The Role of Aged Care Nursing - Case Study Example

Aged Care Nursing: Name: Institution: Aged care nursing Introduction Whenever a patient presents him/ herself to the hospital, it is because they believe that they will receive the best care, and that they are in good hands (Bodenheimer, Wagner & Grumbach, 2002). The patients also hope to get well, and have their condition normalised, cured or even stabilised (Maskell, 2012). Therefore, it is the duty of registered nurses who are in charge of the patients to make sure that the patient receives the best quality care that the hospital and the care givers can afford (Shanley & Whitmore, 2008). (Sumner, Avery & Beckwith, 2009), therefore, to deliver the required outcome and give the best quality care, the nurses need to plan for their patients, so as to know the type of care, and how it will be given to the patient (Bodenheimer, Wagner & Grumbach, 2002). A care plan acts like a guide for the registered nurse to assess the patient, understand the patient, as well as to come up with the correct diagnosis (Sumner, Avery & Beckwith, 2009). This plan will help the nurse highlight the special needs required by the patient, as well as how to deal with them (Hillson, 2008). The need for a registered nurse to come up with a care plan for this patient is in order to provide and pave way for the continuity of quality care for the patient. Assessment The patient is a male aged approximately mid- sixties, who appears to be so dishevelled and confused (Hillson, 2008). The patient appears to be continuously hungry, as stated by his continuous need to leave the department to go home for dinner, yet he appears confused and cannot even remember his address. There is an acetone odour in the breath of the patient, and he repeatedly keeps on saying that he want to pass urine (Shanley & Whitmore, 2008). On the right side of his forehead, the patient has a haematoma, which is the size of a 50 cent. The patient keeps on scratching his right upper arm (Hillson, 2008). The first intervention measure to help the patient would be to admit the patient as an emergency case (Hillson, 2008). A registered nurse in charge of the patient need to prepare a health assessment from the day the patient is admitted up to the 14th day of admission. Tests to determine the cause of the haematoma, continuous urinating, frequent hunger, and confusion as well as forgetting things like his address, should be administered by the registered nurse in charge of the patient (Dunning, 2009). There is also need to determine the cause of the acetone in the breath of the patient (Maskell, 2012). Diagnosis The fact that the patient keeps on passing urine many times, could suggest a kidney problem or diabetes (Shanley & Whitmore, 2008). The possibility of diabetes is strengthened by the fact that there is acetone on the patient’s breath, which is very common with people suffering from diabetes (Guthrie & Guthrie, 2002). Acetone is produced by the body and excreted by it, and through breathing is one way that it is lost and excreted from the body (Maskell, 2012). The continuous attempt by the patient to leave the department to go home for dinner signifies that the patient is getting hungry many times, which is also a symptom of diabetes (Dunning, 2009). The patient keeps on scratching his right upper arm, another sign of diabetes caused by numbness. The haematoma on the left side of the forehead could have been caused by a fall (Guthrie & Guthrie, 2002). Most of the symptoms being inhibited by the patient portray a likelihood of diabetes. The patients also shows signs of amnesia in that he wants to leave the department to go home for dinner, yet is unable to state his address. This inability to state his address portrays amnesia, which is a sign of diabetes. To determine if the patient is suffering from diabetes, a physical examination should be done together with a plasma glucose test (Shanley & Whitmore, 2008). The plasma glucose test is done using glucosylated haemoglobin (GH). As a registered nurse, one should do tests to confirm any diagnosis made. The tests are also important so as to determine what type of diabetes the patient is suffering from, in order to determine the type of treatment the patient will be given (Salmon, 1993). Rationale for the diagnosis Diabetes is very common to elderly patients aged from 60 years old. Research shows that 28.5 million Americans suffer from diabetes, an astonishing 8.3% of the population. More so, is the population of people aged