Nursing Care Practice - Free Paper Sample

Introduction

Caring for the old is critical since there are many conditions associated with old age. Special care is needed when looking after the old, whether in homes or care facilities (Malara et al., 2016). The paper will analyze a patient with dementia case, identify health risks for the patient, and discuss the possible nursing interventions. Part B will evaluate how the interventions are appropriate.

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The patient’s name is PQR. She is 96 years old and is a resident of Good Shepherd Nursing home. She was admitted on 24th July 2020 and discharged on 3rd August 2020. Her condition at the time of discharge was good. She has dementia and other health conditions.

Cognitive Impairment

Dementia is mainly associated with memory loss (Höbler et al., 2018). PQR need critical care since she has a fall history that dates back from 2019.As a result of the frequent falls, her right side hip was fractured. She has low oral intake and that led to NG feeding being recommended after the family was consulted. She was first given Glucerna 250 ml and 100 ml of water. The condition should be controlled before developing other health conditions like difficulty in communication and poor judgment which is associated with dementia. The disease also is positively related to heart diseases.

Health Conditions

PQR has other existing conditions that she had been on medication. The main reason for her admission was Atrial Fibrillation. She has severe Peripheral vascular disease (PVD), and the condition was discovered due to her feet being cold below the knees. Due to PVD, she has gangrenous toes. Amputation was suggested as the best treatment option available due to her age. She also has diabetes mellitus and has lost her sense of hearing.

Medications

She is currently using medications for the treatment of the symptoms and the existing conditions. She is on cephalexin 500mg, which is used to treat infections. IV Rocephin was also prescribed due to the wound. She is using Metronidazole powder on the toes. The medication that is being used for AF is Bisoprolol. She is also on Prednisolone after she developed an acute respiratory wheeze.

Risk Assessment

Patients with dementia have a risk of getting other medical conditions. Some of the health risks include vision impairment, falls, and incontinence. Vision impairment is common with dementia patients since the disease affect the brain and fails to get the visual information that is coming from the eyes (Höbler et al., 2018). Early signs of vision impairment include seeing only a short distance and failing to recognize people.

The patient has a risk of having frequent falls. The problem is caused by lack of stability, which develops as cognition challenges advances. Most of the time, the patient will prioritize the task they are doing instead of maintaining stability (Whitlock et al., 2017). Falls can lead to other problems like spinal code injury.

The patient is at risk of having incontinence. Incontinence is more common as dementia advances on the patient. Sometimes, it might be due to a cognition problem. The patient is unable to sense when she needs to visit the washroom. In other cases, there are underlying conditions that can be treated, such as urinary tract infection.

Risk Assessment Tool

Since the patient has an advanced age, visual impairment is common, and the tool to be used for her assessment is not the same as those in schools or workplaces. A chart with colors, symbols or letters can be placed at a distance to test her eyes' ability. If she fails to see, the chart can be brought closer up to a point she will see with ease.

A seven-factor screening tool can be used in assessing the risk of dementia patients falling (Toots et al., 2019). It is a combination of factors that comprise the measure of cognition, balance, impulsivity, walking aid use, fall history, the medication which is being used, and the likelihood that a person would fall in a 6-month period. The combination of factors ensures that the risk level of the patient to fall is identified.

The risk assessment tool for incontinence is testing for some diseases which lead to the problem. Urinary tract infection should be the first one to be tested. If the patient turns out positive, it means that she is at a high risk of having incontinence (Wallhagen et al., 2018). There also other infections that can be tested.

Nursing Care Activities

Care activities to prevent visual impairment. Nurses are supposed to educate the patient on healthy living like eating a diet which is nutritious. Nurses should do regular eye examination to prevent visual impairment arising from unknown conditions.

The nurse should advise the patient on the appropriate exercises that are useful in prevention of incontinence. If the patient cannot exercise sometimes, she should be massaged.

Reminding the patient to visit the washroom on a programmed schedule will also help prevent incontinence since some forget.

Appropriateness

One should do activities that help in preventing visual impairment continually. It is crucial to take a balanced diet. There are specific vitamins that are critical to avoid visual impairment (Baird et al., 2017). Since the patient is diabetic, she should eat food that will help her blood sugar to decrease. Some diabetic patients also have visual impairment if the glucose levels are not well maintained (Whitlock et al., 2017). Regular eye examination is crucial since any health conditions that can causes visual impairment is diagnosed early and treated. Prevention is better than cure when it come it comes to eyes’ health.

