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Instructions: Structure your assignment so that it meets the following requirements:

1. Introduction. Serves as a "map" of the essay, outlining to the reader the key points contained in the body of the work.

2. Discussion of Activities of Living (AoL's) related to the Case Study – Maintaining a Safe Environment, Eating and Drinking, Personal Cleansing and Dressing and Elimination

Choose 3 of the four AoL’s and discuss how they have been altered for Mr Manor.  Your answer must include the following:

An overview of how the three AoL’s may be affected

How you would assess Mr Manor’s in relation to the three identified AoL’s. Include in your answer what care you would provide Mr Manor

3. Nursing Care Plan. Using the Nursing Care Plan provided identify one issue related to each AoL (3 issues in total) that has arisen from the case study. You are required to formulate a plan/goal for improving each issue, identify strategies for meeting each plan/goal and then discuss what evaluative measures will be taken to determine if each plan/ goal was met.

The Roper, Logan and Tierney Model of Nursing and Activities of Living

Nurses have to provide an array of support services to the patients while they are availing the care services. Especially for the aged care sector, the nursing professionals often have to indulge in supportive assistance that even encompasses the activities of living for the patients as well (Ahmed et al., 2018). On a more elaborative note, it has to be mentioned that for the nurses that are practicing in the aged care facility, they have to address to the aged, frail and elderly patients that are suffering with chronic illnesses which often renders them incapable of completing their own activities of living and personal care needs.

Hence, the care providers, the nurses in most cases are associated with providing assessment and care interventions to support and assist the patient in completing the activities of living. The Roper, Logan and Tierney model of nursing that was coined in the year of 1980 which focuses entirely on the activities of living and providing systematic and comprehensive supportive assistance to the patients in achieving the AOLs (Holland, 2008). There are 10 different activities of living that had been listed in the model which each provides guidance for the nursing professionals to be able to provide adequate care. This assignment will utilize the Roper, Logan, and Tierney model of nursing and AoLs to address three disrupted AoLs in the patient from the case study chosen. The essay will discuss the activities of living associated with the case study, how the AoLs were affected, how it will be assessed and what care intervention can be provided to the patient followed by an extensive care of plan for the patient as well.

The case study chosen for the assignment focuses on the patient named Mr. Keith Manor, who is an 86 year old admitted to the medical ward with complaints of gastroenteritis and dehydration. Elaborating more, it has to be mentioned that Keith had also been suffering with two day history of diarrhea and abdominal cramping. His current symptoms are pertaining of watery diarrhea, a mild temperature of 37.7degrees Celsius, abdominal pain, headache and mild dehydration. Along with that, the patient is also suffering with extreme fatigue or lethargy as well. Hence, from the key information that is provided regarding the patient and his present medical condition, it can be stated that a variety of different AoLs of the patient is affected. With the symptoms that Keith is exhibiting the first and foremost AoL, that seems to be affected drastically is eating and drinking.

Disrupted Activities of Living in a Patient Case Study

First and foremost it has to be mentioned that eating and drinking is one of the most fundamental activities of living which everyone has to carry out in order to sustain the Metabolic functions of body (Roper, 2000).  In this case Keith had been suffering from extreme watery diarrhea abdominal cramp and pain headache mild dehydration and extreme fatigue. activities of Living outlines both the norms of the patient as well as any changes that can have occurred due to the current changes in his body function in and condition which are also accessed when the patient has been admitted into the ward.  Abdominal cramps can have a profound impact on the activities of daily living of a patient. It does not only affects the ability of the patient to continue eating and drinking as an activity of living on is on but it also affects the appetite of the patient which can also lead to the activity of living of eating and drinking to be impacted.  according to the authors for aging patients exhaustive health conditions such as diarrhea coupled with abdominal cramps can obliterate appetite and then also affect the ability of the patient to move around on his own or complete activities of living including even eating and drinking which can have a significant impact on the health and wellbeing of the patient (Amjad et al., 2016).  

It has to be mentioned in this context that the case study information also reveals the patient has also been suffering from dehydration, the activity of living of eating and drinking is affected for the patient in this case can also deteriorate his hydration and can exercise with the condition for the patient concession his age and immunity status. On the other hand as discussed by authors extreme dehydration can even lead to fitting consequences for children and extremely aged individuals due to their compromised immunity and innate defense. Hence, the care providers providing assistance support to the patient will have to take into consideration addressing the activity review of eating and drinking too ensure optimal health and wellbeing of the patient and avoid the risk of any severe consequences (Huynh,  Nguyen, Liem & Tran, 2015).

