Nursing Care Issues And Priorities For An Elderly Client - Mrs. Barbara (Essay).

Age-related changes in patient (Not modifiable)

It is very important to add life to the years of elderly rather than merely adding years to their life. The nursing plays a very important role in promoting wellness in older adults. The care of a nurse goes beyond physiological parameters, to the surrounding environment of the elderly and how it affects the person as a whole i.e. his body, mind and spirit (Hunter, 2012).

A nurse should have the ability of clinical reasoning which is more than mere clinical judgement and is, “the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process” (Levett- Jones et al, 2010, Pg 516).

The purpose of this essay is to identify and prioritise the most important nursing care issues for a client named Mrs Barbara. The essay will use two theoretical nursing frameworks: Levett- Jones Clinical Reasoning Model and Miller’s Functional Consequences Theory; to identify three nursing priorities and provide a comprehensive and effective nursing care plan.

This is an 89 year old woman – Mrs Barbara. She faces difficulty in performing routine activities and has become isolated in her house due to altered mobility and altered vision. She has a history of Dry macular degeneration and thereby has developed vision deficit. Due to this reason she is unable to drive and go out and thus, has become socially isolated. She also has a history of rheumatoid arthritis and osteoarthritis and thus, suffering from painful joints, joint stiffness, swollen feet and enlarged joints and limited joint movement. This has further resulted in altered mobility and difficulty in performing routine activities. Also she is losing weight due to improper diet.

Mrs Barbara has a son and a daughter; who live separately but keep a contact with her regularly. Mrs Barbara does not want to be a burden on her children and wants to stay in her own house in order to maintain her self-esteem. In order to do this, she needs help from a registered nurse who can take proper care of her in her home.

Age- related changes in patient (Not modifiable)

The age- related changes experienced by Mrs Barbara include vision deficit, occasional dizziness, joint stiffness, altered mobility and limited joint movement. These changes have affected quality of life and well-being of Mrs. Barbara. There are age- associated changes in the systems contributing to altered vision and mobility; which have implications on psychosocial aspects of life and well-being (Hanson et al., 2016). These age-related changes are inevitable, and a nurse must also look for risk- factors which may have negative functional consequences (Hunter, 2012). Age-related changes in Mrs Barbara are not limited to these physiological aspects; but also include increased wisdom, and increased emotional and spiritual development (ibid). From a body-mind-spirit perspective, a nurse can build on these aspects of Mrs Barbara to help her cope with physiological decline (ibid).

Multidimensional functional assessment is an important part of the care of the elderly

Mrs Barbara is living alone in her house and has lost contact with her friends and thus has become isolated; which is a risk factor (Perissinotto, Stijacic, & Covinsky, 2012). Another risk factor is her inability to maintain proper diet (Jankovic, 2014). She has minimal amount of food in her home and that too processed food items. Due to her limited mobility, she may not be able to bring fresh food for herself including fruits and vegetables; which is a major risk factor (ibid). These risk factors can be modified or eliminated towards achieving well-being and quality of life for Mrs Barbara (Hunter, 2012). There is a need to address these risk factors through health promotion interventions (ibid).

Multidimensional functional assessment is an important part of the care of the elderly (Hunter, 2012).

Increased age, being female, physical disability and social isolation may lead to onset of depression in Mrs. Barbara (Bekhet & Zauszniewski, 2012).

Mrs Barbara is taking Non-steroidal anti-inflammatory drugs (NSAIDS) and also not eating proper meals; which are risk factors for Constipation (Costilla & Foxx-Orenstein, 2014). Mrs Barbara is already suffering from constipation which may worsen further if these risk factors continue.

Interventions in the form of health promotion, disability limitation, rehabilitation and environmental modification; are required to address these negative functional consequences in Mrs Barbara (Hunter, 2012).

Impaired mobility and altered vision – Social isolation – Improper diet – constipation and weight loss – Decline in health and well-being

Impaired mobility and vision – Difficulty in performing routine activities – Improper diet – Constipation and Weight Loss – Decline in health and well-being

Rheumatoid Arthritis and Osteoarthritis – Medications (NSAIDS) – Constipation

Age- related impairments in mobility and vision has restricted Mrs Barbara to her house and thus made her socially isolated. This social isolation along with inability to perform routine activities has deprived her of nutritious and balanced diet. Also she is taking medications which have led to development of constipation. Thus her health and well-being is declining abnormally due to certain age-related changes and risk factors which need to be addressed urgently.

After collecting cues from physical and social environment of Mrs Barbara and processing that information; following 3 main nursing issues have been identified.

