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Assessment for Daily Activities of Living and services that would be required

1.Examine what determined Greta’s Current Health Condition?

2.Explain how those medications improve Greta’s current health situation and how they will help to reduce future health issues.

3.Why is Greta potentially vulnerable to elder abuse?

Determinants of health are the social and economic factors that influence the health status of an individual. These factors might be promoting health or leading to deterioration of health, depending on the case (Marmot and Allen 2014). The present paper highlights the determinants of health pertaining to the case study of Greta Balodis, a 75 year old widow who has currently suffered cerebrovascular accident (CVA) and has been discharged home after treatment at a health care unit. The first section of the paper highlights how observation and communication skills would be used for assessing the patient’s activities of daily living, and the services that can be helpful in managing her condition. The second section of the paper would discuss the determinants of health contributing to the cerebrovascular accident, or stroke suffered by the patient. Thereafter, the pathophysiology behind the health conditions that the medications given to Greta targets is highlighted along with the way the medications work. The following section addresses why Greta is at risk of elder abuse. Lastly, the responsibilities of a nurse towards Greta are brought into focus. The paper ends with a summary of the complete discussion.

Activities of daily living (ADLs) are the series of fundamental daily activities carried out by individuals for independent living in the community or at home. Measurement of the ability of an individual to carry out the ADLs is crucial for determining the degree of assistance needed by the client, and it is also important a metric for a range of programs and services required for providing assistance (Tabloski 2013). As a nurse visiting Greta for the first time at her home, it is essential to gain objective and subjective data about her ability to carry out ADLs. A combined interview and observation approach would be beneficial in here. The patient is to be asked about the difficulty with the functional tasks. The patient’s general appearance is to be observed as it reflects the ability of the patient to perform an essential activities like dressing, bathing, feeding. The patient’s strength, spinal flexion, coordination, manual dexterity and balance are to be evaluated. Greta can be asked to demonstrate the body motions that are involved in performing the tasks. The patient is to be observed ambulating. Determination of how much assistance the patient needs for performing the activities safely is also necessary. Changes in self-care skills and behaviour are also important. A strong bond is to be created with the patient so as to foster effective communication with her. Respect and empathy are to be shown so that Greta can trust the nurse and share her concerns (Dunlay et al. 2015). For the interview, a suitable assessment tool is to be utilised, such as the Katz Index of Independence in Activities of Daily Living. According to Arik et al. (2015), the tool has wide utility in the evaluation of the functional status of the elderly population. It is known to be a flag that signals functional capabilities of older patients in home environments. Greta would be requiring support from services that would help her in managing herself safely at home. It would be advisable that Greta seeks help from a home care service provider that assists with planned care plan encompassing bathing and dressing assistance, meal preparation, diet monitoring, medication reminders, joyful companionship, and light housekeeping (Eliopoulos 2013).

Determinants of health

1.Determinants of health

Conditions under which individuals live, work and spend leisure time affect a diverse range of health outcomes and risks. These conditions come to be known as the determinants of health (Pacquiaon 2016). In the present case, Greta has suffered a cerebrovascular accident, commonly known as stroke. It is likely that social support as a determinant of health has contributed significantly to her condition. Social support is the actuality that an individual is provided care and assistance from a social network. The support can be in the form of tangible, emotional, informational and companionship (Northcott et al. 2016). According to Simning et al. (2016), an individual devoid of social support has increased chances of suffering a cardiovascular complication. Greta has been living alone at a considerable old age of 75 years. The main reason for her to suffer a stroke is stress, a result of leading a life in isolation. Solitude can be a reason for high blood pressure and subsequently poor cardiovascular health. In times of stress, emotional support from a near one helps in the reduction of psychological distress, and can function as a coping strategy. Absence of social support leads to a number of conditions including stroke.

Greta has been discharged home with prescribed medicines after she had suffered a cerebrovascular accident. The medicines include Aspirin PO 100mg daily, Clopidogrel PO 75mg daily, Digoxin 125mcg PO daily. Cerebrovascular accident, or stroke, is the condition wherein there is a sudden interruption of blood supply to the brain that precipitates neurologic dysfunction for more than 24 hours. There are two major forms of stroke; ischemic when there is a blockage or blood clot-reducing the blood flow, and hemorrhagic, when bleeding in the brain is responsible for triggering a response restricting blood supply in any other part of the body (Rao et al. 2016). Greta is presented with high chances of suffering cerebrovascular accident again. The purpose of the medication is to prevent her conditioning from worsening. Aspirin is the medication used for preventing a heart attack by interfering with the clotting action of the blood. Blood clotting can take place within the blood vessels, thereby narrowing the vessels and blocking the artery, ultimately leading to prevention of blood flow and heart attack. Aspirin is used for reducing the clumping action of platelets, the blood clotting cells. Clopidogrel is the medication used in case of patients who have already suffered a stroke. The medicine is a platelet aggregation inhibitor and slows down the sticking of platelets to blood vessel walls. Digoxin is used for maintaining strong heart beat and regular heart rhythm (Lilley, Collins and Snyder 2014).

