1995. Therefore, consenting to the patient’s request could cause both ethical and legal implications (Bartels & Otlowski 2010, p532–555). Increased risk of complication is another issue emerging from this case study. The above patient has been suffering from Diabetes for a long period of time. As a result, he has succumbed to Chronic Renal Failure that has reached its critical stages. Williams (2006, p 5) observes that Diabetes Mellitus can affect body systems and organs and cause complications such as kidney failure. Given the fact that the patient suffers from both Diabetes Mellitus and Chronic Renal Failure and his current health condition is diminishing, there are chances that the patient could be at risk of other life-threatening complications like, stroke , nerve damage, heart attack and diabetes related coma among many other complications (Williams 2006, p5). The patient’s overall health is a major issue that should be put into account in this case. Despite the various medical interventions that the patient has been subjected to his overall health is continuously diminishing. It is questionable on whether there are some other external factors or psychological factors that could be contributing to the overall deterioration of health. The questions arising in this case based on the current condition of the patient include; is the patient managing his condition effectively? Owing to the fact that Diabetes Mellitus is a chronicle disease that is difficult to cure, it is important that the patient and even the care givers adopt effective ways of managing the condition. The use of medication and lifestyle modifications such proper nutrition and exercising are among the main ways of effectively managing Diabetes (Tonelli et al 2005, p3748-3754). Therefore in this case, it is necessary to question whether the patient is effectively managing his condition by, exercising, eating right and using his medication regularly as prescribed. In addition, psychological factors such as stress or mental disturbance could be another factor that is causing the patient’s health to diminish. Following the death of the patient’s wife two years ago, his overall health has been diminishing. Thus it is worth questioning on whether the death of his wife and other challenges are stress contributing factors in the patient’s life that have over time caused his health to deteriorate. Stress related factors can contribute to the deterioration of health especially amongst patients with chronic illnesses (Tonelli et al 2005, p3748-3754). Moreover, the patient’s decision to stop dialysis is also another issue that should be critically assessed. In most cases, dialysis is a life sustaining measure especially for patients with Chronic Renal Failure. Choosing to discontinue dialysis could have severe implications, a good number of patients who stop dialysis die within a very short period (Foley & Murray 2005, p489 -495).Nevertheless, adult patients have the right to decide whether they want to continue or discontinue dialysis. In this case it is imperative for the nurses to establish why the patient wants to stop dialysis. Are his reasons to stop dialysis emotional ones? or Medical? Is the patient’s decision rational or irrational? Some patients may decide to discontinue dialysis since they may find dialysis treatment undesirable and one that robs them off quality of life (National Kidney Foundation 2007, p180). On the other hand, some patients choose to discontinue dialysis due to medical reasons. Some people may stop dialysis due to the related complications and side effects like low blood pressure, allergic reactions, fever and loss of appetite among many other side effects. Moreover, given the fact the patient in discussion is seventy years old, his decision to discontinue dialysis could be irrational. Therefore, it is essential for the nurses to establish why the patient wants to stop dialysis. Are his reasons to stop dialysis emotional ones? or Medical? Is the patient’s decision rational or irrational? Nursing assessment Nursing assessment in this case is a very crucial measure that should be carried out in order to effectively address the various issues that are affecting the patient. Nursing assessment entails gathering information on the patient’s sociological, physiological, spiritual and psychological status. In order to fully understand why the patient’s health condition has been deteriorating over the years and why the patient has decided to discontinue dialysis, it is important to carry out nursing assessment. It is essential for the nurses to conduct a holistic nursing assessment in order determine the needs of the patient (Royal College of Nursing 2010). Nursing assessment in this case will involve; assessing, the nursing history of the patient, social and physiological assessment, and physical assessment. Assessing the nursing history of the patient In order to establish why the patient’s health condition has been deteriorating over the years, it is essential for the nurses to assess the nursing history of the patient. One of the ways that the nurses can use to assess the nursing history of the patient is by reviewing and analyzing the medical records of the patient. By reviewing the medical records of the patient, the nurses will be able to examine the how the patient’s medical condition has been over the years. This assessment will also enable the nurses to identify any ways that can be used to address the issues affecting the patient. The elements of the patient’s history that should be examined include the overall health status of the patient such as the apparent symptoms, his medical history, his familial medical history and his past and present ways of managing his illnesses. By so doing, the nurses will be able to establish whether there are issues