BNURS20 Nursing

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Question:

1- He is at High Risk of Fall due to Visual Impairment, Hearing Loss and Confusion.

2- wandering away from the venue, becoming lost or being exposed due to dementia, wonder behavior and confusion.

3 Behavioral management is required due to wandering behavior and getting in the room of other residents.

These 3 symptoms are signs and symptoms that indicate a patient’s condition. How can they be correlated to the patho

5- He may need pain management for his chronic lower back pain. This could impact his ADLs.

Is pain a sign/symptom of his disease/patho?

6- Dementia and confusion can lead to the ingestion of small objects and toiletries.

Answer:

Introduction

The patient Mr. X was a 87 year-old man who had multiple health problems and was admitted to the hospital.

As an ethical matter, the patient’s name has been withheld.

The patient is a retired professor. His wife is his primary caretaker.

The patient had been hospitalized for aspiration pneumonia and APO.

The patient was too stressed to care for his wife, so he was moved to the aged care facility to live as a permanent resident.

The patient must be assessed immediately for any of the following conditions: he or she needs to be evaluated by a physician. A care plan will be created to ensure that the patient has better health outcomes.

This paper will explain the pathophysiology behind the symptoms and the pharmacological treatment options.

This would include nursing considerations, adverse effects, contraindications, and the effect of the durg.

It would also be possible to discuss the results of any investigations and assessments that were done on the patient. This would highlight how this could affect the care plan.

The final step would be to make recommendations that will lead to better outcomes for the patient.

Pathophysiology & Pharmacology

The patient was presenting multiple symptoms at the time they were admitted to the aged care facility. It was imperative that immediate actions be taken to address them.

There is a high risk of falls from hearing loss, visual impairment, confusion and other factors that could result in an adverse physical injury.

The patient has recently been diagnosed with Alzheimer’s disease.

Wimo et. al. (2013. p. 15), the most serious complications for patients with Alzheimer’s disease, a type of dementia, are hearing and sight loss.

Numerous cross-sectional studies show that there is a link between cognitive decline and sensory impairments in dementia cases.

This includes hearing and visual impairment.

Alzheimer’s disease and dementia are major disorders that affect people over 70.

The abnormal accumulations of beta-amyloid in the brain as senile plaques and neurofibrillary tau tangles are the hallmark of this disease.

Dementia can cause visual problems like colour vision loss, vision loss, changes in pupillary reaction to mydriatics and defects eye movements. It also causes disturbances in complex optical functions, such as reading and detecting things.

Due to brain functioning changes, hearing loss is a neurological impairment.

There are both intrinsic (person-centered), as well as extrinsic risk factors for older patients falling.

Balance impairment, hearing loss, cognition and muscle strength are some of the most important intrinsic factors.

For older adults 65 and over, hearing impairments are the third most prevalent chronic ailment.

Hearing impairment can reduce quality of life. It is also associated with impaired cognition, walking difficulties, functional decline, social isolation, and impaired cognition.

Research has shown hearing loss is closely linked to fall-related risk.

Patients with hearing impairment must pay more attention to auditory cues and balance control.

The risk of falling is directly tied to vision impairment.

One simple explanation is that vision impaired people are not able to identify environmental hazards beyond what they can see (Beltran, p.E5844-45).

Patients with confusion or disorientation should be seen immediately.

The patient wandered from one place and was predisposed to get lost.

Additionally, he was getting into the rooms belonging to other residents.

These circumstances put him at increased risk of becoming injured.

These conditions can be linked to Alzhiemr’s Disease.

Alzhemier patients have lost short term memory but their long term memories are linked to their past lives.

Mrs. X’s wandering behavior is due to the fact that he was a paediatrician and used to wander around in hospital caring for his patients.

Alzheimer’s disease has been shown to be the primary cause of confusion and disorientation.

The brain functions are affected so that the patient is unable to perceive and understand the environment around him (Berry, 2014; p.

Caregivers should pay attention to chronic lower back pain (LBP).

If the normal connective tissues don’t heal within three months, lower back pain is considered chronic.

Chronic LBP can be complicated by a slow rate in tissue repair in the intervertebral disk, which is quite avascular.

Chronic LBP can be caused by trauma or degenerative spine conditions (Arneja and al., 2016, page 453).

This case shows that the patient is suffering from a condition that has adversely affected his daily activities.

The patient is dependent on his wife for all aspects of daily living.

People with dementia have trouble expressing their pain.

It is because they have a decreased ability to communicate with other people and their cognitive abilities are reduced.

The patient may find his or her own way to get rid of the pain (van Kooten, p.523).