from 65 years, where one person out of four suffers from diabetes (Maskell, 2012). The patient is approximately in his mid- sixties, therefore he stands a high chance of having diabetes. Most signs of diabetes type 1 and diabetes type 2 are same. In both cases, diabetes is caused by the level of glucose in the body being too high, and there being too low glucose in the body cells (Bodenheimer, Wagner & Grumbach, 2002). When the cells lack enough glucose needed by the body, the body gives out signs and symptoms, to show that something is wrong in the body, and to maintain homeostasis (Shanley & Whitmore, 2008). The fact that the patient keeps on urinating all day long shows that there is a likely hood of diabetes. This is because, if there is too much glucose in the blood, a person urinates a lot. When there is no insulin or what is present is ineffective, it becomes hard or impossible for the kidneys to filter the glucose back to the blood (Salmon, 1993). The kidneys become so overwhelmed, and they in turn draw extra water from the blood in order to dilute the glucose. As a result of this, the bladder is always full, hence the continuous urination (Renders, Valk &Griffin, 2001). The patient keeps on scratching his right upper hand. This is a symptom of diabetes called neuropathy (Renders, Valk &Griffin, 2001). This numbness or tingling in the hand and it is caused by the consistence high glucose in the blood, which damages the nervous system, especially in the extremities. The itching and scratching is normally improved as the tighter blood glucose is achieved. The continuous itching could be caused by a dry skin which is common in people with diabetes (Maskell, 2012). The patient has acetone in his breath, and this is a symptom of diabetes. Acetone is normally present in the urine and blood, and it is produced and excreted from the body through the normal metabolic process (Renders, Valk &Griffin, 2001) and Polit & Beck, 2008). People with diabetes produce acetone in very large amounts. Glucose is used by cells as fuel (Jeffry. 1999). When there is less glucose in the bloodstream, the body tries to maintain homeostasis by producing hormones which break down the fat. Acetone is produced by the fat- burning process (Ketosis), and acetone is a toxic chemical (Shanley & Whitmore, 2008). It causes ketoacidosis, which is fatal. The presence of acetone odour in the breath is a high indicator of diabetes, and an indicator of high risk in the patient, because of ketoacidosis, which is fatal. The presence of acetone signals for an emergency care and medical attention for the patient (Salmon, 1993). Polit & Beck, 2008), The patient cannot remember his address as much as he keeps wanting to leave the department (Renders, Valk &Griffin, 2001). This is loss of memory, which is also an indicator of diabetes (Jeffry. 1999). This condition also put more weight in diagnosing the patient with diabetes. Amnesia or memory loss is very common in cases of severe hypoglycaemia (Shanley & Whitmore, 2008). A person is sometimes unaware of his or her surroundings while in severe hypo, or sort of blanks out (Jeffry. 1999). Australian Government Department of Health and Aged Care (1999), the reason for this is that the primary fuel for the brain is glucose, and when a person is hypoglycaemic, the brain does not get the glucose needed to function properly (Salmon, 1993). Therefore, in desperation, the functions that are not vital for survival are shut by the brain, and this makes a person in a situation of a haze, and sometimes a person may only be partially aware of the surroundings (Jeffry. 1999). The amnesia reduces when the level of glucose gets back to normal, and the brain can resume its job of thinking rationally (Maskell, 2012). The patient has a haematoma on the forehead, which is likely to have been caused by falling (Jeffry. 1999). Due to diabetic retinopathy and normal aging process, poor vision develops, which increases the risks of falling. This could be the cause of the haematoma (Shanley & Wall, 2004). Nursing care The nurse should involve the family and care takers of the patient while preparing a care plan for the patient (Jeffry. 