1. Chronic Physical disability
2. Social isolation
3. Improper diet

Mrs Barbara’s medical history includes Dry Macular Degeneration, Hypothyroidism, Rheumatoid Arthritis and Osteoarthritis. These medical conditions along with age-related changes have led to chronic physical disability in Mrs Barbara. It is very imperative to take steps towards disability limitation and rehabilitation to prevent any further negative functional consequences (Nelson, Allen, Golightly, Goode, & Jordan, 2014).

Identified nursing care issues and priorities

Mrs Barbara being socially isolated has high risk of morbidities such as infections (Arranz, Gimenez-Llort, De Castro, Baeza, & De la Fuente, 2009); depression (Bekhet & Zauszniewski, 2012); cognitive impairment (Boss, Kang, & Branson, 2015) and other deleterious effects on health and well-being (Perissinotto, Stijacic, & Covinsky, 2012). Social participation and social integration provide social support which is very important for productive and healthy ageing (Steptoe, Shankar, Demakakos, & Wardle, 2013). Thus it is very important to address the issue of social isolation in Mrs Barbara to prevent its potential emotional and psychological damage (ibid).

In old age, many factors contribute to poor diet and thus malnutrition. For example, the ability to prepare nutritious food or functional ability is impaired, along with the availability of dietary assistance (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). An appropriate meal environment such as company and food presentation is also required for the uptake of an adequate diet (Berge et al., 2014). A poor diet in older age could lead to metabolic abnormalities and lowered immunity which could further complicate the age-related functional limitations in the elderly. Thus it becomes imperative that Mrs Barbara start taking appropriate diet in consultation with a dietician.

The following goals will be set-up in consultation with Mrs Barbara:

1. Mrs Barbara will start taking appropriate diet from today in consultation with a dietician.
2. Mrs Barbara will start participating in group activities in her community from next week.
3. Mrs Barbara will start doing her daily activities from next month.
4. Mrs Barbara will gain weight within two months.
5. Mrs Barbara will feel happy and contented from next month.

The following action plan will be worked in consultation with Mrs Barbara; by taking leverage from her wisdom and “everyday- problem- solving” skills (Hunter, 2012).

There is a need to refer Mrs Barbara to General Practitioner for regular follow-ups regarding her medical ailments.

There is a need to provide rehabilitative aiids to Mrs Barbara for her altered vision and altered mobility. The rehabilitative aiids will assist Mrs Barbara in performing her daily activities. The General Practitioner will be consulted regarding appropriate aiids according to medical conditions of Mrs Barbara.

There is a need to take the help of a physiotherapist to assist Mrs Barbara in some daily exercises and help tackle the problem of impaired mobility.

There is a need to help Mrs Barbara to participate in some group activities like discussions, telephone support services, community senior support services, provision of internet and electronic mail access (Liu, Gou, & Zuo, 2014).

There is also a need to consult dietician to prepare diet chart for Mrs Barbara, keeping in mind her medical ailments.

A cook is required to facilitate cooking and thus healthy eating in the routine of Mrs Barbara.

Giving her company during meals is also very important for healthy eating (Berge et al., 2014).

Goals and action plan for nursing care

The negative functional consequences have been accumulated to the extent that Mrs Barbara urgently needs a care-giver to support her for daily needs (Hunter, 2012). A care taker is required to facilitate Mrs Barbara in her daily activities and to bring fruits, vegetables and other items from market.

Proper monitoring of BP, Pulse, Weight, and Hb.

Periodical diagnostic tests as recommended by GP to monitor her medical conditions. For example, periodical Thyroid profile for management of Hypothyroidism.

Mrs Barbara do not feel pain.

Mrs Barbara is able to connect socially to the outer world.

Mrs Barbara is eating regular and nutritious meals.

Mrs Barbara is able to perform her daily activities.

Mrs Barbara feels happy and contented and smiles often.

Mrs Barbara talks happily and laughs often.

I have learned that age- related changes in old age may limit mobility of patient which has severe consequences for her social and emotional well-being which further aggravate their age-related changes to risk factors and thus the viscious cycle continues. It is very important for a nurse to provide social and emotional support to the elderly patients in order to break this viscious cycle. Social isolation is very critical in elderly and the nurse should take care of this aspect of a patient while providing her nursing care. A nurse should aim towards complete physical, mental, social and spiritual well-being of her client.

Conclusion

Nursing care should be a holistic approach, considering patient as a whole, taking into account her physical and social environment. A nurse should be able to collect social cues along with clinical cues. While making a plan of action, nurse should also be able to address emotional, psychological and social needs of a patient along with proper management of her clinical needs. Nursing an elderly patient is often a team work which may also require the help of a dietician, physiotherapist and a care-taker. Thus nursing care is as much a social and emotional process, as a clinical/ medical one.

References

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