In this case, the patient might be searching for relief from chronic backache pain.

ADL may be affected by the pain.

Researchers believe that ADL difficulty can be caused by pain or functional impairment.

Based on the signs and symptoms the patient is presenting, the pharmacological interventions for him would include Paracetamol Mirtazapine and Oxazepam.

Paracetamol or Acetaminophen is a common pain relief drug.

As a first-line treatment of low back pain, the drug is highly recommended.

The drug has no known side effects. However, some patients might experience allergic reactions, severe dizziness or liver damage.

Poor nutrition and renal impairment are contraindications.

Paracetamol is a component in paracetamol. A nurse will check to see if any other medications are being used.

The evaluation of the therapeutic response is also important (Lehne& Rosenthal (2014) p. 254).

Mirtazapine can be used to treat depression.

The drug’s efficacy is measured by its ability to elevate mood.

Side effects include restlessness, nervousness, dizziness, mood elevation, nausea, vomiting, diarrhea, dysphagia, weakness, and drowsiness.

This drug is contraindicated in cases of hypersensitivity to mirtazapine or acute myocardial Infarction.

The nurse must monitor patients for any signs and symptoms that could indicate a worsening in depression.

Along with cerebrovascular disease history, orthostatic hypotension must be checked (Adams & Urban (2015) p. 57).

Oxazepam can be used to treat and manage anxiety.

It is a hypnotic and anxiolytic drug that can also be sedative and skeletal muscles relaxant.

Side effects of the drug include dizziness. Vertigo. slurred speaking.

Hypersensitivity to oxazepam or other benzodiazepines as well as psychoses are contraindications.

Signs of overdose are among the nursing considerations.

If the patient has a depressed daytime psychomotor function, the physician must be informed (Karch&Karch 2016 p. 87).

Alzheimer is a common type of dementia. Therefore, it is important to conduct a neurological assessment in order to assess the extent of cognitive function decline.

Nielsen et.al. (2016) clearly explain the role of neurological assessments in dementia. The cognitive deficits that result from dementia are distinct from those that arise due to age-related problems, which makes the neurological assessment more challenging.

A patient assessment of the neurological function improves the ability to diagnose the disease at an early stage. As was the case for Mr. X.

It is important to understand the deficiencies in executive functions responsible for the mental manipulation and cue-directed behaviour as well as problem solving skills.

Reflexes, eye movement and speech are all included in the test.

According to the assessment, the main complications of dementia were anxiety and confusion in Mr. X’s case.

An assessment of the cardiovascular system is crucial for patients with dementia, as heart disease is a potential risk factor.

Reduced cerebral blood flow (CBF), which is a result of heart disease, is known to cause brain vascular dysfunction.

Because of the build-up of tau proteins and beta-proteins, cognitive problems are magnified.

Studies have also shown that dementia patients who have had heart disease in the past are more likely to suffer from structural and functional abnormalities of the heart (Liu and colleagues, 2017).

Cardiovascular evaluation for Mr. X showed blood pressure of 151/85 mmHg.

This reading is above the 120/80 mmHg BP norm.

The normal heart rate was 90 bpm, which is normal considering the normal values of 60-100 BPM.

This information showed that blood pressure must be controlled with medication and proper dietary habits.

A renal assessment is essential for patients as it allows them monitor disease progress, identify kidney impairments, and assess baseline measurements before starting on medication.

A renal assessment is recommended in this situation as the patient may need to be administered several medicines for his symptoms.

This assessment can help to determine the best medication regimen (Wanner, et al. 2016, p. 325).

The present patient reported faecal problems.

This case would require a detailed gastrointestinal exam.

This condition is marked with the involuntary passing of faeces, or the inability control the discharge.

An assessment of the condition will allow the nurse to improve the patient’s quality of living.

Because Mr. X cannot perform ADL on his own and has multiple impairments, addressing concerns about faecal Incontinence could help him to overcome these complications.

Although the facility’s policy requires that vital signs be taken for every resident, they did not keep records of patient’s vitals for 3 months.

Vital signs are the key indicator of a patient’s health status and help to determine their respiratory, neurological,circulatory, endocrinal and other functions.

Vitals signs communicate the severity and condition of a patient’s illness.

These parameters are used by nurses to identify the best treatment options for patients.

Black, 2016, p. 264. Vitals includes the physiological measurement of blood temperature, heart rate, and blood pressure.

BGL must be taken pre-meal on Friday for Mr.X as per the doctor’s orders. They have been missing this since 6/6/2017.

On 6/6/2017, BGL was at 6.4 mmol/l. At the moment it is at 6.1 mmol/l.