1999). This is in order to make sure that everybody involved in the care of the patient have knowledge about diabetes, and how it affects the patient (Shanley & Wall, 2004). The nurse should ensure there are daily foot tracking, accurate and correct blood sugar tracking as well as health eating for the patient, so as to successfully manage the condition of the patient (Shanley & Wall, 2004). The involvement of the patient and the caretakers is to make sure that they are armed with the education on how to care for the patients as well as for the patients to administer self-management of the condition (Salmon, 1993). The nurse should see to it that all the symptoms portrayed by the patient are recorded down, and the proper treatment is administered to the patient to stabilise the condition (Jeffry. 1999). This is to help in the case of transition, where by, other health care practitioners placed in charge of the patient can be able to follow the records and progress of the patient (Maskell, 2012). Emergency The patient’s condition should be treated as an emergency so as to stabilise the condition of the patient (Shanley & Wall, 2004). The fact that the patient’s breath has acetone odour, and there are signs of amnesia shows that the patient is suffering from severe hypoglycaemia, and there is a risk of ketoacidosis which is fatal (Shanley & Wall, 2004). The patient requires emergency medical attention so as to normalise the patient’s glucose level in the blood, as well as save life (Jeffry. 1999). Tests should be done quickly to confirm the diagnosis of the nurse, as well as to the guide the nurse and other health practitioners in the course of taking care of the elderly diabetic patient (Salmon, 1993). Conclusion Australian Government Department of Health and Aged Care (1999) There are always case where patients appear in the emergency department and it is the duty of the registered nurse to see to it that the patient gets the highest quality care, and is safe (Shanley & Wall, 2004). This is because people go to hospitals believing that they will be in good care and their conditions will be stabilised. They also believe that in hospitals they will be safe (Shanley & Wall, 2004). Therefore, it is the duty of the medical practitioners to take care of the patients and deliver quality care, providing quality care involves proper assessment, correct diagnosis, apply the right intervention, and administer the correct treatment (Salmon, 1993). In case of a patient whose condition need to be stabilised like diabetes (Bodenheimer, Wagner & Grumbach, 2002). Providing information and education to the patient’s themselves and the caregivers of the patient help significantly in monitoring and stabilising the condition of the patient (Shanley & Wall, 2004). Providing the patient and care givers with the right skills for maintaining a lifestyle that is healthy, enhancing and encouraging positive attitude towards self-management of diabetes helps in building supportive network. This makes the work of managing diabetes easier (Salmon, 1993). References Australian Government Department of Health and Aged Care (1999). Primary care initiatives: Enhanced Primary Care package. Australian Institute of Health and Welfare. (2002). Diabetes: Australian facts. Diabetes Series 3. Bodenheimer, T. Wagner, E.H, & Grumbach, K (2002). Improving primary care for patients with chronic illness: the chronic care model, part 2. 288: 1909-1914. Dunning, T. (2009). Care of People with Diabetes: A Manual Nursing Practice. New York: Wiley. Guthrie, D.W. & Guthrie, A.R. (2002). Nursing Management of Diabetes Mellitus. London: Springer Publishing Company. Hillson, R. (2008). Diabetes Care: A Practical Manual. Sydney: Oxford. Jeffry. I. W. (1999). Management of Diabetes in the Elderly. Journal of Clinical Diabetes.  Maskell, C. (2012). Quality of advance care planning in Australian Aged Care Planning Must Improve. The Hospice. Polit, H, & Beck C.T. (2008). Nursing Research. New Delhi: Williams and Wilkins. Renders C.M, Valk G. D, Griffin S. (2001). Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database System Journals. Salmon, P. (1993). Interactions of nurses with elderly patients: relationship to nurses’ attitudes and to formal activity periods. Journal off advanced nursing, 18 (1), 14- 19. Shanley C, Wall S. (2004). Promoting patient autonomy and communication through advance care planning: a challenge for Australian nurses. Australian Journal of Advanced Nursing; 21: 32-38. Shanley C, Whitmore E. (2008). Preparing for end-of-life in residential aged care. Aged Care Research Unit, Liverpool Hospital. Sumner, J., Avery, L., & Beckwith, S. (2009). Handbook in Diabetes Nursing. London: Oxford. Tornval, E. & Wilhelmsson, S. (2008). Nursing documentation for communication and evaluating care. Journal of Clinical Nursing; 17: 16, 2116-2124. Read More