There is a tremendous increase in the number of people aged 65 years and above all over the world. Recent study conducted by the world Health organization indicates that this cluster of the world’s general population is growing faster than any other age group (World Health Organization, 2015). Soon the world will be a place for the older persons. It is a positive indication of the achievement made by the health professionals to prolong the life expectancy. However ageing persons usually experience decline in their ability to fulfil daily responsibilities; serious health issues such incontinence, delirium, falls and fractures and Alzheimer’s disease (Marengoni, Winblad, Karp, & Fratiglioni, 2016) .
In this paper, I am going to focus on the need to improve health care services for the ageing populace in line attempt to address their increasing demand for medical care, and also the urgent need to identify programs that can help to improve their ability to survive on their in the community (King, Shames, & Woodhouse, 2016).I will analyze the case of a 68 year old who is a chronic patient and disability, to reveal the stereotypes allied to aging persons, relevant nursing requirements and the care plan appropriate for an ageing patient suffering from incontinence and delirium.
John is 68 years old, his wife died of a stroke three years ago. Their daughter, not yet married, Anne have been taking care of John since then. Anne realized his father felt thirsty often. Since he attained the age of 45 years, John have been going for the periodic diabetes checkup after every four years. He last went for glycated hemoglobin test four years ago.
Lately John have been drinking a lot of water and complained of dry lips at the same time. Anne took a close examination at his father and noticed that from time to time, her father would visit the toilet to pee, John’s condition grew worse when he could eat a big junk of food, which Anne viewed as improved appetite, but continued to lose weight at an alarming rate. As few weeks passed by he complained intensely about fatigue (World Health Organization, 2015). It graduated to poor vision, he could not allocate things that were right before him. There is a day Anne left him in the house, she rushed to the grocery to buy some cereals. When she came back, she found her father complaining that he could not be able to tune to his favorite television station. The writings on both the television remote controller and the guidelines that were popping up on the screen were too small in font size he pointed out. Anne became more worried about his father as he could not perform some of the basic roles by himself. And sometime he used to forget her name and talk to their house help Mary as, if she was her late wife, Petronillah.
At a times he could urinate on himself when he lost his consciousness. Anne took her father to the hospital for a checkup. The doctor conducted A1C test (Kramer, Kramer, & Barrett-Connor, 2016) and a random blood sugar test on John after listening to the narration from Anne about her father’s recent behavior. The laboratory test results indicated that he had hyperglycemia, hyperglycemic hyperosmolar nonketotic syndrome (HHNS). This is because his blood sugar was detected at a level above 610 mg/dl with a fever above 103F (Inzucchi, et al., 2015).
Anne attached the declining functional status of her father to his increased age. She pity her father, pity is a typical response given to the elderly people who face diminished life status (Greer, 2018).It stems from the myth that all seniors are the same as they are falling apart. Even though everyone is happy about the long life expectancy but this phenomena of getting old is not welcomed to all.
Older persons are generally viewed as absent minded and disoriented in their course. This belief is what made Anne not to suspect that his father could be suffering from delirium (Breitbart, et al., 2014). John was more vulnerable to the effects of this negative stereotype on his condition. It is not only the physiology that explains the reduced functional status of John but also psychological and environmental changes. John’s wife death has caused him to feel lonely, lacking the relevant energy needed from him to survive on his own. There is significant increase in occasions when John speaks to himself and moves around the room relentlessly. Sometimes he looks like someone searching for a particular thing then suddenly stops as he gives up on the search. He has been admitted as an inpatient.
Plan of care for John
Care plan is a document containing systematic set of intended actions in regards to nursing interventions. It focuses on how to improve health status of a particular patient by providing guidance on which type of nursing care is more appropriate for the patient (Mayers, 2015). Over the years there have been progressive developments in the nursing care planning. Initially, in the early 1950s, it was argued that care planning did not lie within the nurses’ scope of operations. In the 1980s, there were generally increase in the trend of planning for care to be administered to a particular patient. It mainly focused on the activities performed by the nurse and not the patient (Battersby, 2016). Currently the care plans focus more on the patient’s exclusive needs and goals. They are patient centered and demands for physical assessment of the patients. This is done earlier to developing a comprehensive care plan for the patient (Green, 2017).
A good care plan for John will include physical assessment by the health practitioners. In particular they will evaluate the emotional, psychosocial, mental status and environmental impacts on John. In developing care plan for John I will only use his medication outcomes and diagnosis information. I have analyzed the expected long and short term goals to document nursing interventions that are appropriate for John’s condition. The nursing interventions are well integrated into the care plan (Ballantyne, 2016). The nursing intervention are shouldered on the evidence from John’s health condition. Finally I have also documented the expected outcomes from the nursing intervention, this will help to evaluate if the nursing care plan for John is successful or not (Doenges, Moorhouse, & Murr, 2014).
Objectives of the Care Plan
Care plan focuses on promoting holistic care for the patient. This is made possible by developing an evidence based nursing care. It includes the following parts;
Assessment of the John’s Condition
There is great need to make evidence-based decisions when reconciling a nursing care plan with the general plan for care. The most initial step taken to realize this is by conducting assessment to collect all crucial and relevant information about a particular patient (John). This process helps to collect, organize, examine and document the patient’s information. This helps the health practitioners to establish a file with all the information concerning the patient. Some of the data collected includes: physiological, psychological, sociocultural and functional data. This is according to (Ballantyne, 2016).
To assess John’s condition, there is need of Anne to provide information relating to her father’s past health history. What type of ailments have he suffered from earlier? What type of nursing interventions have been given to him before? These are just but a few facts that need to be established from the medical history of John. Other relevant information may be obtained from appraising current medical methods. There is also need to conduct other health professionals for purposes of validating and interpreting the information (Doenges, Moorhouse, & Murr, 2014).