The caregivers do a lot of activities to ensure that dementia patients are prevented from falling. The activities for fall prevention are ensuring that the patient needs are meet and reducing the noise levels. The old most of the time have communication challenges and tend to do many activities on their own without asking for assistance (Jensen-Dahm et al., 2016). As the patient goes looking for what they need, they can fall, leading to injuries. For the second one, having an excellent acoustic environment reduces confusion hence eliminating falling. Dementia affects the sensory level. Hearing is related to balance and that is why dementia patients are more likely to lose control as the noise increases.

The first care activity used for incontinence is exercising or body massage . Pelvic floor muscle exercise is a therapeutic option that can be used on dementia patients having urinary incontinence (Delwel et al., 2018). Since the problem might be cognition, the exercise does not work for all patients. It does not eliminate the problem entirely, but there is some improvement. However, practices are a good option since the whole body works out and there will be an improvement even cognition (Delwel et al., 2018). Sometimes the patient can be forgetting to go to washrooms. The caregiver should remind the patient to go and relieve themselves on a programmed schedule. The pathways should also be cleared so that the patient can reach the washrooms easily.

Changes

The care plan for dementia patients requires continually changing the methods that one is using and come up with the most appropriate ones. I can try engaging the patient in some activities that she liked before getting sick. Some can be hobbies like watching football or cooking (Malara et al., 2016). Such activities help in improving cognition, and the patient can start doing some things by themselves. A pet also can provide some playful interactions. Ensuring that the patient is not left out through talking with her and asking some questions makes the patient mind to be active (Catic, 2020). The patient also avoids wandering when they are busy. Doing exercise in groups can keep the patient occupied. Since the patient is in a care facility, she can do some activities with other members who she has got used to. However, large groups of strangers should be avoided since they can increase the stress of the patient (Särkämö, 2018).

Conclusion

Caring for the old is crucial since most of them require assistance for even personal activities. The care plan presented will help the patient to have a more quality life. Dementia patients require critical care since they have many health risks like falls, incontinence, and heart diseases. There are various nursing care activities that can be used in these patients. Dementia patients should exercise, eat healthily, and be involved in daily activities that they liked before.

References

Baird, C., Lovell, J., Johnson, M., Shiell, K., & Ibrahim, J. E. (2017). The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: a systematic review. Respiratory medicine, 129, 130-139. https://www.researchgate.net/publication/314866148

Catic, A. G. (2020). Dementia and chronic disease: Management of comorbid medical conditions. Springer. https://link.springer.com/book/10.1007%2F978-3-030-46398-4

Delwel, S., Binnekade, T. T., Perez, R. S., Hertogh, C. M., Scherder, E. J., & Lobbezoo, F. (2018). Oral hygiene and oral health in older people with dementia: a comprehensive review with a focus on oral soft tissues. Clinical oral investigations, 22(1), 93-108.
https://doi.org/10.1007/s00784-017-2264-2

Höbler, F., Argueta-Warden, X., Rodríguez-Monforte, M., Escrig-Pinol, A., Wittich, W., & McGilton, K. S. (2018). Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study. BMC geriatrics, 18(1), 235.
https://link.springer.com/article/10.1186/s12877-018-0917-x

Jensen-Dahm, C., Palm, H., Gasse, C., Dahl, J. B., & Waldemar, G. (2016). Postoperative treatment of pain after hip fracture in elderly patients with dementia. Dementia and Geriatric Cognitive Disorders, 41(3-4), 181-191. https://www.researchgate.net/publication/299769400

Malara, A., De Biase, G. A., Bettarini, F., Ceravolo, F., Di Cello, S., Garo, M., ... & Rispoli, V. (2016). Pain assessment in the elderly with behavioral and psychological symptoms of dementia. Journal of Alzheimer's Disease, 50(4), 1217-1225. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad150808

Särkämö, T. (2018). Music for the aging brain: Cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia. Dementia, 17(6), 670-685. https://journals.sagepub.com/doi/abs/10.1177/1471301217729237.