Nursing essay: Mr. Manor - gastroenteritis & dehydration.

You are the nurse looking after Mr Keith Manor, an 86 year old male admitted to the Medical ward with gastroenteritis and dehydration. Keith has had a two day history of abdominal cramping and diarrhoea. He also has a one day history of vomiting. He currently has symptoms of watery diarrhoea, a mild temperature of 37.7 degrees Celsius, abdominal pain, headache and mild dehydration. Mr Manor is also complaining of lethargy.

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

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

Activities of Living (AoL's)

The following assignment is based on the case study of Mr. Jones, an 80-year old man admitted in the medical ward due to watery diarrhoea resulting from the infection of Clostridium difficile. His present symptoms include loss of appetite, drastic weight loss, abdominal pain, mild increase in body temperature and lethargy. The assignment will initiate will a detailed focus on the three main activities of living in relation to the case study and how these activities are affected in relation to the disease progression.

The main activities of living that will be discussed in detail in this assignment are eating and drinking, personal cleansing and dressing and elimination. The assignment will then provide a comprehensive and accurate explanation of how the patient will be treated in relation to the AoLs. The second part of the assignment will deal with the comprehensive and accurate description of the three nursing care plan in relation to the case study. The main nursing care plans that will emphasized include loss of appetite, increase chances of getting dehydrated and developed of pressure ulcers. The nursing care plan will be illustrated in a tabular format with elaborate description of gaols, strategies and evaluation against each plan.

2. Activities of Living (AoL’s)

The main AOL’s that can be highlighted in relation to the case study of Mr. Jones include eating and drinking, personal cleansing and dressing and elimination.

Eating and Drinking

Eating and drinking are required to sustain a healthy and normal life. In case of Mr. Jones, the AoL’s, eating and drinking will can be effected because Mr. Jones is 80 years old and lately he is suffering from watery diarrhoea due to Clostridium difficile infection. According to Nicklett and Kadell (2013), with an increase in age, the urge of the consumption of the fresh fruits and vegetable in the diet plan decreases. Moreover, Mr. Jones is suffering from watery diarrhoea accompanied with abdominal pain. Both these factors lead to decrease in the consumption of food. Moreover, frequent vomiting will also decrease his urger for food and water consumption (Volkert, 2013). The people who are above 75 years of age suffer from loss of appetite,

Mr. Jones, who is now 80 is also suffering from loss of appetite and this may be attributable both due to his age and his present Clostridium difficile infection. However, healthy eating and drinking is an important part of healthy aging as it helps to fight against chronic diseases, complex geriatric condition along with improving overall physical health status (Nicklett & Kadell, 2013).

Personal cleansing and dressing

The personal cleansing and dressing mainly covers the basic hygiene needs along with assistance with dressing and undressing and maintenance of the usual hygiene practice (Williams, 2015). The personal cleansing and dressing of Mr. Jones can be hampered keeping into consideration his age. According to Kitson, Muntlin Athlin and Conroy (2014), people who are above the age of 75 suffers from loss of memory along with complications in the motor neurons leading to problem in the hand-eye co-ordination. The loss of the memory leads to unwanted neglect in personal care hygiene. However, since Mr. Jones is at present admitted to the medical ward, the onus of maintenance of personal cleansing and dressing will belong to the nursing professional in charge.

Eating and Drinking

Still then the AoL like cleansing and hygiene can be hampered in case of Mr. Jones because he is suffering from watery diarrhoea and this may lead to frequent discharge of stool while on bed, endangering the basic hygienic requirement. The personal cleansing and hygiene also entails properly cleaned and trimmed nails long with nicely combed hair and regular brushing of teeth (Williams, 2015). However, the case study highlights that Mr. Jones has developed lathery therefore; his self-initiative in brushing his own teeth or washing hands and cleaning nails will less in comparison to other healthy adults.

Elimination

Elimination is comprised of three different components and this includes managing the bladder care, managing the bowel care and getting in and out from toilet. The bladder care mainly compromise catheter care, proper toileting schedule, proper monitoring of the infection and ostomy care (Avgerinakis, Briassouli & Kompatsiaris (2013). Mr. Jones since suffering from water diarrhoea, his toileting needs is required to be addressed on timely manner in order to prevent unwanted discharge of stool in clothes or in bed. The catheter care is also important keeping into consideration of the age of Mr. Jones and his current pathological condition. According to Nicolle (2014), lack of timely replacement of the catheter might lead to the generation of the catheter associated urinary tract infection (CAUTI). CAUTI might further increase the level of septicemia for Mr. Jones as he is already pre-disposed to Clostridium difficile infection.

