Care of the Elderly - Essay Example

Running Head: Nursing In the Elderly Care of the Elderly Name Institution Date History taking in the old would include collection of information from Mr. James and family members such as his son and daughter in-law about the various symptoms or complains Mr. James has been having in the recent past before his admission. This will include the symptoms of Mr. James having delirium for example the changes in cognition and alertness levels of the patient, any episodes of confusion that might have occurred, or any forms of behavior which might be deviant from the normal behavior of the patient (Cole et al, 2006). In the past medical history of Mr. James will involve collection of information regarding Mr. James’ past history of ailments or diseases that have affected him which in this case would include heart diseases ,fungal infection of the feet, dementia and confusion the patient has been having in the recent past ( Siddiqi et al, 2006). An effort is made to find out how long ago he had the ailments and what interventions were put into place to alleviate the disease condition and if he was admitted to hospital the reason needs to come out clearly as to why the patient was admitted and also what was done from the time of admission till discharge and recovery of the disease condition. There is also need to find out the possibility of the patient ever having under gone any surgical procedure being conducted or any previous histories of ever having blood transfusion is also taken into account (Adamis et al, 2005). The assessment of Mr. James’ social habits will include conducting of an inquiry to find out whether the patient is an alcoholic or a smoker will also be done. For instance in this case the patient is a known smoker and also how the patient relates with other family members (McCusker et al, 2003) .The examinations to be conducted on the patient will involve the carrying out of a specific and a general exam. The specific exam of the patient will focus majorly on the affected system which in this case is the central nervous system where Mr. James will be assessed for the function of the higher centers which include the memory, speech and knowledge (O’Keeffe et al, 2005). He will also be assed for any derangements in his daily behaviour.On examination, a glasco comma scale will also be taken and the level of alertness, verbal responses and the various responses to stimuli being assessed. The cranial nerves will also be examined with the motor and sensory functions also being considered too. The level of confusion will also be established through the use of the confusion assessment method (Inouye SK, 2003). The nutritional status of the patient will also be assessed as this will help in giving an idea of how delirium is having its effect on the patient. An enquiry for the evidence of alcohol or substance abuse or withdrawal will also be made since they could also trigger delirium to occur (Alagiakrishnan et al, 2004). On the other hand the general exam will deal with the other systems which are not affected by the disease processs.In the elderly the examination will be more centered on the cardiovascular system to find out the possibility of Mr. James having hypertension and also cardiomegally due to the heart having worked for many years (McAvay et al, 2006). The skin will also be examined for the presence of bed sores, ulcers and wounds. The eye sight and hearing abilities also need to be assessed since the elderly people tend to have visual and hearing problems respectively. In the musculoskeletal system, Mr. James will be examined for nay deformities or the presence of osteoarthritis which he will be predisposed to developing due to being advanced in age. In the musclosketal system, assesement for muscle bulk, power and tone will also be done (Inouye et al, 2003). Other information to be collected while taking the history of the patient will include the activities of daily living of the patient in order to find out if Mr. James is totally dependent or is independent in the carrying out of his daily activities which include dressing, bathing, and bowel emptying social support and feeding. The information concerning the social support that Mr. James gets either from the son and his daughter in-law or the monetary or financial support that he gets from the social support schemes such as pension as the treatment and management of his condition will require financing of medication and other treatment expenses (Gregorio et al, 2003). Delirium is a geriatric mental disorder and its effects tend to affect the older person as well as the family that is around Mr. James .delirium is a syndrome that normally has an acute onset. Delirium is characterized by the patient having the levels of consciousness being altered. The patient will tend to have the level of orientation, memory as well as thinking and perception. Delirium tends to increase the levels of independence in the patients. Mr. James will also tend to have hallucinations and disturbances of the sleep-wake pattern. There are three clinical subtypes of delirium and they would include hyperactive, hypoactive and the mixed forms of delirium. The patients have disturbances in cognition as well as functional decline in the patient. The functional decline would affect the daily activities of the patients which include dressing ,bathing, bowel and bladder emptying, and the feeding habits of the patient and this will require the family members to be able to give the patient assistance in meeting his daily needs since the patient will be totally dependent (Townsend, 2003). The patients will also tend to not abide to treatment as well as the taking of medication hence this might end up affecting the prognosis of the syndrome. The patient might also have incontinence and this will make the emptying of the bladder to become difficult hence might require catheterization to assist in the emptying of the bladder. The mobility of the patient will also be affected and the patient might get difficulties in the movement from one place to another by himself and hence might require help with mobility. They could also be rendered bed ridden and his could predispose them to be candidates for the development of decubitus ulcers due to the pressure exerted on the skin (Townsend, 2003). Medical management of delirium will include the use of antipsychotics, anticonvulsants, antiemetics and antidepressants which will go ahead to ameliorate a range of symptoms that the patient might be exhibiting. The use of antipsychotics will result in improvement of the cognitive functions of Mr. James (Caplan et al, 2006). Most of the symptoms that the patient will be having will be alleviated by the use of medication. This will involve the use of haloperidol and chlorpromazine. Anticonvulsants will be of use when the patient develops spells of convulsions or becomes aggressive and features of