in the past or present that are currently causing the patient’s health to diminish (Royal College of Nursing 2010). Social and physiological assessment Social and physiological assessment in this case will involve the psychological examination of the patient with regards to the patient’s emotional and intellectual health. These assessments will cover the cognitive function of the patient of by checking for delusions and hallucinations since the elderly patient tend to be delusional. It is also important to analyze the patient’s friendship association, familial ties, interests and hobbies so as to establish whether the patient’s social life is apt following the death of his wife (Royal College of Nursing 2010). Moreover, the nurses should asses whether the patient has care givers around him who can monitor the patient and help the patient manage his condition by ensuring that he is eating right, exercising and regularly taking his medication as prescribed. The patient’s emotional health can be evaluated inquiring or observing how the patient feels and how responds to his feelings. The psychological assessment of the patient may further include examining the perception of the patient by establishing why the patient thinks that they are undergoing nursing assessment (Royal College of Nursing 2010). In this case, it is also important to assess the spiritual beliefs of the patient. The fear of suffering, dying, abandonment and pain could be a reason to continue or discontinue dialysis(White & Fitzpatrick 2006, p99-103). By carrying out these assessments the nurses will be able to establish whether there are some social or psychological factors that could be contributing to the overall deterioration of health. Furthermore, the nurses will be able to establish whether the patient is managing his condition effectively. These assessments will depict whether psychological factors such as stress or mental disturbance following the death of the patient’s wife two years ago, could be another factor that is causing the patient’s health to diminish. Moreover, this assessment will help the nurses to establish if the patient’s decision to discontinue dialysis is a rational one, or one that is based on delusional or stereotypic beliefs. Through these assessments, the nurses will also be able to ascertain whether patient’s decision to stop dialysis is due to emotional reasons or medical reasons Physical assessments Physical assessment in this case may involve conducting physical examination on the patient through measurement or observation. In order to establish why the patient’s health is diminishing and whether there are chances that the patient could be at risk of other life-threatening complications like, stroke, nerve damage and heart attack, it essential for the nurses to measure or observe the various symptoms that are portrayed by the patient such as his blood pressure, pulse rate, respiratory rate (Royal College of Nursing 2010). Moreover, this will also help the nurses to establish whether the patient’s decision to stop dialysis is due to medical reasons such as the impending side effects of dialysis. In addition, the nurses should conduct examinations on the patient’s body systems like musculoskeletal or cardiovascular systems so that they are able to know how to address the current condition of the patient (Royal College of Nursing 2010). Nursing Interventions Given the fact that is no cure for Diabetes Mellitus and Chronic Renal failure, nursing interventions in this case must become more aggressive as the patient’s kidney continue to diminish towards failure. In this case, applicable nursing intervention may include controlling the level of the patient’s blood pressure and the levels of blood glucose. According to Gerstein & Miller et al (2008, p 2545–59), monitoring the patient’s blood pressure and the level of blood glucose is very crucial. In order to actualize this patient should be subjected to proper diets, exercises and medications. Furthermore, stress causing factors should be averted, the patient should not be subjected to any strenuous activities that would alter the normal blood pressure (Gerstein & Miller et al 2008, p2545–59.). In reference to the recommendations released by the National Institute for Health and Clinical Excellence (NICE) in 30th May 2008, self-monitoring the levels of blood glucose for patients with diabetes should be a part of self-management plan. Medication can also be used to minimize high blood pressure, especially angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers to restrain kidney damage (Williams 2006, p131). The function of Dialysis for patient’s with Chronic Renal Failure is integral, this mainly because dialysis is the only way through which waste materials can be removed from the patient’s body while salts and water are preserved. In most cases, the kidneys of patients with Chronic Renal Failure, do not function properly hence there is need for an intervention such dialysis or else the patient is bound to be intoxicated (Blake, Ing & Daugirdas 2008, p 323-338). Owing to the fact that the patient has expressed his wish to discontinue dialysis, it is imperative for the nurses to establish why the patient wants to stop dialysis and advice the patient or his next of keen accordingly on the implications of discontinuing dialysis. Alternatively if possible the patient should get a kidney transplant from a healthy donor, thereby replacing the function of the damaged kidneys (Blake, Ing & Daugirdas 2008, p323-338). According to Poretsky (2010, p 352) in the book “Principles of Diabetes Mellitus”, observes that tight glycemic control is an effective intervention when it comes to preventing and treating established nephrology. In Diabetes Type 1, intensive insulin therapy minimizes the mean glycated