Bowel management includes tasks like toileting schedule. The toileting might be a complicated issue with Mr. Jones as he is suffering from watery diarrhoea along with abdominal pain due of infection of Clostridium difficile. According to Burke and Lamont (2014), watery diarrhoea resulting out of Clostridium difficile infection causes enlargement of the colon due to bacterial colonization inside the colon and subsequent inflammation. The enlargement of colon leads to frequent discharge of loose stool which is frequently regarded as watery diarrhoea 10 to 15 times a day. Thus proper bowel management will be important.

Toileting means assistance for getting in and out from the toilet like bedpan, commode or urinal. Mr. Jones who is 80 years old is lethargic with mild rise in the body’s temperature and thus he might need full or partial assistance for getting in and out from toilet (Talley et al., 2014).

Nursing care

The nursing care that will be suitable for Mr. Jones will include proper management of the fluid content of the body in order to prevent dehydration. According to Barr and Smith (2014) dehydration is the common complication associated with watery diarrhoea which leads to the development of lathery and this was the case of Mr. Jones. Other nursing care plan will include management of the loss of appetite, proper nutritional planning to prevent drastic weight loss to promote eating and drinking. The role of the nursing professional will be to encourage Mr. Jones to increase the consumption of food at periodic interval while giving focus over the nutritional intake (Vandermolen et al., 2014). In order to improve the AoLs, Mr. Jones will be given assistance in order to maintain normal hygienic requirements like going to toilet, washing hands, brushing teeth and cutting nails.

Personal Cleansing and Dressing

Nursing Assessment

Fluid and Diet Assessment

The nursing care in order to assist healthy eating and drinking will initiate with assessment of the water or the fluid content of the Mr. Jones body. The hydration evaluation will aid in estimating the current fluid need of the body. This can be done with the help of fluid balance chart. The proper nutritional assessment based on body mass index and age will help the nursing professional to ascertain the present nutritional requirement of Mr. Jones.

Pain Assessment

The abdominal pain arising out of diarrhoea might be due to abdominal bloating, ischemic colitis, irritable bowel syndrome or inflammatory bowel disease. Proper abdominal inspection and examination will be help in ascertaining the origin of pain, the level of pain score, the trace of any abdominal distension or abdominal tenderness (Omar & Alexander, 2013). The proper assessment of the pain score along with its origin will help in effective management of the pain score.

Assessment of the vital signs

Keeping the age of Mr. Jones into consideration, along with his mild increase in body temperature (38.5 degree Celsius), the assessment of the vital signs like respiratory rate, oxygen saturation, blood pressure, pulse rate and the level of consciousness are also important. According to Barr and Smith (2014), excretion of water from stool in case of diarrhoea leads to dehydration and fatigue which ultimately leads to decrease in the level of consciousness, decrease in pulse rate and fall in the blood pressure. Along with the assessment of the vital signs, the number of times of the excretion of the dilute urine will also be examined in order to highlight the severity of the disease (Omar & Alexander, 2013)