Coming to the psychosocial factors that put Greta at increased risk of poor well-being, it can be noted that Greta is at high risk of suffering elder abuse. Elder abuse refers to the act of abusing or harming or attempting to harm an older individual. In families where there are incidents of substance abuse, violence, and where the individuals face psychosocial imbalance, the adult members are placed at high risk for suffering abuse. The relationship between the family members serves as a crucial point for determining the extent of healthy behaviour with the elderly member. Abuse is also profound in cases where the individual is found to be cut off from the outside world, leaving little or no scope for reporting the abuse. For patients with disability or poor health status, the chances of suffering abuse are also more (Lachs and Pillemer 2015). Coming to the present scenario, Greta is at high risk of suffering abuse due to a number of factors. Firstly, her family suffers from psychosocial and psychological complexities. The relation between the family members might not be stable and positive. In addition, the relationship between her daughter and her son-in-law is not good, and this increases the chances of a poor impact on Greta. The most significant risk factor for abuse is the drug and alcohol use of her son-in-law and grandson. Potential harm might be caused if they both are not in a controllable state. Lastly, Greta has suffered a fall, and her condition is deteriorating. She also has dementia and had suffered a stroke earlier. The poor health condition reduces her ability to resist abuse.

Pathophysiology of disease and how medications improve Greta’s condition

Responsibility of nurse

The responsibilities of the nurse as a healthcare professional providing individualistic care to Greta is pivotal to be discussed. The nurse needs to contribute in aiding the patient by providing care centred on social, emotional, physical and mental welfare. A healthful environment is to be created for Greta. She needs to be assisted with the basic activities of independence. Emotional support and encouragement are to be given in the form of companionship and counselling. It is crucial in this regard that an ethical nursing practice is carried out by considering non-maleficence, beneficence and respect for the autonomy of the patient. The nurse has to put the focus of the comprehensive care approach on human dignity, the relationship between nurse and patient and collaborative care (Eliopoulos 2013).  According to the code of conduct for nurses, they are to practice in safe and competent manner. They are to respect the dignity of the patients. In addition, they need to promote the privilege and trust embedded in the relationship between the patient and the nurse (nursingmidwiferyboard.gov.au 2017). As per the code of ethics for nurses, they are to respect others and value quality of nursing care. They also need to value a socially sustainable environment that can promote well-being and health of an individual (waubrafoundation.org.au 2015).

Conclusion

The presented case study demonstrates the impact of social determinants of health on health outcomes of an elderly patient. By studying the key points of the case, a deep-insight is gained pertaining to why determinants of health are to be addressed for achieving better patient outcomes. It is the responsibility of the nurse to deliver a comprehensive, competent and ethical care to the patient. It can be expected that addressing the health determinants the patient would be provided with the required care and support.

References

Arik, G., Varan, H.D., Yavuz, B.B., Karabulut, E., Kara, O., Kilic, M.K., Kizilarslanoglu, M.C., Sumer, F., Kuyumcu, M.E., Yesil, Y. and Halil, M., 2015. Validation of Katz index of independence in activities of daily living in Turkish older adults. Archives of gerontology and geriatrics, 61(3), pp.344-350.

Code of Ethics for Nurses in Australia. (2015). waubrafoundation.org.au. Retrieved 14 June 2017, from https://waubrafoundation.org.au/resources/code-ethics-for-nurses-australia/

Dunlay, S.M., Manemann, S.M., Chamberlain, A.M., Cheville, A.L., Jiang, R., Weston, S.A. and Roger, V.L., 2015. Activities of daily living and outcomes in heart failure. Circulation: Heart Failure, pp.CIRCHEARTFAILURE-114.

Eliopoulos, C., 2013. Gerontological nursing. Lippincott Williams & Wilkins.

Lachs, M.S. and Pillemer, K.A., 2015. Elder abuse. New England Journal of Medicine, 373(20), pp.1947-1956.

Lilley, L.L., Collins, S.R. and Snyder, J.S., 2014. Pharmacology and the nursing process. Elsevier Health Sciences.

Marmot, M. and Allen, J.J., 2014. Social determinants of health equity.

Northcott, S., Moss, B., Harrison, K. and Hilari, K., 2016. A systematic review of the impact of stroke on social support and social networks: associated factors and patterns of change. Clinical rehabilitation, 30(8), pp.811-831.

Nursing and Midwifery Board of Australia - Professional standards. (2017). Nursingmidwiferyboard.gov.au. Retrieved 14 June 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Pacquiao, D.F., 2016. Social Determinants of Health. Global Healthcare: Issues and Policies, p.159.

Rao, A., Suliman, A., Story, G., Vuik, S., Aylin, P. and Darzi, A., 2016. Meta?analysis of population?based studies comparing risk of cerebrovascular accident associated with first?and second?generation antipsychotic prescribing in dementia. International journal of methods in psychiatric research, 25(4), pp.289-298.

Simning, A., Seplaki, C.L. and Conwell, Y., 2016. Variation by Social Support in the Risk for Depression Following a Heart Attack or Stroke: Preliminary Findings From the National Health and Aging Trends Study. The American Journal of Geriatric Psychiatry, 24(3), p.S103.

Tabloski, P.A., 2013. Gerontological nursing. Pearson Higher Ed.

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