General appearance of John should be examined to establish his current emotional, behavioral and physical. It can be ascertained that John has difficulty moving around on his own, he has lost hope and energy for his condition. He has dry lips and is also underweight. His eyes are not able to see clearly and he complains of fatigue. (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2016). A complete assessment involves inspection of the dynamic signs with the patient. Common techniques employed in assessment includes: palpation, inspection, observation, auscultation and percussion. They will help with complete assessment of John’s conditions. Data collected at this stage is very crucial for purposes of designing nursing care plan. The data is the ultimate evidence which influence decision making. It also promotes holistic care for the patient.
It entails the process of grouping, analyzing and producing information so as to identify the possible problem which corresponds to the signs and symptoms of the patient. It is usually complex in nature as it requires the health professionals to go beyond the listed symptoms depicted by a patient. Substantive history about the patient’s illness is obtained at the beginning. Previous studies shows that most of the medical diagnosis are based on the patient’ illness history alone. Pathological process usually influences the type and chronological order in which the patient experiences the symptoms (McPhee, Papadakis, & Rabow, 2016).
The nurses and other health practitioners should have sound clinical knowledge and rich expertise. John have been experiencing confusion, memory loss and loss of weight. The health professionals need to reveal the underlying illness. The diagnostic tests to be undertaken are evidence-based and also arrived at through deductions from the known and acceptable standards. Laboratory tests, analyses of the signs and the symptoms and the historical medication information are all examined to determine the specific ailment of the patient (McFarland & McFarlane, 2014).
At this stage the health professionals come up with activities and measures that are patient specific aimed at preventing, reducing or eradicating the specific problem identified during the diagnosis. These activities are determined by the signs and symptoms depicted by the patient, the history of the patient’s medication and the result of the diagnosis. The activities should aim at improving the strengths of the patient to meet the outlined goals. The proposed activities are supposed to improve the health condition of a particular patient. The health practitioners record specific goals or the expected outcomes in the order of priority, they do this together with the patient and the care giver. (Doenges, Moorhouse, & Murr, 2014).
The health professionals handling John’s case should understand to what extent age, comorbidities, and reduced functional status are interrelated. This information helps with the process of coming up with short and long term objectives (Matthews, et al., 2016). Diabetes Mellitus in old age is associated with many prevalent conditions like delirium and incontinence. These conditions are responsible for the reduced functional status and declining health conditions.
Some of the appropriate nursing interventions for John’s scenario at this stage will include providing enough lighting in his room. This is because of his poor vision. For the fatigue the nurses need to help John reduce his bed movements. Due to memory loss experienced by John the nurses and any other care giver will need to re-introduce themselves to John. Explain who they are and what their responsibility entails. Vision of John, his room should well light, with a clock placed close to his bed and a calendar.
There is need for john to engage in regular exercises as it increase the borne mineral content. Other health benefits that originates from exercise includes: regaining and maintaining body weight, increased longevity, low depression and anxiety and reduced risks of osteoporotic fractures. (Reiner, Niermann, Jekauc, & Wol, 2013).
The nurses will need to assess pain from time to time, since it has been established that John is suffering from delirium there is need for the nurses to look for non-verbal signs on his face to determine if he is experiencing pain. Implement appropriate pain management and avoid excessive use of invasive devices like cannula and urinary catheter. The nurses will inspect for infections and apply appropriate infection procedures (Gagnon, 2017). These are the goals that the nurses will be aiming to achieve.
It ensures that the planned nursing interventions are established as per the timelines so that the patient can realize both the short and long term objectives. Each intervention activity is prioritized and given timelines. Particular clinical factors identified and the interventions required are organized into a sheet. The patient, caregiver and team of nurses are supposed to sign against each activity as an indication that the plan is successfully implemented (Ballantyne, 2016).
The team of nurses and other health professionals handling John will carefully select the nursing strategies. They should ensure that the time allocated for training the bladder to hold urine, scheduled toilet trips, double voiding practices and the diet and fluid management measures are successfully implemented (Boustani, et al., 2014). There should be a smooth and consistent communication between the patient, the team of health professionals and the patient. This helps with management of the progress of the patient.
The nurses and other health professionals should collaborate closely at this stage. Clear records of the care administered and the response of the patient to the care should be maintained. These documents are very critical for the evaluation of the success of the care plan (Pun, et al., 2016).The care plan is supposed to be carried out by doing what needs to be done within the time frames. All the nursing interventions are actualized at this stage. The intensity of care will depend largely on the health condition of John. The nurses will monitor his health progress closely to determine if there is a case of emergency.
The expected outcomes, short and long term, need to be measured for the purposes of determining if they have been achieved. The results established will determine whether to continue with the care plan or it should be terminated. It is marked by comparing the collected data against the objectives of the care plan (Griffiths & Hutchings, 2017).In the case of John’s illness. It is expected that the care plan should address: disorientation, fatigue, immobility, weight loss, agitation and disturbance. The care givers and the health professionals should give a positive report on John in relation to these problems. If there is feedback is negative then it is advisable that the care plan to be terminated.
The care above care plan is complete with all the objectives of the nursing intervention objectives. A patient of incontinence and delirium, these are diseases that are common with the ageing population and they are caused by a number of chronic ailments, need to be admitted to this plan of care. It facilitates nursing interventions which are guided by specific evidence from the patient. It provides a good foundation for an all-inclusive care for the patient. The plan gives a room for collaboration among the health professionals, who strive to provide standardized care to the ageing patient. The care given to the patient is documented and measured. This can be used by other health professionals in the future as they develop a different care plan for the patient.
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