Another very important activity of living which can be potentially affected by the condition that the patient is suffering from is maintaining a safe environment. According to the Roper Logan theory model of nursing care, maintaining a safe environment is the first and most important activity of living which is listed in the model. As discussed by the authors of this model maintaining a safe environment is one of the most important activities that is the only totally independent activity of living, that the patient can often take for granted.  It has been argued that the impact of illness or a disability on a patient can have a deliberating impact on his or her ability to ensures safety and protect themselves from harm (Yoshimura, Uchida, Jeong & Yamaga, 2016). In this case, the patient named Keith Manor had been suffering from extreme diarrhea which had led to severe dehydration for the patient as well. Now dehydration is a very common concern which inversely can lead to fatigue and can enhance the risk of fall as well. Hence, maintaining safe Hence, maintaining safe environment is one of the most important concerns associated with the patient and is a plausible activity of living which is affected of the patient as well.

Assessment, Planning, Implementation, and Evaluation of Care Plan

Lastly, the third activity of living which is pertaining to be affected completely by the presenting health adversities which the patient in the case study, Mr. Keith Manor had been exhibiting is the personal cleansing. It has to be mentioned or acknowledged in this context that the personal cleansing and dressing is an activity of living which is intricately associated with self-care. As illustrated by the Roper, Logan and Tierney model of nursing care, the self-care activities including dressing and washing themselves which is a very important self-care activity to carry on with the daily living for an adult (McClelland, 2004). In this case, due to the extreme diarrhea and dehydration that the patient had been going through also requires multiple visits to the toilet and will require him to wash and dress himself considerable amount of times. Due to the fatigue and dehydration, the inability of the patient not being able to wash and dress himself on his own will also affect the emotional and psychological health of the patient due to the dependency and struggle. Hence, this is a very important activity of living which needs to be addressed adequately for the patient in this case study as well.

Considering the care that will be provided to the patient in the case study, the aid of fluid therapy, fall risk management and self-care assistance can be considered. On a more elaborative note, it has to be taken into account that the first and most basic or important activity of living which had been identified for Mr. Keith had been eating and drinking which had been jeopardized in the case of the patent in the case study as well. This particular jeopardized activity of living can also be considered as the contributing factor leading to the sequence of events facilitating the dehydration in the patient and the resultant lethargy and fatigue. Considering the present condition of the patient, the most plausible care approach for him will involve fluid therapy, a balanced solution of necessary electrolytes to the help the restore the electrolyte balance in his body and retrieve the state of homeostasis so that Keith can regain his strength and start recovering fast. However, in this case, Keith is a very elderly man and the impact of his age and physically frail condition has to be minded while deciding on the electrolyte solution for the patient as well. On the other hand oral repletion of the fluids is also needed to be considered in this context as well. As mentioned by the Picetti et al. (2017), oral repletion of the fluids is preferred under all circumstances, although this type of intervention strategy is only effective in case of absence of severe symptoms. In case the patient is acutely dehydrated and is exhibiting extremely low concentration of mandatory nutrients, the only plausible rehydration strategy that can be employed is the intravenous fluid therapy. For the maintaining safe environment for Keith will require the addition of fall risk assessment. On a more elaborative note, the patient is fatigued and dehydrated along with being frail due to his age and his diarrhea. Hence, the risk of fall for him is crucial and hence the risk assessment is a very important intervention for him. Along with that, the care interventions in this case will also include modifying the physical environment of the patient taking into consideration the safety requirements that the patient will require (Oates & Price, 2017). Lastly, for cleansing and dressing, the care strategy that I will be incorporating will be supportive assistance by either myself or a community care nurse.

Conclusion

Assess

Plan

Implement

Evaluate

Factual data:

For the patient a few assessment data that will be needed to be gathered for Keith includes his medical history, medicine list, and known allergen or hypersensitivity.

For the first activity of living, the assessment will include vital signs, total blood count test and hydration assessment so that the exact nutritional state of the patient can be taken into consideration (Bail & Grealish, 2016).

The patient will also need a thorough pain assessment as well as he had been complaining of abdominal cramps when he had been admitted to the facility.