3. Nursing Care Plan

Issues or Problem	Goals	Strategies	Evaluation of Measures
Decreased level of appetite	1. Increase in the level of patient’s appetite 2. Increase in the level of food consumption 3. Increase in the overall body mass index 4. Motivating the patient to increase consumption of food through mouth	1. Formulation of palatable diet plan under the strict supervision of professional dietician. The diet given to Mr. Jones must be easy to digest while high on the nutritional value (Vandermolen et al., 2014) 2. Explaining the patient why certain food are restricted in his condition and this will help to increase patient’s participation in the current diet plan (Nicklett & Kadell, 2013) 3. Promoting adequate and timely intake of food in an estimated interval along with limiting the fluid intake before one hour of food intake in order to increase the level of appetite (Vandermolen et al., 2014) 4. Reducing the level of sadness, anxiety or depression and elevating the mood condition to promote food intake 5. Following the cyclic diet plan in order to eradicate the monotony of following the same old diet (Ashraf et al., 2013)	Increase in the level of the food intake will be reflected with increase the level of the body mass index. The body mass index both before and after 1 week of intervention implementation will be used to evaluate the success of the strategy (Vandermolen et al., 2014) Patient himself seeking for food and notifying the doctor that he is hungry (Nicklett & Kadell, 2013)
Increase in the risk of developing pressure ulcer	1. Proper assessment of the Glamorgan score in order to detect the severity of developing pressure ulcer. 10+ score (Risk): inspection of skin twice daily 15+ score (High risk): inspection of skin during each repositioning 20+ score (Very High Risk): Hourly inspection of skin (Kottner, Kenzler & Wilborn, 2014) 2. Reduction in the chances of developing or increase in the severity of the pressure ulcer	1. Reduction in the frictional force via lowering the head-side of bed before repositioning, use of slide sheets while moving Mr. Jones and application of skin dressing. According to Sving et al. (2014), reduction in the frictional force leads to decrease in the risk of developing pressure ulcer 2. Reduction in the skin moisture through application of the barrier skin, keeping the skin clean and dry. According to Sving et al. (2014) moisture in the skin increases the risk of developing pressure ulcer. The same logic is also applicable when the skin is extremely dry 3. Investigating other causes of the development of the pressure ulcers like immobility, faecal impaction, side-effects of medication, urinary tract infection, poluyuria arising out of glycosuria or hypercalcemia (Sving et al., 2014) 4. Inspection of the skin during each repositioning in order to identify the indications of the pressure injury like localised heat, blanching response, oedema, skin breakdown and induration (Sving et al., 2014) 5. Maintaining proper diet and fluid balance for securing skin integrity (Sving et al., 2014)	Inspection of the skin based on the score of the Glamorgan scale in order to detect the level of skin integrity and the skins of pressure ulcer. Improvement of the skin integrity will help to highlight decrease in the risk of developing pressure ulcer (Sving et al., 2014)
Risk of developing electrolyte imbalance	1. Increase in the level of patient’s understanding about the cause of dehydration and importance of the measured water intake (Boger et al., 2015) 2. Consumption of 1600 mL of clear fluid per day by the patient in order to retain the fluid balance (Bonder & Dal Bello-Haas, 2017) 3. Self reporting of the patient in the domain of the reduction in the frequency of excretion of dilute urine within one day 4. Educating the patient to verbally inform the level of pain or abdominal cramping arising out of excretion of watery stool (Boger et al., 2015) 5. Reduction in the level of watery stool excretion via decreasing the severity of the bacterial infection from the gastro-intestinal tract.	1. Administration of intravenous fluid in order to maintain the body balance (Godin, Bouchard & Mehta, 2013) 2. Timely administration of the antibiotics and completing the full-course of antibiotic on time with proper observance of the mode and the dosage of administration. This will help to uproot the primary reason behind all the complication (Farthing et al., 2013) 3. Given bed-side education to the patient about disease and its progression along with the treatment process, this will help to increase the level of awareness of the patients about the disease leading self-management of the disease (Boger et al., 2015) 4. Proper education of the patient about the disease prognosis in order to promote timely update about signs and symptoms from the patient only (Boger et al., 2015)	1. The fluid balance of the patient will be accessed based on the parameters of the fluid balance chart. The accurate fluid balance chart will record oral input of fluid, intravenous input of fluid, cumulative input of fluid, followed by urine output, bowel output, vomit output and cumulative output (Godin, Bouchard & Mehta, 2013) 2. The skin turgor integrity will be used to accessed the level of improvement in the fluid balance. Improvement in the skin turgor integrity will reflect improvement in the fluid balance (Godin, Bouchard & Mehta, 2013) Increase in the level of patient’s participation in the care plan will be used to evaluate the increase in the level of patient’s awareness about the disease prognosis (Boger et al., 2015)

4. Conclusion

Thus from the above discussion, it can be concluded that different medical condition affect the AoLs in different ways. The assignment is based on the case study of Mr. Jones, an 80-year old man who is suffering from Clostridium difficile. He is diagnosed with excretion of watery stool, abdominal pain, lethargy, drastic weight loss and loss of appetite. The main AoLs affect include eating and drink, personal cleansing and dressing and elimination. The analysis of three AoLs highlighted that excessive excretion of dilute stool has increase in the level of weakness leading to lack of energy in order to conduct the AoLs.

Moreover, his age and frequent excretion of stool is endangering this personal level of hygiene and dressing. The main nursing care plan in order to assist activities of living will include proper nursing assistance in eating and drink and going to toilet along with framing of the proper diet plan in order to increase in interest towards food intake. The assignment also highlighted the three main pillars of the nursing care plan that will be effective for Mr. Jones increasing the level of appetite, decrease the risk of developing dehydration and pressure ulcers. The implementation of the nursing strategy in order to reduce the main nursing care goals will be associated with proper evaluation strategy in order to highlight the level of success of the care plan.

References

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Avgerinakis, K., Briassouli, A., & Kompatsiaris, I. (2013, July). Recognition of activities of daily living for smart home environments. In Intelligent Environments (IE), 2013 9th International Conference on (pp. 173-180). IEEE.

Barr, W., & Smith, A. (2014). Acute diarrhea. American family physician, 89(3).

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Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance and infection control, 3(1), 23.

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Sving, E., Idvall, E., Högberg, H., & Gunningberg, L. (2014). Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. International journal of nursing studies, 51(5), 717-725.

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