self harm. If Mr. James will be hyperactive, he will managed by the use of anticonvulsants while if he will be hypoactive delirium, this will be managed by the use of the antidepressants (Hazzard et al, 2003). Skin care of the patients who have delirium tend to be bed ridden and this predisposes then to the risk of developing of ulcers as a result of continued pressure being exerted on the skin. This pressure causes the patients to develop decubitus ulcers due to the skin regions under pressure being deprived of blood supply and hence necrosis and ulceration begin to ensure (Kiely et al, 2004). This could be done either physically or mechanically, the physical means will involve the family members who will be to be able to offer help to Mr. James which will involve provision of two hourly turning of the patient to avoid pressure being exerted on the skin for longer durations of time. This could also be done mechanically by the use of the ripple bed which will be automatically be programmed to turn the patient two hourly to avoid the development of the ulcers. The skin care will also involve the examination of the skin for any changes that may occur due to the patient having adverse reactions to the drugs given to him during this period when he is ill (Roche, 2003). The elderly patient with delirium will also tend to exhibit incontinence. They will have tendencies of having problems with the emptying of the bladder. In some cases they could also have independence and would require helping the emptying of the bladder. Most of the delirium patients will be catheterized to help in the management of incontinence. This could involve the insertion of either a intermittent or an indwelling catheter depending on the effect the delirium has on the patient. Mr. James will also undergo pelvic rehabilitation where he would be encouraged to have pelvic muscles exercises to help solve the problem of incontinence (Casarett et al, 2001). The patient should be given assistance in carrying out of the activities of daily leaving which will include bathing, bowel and bladder emptying, dressing and feeding since delirious patients tend to be totally dependent in their functions. This help will be offered by the son or even the in-law or any other person who will be offering care to the patient to ensure that the patient is able to lead a normal, quality and dignified life (Han, 2003). This will go in the long way to creating improvement in the condition of the patient. The patient should also be assisted in mobility from one place to another since most times the delirious patients would be rendered immobile. The patients having delirium will at most times be bed ridden and hence routine two hourly turning of the patient should also be done to minimize the risks of the patient developing decubitus ulcers due to lying in bed for longer periods or duration. This will ensure that pressure is not exerted on the skin for longer periods since it would result in skin ulceration. The provision of oral care to the patient will also be vital to prevent respiratory infections since the oral cavity is the gate way of most of the respiratory infections and to avoid this the patient should therefore be given oral care daily since the patients with delirium will need help concerning the provision of oral care (McCusker et al, 2003). Discharge plan will include the care of Mr. James who has dementia is interdisciplinary and this will involve the family, the hospital staff such as the physiotherapist, nutritionist, pharmacist and a psychologist and also the community as a whole. The discharge plan will include the follow up, professional monitoring and treatment of the patient .the hospital team to be involved will include the pharmacist who will provide the family on advice regarding to medication of the patient to help in the alleviation of the delirium symptoms (Jackson et al, 2004). The nutritionist will offer recommendations regarding the nutrition of the patient and other alternative methods to be used to help the patient to be able to feed and if the patient has difficulty he could be assisted in the feeding since nutrition will play a vital role in terms of the recovery of the patient (Tullman et al, 2008). The physiotherapist who will make necessary recommendations on physical and therapeutic recreation follow up for the patient in order to prevent the formation of contractures and stiffness of the limbs through the enhancement of joint mobility. The follow up of the patient will be done routinely to address the various complains and complications that the patient might develop. The communication to the family of what level of care they are supposed to give to the patient is done before the patient is discharged home. The psychologist will offer counseling to the family members with regards to the progression of the patient and also offering of ways and methods the family members could use to help in the offering of care to the patient (Inouye, 2006). References Cole C. et al., (2006).Assessment and discharge planning for hospitalized older adults with delirium, Medsurg nursing official journal of the Academy of Medical Surgical Nurses. 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Inouye SK. et al., (2003).The role of adherence on the effectiveness of nonpharmacologic interventions,evidence from the delirium prevention trial. Arch Intern Med. Caplan GA. et al., (2006). Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (the REACH-OUT trial),Age Ageing. Hazzard WR. et al., (2003).Principles of geriatric medicine and gerontology,5th ed. New York: McGraw-Hill. Kiely DK.et al., (2004). Characteristics associated with delirium persistence among newly admitted postacute facility patients. J Gerontol A Biol Sci Med Sci. Roche V., (2003) Etiology and management of delirium. Am J Med Sci. Casarett D.et al., (2001).Diagnosis and management of delirium near the end of life. Ann Intern Med 2001. Han L., (2003). An empirical study of different diagnostic criteria for delirium among elderly medical inpatients. J Neuropsychiatry Clin Neurosci. McCusker J. et al., (2003). The course of delirium in older medical inpatients: a prospective study. J Gen Intern Med. Jackson JC. et al., (2004).The association between delirium and cognitive decline: a review of the empirical literature, Neuropsychol Rev. Inouye, S. K. (2006). Delirium in older persons, New England Journal of Medicine, Evidence Level VI: Expert Opinion. Tullman et al., (2008). Delirium: Prevention, Early Recognition, and Treatment,(Eds.) Evidence-Based Geriatric Nursing Protocols for Best Practice (3rd ed.). New York: Springer Publishing Company, Inc. Gil Gregorio P.et al., (2003). Dementia and nutrition: Intervention study in institutionalized patients. The Journal of Nutrition, Health, & Aging. Townsend., (2003). Psychiatric/Mental Health Nursing: Concepts of Care) F.A. Davis Company--the Taber's Publisher.   Read More