Based on the assessment data including the hydration data and nutritional status assessment, the patient will be either provided oral repletion or intravenous mode of fluid therapy (Forbat, Kunicki, Chapman & Lovell, 2017).

The patient will also be given the aid of hydration bundle considering his age and clinical condition.

The implementation section of the APIE care plan method emphasizes on the documentation that will be carried out by the nursing professional during implementing the care plan made for the patient (Johnson, Waldreus, Hahn, Stenström & Sjöstrand, 2015).

For the first activity of living, the nurse will need to document the bolus and infusion rates in case of intravenous fluid repletion (Forbat, Kunicki, Chapman & Lovell, 2017).

In case the patient is able to take oral fluid repletion method, the exact status of administration will need to be adequately documented as per the standard protocol.

Lastly, the vital signs of the patient will also be monitored frequently and periodically.

Considering the evaluation of care, the care outcome indicators will need to be assessed and evaluated.

The patient in this case after the fluid repletion therapy exhibited improvement in the vital signs (Forbat, Kunicki, Chapman & Lovell, 2017).

He seemed visibly better with much lesser abdominal pain, fatigue or lethargy.

He appeared capable of moving on his own with slight supportive assistance (Johnson, Waldreus, Hahn, Stenström & Sjöstrand, 2015).

For the maintaining safe environment, the first and foremost assessment that nurse will carry out if the fall risk assessment using a fall prevention check list. The patient Mr Keith Manor will also be enquired regarding his exact care needs with respect to maintaining safety environment (DuPree, Fritz-Campiz & Musheno, 2014)

In this case the care plan will focus entirely on improving the safety environment of the patient (Phelan, Mahoney, Voit & Stevens, 2015).

His bed rails will be raised and the call light will be placed within his reach to reduce risk of fall.

The physical environment of the room will be de-cluttered and brightened to reduce the risk of falls (Sherrington et al., 2017).

Lastly he will be provided with non-skid footwear and walking support if required to reduce the risk of falling further.

In this case, the documentation will involve the data collected by the fall risk assessment which also will need to be carried out periodically to assure minimal risk of falling (Phelan, Mahoney, Voit & Stevens, 2015).

The patient preferences and needs will also need to be documented for future preferences.

A thorough handover note preparation will need to be carried out for the patient effectively as well (Bergen, 2016).

The patient avoided any risk of fall and safety and security appeared unaffected throughout his stay in the facility.

The patient verbalized being comfortable and content during his stay.

For the last activity of living, which is the personal cleansing and dressing which is a very crucial AoL. The inability to perform this particular activity of living can have a significant imp[act on the behaviour and emotional stability of the patient. Hence in this case, the assessment carried out by the nurse will need to be psychosocial, where the nurse will need to take a compassionate and empathetic approach enquiring the patient the nature of supportive assistance he will be requiring all the while providing a sense of respect and empowerment to his dignity (Rodríguez?Martín, Stolt, Katajisto & Suhonen, 2016).  

Lastly, the care planning for personal cleansing and dressing will be focussed on communicating and partnering with the patient in care.

The patient preferences will be prioritized considering the extent of supportive assistance that will be provided to him (Kogan, Wilber & Mosqueda, 2016).

He will be provided with the option of being cared by his family or take the assistance of the care staff.

Care will be taken to ensure encouraging and safeguarding the dignity and enhancing his sense of empowerment while providing care.  

In this case, the need for documentation is minimal.

Although, a self-care needs assessment documentation can be carried out for the patient in the case study as well to enhance the patient centeredness of the care (Mlinac & Feng, 2016).

The patient was provided supportive assistance while maintaining his dignity and prioritizing his preferences.

He verbalized contentment with the supportive assistance and collaborated with the care provider.

Conclusion: 

On a concluding note, the impact of the aging process and the exhaustion from illness can also contribute to the inability of completing the activities of living. Either ways, the inability has a deliberating impact on the health and wellbeing of the patients as well. This assignment illustrated how the activities of living are affected by the disease process and the aging of the patient taking the assistance of the Roper Logan and Tierney model of care. This assignment gave me the opportunity to understand how to employ this model of nursing care while planning care for an elderly patient suffering from a disease condition which can affect the ability of the patient to carry out the activities of living. It also helped me employ the APIE care plan model to plan a model of care that addressed each of the three affected activity of living for the patient. It can be hoped that the knowledge and expertise gained from this experience will help me immensely in addressing the individual care needs of the patients and develop care plans myself in my future practice.