hemoglobin thus reducing the risk of developing microalbumunuria, the rate of urinary albumin excretion and the advancement of clinical albuminuria. Tight glycemic control with a concentrated insulin regime tends to give sustained benefits in cases of creatinine elevation, albuminuria and microalbumunuria. Moreover, improved glycemic control helps to reduce micro vascular diseases particularly in diabetes type 2 in elderly patients (Poretsky 2010, p 352). In this case glycemic control will be an effective intervention for addressing the issues revolving around the patient’s deteriorating health condition. Other nursing interventions that might help to reduce further risks and complications in this case include; subjecting the patient to regular medical tests so as to detect any complications. Furthermore, it is important that urinary tract infections should be treated immediately using antibiotics (Williams 2006, p175). The patient should also be encouraged to drink plenty of fluid such as water and avoid alcoholic beverages. Moreover, at this stage the patient should not be subjected to medical treatments that might stress his kidneys like x-rays that involve the injection of contrasting dyes. In addition, the patient should not be administered with non-steroidal anti-inflammatory drugs (Williams 2006, p 35). Recommended patient teaching/education The key issues affecting the patient in discussion include; his diminishing health status following the death of his wife two years ago. As a result of this, it can be assumed that the reason why the patient’s health is diminishing is due to depression or stress related. Furthermore, it can be assumed that the patient lacks an efficient care giver who will enable him to manage his condition effectively. Another issue affecting the patient in discussion is his decision to stop dialysis. Based on these assumptions the recommended patient teaching will revolve around the management of depression and stress, the various ways of managing his condition and the implications of discontinuing dialysis. With regards to the management of depression and stress, it is important to teach or encourage the patient to undergo regular counseling. The patient should be taught on the various ways of managing avoiding stress such as involving themselves in leisure activities such as reading books, watching television and participating in sporting activities among many other activities. The patient together with his care givers at home should be taught on the effective ways of managing his conditions (Rachmani 2005, p410-414). The patient should be taught on creating a diet plan that comprises of the appropriate nutrients necessary to enhance his health status. Moreover, it is important to teach the patient and those around him on the purpose, route, dosage of medication and the potential side effects. The patient should be encouraged to attend medical check ups regularly so that further complications and risks can be detected. With regards to the patient’s decision to discontinue dialysis, the patient’s decision should be dully respected and put in to account. Nevertheless, the patient and his next of keen should be educated on holistically on the patient’s current condition and the associated complications do stopping dialysis. In this case, emphasis should be directed on evidence revolving around the associated complications of discontinuing dialysis (Rachmani 2005, p410-414). Conclusion The key issues that are apparent in this case study includes, the patient’s age, his overall health status following the death of his wife two years ago, his decision to discontinue dialysis and the risk of further complications. As a result there is need to carry out nursing assessments so as to determine whether the patient has care givers around him who can monitor the patient and help the patient manage his condition by eating right, exercising and regularly taking his medication as prescribed. Moreover, the nursing assessment is geared towards establishing whether his reasons to stop dialysis are rational or irrational? In this case, applicable nursing intervention may include controlling the level of the patient’s blood pressure and the levels of blood glucose, encouraging the patient to continue with his dialysis treatment or alternatively get a kidney transplant. Patient teaching in this case will revolve around the management of depression and stress, the various ways of managing his condition and the implications of discontinuing dialysis. 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National Kidney Foundation, 2007, Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease, American Journal of Nephrology 49: S1-S180, 2007. National Institute for Health and Clinical Excellence (NICE), 2008, Type 2 diabetes: the management of Type 2 diabetes. Clinical guideline 66, NICE, London. Poretsky, L., 2010, Principles of Diabetes Mellitus, Springer, New York, p, 352. Rachmani, R., et al,2005, Teaching and motivating patients to control their risk factors retards progression of cardiovascular as well as micro vascular sequelae of Type 2 diabetes mellitus— a randomized prospective 8 years follow-up study, Diabetic Medicine, Vol 22, Issue 4, April 2005, p 410-414. Royal College of Nursing, Nursing assessment for older people, Retrieved on December 28, 2010 Tonelli, M. et al, 2005, Effect of pravastatin in people with diabetes and chronic Kidney disease. American Journal of Nephrology 16: 3748-3754, 2005. Williams, L., 2006, Diabetes mellitus: a guide to patient care, Lippincott Williams& Wilkins, Philadelphia, p5-270. White, Y. & Fitzpatrick, G., 2006, Dialysis: prolonging life or prolonging dying? Ethical, legal and professional considerations for end life decision making, EDTNA ERCA Journal 2006 Apr-Jun; 32(2):99-103. Read More