Assessment And Care Planning For Older People In Diverse Health Settings
Louis’s Case Study
Discuss the biophysical processes pertinent to the case.
Louis is 86 year old man admitted to the emergency department due to the chief complaints of food poisoning. By reviewing the case study of Louis, it can be observed that the patient has a past medical history of the hypertension, which is commonly observed In the older age individual. Ageing in an individual is associated with the physiological changes in all of the vital organs and making the patient more vulnerable to infection and leading to chronic illness. Ageing in an individual can lead to age related structural changes in different organs such as, digestive system, cardiovascular system, bones and muscle. In the case of Louis, the patient was admitted to the hospital due to the chief complaints of food poisoning. It is because, with age the digestive system of the individual undergoes structural changes and along with that immunes system also get weakens which makes it harder to fight from the bacteria (Farage, Miller and Maibach 2017). Older adults also have less amount of stomach acid and also have weakened kidney which is unable to filter different bacteria from the blood. Due to which the prevalence rate of food poisoning increases among the older individual.
Discuss the psychosocial processes pertinent to the case.
Ageing of an individual also associated with the psychological changes in the body which decreases the memory and thinking ability of the patient. In the case of Louis, the patient is reported to be suffering from psychological symptoms such as, confusion, agitated, poor self-control, hallucination and difficulty in understanding. By observing the psychological symptoms, it can be stated that patient is either suffering from delirium or dementia. One of the major causes identified for delirium within the older patient is administration of drugs, infections and dehydration (Amarya, Singh and Sabharwal 2015). It is due to the structural changes in brain, where the brain of an individual starts shrinking and losing neurons which possess an adverse impact on the cognitive abilities of the patient, thereby increasing the risk of psychological complications such as, loss of concentrations and hallucination. Memory decline is also associated with ageing, due to which the brain activation becomes more bilateral for the memory related tasks (Park and Festini 2017).
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
By observing the psychological symptoms of the patient, it can be stated that the patient is suffering from mental illness due to his age. Hence, in order to provide appropriate treatment to the patient, it is important to assess the primary complication of the patient. As by observing the current psychological condition of the patient, it can be stated the patient is at the high risk of getting into delirium. Hence to assess that, the patient is assessed with Delirium Risk Assessment Tool, which aims to identify the individual who are at the high risk of having delirium (Lleixà?Fortuño 2018). In the DRAT tool, a checklist has been provided which includes risk factors that can lead to delirium, such as, visual impairment and severe illness.
Age-related Changes and Complications
Discuss 3 priorities of care for this person.
By observing the physical and mental health condition of the patient, it can be stated tha patient needs an urgent treatment to get recover from the current health condition. The three priorities of care identified in the case Louis includes,
Dehydration: Due to food poisoning, electrolyte imbalance and dehydration has been observed in the patient which is associated with abdominal which if ignored and delayed, cam lead to adverse impact in older individual.
Confusion: It is the priority of care for Louis because, he was experiencing confusion and has obtained a score 4/10 during the confusion assessment (Salluh et al., 2015).
Agitated behavior: Due to the agitated behavior of the patient, the nurse is having difficulty in providing appropriate treatment to the patient, hence it should be considered among priority of care.
Discuss any equity, rights and access issues relevant to the case.
As the patient is an older individual which hinders the access to the primary health care service. As the patient is experiencing agitated behaviour, which can be controlled by restraining the patient. However, restraining the patient violates the ethical rights of the patient (Scheepmans et al., 2018). Apart from this, other ethical issue which is related to the patient is unable to access the primary health care service, as among the seniors the access to care is affected and they also have to experience discrimination based on their age and cognitive ability.
Discuss the biophysical processes pertinent to the case.
It is evident from the case study Josie is suffering from advanced stage metastatic pancreatic cancer and is presented with chronic jaundice due to which she is referred to palliative care. The biophysical process of ageing is often interlinked with the slow functioning of organs and their physical environment. Josie was of 72 years old hence aging has resulted in eruption of vague symptoms which left the patient undiagnosed. It is evident that at certain age, medication given become unresponsive to the body and contributes to development of other health issue (Phillip et al., 2017). Thus, this may have contributed to development of advanced stage cancer in Josie. Due to advanced stage pancreatic cancer, body metabolism and regulation of pancreases become impairs which resulted in chronic jaundice. It is reported that aging is linked with loss of function of organ hence, difficulty in getting cure which could cause deterioration of health.
Assessment and Priorities of Care for Louis
Discuss the psychosocial processes pertinent to the case.
The psychosocial process highlighted in the case study is related to the motivation, engagement, self-esteem, satisfaction, belongingness and commitment (Han and Hyun 2018). It is seen in the case study that Josie after the death of her husband has lived independent life and enjoyed with her families. Thus, it reflect the positive social interaction and caring climate that Josie got from her family which has kept her motivated and lively. It is evident from the research that psychosocial processes related to ageing is often associated with mental illness, loss of cognitive function and struggle in memorising things (Aldwin et al. 2017). However, Josie was not reported with any of the mental illness and despite she was mentally stable even at her stage of end of life. According to “Activity Psychosocial Theory of Aging”, individual engage in full living activities and maintain the productivity of age successfully, which contribute to healthy aging (Berlin, Kruger and Klenosky 2018). Josie lived her life peacefully and ended by satisfying her last wish of meeting her beloved sister.