BGL must be checked once per week to ensure the level is under control. (Aleppo, 2017, p. 539)

Certain oral medications can cause low blood sugar or hypoglycemia. Regular monitoring is recommended.

BGL is also affected by body weight and should be monitored regularly. Type 2 diabetes patients will need to have their blood glucose levels checked.

It is important that a diabetic patient receives a diet that meets his nutritional requirements and lowers his blood glucose.

Normal blood sugar levels in healthy individuals are between 4.0 and 6.0 mmol/L (72-108 mg/dL), when fasting, and as high as 7.8 mg/L (140 mg/dL), after eating.

A mini mental state examination (MMSE), tool was used to evaluate MrX’s mental condition.

An important component of an overall exam of a patient is the assessment of his mental health.

It complements other types of assessment, such as the atienthistoryof complains. Additionally, it provides cues that can be used to conduct a thorough assessment such cognitive assessment or psychometric tests.

Although the patient’s history of health is static, their mental state is dynamic.

The mental state examination provides a guide to organize data concerning the patient’s mental functioning.

Recommendation

Based on the assessment findings and the patient’s current condition, there are several recommendations to address each patient concern.

The patient must first be supported in achieving optimal health and wellness through participation in diverse activities.

This should include both medical and social health care.

The patient has dementia and his cognitive functioning requires special attention.

For the patient to feel better, he can be engaged in recreational activities.

Professionals can assist with these activities.

A physiotherapist is a professional who can improve the patient’s mobility and independence.

Fall prevention is a crucial aspect of the patient’s treatment plan. The patient is at greater risk of falling due to visual or hearing impairment.

An armband should be given to the patient so that professionals can quickly identify high-risk patients.

A visual cue placed outside the room door would alert carers to the possibility of falls.

The number of safety companions should be increased to ensure that people who are disoriented such as Mr. X are continuously monitored and monitored in order to prevent falls.

Bed alarms can be used to alert patients so they can call for assistance at any hour of the day.

Important is to make sure that your bed is equipped with side rails, and that your washroom has handrails.

You must also ensure that floors are clean and non-slippery.

Spills of any kind should be avoided. Floors must also be free from heavy furniture or other objects that might cause a patient to trip (Potter and al., 2016, p. 56).

Care would include dietary intake and pain management, BGL assessment, observation of vital signs, and monitoring of patients for changes in condition.

Black, 2016, p.57.

The administration of medications at regular intervals would help with pain management.

BGL assessment and monitoring of vital signs are important in order to encourage healthy eating habits.

The social worker can encourage patient wellbeing by offering emotional support, so that he can express his feelings.

It is important to remember that communication with dementia patients should follow the “5 S” rule: Slow, Simple. Specific. Show & Smile.

References

Pharmacology: A Connection to Nursing.

Pearson Education.

REPLACE BG: A randomized study comparing continuous glucose monitoring and routine blood glucose monitoring in adults who have well-controlled type 1.

Diabetes Care, 40(4). 538-545.

The use of electromagnetic fields in the treatment for chronic lower back pain in patients suffering from degenerative disc disease.

Future science in OA 2(1).

Retinal gene therapy can now be used to treat vision loss and photoreceptor failure.

Proceedings of the National Academy of Sciences (113(43), E5844–E5853).

Cognitive support for informal dementia caregiving. Minimizing confusion, disorientation.

Journal of Aging Studies 30, 121–130.

Professional Nursing-Ebook: Concepts and Challenges.

Elsevier Health Sciences. Pharmacology: Nursing Care-Ebook.

Association of dementia and cognitive function in seniors living in nursing homes in Australia: Cardiovascular system medication.

Nielsen, T. R. Phung T. K. T. Chaaya M. Mackinnon A., &Waldemar G. (2016). Using the Informant Questionnaire about Cognitive Decline in Elderly and the Rowland Universal Dementia Assessment Scale to detect dementia in an Arabic-speaking community.

41(1-2), 46–54.

A Montreal Cognitive Assessment Does Not Include White Matter Microstructural Deterioration in Small Vessel Disease.

ABCA7 variants that cause loss of function increase the risk for Alzheimer’s disease.

Prevalence of pain among nursing home residents: The Role and Subtypes of Dementia Stages.

Journal of the American Medical Directors Association (18(6), 522-527.

The progression of type 2 diabetes kidney disease: empagliflozin.

New England Journal of Medicine 375(4): 323-334.

Wimo A. and Jonsson L., Bond J., Prince M., Winblad B. & International A. D. (2013). The global economic impact of dementia 2010.

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