References:

Ahmed, M., Weddih, A., Benhafid, M., Bollahi, M., Sidatt, M., Makhalla, K., ... & Filali-Maltouf, A. (2018). Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0–5 Years in a Referral Hospital of Mauritania. Tropical medicine and infectious disease, 3(3), 103. Doi: 10.3390/tropicalmed3030103

Amjad, H., Roth, D. L., Samus, Q. M., Yasar, S., & Wolff, J. L. (2016). Potentially unsafe activities and living conditions of older adults with dementia. Journal of the American Geriatrics Society, 64(6), 1223-1232. Doi: 10.1111/jgs.14164

Bail, K., & Grealish, L. (2016). ‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. International journal of nursing studies, 63, 146-161. Doi: 10.1016/j.ijnurstu.2016.08.001

Bergen, G. (2016). Falls and fall injuries among adults aged≥ 65 years—United States, 2014. MMWR. Morbidity and mortality weekly report, 65. Doi: 10.15585/mmwr.mm6537a2.

DuPree, E., Fritz-Campiz, A., & Musheno, D. (2014). A new approach to preventing falls with injuries. Journal of nursing care quality, 29(2), 99-102. doi: 10.1097/NCQ.0000000000000050

Forbat, L., Kunicki, N., Chapman, M., & Lovell, C. (2017). How and why are subcutaneous fluids administered in an advanced illness population: a systematic review. Journal of clinical nursing, 26(9-10), 1204-1216. Doi: 10.1111/jocn.13683

Gibney, J., Wright, C., Sharma, A., & Naganathan, V. (2015). Nurses’ knowledge, attitudes, and current practice of daily oral hygiene care to patients on acute aged care wards in two Australian hospitals. Special Care in Dentistry, 35(6), 285-293. Doi: 10.1111/scd.12131

Holland, K. (Ed.). (2008). Applying the Roper-Logan-Tierney model in practice. Elsevier Health Sciences.

Huynh, Q. T., Nguyen, U. D., Liem, K. T., & Tran, B. Q. (2015). Detection of activities daily living and falls using combination accelerometer and gyroscope. In 5th International Conference on Biomedical Engineering in Vietnam (pp. 184-189). Springer, Cham. Doi: 10.1007/978-3-319-11776-8_45

Johnson, P., Waldreus, N., Hahn, R. G., Stenström, H., & Sjöstrand, F. (2015). Fluid retention index predicts the 30-day mortality in geriatric care. Scandinavian journal of clinical and laboratory investigation, 75(6), 444-451. Doi: 10.3109/00365513.2015.1039057

Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person?centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1-e7. Doi: 10.1111/jgs.13873

McClelland, H. M. (2004). Applying the Roper, Logan, Tierney model in practice. Accident and Emergency Nursing, 12(3), 189. doi: 10.1016/j.aaen.2004.02.002

Mlinac, M. E., & Feng, M. C. (2016). Assessment of activities of daily living, self-care, and independence. Archives of Clinical Neuropsychology, 31(6), 506-516. Doi: 10.1093/arclin/acw049

Oates, L. L., & Price, C. I. (2017). Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review. BMC nursing, 16(1), 4. Doi: 10.1186/s12912-016-0195-x

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics, 99(2), 281-293. DOI: https://doi.org/10.1016/j.mcna.2014.11.004

Picetti, D., Foster, S., Pangle, A. K., Schrader, A., George, M., Wei, J. Y., & Azhar, G. (2017). Hydration health literacy in the elderly. Nutrition and healthy aging, (Preprint), 1-11. doi:  10.3233/NHA-170026

Rodríguez?Martín, B., Stolt, M., Katajisto, J., & Suhonen, R. (2016). Nurses' characteristics and organisational factors associated with their assessments of individualised care in care institutions for older people. Scandinavian journal of caring sciences, 30(2), 250-259. Doi: 10.1111/scs.12235

Roper, N. (2000). The Roper-Logan-Tierney model of nursing: based on activities of living. Edinburgh: Churchill Livingstone.

Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., ... & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med, 51(24), 1750-1758. Doi: 10.1136/bjsports-2016-096547

Yoshimura, Y., Uchida, K., Jeong, S., & Yamaga, M. (2016). Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial. The journal of nutrition, health & aging, 20(2), 185-191. Doi: 10.1007/s12603-015-0570-4

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