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
The Carer Support Needs Assessment Tool (CSNAT) which focus on to give patient centered care and support for the family member. It is mainly used in palliative and end of life care (Aoun et al. 2015). It provides the measure of carer support needs for use in end of life of patient. It also tends to development therapeutic relationship by using CSNAT which comprise of 16 questions. As Josie is under palliative care and approaching towards end of life, she was assessed to know her desire and feeling. Hence, the tool will help to determine the kind of support she needs and other wishes which could contribute to mental stability. In the case study, the CSNAT Tool is appropriate because Josie was at end of life and there was the need to assess her desire and requirement (Grande et al. 2017). Moreover, as the tool also focus to provide psychological support to the family, therefore it will be useful to assess the need of mental support because of death of Josie.
Discuss 3 priorities of care for this person.
The three priorities of care that could have been given to Josie are:
The patient is suffering from chronic jaundice which has made her skin yellow and is at the risk of developing infection. It is evident that jaundice in older adult could contribute to loss of function of liver and irregular metabolism which can deteriorate the health (Bacon et al. 2017). Therefore, the nurse should provide effective medication in consultation with doctor to treat jaundice.
Ethical Issues Relevant to Louis’s Case
The patient was of 72 years of age and due to pancreatic cancer has made her realize that she is at the end of life stage. Hence, nurse could provide mental care to the patient and motivate her for coping with the health issue (Lin et al. 2018).
Another priority of care that could be given to Josie can be addressing the desire and making her emotionally strong.
Discuss any equity, rights and access issues relevant to the case.
One of the ethical issues identified in the case is lack of advanced care planning and respect of patient autonomy in relation of end of life care decision. Although Josie’s family were frequently contacted to discuss about range of service available for Josie, however no such preference related to type of treatment was discussed with Josie (Klingler, in der Schmitten and Marckmann 2016). As the psychological aspect of patient was addressed but the clinical care that require to be given was ignored by the health care professional. Therefore, there was the issue of the access of adequate of care that is need at stage of end of life.
References:
Aldwin, C.M., Igarashi, H., Gilmer, D.F. and Levenson, M.R., 2017. Health, illness, and optimal aging: Biological and psychosocial perspectives. Springer Publishing Company.
Amarya, S., Singh, K. and Sabharwal, M., 2015. Changes during aging and their association with malnutrition. Journal of Clinical Gerontology and Geriatrics, 6(3), pp.78-84.
Aoun, S.M., Grande, G., Howting, D., Deas, K., Toye, C., Troeung, L., Stajduhar, K. and Ewing, G., 2015. The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial. PloS one, 10(4), p.e0123012.
Bacon, L.D., 2017. The Hepatic System. Treatment and Care of the Geriatric Veterinary Patient, p.115.
Berlin, K., Kruger, T. and Klenosky, D.B., 2018. A mixed-methods investigation of successful aging among older women engaged in sports-based versus exercise-based leisure time physical activities. Journal of women & aging, 30(1), pp.27-37.
Farage, M.A., Miller, K.W. and Maibach, H.I., 2017. Degenerative changes in aging skin. Textbook of aging skin, pp.15-30.
Grande, G.E., Austin, L., Ewing, G., O’Leary, N. and Roberts, C., 2017. Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial. BMJ supportive & palliative care, 7(3), pp.326-334.
Han, H. and Hyun, S.S., 2018. Role of motivations for luxury cruise traveling, satisfaction, and involvement in building traveler loyalty. International Journal of Hospitality Management, 70, pp.75-84.
Klingler, C., in der Schmitten, J. and Marckmann, G., 2016. Does facilitated advance care planning reduce the costs of care near the end of life? Systematic review and ethical considerations. Palliative medicine, 30(5), pp.423-433.
Lin, J., Supiano, K.P., Madden, C. and McLeskey, N., 2018. The impact of the end-of-life nurse education consortium on attitudes of undergraduate nursing students toward care of dying patients. Journal of Hospice & Palliative Nursing, 20(4), pp.340-348.
Park, D.C. and Festini, S.B., 2017. Theories of memory and aging: A look at the past and a glimpse of the future. The Journals of Gerontology: Series B, 72(1), pp.82-90.
Phillip, J.M., Wu, P.H., Gilkes, D.M., Williams, W., McGovern, S., Daya, J., Chen, J., Aifuwa, I., Lee, J.S., Fan, R. and Walston, J., 2017. Biophysical and biomolecular determination of cellular age in humans. Nature Biomedical Engineering, 1(7), p.0093.
Salluh, J.I., Wang, H., Schneider, E.B., Nagaraja, N., Yenokyan, G., Damluji, A., Serafim, R.B. and Stevens, R.D., 2015. Outcome of delirium in critically ill patients: systematic review and meta-analysis. bmj, 350, p.h2538.
Scheepmans, K., de Casterlé, B.D., Paquay, L. and Milisen, K., 2018. Restraint use in older adults in home care: A systematic review. International journal of nursing studies, 79, pp.122-136.
Solà?Miravete, E., López, C., Martínez?Segura, E., Adell?Lleixà, M., Juvé?Udina, M.E. and Lleixà?Fortuño, M., 2018. Nursing assessment as an effective tool for the identification of delirium risk in older in?patients: A case–control study. Journal of clinical nursing, 27(1-2), pp.345-354.